Testicular torsion occurs most often in the neonatal period and around puberty. Perinatal testicular torsion mostly occurs extravaginally in the prenatal period. On the other hand, pubertal torsion usually occurs intravaginally and requires prompt surgical treatment. The degree of cord twisting and the time between onset of symptoms and detorsion are most important factors to decide early salvage rate of the testis. In order to revive blood supply until operation, consider manual detorsion by rotation from within outward in pubertal boys with intravaginal torsion. If the color of the testis recovers after untwisting it, orchiopexy is performed in the dartos pouch with at least three places of fixation using nonabsorbable sutures. In all cases, contralateral orchiopexy should be done to prevent future torsion. Patients would need a long-term follow-up mainly for fertility and hormonal issues.
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