Torsion of the testis: techniques of assessment

Results of treatment of torsion of the testicle can be measured only by determining the rate of testicular salvage, which has been low but has improved in recent years. The Doppler instruments and the technique of scrotal imaging with the gamma camera provide noninvasive and rapid diagnostic aids with a high degree of accuracy. There is evidence that these techniques will aid in the differential diagnosis of equivocal cases, and thus lower the incidence of delay in the diagnosis of torsion, a cause of lower than optimal salvage rates in the past. Fluorescein staining can also be used in the operating room if there is a question of testicular viability. The availability of these new modalities, however, is no substitute for early evaluation. Quick referral from primary physicians and a high awareness of torsion as a cause of acute scrotal pain and swelling are extremely important. Reviews clearly indicate that improved salvage rates are achieved with early evaluation and treatment. Therefore the urologist has a continuing responsibility to educate pediatricians, family practitioners, and emergency room physicians in the urgency of diagnosis and treatment in cases of testicular torsion. Although new diagnostic aids are useful, only early surgical exploration can save a torsive testis.