Testicular Compartment Syndrome: A New Approach to Conceptualizing and Managing Testicular Torsion

Objectives: Decompression of compartment syndrome is known to salvage tissues in numerous organ systems. To demonstrate evidence that testes exposed to prolonged ischemia exhibit compartment syndrome physiology and propose a novel technique in treating this phenomenon. Methods: Three boys, aged 11, 14, and 16 years, with prolonged testicular torsion lasting 6-7 hours were taken to the operating room. All testes appeared dusky and congested on manual detorsion. Testicular fasciotomy was performed by making a longitudinal incision in the tunica albuginea. The coloration of all testes improved dramatically. When the tunica albuginea was reapproximated, each testis returned to an ischemic appearance. The tunica albuginea was again opened. A harvested tunica vaginalis patch was placed over the exposed seminiferous tubules and secured in place. In the case of the 11-year-old boy, a handheld compartment monitor needle was used to measure the compartment pressure at all stages of the procedure. Results: All testes maintained a well-perfused coloration at completion of the procedure. The compartment pressures in the testis of the 11-year-old boy (diastolic pressure 52 mm Hg) were as follows: 34 mm Hg after detorsion, 5 mm Hg after testicular fasciotomy, 46 mm Hg after reapproximation of the tunica albuginea, 3 mm Hg on repeat fasciotomy, and 5 mm Hg after tunica vaginalis patch application. Conclusions: Testicular compartment pressures appear elevated after prolonged torsion. Testicular fasciotomy, combined with a tunica vaginalis patch, relieved testicular compartment syndrome. Additional investigation is warranted to determine whether this technique affords improved preservation of testicular tissues.