Operative note 12 Core CORE (emergency)
Scrotal exploration for torsion
What it does: urgent undo of a twisted testis.
- Suspected torsion = theatre now. Save rate: 9 in 10 inside 6 h. 1 in 2 at 12 h. Under 1 in 10 at 24 h.
- Scan only if it will not delay theatre.
- Midline scrotal cut. 1 cut reaches both sides.
- Open the tunica. Deliver the testis.
- Untwist the cord by hand, outwards like opening a book (right side: counter-clockwise, left: clockwise, seen from the foot of the table). Watch for colour return.
- Wrap in warm saline gauze.
- Fix the OTHER side first while you wait.
- Viable? Fix to dartos or tunica.
- Dead? Remove it. Prosthesis can go in now.
- Watch: Fixation method is debated. Fixing both is not.
- 2026 update: EAU grades contralateral fixation as "weak". UK practice still fixes both. Coroners ask.
From the UroRef Operative Quick Guide.