The Effectiveness of Manual Detorsion Applied in the Emergency Department in Testicular Torsion: A Single - Center Experience of 13 Years

Abstract

Objective: As a urological emergency, testicular torsion is one of the causes of acute scrotum in all age groups. This study aimed to evaluate the effectiveness of manual detorsion performed before surgical intervention. Materials and Methods: Retrospective data analysis of the patients with acute scrotum who applied to the emergency department of a 3rd level hospital between the years January 2010 and January 2023 with the complaint acute unbearable pain within the first 12 hours of its onset was performed. Patients were grouped according to whether or not manual detorsion was performed in the emergency department. Successful manual detorsion was defined as postprocedural normal color Doppler ultrasound findings and complete resolution of pain. All patients had undergone surgical exploration. Age, laterality of the torsional testis, manual testicular detorsion attempt (if any), and surgical conditions resulting in testis preservation or orchiectomy were the patient data analyzed. Results: Sixty patients were included in the study. Manual detorsion was performed in 29 (48.3%) patients in the emergency department (Group 1). Scrotal exploration was performed in 31 (51.7%) patients without applying manual detorsion (Group 2). In Group 1, testicular preservation was achieved in 26 (89.7%) patients. In Group 1, in 3 patients (10.3%) testicular necrosis occurred due to failure to achieve adequate blood supply, while orchiectomy was performed in 11 (35.5%) patients in Group 2. Lower rates of orchiectomy were observed in Group 1 compared to Group 2 (p=0.021). We also observed that manual detorsion decreased the rate of orchiectomy (rho- 0.297, p=0.021), and the probability of undergoing orchiectomy increased with increasing age (rho 0.512, p<0.001). Conclusion: Manual testicular detorsion is a noninvasive method that can be safely applied to all patients diagnosed with testicular torsion. We think that it will shorten the duration of testicular ischemia in the emergency department and contribute to testicular salvage.