Orchidopexy for testicular torsion

Orchidopexy for testicular torsion

Orchiopexy (or orchidopexy) is a surgery to untwist a twisted (torsion) testicle in the scrotum and permanently fix it there.

Types of testicular torsion


Fixation of the testicle. Pic from Abdominal Key

Treatment of testicular torsion is immediate surgical exploration and to assess if there is twisting of the testicle. The spermatic cord needs to be untwisted (de-torsion) to restore the blood supply as soon as possible. Lasting damage starts after 6 hours of torsion. Nearly 75% patients need the testicle removed (orchidectomy) if surgery is delayed past 12 hours.

Longer duration of torsion increases the risk of tissue necrosis and death

  • Torsion recognized within 6 hours has an 80-100% salvage rate to save the testicle
  • Persistent symptoms > 24 hours has a nearly 0% salvage rate to save the testicle

After untwisting the testicle, the doctor will check the color of the testicle and whether adequate blood supply has been resumed. If adequate blood supply has resumed, the testicle must be fixed by sutures (called orchidopexy) so that it does not twist in future. The opposite unaffected testicle should also then be fixed as the “bell-clapper” deformity that predisposes to testicular torsion is present on the opposite side in 50% of cases.

In the event it is too late and the testicle has already died (infarct), and blood flow cannot salvage the testicle, then the testicle need to be removed and the opposite testicle need to be fixed.

If the testicle has already died (infarcted), it must be removed and cannot be left back. This is because a dead testicle can be a source of infection and abscess formation, and it has been suggested that it may subsequently affect the function of the opposite normal testicle in future as a result of presumed immune damage (known as sympathetic orchiopathy).

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