JRSM > Volume 95, Number 8 > Pp. 425

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Management of testicular torsion

Iqbal Shergill   Manit Arya

Institute of Urology and Nephrology, University College London, 67 Riding House Street, London W1W 7EY, UK

Mr Pearce and his colleagues (May 2002 JRSM¹) propose a protocol for management of suspected testicular torsion, based on their observations of clinical practice in the North West of England. They recommend fixation with delayed-absorption or non-absorbable sutures. There is, however, much controversy surrounding the method used for testicular fixation when a torted testis is deemed salvageable. Sutureless dartos muscle pouch fixation is a technique which is now increasingly being used by urologists and paediatric surgeons². The main reason for this is that fixation with sutures, which traverse the blood—testis barrier, can generate an autoimmune response that leads to eventual infertility³. Suture fixation has additional complications. Non-absorbable sutures are associated with the formation of microabscesses and granulomas, predisposing to chronic testicular pain⁴, whilst absorbable sutures result in only fine adhesions at the site of placement and thus increase the risk of recurrent torsion⁵. Is suture fixation actually necessary? Eversion of the tunica vaginalis, as is performed in a Jaboulay procedure for hydrocele, leads to the formation of satisfactory adhesions and aids in the prevention of future torsion⁶. In conclusion, eversion of the tunica vaginalis together with sutureless fixation in a dartos pouch probably provides the best method of fixation.

REFERENCES

1. Pearce I, Islam S, McIntyre IG, O'Flynn KJ. Suspected testicular torsion: a survey of clinical practice in North West England. J R Soc Med 2002;95:247 -9[Abstract/Free Full Text]

2. Frank JD, O'Brien M. Fixation of the testis. Br J Urol Int 2002;89:331 -3

3. Coughlin HT, Bellinger MF, La Porte RE, Lee PA. Testicular suture: a significant risk factor for infertility among formerly cryptorchid men. J Pediatr Surg1998; 33:1790 -3[Medline]

4. Morse TS, Hollabaugh RS. The ‘window’ orchidopexy for prevention of testicular torsion. J Pediatr Surg1977; 12:237 -40[Medline]

5. Sells H, Moretti KL, Burfield GD. Recurrent torsion after previous testicular fixation. Aust NZ J Surg2002; 72:46 -8[CrossRef]

6. Lent V, Stephani A. Eversion of the tunica vaginalis for prophylaxis of testicular torsion recurrences. J Urol1993; 150:1417 -21

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This Article Full Text (PDF) Send a Quick Comment Alert me when this article is cited Alert me when Quick Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Shergill, I. Articles by Arya, M. Search for Related Content PubMed PubMed Citation Social Bookmarking                      What's this?