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J R Soc Med. 2002 August; 95(8): 425.
PMCID: PMC1279978

Management of testicular torsion

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.


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 [PMC free article] [PubMed]
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 Surg 1998;33: 1790-3 [PubMed]
4. Morse TS, Hollabaugh RS. The ‘window’ orchidopexy for prevention of testicular torsion. J Pediatr Surg 1977;12: 237-40 [PubMed]
5. Sells H, Moretti KL, Burfield GD. Recurrent torsion after previous testicular fixation. Aust NZ J Surg 2002;72: 46-8 [PubMed]
6. Lent V, Stephani A. Eversion of the tunica vaginalis for prophylaxis of testicular torsion recurrences. J Urol 1993;150: 1417-21 [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press