Date of Award


Document Type


Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Stanely Machoki Mugambi

Second Supervisor/Advisor

Fariha Akil Fazal

Third Supervisor/Advisor

Miriam Mutebi


General Surgery (East Africa)


Background: Preoperative manual detorsion for acute testicular torsion has been postulated to improve testicular salvage rates through reduction in testicular ischemia time. Manual detorsion however has several potential risks including worsening degree of torsion, incomplete detorsion and potentially missing the opportunity to perform definitive orchidopexy.

Objectives: To assess the efficacy of preoperative manual detorsion compared to immediate scrotal exploration in improving testicular salvage in acute intravaginal testicular torsion.

Methods: The MEDLINE, SCOPUS and AJOL databases along with the CENTRAL registry were searched for trials comparing preoperative manual detorsion to immediate scrotal exploration for acute intravaginal testicular torsion. Both randomized and non randomised trials of interventions were considered. Screening of abstracts, review of full text, extraction of data and risk of bias assessment were performed independently by two reviewers.

Results: Four retrospective cohort studies with 473 participants were included. Preoperative manual detorsion resulted in fewer orchidectomies compared to immediate scrotal exploration with a pooled risk ratio of 0.13 (95% CI 0.06 to 0.25, P < 0.00001). The overall certainty of the evidence was however downgraded to very low, predominantly due to elevated risk of bias in the included studies. Failure of manual detorsion and incomplete detorsion were noted across the included studies.

Conclusion: Preoperative manual detorsion may possibly increase testicular salvage rates amongst males presenting with testicular torsion. The reviewed data is however set in tertiary facilities and of very low certainty. Additionally, the risk of failure of detorsion and incomplete detorsion should always be kept in mind. Based on available data manual detorsion cannot be recommended for routine practice outside tertiary facilities. Future investigations should evaluate the utility of this intervention in varied settings, optimal endpoints and purpose to control for prognostic determinants of testicular salvage.

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Surgery Commons