Intraoperative multiple needle puncture of the Tunica Albuginea after detorsion: A simple decompressive technique to improve testicular salvage

Abstract

Testicular torsion causes a compartment syndrome physiology in which detorsion alone may fail to restore perfusion because intratesticular pressure remains elevated after untwisting. This report describes a simple intraoperative adjunct practised by the author in a district hospital setting in Zambia: multiple needle punctures of the tunica albuginea immediately after detorsion, without formal fasciotomy or tunica vaginalis flap. The technique decompresses the intratesticular compartment, releases congested venous blood and allows clinical grading of testicular viability by the colour and speed of bleeding from the puncture sites. It requires no equipment beyond a standard needle, adds less than two minutes to the procedure and avoids the complexity of formal fasciotomy. The colour grading system derived from needle puncture response is described, and the physiological basis of the technique is outlined. Prospective documentation is encouraged.