Background Testicular torsion is a pediatric urology emergency. Numerous studies suggest etiologies consistent with anatomy and that factors such as time from initial presentation to surgery lead to salvage. However, few studies exist that characterize features associated with testicular torsion recurrence, which is postulated to be a rare event. We aimed to describe the presentation, diagnosis, risk factors, management, outcomes, and recurrence of testicular torsion over ten years in a single state.
Methods Retrospective chart review of an IRB-approved database containing testicular torsion diagnosis from 1/1/2013 through 1/1/2023 was evaluated. This database represented the breadth of a single hospital system covering a state-wide geographic area. Male patients up to age 35 with a diagnosis of testicular torsion who subsequently underwent scrotal exploration were considered. Neonatal torsion was excluded.
Results Over a decade, there were 152 operative cases for testicular torsion, with 147 meeting inclusion criteria, representing a testicular torsion rate of 5.5 per 100,000 males less than 35 years. Mean age of presentation was 14.3 years (minimum 2.2, maximum 31.0, S.D. 5.19). This group represented 56 (38.1%) with intermittent torsion and 91 (61.9%) who had acute torsion. Surgery was performed by 27 surgeons at eight locations.
The intermittent torsions (mean 12.5 years, S.D. 4.79) included 5 (8.9%) undergoing an ipsilateral orchiopexy and 51 (91.1%) bilateral orchiopexy. Twenty-nine (52.7%) received two-point fixation and 26 (47.3%) three-point fixation. Seventeen patients received absorbable sutures (31.5%) and 37 (68.5%) received permanent.
In the acute torsion group (mean 15.3 years, S.D. 5.16), 6 (6.6%) underwent a unilateral orchiopexy, 63 (69.2%) bilateral orchiopexy, and 22 (24.2%) orchiectomy +/- contralateral orchiopexy. Manual detorsion in the ED was performed on 24 (26.4%) prior to surgery. Of the 88 orchiopexies with suture data available, single-point, two-point, and three-point fixation was used in 4 (4.6%), 23 (26.1%), and 61 (69.3%), respectively. Fifty-five (64.0%) received absorbable sutures, whereas 31 (36.0%) received permanent sutures.
Two cases of recurrence in the ipsilateral testicle were noted, with a recurrence rate of 1.4%. Both cases used 5-0 Prolene and two-point fixation. Recurrence occurred 18 and 23 months after initial surgery. On redo orchiopexy, prior Prolene sutures were noted to be intact in tunica albuginea as described in original surgery but no longer anchored to dartos layer thus allowing for recurrence of torsion.
Conclusion This study confirms the rarity of testicular torsion recurrence after initial treatment regardless of 2-point or 3-point fixation and absorbable or nonabsorbable suture utilization. Our data show that the rate of testicular torsion is about 5.5 cases per 100,000 males less than 35 years of age and the rate of recurrence after orchiopexy is 1.4%. The majority of testicular torsion treatments employed bilateral orchiopexy, but the points of fixation and absorbable versus nonabsorbable suture use varied. Using state-wide healthcare data, we were able to describe testicular torsion and recurrence in the US population based on current practice trends.
