Mini Review Volume 1 Issue 2 - November 2016 JOJ uro & nephron Copyright © All rights are reserved by Paddy Dewan A Survey of Manual Detorsion of The Testicle Paddy Dewan 1 , Bhavish Kowlessur 2 and John Lazarus 2 1 Kind cuts for Kids and Urology Unit, Red Cross Children’s Hospital, Australia 2 University of Cape Town, South Africa Submission: October 29, 2016; Published: November 14, 2016 *Corresponding author: Dewan P, Kind cuts for Kids and Urology Unit, Red Cross Children’s Hospital Post Box 152, Parkville 3052, Australia, Email: Introduction Testicular torsion occurs in 1 in 4000 males before the age of 25 years [1], but despite the common occurrence and multiple papers published on the use of manual detorsion there appear to be strong views against the use of the technique, and a wide variation between the different specialties in how to manage testicular torsion patients. Certainly, there are not any public education programs to ensure teenage boys know how to self detort a twisted testicle, despite the high testicular loss rate from torsion [2-3] and the high incidence of litigation when testicular loss occurs. How to manage the infracted and ischemic testicle like-wise seems opinionated, rather than based on science as highlighted in studies of the testis compartment syndrome [1-4], which is managed by incision by most and insertion of tunica vaginalis in recent studies [1-4]. There are a number of anaesthetic techniques advocated by respondents to the survey, but little literature on the subject [5-6]. And, many are sceptical about the need cause to cause severe pain when they optimistically reflect on easy access to theatre, a view that fails to appreciate that most patients attend a non-hospital practitioner prior to arriving in the emergency department, therefore it would be important for the community, and community health workers, to be aware of a procedure that would buy time. There are now many papers that advocate manual detorsion [5-12] including publications from the 19th Century [13]. A further barrier to the use of preoperative manual detorsion appears to be uncertainty about the direction of the twist. However, this does not appear to be a problem in the clinical setting, as it the instant pain relief is a marker of the direction in the early presentation cases. Several studies have documented JOJ uro & nephron 1(2): JOJUN.MS.ID.555556 (2016) JOJ Urology & Nephrology 001 Abstract Purpose: A nine question survey was established on an internet survey provider, aimed to understand attitudes to two principle aspects of management of testicular torsion. Respondents were asked about their experience and attitude toward the use of preoperative manual detorsion, the analgesic usage for that manoeuvre and the approach to the significantly ischaemic testicle at the time of scrotal exploration. Materials Methods: A monkey survey platform included 9 questions, the results of which were analysed via an access database. In all, 561 emails were sent from the authors, and the numbers linked via the Australasian Urology and Paediatric Surgery societies, for privacy reasons, were not defined. A total of 285 responses were collected; 181 via emails responses and 104 via a web link. Results: Results of 285 who did respond, 134are Urologists, 33 Urology trainees, 45Paediatric Urologists,58Paediatric Surgeons and 15 Paediatric Surgery trainees.19 of 58 (32.8%) of Paediatric surgeons, 32 of 45 (66.7%) Paediatric Urologists and 84of 134 (62.7%) of Urologists had untwisted a testicle before theatre, but 12 (25.0%) of 48 trainees have either never been taught or do not believe in the manual detorsion; 46.7% of those in Paediatric Surgery compared to four of 33 urology trainees 15.1%. Conclusion: The majority of surgeons rely on manual detorsion of the testicle as part of the management of patients with a twisted testicle in the adolescent age group, and there appear to clinical criteria that are used to assess the appropriateness of the manoeuvre. Keywords: testicular torsion; spermatic cord torsion; manual detorsion; capsulotomy; testicular infarction.