How Do You Do Manual Detorsion of a Testicle?

Manual detorsion of the testicle is done after administering sedation and pain medications. Anesthesia (local or general) is not required. In most cases, the doctor uses a Doppler ultrasound before and after the procedure to confirm that blood flow to the testis has been successfully restored.

During manual detorsion, you will lie down with your doctor standing in front of you. Your doctor will hold the testicle with their thumb and forefinger to twist it:

• Left testicle: Doctor will use their right thumb and forefinger to twist it clockwise
• Right testicle: Doctor will use their left thumb and forefinger to twist it counter-clockwise

This may be repeated 1-2 times because testicular torsion can involve 180-720 degrees of rotation. Success of the detorsion is confirmed by pain relief and revascularization of the testis observed on Doppler ultrasound. 

This is followed by surgery to correct any residual torsion that may hamper testicular viability. Surgery helps prevent a repeated testicular torsion.

Manual detorsion should be avoided if more than 6 hours have passed since the onset of testicular torsion.

Testicular torsion occurs when a testicle rotates and twists the spermatic cord, which is a cord-like structure containing blood vessels, nerves, and ducts that run to and from the testes. This results in swelling and pain in the affected scrotum. 

Pain is generally severe, unilateral (on one side), and radiates to the abdomen. Pain may make walking or standing difficult and may be associated with nausea, vomiting, fever, and frequent urination. On examination, one testicle may appear higher than the other.

Testicular torsion can occur at any age, although it is more common in the first year of life and at puberty (peak age being 12-18 years). Testicular torsion can even occur before birth (during the prenatal period). Left testicle torsion is more common than right testicle torsion.

The exact cause of testicular torsion is not known. Some males inherit the trait that causes the testicle to freely rotate, making them prone to torsion.

Risk factors that may contribute to testicular torsion include:

• Genetic tendency
• Rapid growth of testes during puberty
• Testicular injury
• Cold temperatures
• History of previous testicular torsion
• Vigorous physical activity
• Sexual arousal
• Testicular abnormalities (undescended testes, bell clapper deformity)

Testicular torsion is a medical emergency because it can cut off blood supply to the testes. 

If left untreated even for a few hours, testicular torsion can result in permanent damage to the affected testicle. This can permanently damage the testicle and necessitate surgical removal, which can lead to infertility in some cases.

In some males, testicular torsion may correct on its own. However, even if this happens, medical attention should still be sought. This is because there is a chance that the testicular torsion will occur again, or you may have dead testicular tissue (necrosis) left.