Preoperative manual detorsion of the torsed spermatic cord.

During a 10-year period 35 of 104 patients with torsion of the spermatic cord had preoperative manual detorsion. The detorsion was performed at the initial physical examination, most commonly without analgesia or sedation. In 34 evaluable patients all of the testes were salvaged without any evidence of atrophy. One patient whose testis appeared viable at operation was not available for followup. Recurrence was prevented by subsequent orchiopexy. The elapsed time between urological consultation and surgery ranged from 1 hour 40 minutes to 2 months. Six patients underwent an elective operation. Torsion did not recur between the time of manual detorsion and orchiopexy. Preoperative manual detorsion should be attempted at the initial physical examination because, if successful, the relief of testicular ischemia converts an acute urological emergency into an urgent or elective surgical procedure. More important, 100 per cent of the testes are salvaged.