The management of testicular torsion in the acute pediatric scrotum.

From July 1976 through June 1981, 51 children with acute scrotal pain and swelling underwent surgical exploration. Testicular torsion (27 cases) and torsion of an appendage (18 cases) were the most common diagnoses. In the group with testicular torsion 5 testes were considered unsalvageable and these were removed. The remaining 22 testes, including those of questionable viability, were left in place. The early salvage rate of 81 per cent decreased to 50 per cent due to testicular atrophy found in the late followup period. The attempt to salvage all testes except those with obvious necrosis resulted in minimal morbidity. This approach is discussed in view of recent reports of long-term damage to the contralateral testis when an ischemic testis is not removed initially.