Testicular torsion in the adult

Testicular torsion in men more than 21 years old seems to be as common as in prepubertal boys, accounting for 26 per cent of our cases. Of these patients 10 per cent were more than 30 years old. A previous similar episode will have occurred in nearly half of the patients and is the only helpful historical data. A negative urinalysis is the rule and, while not diagnostic, testicular torsion should be the presumptive diagnosis. Doppler examination and radionuclide scans are accurate and reliable but in our series these studies added little to the plan of management. Manual detorsion can be accomplished with local anesthesia in approximately 70 per cent of the patients and always should be attempted. Delay in operation beyond 12 hours resulted uniformly in loss of the testicle, primarily by orchiectomy or secondarily by atrophy. While correction of the torsion before 6 to 8 hours does not ensure success the rate of salvage is higher. Scrotal exploration for testicular torsion is simple and has little morbidity. Exploration should be done in any patient with acute unilateral scrotal swelling and a negative urinalysis, regardless of age.