Urgent intervention is required. The patient or his parents must be warned of the possible need to remove the testis.
If surgery is unavailable, or presentation is at an early stage, it may be possible to untwist the testis without operation. The direction of rotation is that in which the pain is decreased. This is a temporary measure. The testis must later be secured surgically to prevent recurrence.
If the testis cannot be untwisted, urgent operation is necessary if the testis is to be saved. A scrotal incision is made and the testis examined.
A black testis that fails to recover its colour is necrotic and must be removed. If some colour returns, the testis may be viable and should be left. It is untwisted and sutured to the tunica vaginalis or placed into a dartos pouch to prevent recurrence. The other testis should be fixed as predisposition is usually bilateral.
If the testis has been saved, the patient is given a scrotal support and should take bed rest for 24 hours to assist the swelling to settle.
If the testis has been removed, early mobilisation is encouraged.
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