Manual detorsion allows time for orchidopexy in testicular torsion

Aims: To investigate the efficacy of color Doppler ultrasound (CDUS)-guided manual detorsion (MD) as an immediate intervention in pediatric testicular torsion (TT) and its impact on testicular preservation, surgical timing, and postoperative outcomes. Methods: A retrospective analysis was conducted on 43 pediatric patients who underwent surgery for TT between July 2019 and January 2025. Patients were divided into two groups based on whether MD was attempted prior to surgery (MD group, n=15) or not (non-MD group, n=28). MD success was defined by symptom resolution and confirmed reperfusion on CDUS. Data on symptom duration, time to surgery, intraoperative findings, orchiectomy rates, contralateral testicular fixation (CTF) feasibility, and postoperative complications were compared between groups. Results: MD was successful in 14 of 15 cases (93.3%), significantly prolonging the median time to surgery (11 ± 5.9 hours) compared to the non-MD group (2.0 ± 1.28 hours; p<0.001), allowing for improved surgical conditions. Orchiectomy was avoided in all successful MD cases but required in four patients in the non-MD or failed MD group. Testicular atrophy occurred only in the non-MD group. CTF was more frequently performed in the MD group due to reduced scrotal edema. No recurrences or major complications were observed in the MD group during follow-up. Conclusion: CDUS-guided MD is a safe and effective temporizing maneuver that facilitates testicular salvage and surgical planning in TT. However, timely orchidopexy remains essential to prevent recurrence and ensure optimal outcomes.