Materiały źródłowe

• #1 Testicular Torsion: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15382-testicular-torsion

  The outlook for testicular torsion is good if you get treatment right away within six hours. […] If you dont get treatment right away within six hours testicular torsion can permanently damage (infarct) your testicle. A surgeon will remove the damaged testicle if a torsion doesnt receive treatment in time.

• #2 Testicular Torsion Treatment & Management: Manual Detorsion, Surgical Detorsion

  https://emedicine.medscape.com/article/2036003-treatment

  Success of manual detorsion can be assessed with the use of Doppler sonography and resolution of symptoms. […] Surgical detorsion and subsequent orchiopexy or orchiectomy is the definitive management strategy and should proceed immediately in patients whose clinical findings suggest torsion. The patient and/or caregiver should be counseled on the risk of immediate or delayed testicular loss. Additionally, they should be advised that the impact of torsion on later fertility, even if testicular salvage occurs, cannot be assured. […] Immediate surgical exploration with detorsion and orchiopexy or orchiectomy is the recommended and accepted management strategy for males presenting with clinical signs of testis torsion. Surgical exploration should not be delayed to obtain confirmatory radiologic studies in patients who present with suggestive clinical signs of torsion.

• #3 Testicular Torsion: Diagnosis, Evaluation, and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1215/p835.html

  Testicular torsion is a twisting of the spermatic cord and its contents and is a surgical emergency affecting 3.8 per 100,000 males younger than 18 years annually. […] Prompt recognition and treatment are necessary for testicular salvage, and torsion must be excluded in all patients who present with acute scrotum. […] If history and physical examination suggest torsion, immediate surgical exploration is indicated and should not be postponed to perform imaging studies. […] There is typically a four- to eight-hour window before permanent ischemic damage occurs. Delay in treatment may be associated with decreased fertility, or may necessitate orchiectomy. […] Immediate surgery should be performed if testicular torsion is suspected, and should not be delayed by imaging studies if physical examination findings are strongly suggestive.

• #4 Testicular torsion – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/testicular-torsion/diagnosis-treatment/drc-20378274

  Surgery is required to correct testicular torsion. In some instances, the doctor might be able to untwist the testicle by pushing on the scrotum (manual detorsion). But you’ll still need surgery to prevent torsion from occurring again. […] Surgery for testicular torsion is usually done under general anesthesia. During surgery, your doctor will make a small cut in your scrotum, untwist your spermatic cord, if necessary, and stitch one or both testicles to the inside of the scrotum. […] The sooner the testicle is untwisted, the greater the chance it can be saved. After six hours from the start of pain, the chances of needing testicle removal are greatly increased. If treatment is delayed more than 12 hours from the start of pain, there is at least a 75 percent chance of needing testicle removal.

• #5 Testicular Torsion: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15382-testicular-torsion

  Testicular torsion requires surgery (orchiopexy). During an orchiopexy, a surgeon will untwist your testicle, which restores blood flow to the area. Theyll then secure your testicle to an inner wall in your scrotum with stitches (sutures). This prevents testicular torsions from occurring again. […] No, testicular torsion cant fix itself. If you dont get surgery within six hours, a surgeon will likely need to remove your affected testicle. […] The first few days after testicular torsion surgery are often the most painful. There may be swelling or bruising on your scrotum or groin for about a week. […] After a week, your pain should decrease, and you should be able to return to normal activities, including work or school. […] The only way to prevent testicular torsion is through surgery. Most people dont know theyre susceptible to testicular torsion until they have it. Surgery prevents a torsion from occurring in your other testicle.

• #6 Testicular torsion: Causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/190514

  Testicular torsion normally requires emergency surgery, where the surgeon will attempt to untwist the spermatic cord to restore blood supply. Manual detorsion is sometimes possible, but surgery can prevent recurrence of testicular torsion. […] The operation is simple and minimally invasive. A surgeon will usually conduct the procedure while a person is under general anesthesia, and it does not usually require a stay in the hospital. […] During surgery, the doctor will: make a cut in the scrotum, untwist the spermatic cord if necessary, stitch one or both testicles to the inside of the scrotum to prevent rotation. […] Suturing both testicles will prevent torsion from occurring on the other side. […] Surgery within 68 hours of testicular torsion has a good likelihood of saving the testicle, although recent research states waiting longer can still result in a doctor being able to save the testicle. However, the longer a person delays treatment, the lower the likelihood of saving the affected testicle. […] For this reason, the sooner a doctor can untwist the testicle, the greater the chances of successful treatment. […] After surgery, an individual will need to avoid strenuous or sexual activity for several weeks.

• #7 Testicular Torsion Treatment & Management: Manual Detorsion, Surgical Detorsion

  https://emedicine.medscape.com/article/2036003-treatment

  After the testis is untwisted, it is wrapped in warm wet gauze. Exploration of the contralateral hemiscrotum and orchiopexy of the unaffected testis is then performed to reduce the risk of asynchronous torsion. The affected testis is re-examined for viability. If blood flow remains questionable, intraoperative Doppler can be utilized, or an incision can be made into the tunica albuginea. If the testis appears viable, orchiopexy is performed. If the decision is made to perform orchiectomy, a prosthesis can be placed at this time, but insertion is often deferred for the nonacute setting.

• #8 Testicular torsion – what all men and boys should know | Queensland Health

  https://www.health.qld.gov.au/newsroom/features/testicular-torsion-urgent-medical-attention-what-all-men-and-boys-should-know

  The only treatment for testicular torsion is an urgent operation. […] After the examination, if testicular torsion is diagnosed, the doctor may perform surgery straight away. […] During the operation, a surgeon will untwist the spermatic cord through an incision in the scrotum. They will then stitch the testicle inside the scrotum to prevent it happening again. […] The surgery itself is usually over and done within 30-45 minutes and your child or teen can usually go home by the next day. […] After surgery for testicular torsion, there will be bruising and swelling for about a week or so. The good news is dissolvable stitches are usually used, so there is no need for removal. […] Your child or teen will be able to go back to normal activities, including attending school, in about 1-2 weeks. Strenuous activities (like sports) can usually be picked up about 2-3 weeks after the operation, subject to the go ahead of your doctor.

• #9 Testicular torsion repair Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/surgery/testicular-torsion-repair

  Testicular torsion repair is surgery to untangle or untwist a spermatic cord. The spermatic cord has a collection of blood vessels in the scrotum that lead to the testicles. Testicular torsion develops when the cord twists. This pulling and twisting blocks blood flow to the testicle. […] Most of the time, you will get general anesthesia for testicular torsion repair surgery. You will be asleep and pain-free. […] Testicular torsion is an emergency. In most cases, surgery is needed right away to relieve pain and swelling and to prevent the loss of the testicle. For the best results, surgery should be done within 4 hours after symptoms begin. By 12 hours, a testicle may become damaged so badly that it has to be removed. […] Most of the time, this surgery is done as an emergency, so there is often too little time to have medical tests beforehand. You may have an imaging test (most often ultrasound) to check for blood flow and tissue death. […] Following your surgery: Pain medicine, rest, and ice packs will relieve pain and swelling after surgery. […] If surgery is done in time, you should have a complete recovery. When it is done within 4 hours after symptoms begin, the testicle can be saved most of the time.

• #10 Testicular Torsion: Diagnosis, Evaluation, and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1215/p835.html

  Manual detorsion should be attempted if surgery is not an immediate option; however, prompt referral should not be delayed to perform this maneuver. […] Prompt restoration of blood flow to the ischemic testicle is critical in cases of testicular torsion, and prompt referral to a urologist is recommended. […] Reported testicular salvage rates are 90% to 100% if surgical exploration is performed within six hours of symptom onset, decrease to 50% if symptoms are present for more than 12 hours, and are typically less than 10% if symptom duration is 24 hours or more. […] Manual detorsion should not replace surgical exploration. […] Preoperatively, patients should be counseled on the potential need for orchiectomy as part of the surgical informed consent. […] Orchiectomy is performed if the affected testicle appears grossly necrotic or nonviable. […] If the affected testicle is deemed viable, orchiopexy with permanent suture should be performed to permanently fix the testicle within the scrotum. […] Contralateral orchiopexy should be performed regardless of the viability of the affected testicle.

• #11 Testicular Torsion (for Teens) | Nemours KidsHealth

  https://kidshealth.org/en/teens/torsion.html

  A surgeon or urologist will make a small cut in the scrotum, untwist the spermatic cord, and stitch the testicles to the inside of the scrotum to prevent future torsions. […] The surgery to attach the testicles to the scrotum takes about 45 minutes. There may be some pain, but it shouldn’t be too bad. It’s much better than the torsion. […] Sometimes, if the torsion goes on too long, doctors can’t save the affected testicle. They’ll need to remove it through a type of surgery called an orchiectomy. […] Guys need to skip strenuous activities (like sports) and sex or sexual stimulation (like masturbation) for a few weeks after testicular torsion surgery. Talk to your doctor about when it will be safe to go back to your normal activities. […] Even if your torsion led to the loss of a testicle, you can still lead a normal life, just like anyone else. Most guys will still be able to father children later in life and have normal sexual relations with one working testicle. Many also opt for a prosthetic, or artificial, testicle a few months after surgery. This can help make some feel more comfortable about their appearance.

• #12 Testicular Torsion – The Urology Foundation

  https://www.theurologyfoundation.org/urology-health/male-reproductive-organs-conditions/testicular-torsion/

  Testicular torsion requires emergency surgery to explore the scrotum, this usually requires a general anaesthetic. If the testicle is untwisted and has not been permanently damaged it may then be fixed on one or both sides. […] If the testicle has been twisted for too long and has permanent damage it will need to be removed with a procedure called an orchidectomy. Removing the testicle will not affect your sex life or ability to have children. You may be able to have a prosthesis fitted later on.

• #13

  https://www.healthychildren.org/English/health-issues/conditions/genitourinary-tract/Pages/Testicular-Torsion.aspx

  Immediate surgery to untwist the testicle is required to potentially save the testicle. After untwisting, the testicle is secured in the proper position. If the torsion has caused too much damage, the testicle may need to be removed. It may also be necessary to secure the other testicle to prevent it from twisting. Some urologists may untwist the testicle with a bedside maneuver before surgery, but surgery is still required. […] The testicle is removed (orchiectomy) if the torsion is severe, the blood supply is lost, and the tissue in the testicle dies. Fortunately, only one testicle is generally needed to carry out the functions of a testicle: […] While there is nothing to be ashamed about in losing a testicle, loss of a testicle can be emotionally difficult for some boys. At a later time, if you and your son desire a more cosmetic appearance, testicular implants exist that can be placed surgically.

• #14 Managing Testicular Torsion – Symptoms & Treatment | Carle.org

  https://carle.org/conditions/pediatric-conditions/testicular-torsion

  DONT ignore a painful testicle, delay getting medical advice, or be embarrassed! This condition is a medical emergency and needs surgery quickly, within several hours, or the testicle may die. The surgeon will take your condition seriously. […] DONT be misled. The loss of one testicle does not mean loss of erections, orgasms, or ability to father children.

• #15 Testicular torsion – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/testicular-torsion/symptoms-causes/syc-20378270

  Testicular torsion usually requires emergency surgery. If treated quickly, the testicle can usually be saved. But when blood flow has been cut off for too long, a testicle might become so badly damaged that it has to be removed. […] Seek emergency care for sudden or severe testicle pain. Prompt treatment can prevent severe damage or loss of your testicle if you have testicular torsion. […] You also need to seek prompt medical help if you’ve had sudden testicle pain that goes away without treatment. This can occur when a testicle twists and then untwists on its own (intermittent torsion and detorsion). Surgery is frequently needed to prevent the problem from happening again. […] If you have this trait, the only way to prevent testicular torsion is surgery to attach both testicles to the inside of the scrotum.

• #16

  https://www.byramhealthcare.com/blogs/what-is-testicular-torsion

  Testicular torsion requires emergency surgery to avoid loss of a testicle. If the blood flow remains cut off for an extended length of time, the testicle can become damaged beyond repair and require removal. By seeking prompt treatment, you can prevent severe damage or loss of the afflicted testicle. […] If you experience any signs or symptoms of testicular torsion, your doctor will perform a physical exam and may order an x-ray or ultrasound to check blood flow. The treatment requires immediate surgery to avoid the above complications. […] In almost all cases of testicular torsion, surgical repair is needed. This allows for your doctor to untwist the testicles and ensure blood flow is restored as soon as possible. It’s completed under general anesthesia, so you’ll be asleep during the procedure. The surgery is done through a small incision that allows for the spermatic cord to be untwisted. Your surgeon will then secure the testicle using sutures to prevent future rotation and close with stitches. It’s a simple procedure and while you may feel discomfort during recovery, you won’t likely need to stay in the hospital overnight. […] The only preventative measure you can take is if you have Bell Clapper. If you experience this deformity, having surgery to reattach the testicles to the inside of your scrotum will restrict their movement and reduce your likelihood of torsion.

• #17 Testicular Torsion Treatment & Management: Manual Detorsion, Surgical Detorsion

  https://emedicine.medscape.com/article/2036003-treatment

  During initial examination, manual detorsion may be attempted. This is done by elevating the testis toward the ipsilateral inguinal ring, stabilizing the cranial portion of the spermatic cord, and rotating the testis laterally. If successful, there will be a lengthening of the spermatic cord and immediate relief of pain. Should the first attempt be unsuccessful, a second attempt could be made using medial rotation of the testis. A study of rotational direction found that 46% of torsions (38 of 81 patients) were laterally rotated. In a series of patients undergoing attempted detorsion, testis salvage was higher in those patients that had successful manual detorsion. Regardless of the outcome of manual detorsion, surgical exploration and testicular fixation should be performed prior to the patient being discharged from the hospital.

• #18 Testicular Torsion | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1115/p1739.html

  Once the diagnosis of testicular torsion is confirmed, the rapid restoration of blood flow to the testis is critical. Manual detorsion can provide quick and noninvasive treatment. The physician stands at the supine patient’s feet and rotates the affected testicle away from the midline, as though opening a book. For suspected torsion of the left testicle, the physician places his or her right thumb and index finger on the testicle and rotates the testicle 180 degrees from medial to lateral. This procedure can be done with intravenous sedation, with or without local anesthesia (5 mL of 2 percent lidocaine [Xylocaine] infiltrating the spermatic cord near the external ring). If successful, there should be a dramatic decrease in pain. […] Attempts at manual detorsion should not delay surgical consultation. Only surgical exploration can provide a definitive resolution if torsion is present, and, as noted above, any patient with a history and physical examination results suspicious for torsion should have surgery immediately. In addition, given the risks of a missed diagnosis, scrotal exploration may be needed if a definitive diagnosis cannot be made. If the testicle is not viable, it must be removed. The anatomic abnormality that predisposed the testicle to torsion may be bilateral. Therefore, prophylactic orchiopexy of the contralateral testis is universally recommended.

• #19 Testicular Torsion Treatment & Management: Manual Detorsion, Surgical Detorsion

  https://emedicine.medscape.com/article/2036003-treatment

  Success of manual detorsion can be assessed with the use of Doppler sonography and resolution of symptoms. […] Surgical detorsion and subsequent orchiopexy or orchiectomy is the definitive management strategy and should proceed immediately in patients whose clinical findings suggest torsion. The patient and/or caregiver should be counseled on the risk of immediate or delayed testicular loss. Additionally, they should be advised that the impact of torsion on later fertility, even if testicular salvage occurs, cannot be assured. […] Immediate surgical exploration with detorsion and orchiopexy or orchiectomy is the recommended and accepted management strategy for males presenting with clinical signs of testis torsion. Surgical exploration should not be delayed to obtain confirmatory radiologic studies in patients who present with suggestive clinical signs of torsion.

• #20 Testicular torsion – Wikipedia

  https://en.wikipedia.org/wiki/Testicular_torsion

  Treatment is by physically untwisting the testicle, if possible, followed by surgery. […] Testicular torsion is a surgical emergency that requires immediate intervention to restore the flow of blood to the testicle. […] If treated either manually or surgically within six hours, there is a high chance (approximately 90%) of saving the testicle. […] Non-surgical correction can sometimes be accomplished by manually rotating the testicle in the opposite direction (i.e., outward, towards the thigh); if this is initially unsuccessful, a forced manual rotation in the other direction may correct the problem. […] A repeat doppler ultrasound scan may confirm restoration of blood flow to the testicle following manual detorsion. However, surgical exploration is often performed in order to assess the health and viability of the testicle and prevent the testicle from torsing again. An orchiopexy is performed to both the affected and unaffected testicles in order to prevent recurrence. If the testis is not viable, it is removed (orchiectomy).

• #21 Manual reduction in testicular torsion and subsequent treatment after successful reduction: a series of reports in a single institution

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10961435/

  To explore the factors affecting the success of testicular torsion manual reduction and the safety of subsequent conservative treatment after successful reduction. […] Manual reduction without anesthesia was performed in 19 patients. Patients with successful manual reduction chose different subsequent treatments according to the wishes of themselves and their guardians, including continuing conservative treatment and surgical exploration. […] Manual reduction was successful in 11 patients (11/19). Seven of them chose to continue conservative treatment, and four underwent surgical exploration immediately. […] The short duration of pain may contribute to the success of manual reduction, and manual reduction did not increase the preparation time before surgery. Due to the unpredictable risk of recurrence, immediate surgical treatment is still recommended, or postponed elective surgical treatment should be offered in the next days or weeks.

• #22 Manual reduction in testicular torsion and subsequent treatment after successful reduction: a series of reports in a single institution

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10961435/

  Although conservative treatment after successful manual reduction may be an option that can be considered in some patients, this choice should also be very cautious, unless the patient and their family make a firm decision and are aware of the risks involved. […] The authors believe that surgical exploration should be performed in the following cases which may be high-risk factors for recurrence: (a) Patients who still have scrotal pain or discomfort after manual reduction may have incomplete reduction or a torsion of the testicular appendage. […] Although manual reduction of TT can achieve better results, not all patients are suitable for manual reduction. […] In today’s China, young students have heavy learning tasks and fierce competition for further education. Due to concerns about the impact of the operation on their studies and the trauma of the surgery, seven patients and their guardians chose to continue conservative treatment in this study.

• #23 Testicular torsion – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/testicular-torsion/diagnosis-treatment/drc-20378274

  Treatment for testicular torsion in infants is controversial. If a boy is born with signs and symptoms of testicular torsion, it might be too late for emergency surgery to help and there are risks associated with general anesthesia. But emergency surgery can sometimes save all or part of the testicle and can prevent torsion in the other testicle. Treating testicular torsion in infants might prevent future problems with male hormone production and fertility.

• #24 Testicular Torsion: Symptoms and Treatment | Doctor

  https://patient.info/doctor/torsion-of-the-testis-pro

  Testicular torsion is an urgent condition, which requires prompt surgical treatment. The two most important determinants of early salvage rate of the testis are the time between onset of symptoms and de-torsion, and the degree of cord twisting. […] After 24 hours there is controversy as to whether the testis should be removed or fixed, even if it shows some viability, as there is some evidence that orchiectomy is more likely to preserve the function and fertility of the ipsilateral testis. About 20-40% of cases of testicular torsion result in an orchiectomy. […] If the testis is viable then orchidopexy is usually performed to prevent recurrence, although there is no consensus about this, as the evidence base is small. […] Whether the affected testis is removed or conserved, the contralateral one should undergo orchidopexy, as the risk of recurrence on the other side is otherwise high. […] A baby born with testicular torsion should have the affected testis removed (because it is always non-viable) and orchidopexy of the other side (because bilateral torsion is common).

• #25 Testicular Torsion – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448199/

  Testicular torsion is a time-dependent diagnosis, a true urologic emergency, and early evaluation can assist in urologic intervention to prevent testicular loss. Surgery is the only treatment. […] The typical window of opportunity for surgical intervention and testicular salvage is 6 hours from the onset of pain. Therefore, early urologic surgery consultation upon presentation may be critical even in the absence of confirmatory testing. […] Manual detorsion should be attempted if urological intervention is not immediately available. The abnormal testicle should be rotated in a medial to lateral direction (open book) 180 degrees and then evaluated for pain relief. […] In neonates, bilateral scrotal exploration is done. Contralateral orchiopexy is always done to prevent future torsion. Patients who require an orchiectomy for a non-viable testis usually have a testicular prosthesis inserted. The prosthesis is usually inserted 4-6 months after the initial surgery to allow for the inflammation to subside. […] Early urology involvement is crucial to avoid testicular loss. The use of color flow is essential in the evaluation of testicular torsion.

• #26 Testicular Torsion Medication: Analgesics, Antiemetics, Antianxiety Agents

  https://emedicine.medscape.com/article/2036003-medication

  Analgesic and antianxiety medications are valuable adjuncts in the treatment of testicular torsion. Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and enables physical therapy regimens. Antiemetics can be used to counter the nausea and vomiting that may accompany testicular torsion. […] Anti-inflammatory agents as adjunctive therapy for testicular torsion have been studied in the rat model. Phosphodiesterase type 5 inhibitors (eg, sildenafil) and statins have been shown to decrease inflammatory markers and to increase blood flow to the testicles. These adjuncts are still in the research stage and are not clinically available for this use. […] A number of other approaches (particularly, antioxidants) have been proposed or tried in animal models, with varying reports of efficacy, as a means of reducing ischemia-reperfusion injury after testicular torsion. Those have included the following: Morphine, Propofol, Melatonin, Dehydroepiandrosterone, Erythropoietin, Calcium channel blockers, Renin-angiotensin system inhibitors (eg, bosentan), Phytotherapeutics (eg, Gingko biloba extract).

• #27 Testicular Torsion Medication: Analgesics, Antiemetics, Antianxiety Agents

  https://emedicine.medscape.com/article/2036003-medication

  Analgesic and antianxiety medications are valuable adjuncts in the treatment of testicular torsion. Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and enables physical therapy regimens. Antiemetics can be used to counter the nausea and vomiting that may accompany testicular torsion. […] Anti-inflammatory agents as adjunctive therapy for testicular torsion have been studied in the rat model. Phosphodiesterase type 5 inhibitors (eg, sildenafil) and statins have been shown to decrease inflammatory markers and to increase blood flow to the testicles. These adjuncts are still in the research stage and are not clinically available for this use. […] A number of other approaches (particularly, antioxidants) have been proposed or tried in animal models, with varying reports of efficacy, as a means of reducing ischemia-reperfusion injury after testicular torsion. Those have included the following: Morphine, Propofol, Melatonin, Dehydroepiandrosterone, Erythropoietin, Calcium channel blockers, Renin-angiotensin system inhibitors (eg, bosentan), Phytotherapeutics (eg, Gingko biloba extract).

• #28 Testicular Torsion Medication: Analgesics, Antiemetics, Antianxiety Agents

  https://emedicine.medscape.com/article/2036003-medication

  Analgesic and antianxiety medications are valuable adjuncts in the treatment of testicular torsion. Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and enables physical therapy regimens. Antiemetics can be used to counter the nausea and vomiting that may accompany testicular torsion. […] Anti-inflammatory agents as adjunctive therapy for testicular torsion have been studied in the rat model. Phosphodiesterase type 5 inhibitors (eg, sildenafil) and statins have been shown to decrease inflammatory markers and to increase blood flow to the testicles. These adjuncts are still in the research stage and are not clinically available for this use. […] A number of other approaches (particularly, antioxidants) have been proposed or tried in animal models, with varying reports of efficacy, as a means of reducing ischemia-reperfusion injury after testicular torsion. Those have included the following: Morphine, Propofol, Melatonin, Dehydroepiandrosterone, Erythropoietin, Calcium channel blockers, Renin-angiotensin system inhibitors (eg, bosentan), Phytotherapeutics (eg, Gingko biloba extract).

• #29 Testicular Torsion | Causes, Symptoms & Treatment

  https://www.cincinnatichildrens.org/health/t/testicular-torsion

  Following surgery, care instructions would include: Resume a normal diet. Wear supportive undergarments to minimize discomfort. Keep the wound clean. It is OK to shower or sponge bathe the area, but avoid soaking the wound (tub bath or swimming) for five days. Apply antibiotic ointment to the wound (Neosporin, Polysporin), three to four times a day for one week. To control pain: Children less than 3 years old alternate Tylenol and Motrin/Ibuprofen every four hours for two days and then continue as needed. Children older than 3 years old may be given a prescription for a narcotic pain medicine. Restrict activity for one week, which includes sports, riding toys or bicycles, and contact activities.

• #30 Testicular torsion surgery – Overview | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/testicular-torsion-surgery

  Most people do not have any side effects with this procedure, but there are some risks. […] After surgery, you will spend some time in the recovery area to be monitored as you wake up from the anaesthetic. […] You might feel sleepy (drowsy) for 1 to 2 days as the anaesthetic wears off. […] Your groin and scrotum might be uncomfortable for 7 to 10 days. This will usually be relieved by simple painkillers (such as paracetamol and ibuprofen) which you will be given to go home with if you do not have any at home. […] You might be given a scrotal support (jockstrap). Try to wear this, or tight briefs or cycling shorts, for the week after surgery to support the area and reduce the risk of bruising after surgery.

• #31 Testicular torsion surgery – Overview | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/testicular-torsion-surgery

  Most people do not have any side effects with this procedure, but there are some risks. […] After surgery, you will spend some time in the recovery area to be monitored as you wake up from the anaesthetic. […] You might feel sleepy (drowsy) for 1 to 2 days as the anaesthetic wears off. […] Your groin and scrotum might be uncomfortable for 7 to 10 days. This will usually be relieved by simple painkillers (such as paracetamol and ibuprofen) which you will be given to go home with if you do not have any at home. […] You might be given a scrotal support (jockstrap). Try to wear this, or tight briefs or cycling shorts, for the week after surgery to support the area and reduce the risk of bruising after surgery.

• #32 Testicular Torsion: Definition, Symptoms, and Treatment

  https://www.healthline.com/health/testicular-torsion

  Orchiopexy doesnt typically require an overnight stay in the hospital. Youll stay in a recovery room for several hours prior to discharge. […] Your doctor will recommend or prescribe the most appropriate pain medication. If your testicle needs to be removed, youll most likely stay in the hospital overnight. […] Your doctor will most likely use dissolvable stitches for your procedure, so you wont need to have them removed. After surgery, you can expect your scrotum to be swollen for two to four weeks. […] You can use an ice pack several times a day for 10 to 20 minutes. Thisll help to reduce swelling. […] Your doctor will recommend refraining from certain types of activities for several weeks following surgery. These include sexual activity and stimulation, such as masturbation and intercourse.

• #33 Testicular Torsion (for Teens) | Nemours KidsHealth

  https://kidshealth.org/en/teens/torsion.html

  A surgeon or urologist will make a small cut in the scrotum, untwist the spermatic cord, and stitch the testicles to the inside of the scrotum to prevent future torsions. […] The surgery to attach the testicles to the scrotum takes about 45 minutes. There may be some pain, but it shouldn’t be too bad. It’s much better than the torsion. […] Sometimes, if the torsion goes on too long, doctors can’t save the affected testicle. They’ll need to remove it through a type of surgery called an orchiectomy. […] Guys need to skip strenuous activities (like sports) and sex or sexual stimulation (like masturbation) for a few weeks after testicular torsion surgery. Talk to your doctor about when it will be safe to go back to your normal activities. […] Even if your torsion led to the loss of a testicle, you can still lead a normal life, just like anyone else. Most guys will still be able to father children later in life and have normal sexual relations with one working testicle. Many also opt for a prosthetic, or artificial, testicle a few months after surgery. This can help make some feel more comfortable about their appearance.

• #34 Pediatric Testicular Torsion Diagnosis & Treatment in Atlanta | Georgia Urology

  https://www.gaurology.com/condition/testicular-torsion/

  The specific treatment for testicular torsion will be determined based on: […] Testicular torsion usually requires immediate intervention to untwist the spermatic cord to restore blood flow. A testicle removal may be necessary when deprived of blood flow for too long as it may not be able to recover. Surgery can also help prevent torsion from re-occurring because the operation involves firmly attaching both testes to the scrotal sac. […] The physicians of Georgia Urology have expertise in the evaluation and treatment of testicular torsion in newborns, boys, adolescents, and adults.

• #35 Emergency Testicular Torsion Care: Symptoms, Surgery & Recovery – The Kingsley Clinic

  https://thekingsleyclinic.com/resources/emergency-testicular-torsion-care-symptoms-surgery-recovery/

  Testicular detorsion surgery is primarily recommended for patients diagnosed with testicular torsion. […] If blood flow is not restored promptly, the testicle may shrink (atrophy) or become non-viable, requiring removal. This risk is primarily associated with delayed treatment rather than the surgery itself. […] Although rare, torsion can recur, particularly if the testicle is not securely fixed. To prevent this, surgeons perform an orchiopexy, a procedure that stitches the testicle to the scrotal wall, greatly reducing the likelihood of future torsion. […] Testicular detorsion surgery is highly effective in treating testicular torsion, particularly when performed promptly. […] The success rate for salvaging the testicle ranges from 80% to 100% when surgery is performed within six hours of symptom onset.

• #36 Testicular torsion repair Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/surgery/testicular-torsion-repair

  Testicular torsion repair is surgery to untangle or untwist a spermatic cord. The spermatic cord has a collection of blood vessels in the scrotum that lead to the testicles. Testicular torsion develops when the cord twists. This pulling and twisting blocks blood flow to the testicle. […] Most of the time, you will get general anesthesia for testicular torsion repair surgery. You will be asleep and pain-free. […] Testicular torsion is an emergency. In most cases, surgery is needed right away to relieve pain and swelling and to prevent the loss of the testicle. For the best results, surgery should be done within 4 hours after symptoms begin. By 12 hours, a testicle may become damaged so badly that it has to be removed. […] Most of the time, this surgery is done as an emergency, so there is often too little time to have medical tests beforehand. You may have an imaging test (most often ultrasound) to check for blood flow and tissue death. […] Following your surgery: Pain medicine, rest, and ice packs will relieve pain and swelling after surgery. […] If surgery is done in time, you should have a complete recovery. When it is done within 4 hours after symptoms begin, the testicle can be saved most of the time.

• #37 Testicular Pain: Causes, Sides, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/symptoms/16292-testicular-pain

  Go to an emergency room (ER) if you have intense testicular pain. It could be a sign of testicular torsion, which is a serious medical emergency. […] If home remedies don’t work, talk to a healthcare provider. They can prescribe medications that help reduce pain, including: […] It depends on what’s causing testicular pain. If you have an emergency condition like testicular torsion or testicular cancer, you need surgery. […] Types of surgery for testicular pain may include: Testicular de-torsion. This is an emergency surgery to untwist the spermatic cord and restore blood flow to one or both of your testicles. They’ll then use stitches to secure your testicles to the inner wall of your scrotum to prevent testicular torsion from happening again. […] You should immediately call a healthcare provider if you have testicular pain or swelling, especially if the pain gets worse or if you feel sick. If you have testicular torsion symptoms, make sure to get to an emergency room as soon as possible.

• #38 Straightening out the testicular torsion care pathway | Children’s NationalSearchLink to: The brain’s fluid-filled spaces during growthLink to: Breast milk helps white matter in preemiesScroll to top

  https://innovationdistrict.childrensnational.org/straightening-testicular-torsion-care-pathway/

  A new collaborative accelerated care pathway for testicular torsion assessment and treatment may save critical time between diagnosis and intervention. […] To increase the likelihood of successfully salvaging the twisted testicle and spermatic cord, surgical intervention – which involves restoring blood flow to the testis – should ideally occur within six hours from the onset of pain. […] In April 2016, the Division of Urology at Children’s National launched a new, accelerated care pathway for testicular torsion assessment and treatment that was developed collaboratively with the Emergency Department, Diagnostic Imaging and Radiology, the Department of Anesthesiology, and the peri-operative and operating room team. […] Analysis of the streamlined care pathway, which emphasizes communication that the condition is a true emergency, has improved time from ED to OR within target ranges.

• #39 Straightening out the testicular torsion care pathway | Children’s NationalSearchLink to: The brain’s fluid-filled spaces during growthLink to: Breast milk helps white matter in preemiesScroll to top

  https://innovationdistrict.childrensnational.org/straightening-testicular-torsion-care-pathway/

  Since the initiative’s launch, 21 cases, from referrals and direct diagnosis, have come into the ED. The new protocol is working efficiently, reducing the mean time from the ED to the OR by more than an hour, now averaging below the team’s target goal of less than 2.5 hours from ED arrival to the OR. […] The hope is that more general knowledge of testicular torsion will allow parents, primary care doctors and emergency department staff to expedite diagnosis when a child complains of scrotal pain or has visible discoloration, further reducing the time from onset of pain to successful intervention. With such a short window of time for treatment, the accelerated care pathway is showing promising results.

• #40

  https://www.byramhealthcare.com/blogs/what-is-testicular-torsion

  Testicular torsion requires emergency surgery to avoid loss of a testicle. If the blood flow remains cut off for an extended length of time, the testicle can become damaged beyond repair and require removal. By seeking prompt treatment, you can prevent severe damage or loss of the afflicted testicle. […] If you experience any signs or symptoms of testicular torsion, your doctor will perform a physical exam and may order an x-ray or ultrasound to check blood flow. The treatment requires immediate surgery to avoid the above complications. […] In almost all cases of testicular torsion, surgical repair is needed. This allows for your doctor to untwist the testicles and ensure blood flow is restored as soon as possible. It’s completed under general anesthesia, so you’ll be asleep during the procedure. The surgery is done through a small incision that allows for the spermatic cord to be untwisted. Your surgeon will then secure the testicle using sutures to prevent future rotation and close with stitches. It’s a simple procedure and while you may feel discomfort during recovery, you won’t likely need to stay in the hospital overnight. […] The only preventative measure you can take is if you have Bell Clapper. If you experience this deformity, having surgery to reattach the testicles to the inside of your scrotum will restrict their movement and reduce your likelihood of torsion.

• #41

  https://www.singhealth.com.sg/patient-care/conditions-treatments/testicular-torsion

  The treatment for testicular torsion is surgery. The surgery is performed under general anaesthesia and you / your child would be asleep throughout the operation. A small cut will be made in the scrotum and the testicles would be checked and untwisted by the surgeon. The surgeon will then put stitches around the testicle to fix it in a normal position so it will not twist again in the future. […] Children who have testicular torsion usually have an underlying abnormality that causes the testicles to rotate easily in the scrotum. This can occur to the other testicle as well. Therefore, the surgeon will place stitches in both the testicles to prevent any future twisting. […] Thankfully, if this is caught early and treatment is given, the chances of a full recovery is very high.

• #42 Testicular torsion – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/testicular-torsion/symptoms-causes/syc-20378270

  Testicular torsion usually requires emergency surgery. If treated quickly, the testicle can usually be saved. But when blood flow has been cut off for too long, a testicle might become so badly damaged that it has to be removed. […] Seek emergency care for sudden or severe testicle pain. Prompt treatment can prevent severe damage or loss of your testicle if you have testicular torsion. […] You also need to seek prompt medical help if you’ve had sudden testicle pain that goes away without treatment. This can occur when a testicle twists and then untwists on its own (intermittent torsion and detorsion). Surgery is frequently needed to prevent the problem from happening again. […] If you have this trait, the only way to prevent testicular torsion is surgery to attach both testicles to the inside of the scrotum.

• #43 Testicular Torsion: Diagnosis, Evaluation, and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1215/p835.html

  Testicular torsion is a twisting of the spermatic cord and its contents and is a surgical emergency affecting 3.8 per 100,000 males younger than 18 years annually. […] Prompt recognition and treatment are necessary for testicular salvage, and torsion must be excluded in all patients who present with acute scrotum. […] If history and physical examination suggest torsion, immediate surgical exploration is indicated and should not be postponed to perform imaging studies. […] There is typically a four- to eight-hour window before permanent ischemic damage occurs. Delay in treatment may be associated with decreased fertility, or may necessitate orchiectomy. […] Immediate surgery should be performed if testicular torsion is suspected, and should not be delayed by imaging studies if physical examination findings are strongly suggestive.

• #44 Testicular Torsion Treatment & Management: Manual Detorsion, Surgical Detorsion

  https://emedicine.medscape.com/article/2036003-treatment

  Success of manual detorsion can be assessed with the use of Doppler sonography and resolution of symptoms. […] Surgical detorsion and subsequent orchiopexy or orchiectomy is the definitive management strategy and should proceed immediately in patients whose clinical findings suggest torsion. The patient and/or caregiver should be counseled on the risk of immediate or delayed testicular loss. Additionally, they should be advised that the impact of torsion on later fertility, even if testicular salvage occurs, cannot be assured. […] Immediate surgical exploration with detorsion and orchiopexy or orchiectomy is the recommended and accepted management strategy for males presenting with clinical signs of testis torsion. Surgical exploration should not be delayed to obtain confirmatory radiologic studies in patients who present with suggestive clinical signs of torsion.

• #45 Testicular Torsion – Diagnosis and Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/testicular-torsion-diagnosis-and-treatment/

  Testicular torsion occurs when the spermatic cord, which provides blood flow to the testicle, becomes twisted and leading to potential ischemia and venous obstruction. […] Considered a surgical urologic emergency and requires prompt treatment to prevent permanent damage to the testicle, and after eight hours of ischemia it is believed the testis can suffer irreversible damage including infertility in the future, even with one normal testis. […] Surgical consultation with urology should not be delayed, but manual detorsion can be attempted in the emergency department, as restoration of blood flow is critical. […] If the testis is successfully manually detorsed, surgical fixation to prevent future occurrences is recommended. […] Urgent surgical intervention to detorse and fixate the testis is warranted in any case of testicular torsion, so urological referral should be made for any suspected case.

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