Introduction. Testicular torsion is one of the most dangerous acute scrotum conditions in children. Emergency revision of the scrotum followed by detorsion and orchiopexy is the main method of treatment. Manual detorsion is a measure that allows to reduce the duration of ischemia and improve the prognosis of gonadal survival.
Materials and methods. In the Children's Hospital of St. Vladimir, Moscow, 264 children with a diagnosis of testicular torsion were operated on. The age range was different: from 12 to 18 years – 217 cases (82%), from 1 to 5 years – 13 (5%), newborns – 34 (13%). The possibility of performing manual detorsion was considered only in the older age group, where in most cases a typical clinical picture was noted, and the duration of the disease was less than 24 hours.
Results. An attempt at manual detorsion was made in 168 cases (77%). In 20 (12%) patients out of 168 cases, the attempt at detorsion was «unsuccessful». In 148 cases (88%), during control ultrasound 30-60 seconds after detorsion, it was possible to record the restorationof the straight course of the spermatic cord and the vascular pattern in the testicular parenchyma, and testicular detorsion was assessed as successful. All patients, regardless of the success of the manipulation, underwent an emergency scrotum revision. In the group of 148 «successful» detorsions, only in 26 (17.5%) cases was the testicle in an incorrect position and required additional straightening. In 122 (82.5%) cases, at the time of revision, the testicle was in an anatomically correct straightened position Сlosed manual detorsion completely eliminated the torsion and the cause of ischemia in the preoperative period.
Conclusions. Manual detorsion is an effective method for restoring blood flow, reducing the duration of ischemic damage. The manipulation is recommended for older patients with a torsion period of less than 24 hours in the absence of signs of destruction. Manual detorsion does not eliminate the need for revision of the scrotum with subsequent fixation/removal of the gonad.