Editing Testicular torsion (section)

== Exploration: ==

* Ask for 15 blade, bipolar diathermy (although can use monopolar), 3/0 Prolene, 4/0 undyed Vicryl Rapide, Opsite spray
* 5cm median raphe incision, then sharply dissect layer by layer directly onto the bunched up testicle with your hand underneath. Usually get a gush of reactive hydrocoele before reaching testicle - once this occurs, means you have opened tunica vaginalis, change to Metz and divide more of tunica vaginalis along the length of skin incision. Divide generously, because it's hard to free this up more once the testis out.
* If unsure of viability, an incision to testicular parenchyma should give good bleeding in a viable testis. If no bleeding after 10 minutes, non-viable testis, should be removed (ligate cord within the scrotum with 0 Vicryl transfixion sutures and excise testis).
* Evert testis from tunica vaginalis and fix with 3x 3/0 sutures (ideally something permanent but soft, like Ethibond) within the tunica albuginea and the lateral scrotal wall, at the upper and lower poles and the equator.
* Torsion of appendix testis - excise cyst, no need to explore contralateral side
* Meticulous haemostasis
* Close tunica albuginea with running 4/0 undyed Vicryl, then local anaesthetic to dartos, then close skin/dartos together with interrupted 4/0 Vicryl.
* Opsite spray
* Supportive underwear