The role of manual detorsion in the management of testicular torsion in the emergency department: A single-group observational study

Testicular torsion (TT) is an emergency condition that leads to disruption of testicular blood supply and risk of necrosis due to rotation of the spermatic cord. In this study, the effect of manual detorsion (MD) procedure performed in the emergency department on patient outcomes was analyzed. Forty-one patients who presented with acute scrotal pain or swelling between January 2009 and December 2019 were retrospectively analyzed. Color doppler ultrasonography (CDUS) was performed at presentation, and all patients underwent MD. Patients were grouped according to symptom duration (0-6 hours, 7-12 hours, ≥13 hours), and subsequent emergency or elective surgery was planned based on post-detorsion CDUS findings. The median age of the patients was 16 years (IQR: 13-27), the most common complaint was pain (92.68%), followed by swelling (7.32%). The right testicle was most commonly affected (51.22%). As the first intervention, 65.85% of the patients underwent surgery and 34.15% underwent manual intervention and elective surgery. MD is more effective in patients who present within the first 6 hours (63.64% but P = .056). In patients who underwent elective surgery after MD (within 1-14 days), no new TT developed and no orchiectomy was required. Of the patients who underwent orchiectomy, 5/6 were symptomatic for 13 hours or more. Approximately 2/3 of the patients presented to the emergency department within 12 hours after the onset of the first symptom. MD was most effective in patients presenting within the first 6 hours. Therefore, it should be emphasized more strongly that TT is an emergency requiring reperfusion just like acute stroke and acute coronary syndromes.