Manual Detorsion by Pediatric Emergency Physicians Shortens Ischemia Time in Pediatric Testicular Torsion

Testicular torsion is a time-sensitive urologic emergency, for which early restoration of blood flow improves testicular outcome. Pediatric emergency medicine (PEM) physicians can perform manual detorsion, reducing ischemia time before definitive surgical management. The primary objective of our study was to determine whether manual detorsion, performed by pediatric emergency medicine physicians, results in shorter ischemia time after diagnosis when compared to patients who undergo surgical detorsion alone. Secondary objectives included the success rate of manual detorsion and testicular salvage rates.

We conducted a retrospective chart review of pediatric patients aged 8-21 years diagnosed with testicular torsion at a tertiary care, level 1 pediatric trauma center between January 2013 and January 2025. Time zero was defined as the start time of the initial ultrasound examination. End times were defined as demonstration of restored blood flow on repeat ultrasound for the manual detorsion group and incision time for the surgical detorsion group.

Manual detorsion was attempted in 141 of 256 patients (55%) and was successful in 65% of attempts. The only baseline difference between groups was the duration of pain, which was longer in the surgical-only group. The mean time to return of blood flow was on average 105.1 min shorter (95% CI 94.9-115.3 min; p < 0.001) in patients with manual detorsion (N = 91, 35.2 min) as compared to surgical-only patients (N = 115, 140.3 min). Findings were almost identical after comparing medians. There were no statistically significant differences in salvage rates between study groups.

Manual detorsion was successfully performed 65% of the time by pediatric emergency medicine physicians and reduced testicular ischemia time by over 100 min. These findings support incorporating manual detorsion into pediatric emergency department pathways for testicular torsion and suggest manual detorsion can be reliably performed by the non-surgeon on pediatric patients.