Early Detorsion Improves Testicular Salvage Rates in Pediatric Patients with Testicular Torsion: Study

A new study published in the journal of Urology showed that when detorsion was placed within 6 hours of the beginning of symptoms, testicular salvage rates and volume were much greater in pediatric patients with testicular torsion.

The most frequent acute scrotal injury in the world, testicular torsion (TT), mostly affects children and adolescents. It results in limited blood supply to the afflicted testis, which causes testicular atrophy and loss in teens. Based on publicly available data, the incidence of TT is estimated to be 1 in 4000 males under 25 and 1 in 160 males over 25. Also, TT is responsible for 13% to 54% of acute scrotal illness cases.

In Ireland, which experiences chilly weather, the incidence was high in 2010 at 21.76 per 100,000 people. As of right now, there are no effective medications for treating TT in people, but, surgical investigation. However, people who have TT experience infertility, subfertility, or testicular loss as a result of delayed diagnosis. The torsion angle and the time between testicular ischemia and surgery are the two most significant parameters that are associated with TT. Thus, Sasa Milivojevic and colleagues evaluated the rate of testicular atrophy and torsion outcomes in the current investigation.

During the 2000 to 2024, 103 patients with an average age of 12.9± 3.0 were followed up with echosonography following testicular salvage and surgical detorquation. Based on the time of the intervention, the research had three groups as Group 1 "<6h," Group 2 "6-12h," and Group 3 ">12h." All groups had a median follow-up of 65 (60 to 84) months.

When compared to 64.7% in Group 2 and just 20.8% in Group 3, the existence of a detorsed testis was substantially greater in Group 1, where all patients had an extant testis. In comparison to Groups 2 and 3, the detorsed testis volume was substantially higher in Group 1. Significant variances between the groups were found by analyzing blood flow via the testis. 20 (55.6%) of the patients in Group 1 had the structural homogeneity, but none of the patients in Groups 2 or 3 had it.

The findings highlight the potential danger of testicular atrophy after several years of follow-up is much higher. If symptoms are present for more than 6 hours, testicular salvage is not feasible. The topic of whether salvaged testes may have a negative effect on male fertility is raised by the high frequency of heterogeneous presentation on ultrasonography of saved testes that did not exhibit atrophy.

Source:

Milivojevic, S., Topalovic, D., Dasic, I., Cvejic, S., Filipovic, I., Mihajlovic, S., Jovic, M., & Lazovic, J. M. (2025). Testicular atrophy following torsion in pediatric patients. Results of a long-term follow-up. Urology. https://doi.org/10.1016/j.urology.2025.01.017