Scrotal exploration

Key principles

• Should be performed if suspicion clinically of torsion
• Explore both hemiscrotum
• Bilateral orchidopexy
• If infarcted → orchidectomy

Testicular torsion is a clinical diagnosis and if suspicion the patient should proceed to an urgent scrotal exploration, exploring and pexying both testis

Specific preoperative preparation

• Consider USS if rapidly available
• Consent for possibility of orchidopexy

Operation Details

• GA. Supine. IVAB
• Sterile prep and drape or both testis.
• Perform a median raphe incision
• Displace testis medially so that soft tissues on the appropriate side are divided using diathermy including dartos, external spermatic fascia, cremasteric fascia, internal spermatic fascia
• Open the tunica vaginalis by picking it up between two artery forceps and widen the incision to deliver the testis
• Viewed from below an anti-clockwise rotation is required for the right side and a clockwise
• rotation for the left side – away from midline somewhere between 180-720 degrees
• If the testis is dusky or black, it is placed in a sponge moistened with warm saline and left for 10 minutes
• If after this the testis remains black, then an orchidectomy is required. Clamp the cord with two large arteries. Double tie the proximal cord with 0 Vicryl transfixing suture and then 0 Vicryl tie. Then cut the cord leaving both ties. Contra-lateral exploration and fixation is then required.
• If the testis is viable then perform bilateral fixation
• To perform fixation, I use a 3/0 prolene suture. I evaginate the scrotum and place a suture in the parietal layer of tunica vaginalis and then a suture in corresponding place in testis
• Place 3 sutures, one at lower pole, one at right and left sides. Tie all sutures only after placed.
• Through the same incision dissect into the contralateral sac and perform fixation as above
• If torted appendix testis or epididymis then place a 2/0 Vicryl tie and excise.
• If epididymitis, then washout with saline
• Closure in layers continuous 2/0 Vicryl to dartos and interrupted 3/0 Monocryl to skin.
• Scrotal support.