LAUSR

FIGURE 1. Manual downward traction of the left testicle followed by external rotation to unwind the twisted spermatic cord. T imely manual detorsion of a torsed testicle saves the organ from ultimate death. Thus, the efficacy and ease with which an emergency physician can accomplish such maneuvers are of the utmost clinical importance. While surgical management is the goal, manual detorsion is an important but greatly underused step in the management of this painful condition. Despite evidence that timely manual detorsion can save testicles, for multiple reasons reduction procedures are greatly underused. Furthermore, there are some torsed testicles that cannot be easily reduced. An adjunct maneuver to improve the ease and success rate of manual reductions of torsed testicles is needed. In this article, we present a new and promising technique for manually reducing torsed testicles, the torsed testicle traction technique. Because the most common direction for spontaneous torsion of testicles is inward rotation, the reduction direction for both testicles is external rotation. Thus, the traditionally taughtmethod ofmanually reducing a testicle torsion is external (medial-tolateral) rotation of either testicle or the open book technique. During manual reduction, the right testicle is typically rotated counterclockwise, and the left testicle is rotated clockwise. However, an estimated 30% of torsion events do not rotate internally but spin externally.When that occurs, the direction to detorse either testicle is an internal spin or inward rotation. Lack of confidence in knowing the correct direction to rotate the torsed testicle causes healthcare providers to hesitate in performingmanual reduction attempts. While detection of torsion direction can often be determined by ultrasound, more commonly, the operator uses a “hard stop” as an indicator to rotate or detorse in the opposite direction. Unfortunately, when the testicle has been torsed for a prolonged period, the associated swelling and edema as well as other mechanical factors increase the difficulty of these rotation maneuvers. While the torsed testicle traction technique may be used as a primary manual reduction maneuver for any testicular torsion, it may