Ultrasound for testicular torsion and manual detorsion

Abstract

Testicular torsion is a urological emergency that requires prompt detorsion. At our hospital, diagnosis is established with ultrasonography, followed by manual detorsion. Ultrasonographic findings for testicular torsion include enlargement of the affected testis and epididymis, asymmetry of the testicular longitudinal axis, absent or diminished intratesticular flow, a whirlpool sign, and alterations within the intratesticular parenchymal echotexture. Manual detorsion is typically attempted to detort toward outward rotation. Successful reduction is indicated by recanalization of blood flow within the intratesticular hyperperfusion and disappearance of the whirlpool sign. If hyperperfusion is absent or recanalization is not absent, reduction failure should be considered, due to residual torsion despite correct rotation or incorrect detorsion. Manual detorsion alone achieves only “detorsion”, whereas surgical detorsion can include detorsion, orchiopexy and/or tunica albuginea incision. Ideally, surgical exploration should follow promptly after manual detorsion.