Lessons learned after 10 years of manual detorsion in testicular torsion

To evaluate the role of manual detorsion (MD) in gonadal salvage and determining non-emergency surgery in testicular torsion (TT).

We retrospectively analysed paediatric patients treated for TT over 10 years at a tertiary centre. MD was attempted based on surgeon preference. Successful MD was defined by complete pain resolution, and normal colour Doppler ultrasound showing no spermatic cord torsion and normal perfusion. All patients underwent surgical exploration. Data analysed included age, referral status, pain duration, MD attempt and result, time to surgery, surgical findings, and outcomes. A comparative analysis between data from previous a published series (2014-2018) and after previous published series (2019-2023) was executed.

Two hundred and seventy-six patients were included. Sixty percent were referred from other centres (165/276). MD was attempted in 57 % (156/276), resulting in significantly less gonadal loss (9 % vs 46 %, p < 0.05). MD was successful in 44 % (68/156) of attempts; all underwent non-emergency bilateral orchiopexy; one patient developed new TT during the waiting period, successfully treated with MD; at surgery, three (3/68, 4 %) cases had partial non-ischemic cord torsion and none suffered testicular loss. After unsuccessful MD, residual cord torsion was 33 % (29/88). After median follow-up of 8 months, gonadal loss (14/156, 9 %) occurred after unsuccessful MD; no losses occurred following successful MD. Successful MD correlated with significantly improved gonadal salvage (p < 0.05). There was no gonadal loss after non-emergency surgery.

Our data shows that attempting MD results in increased testicular salvage rates, and that a successful manoeuvre may safely enable non-emergency orchiopexy.