What is the first step in managing testicular torsion?

The management of testicular torsion is a critical time-sensitive issue. The first step involves attempting an external rotation of the testicle, which is a maneuver to relieve torsion. This is because the torsion occurs due to the testicle twisting around its vascular pedicle, and if the torsion can be resolved manually, it can restore blood flow and prevent testicular necrosis. It is important to note that this maneuver should be followed by definitive surgical intervention to secure the testicle and prevent future occurrences.

While surgery is indeed the definitive treatment required, it is not considered the first step. Administering pain medication may be appropriate for comfort but does not address the urgent need to resolve the torsion. An ultrasound examination can be used to assess blood flow to the testicle and confirm the diagnosis, but this should not delay management in the face of a clinical suspicion of torsion. Immediate intervention is crucial given the risk of testicular loss, making the external rotation the first step in management before surgical fixation is performed.