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Pre-pubertal testicular torsion: a critical analysis of outcomes from a tertiary care center
Journal article   Peer reviewed

Pre-pubertal testicular torsion: a critical analysis of outcomes from a tertiary care center

Deepansh Dalela, Phillip Taboada, Dhillon Advano, Star Okolie, Alexandra Carolan, Shane Batie, Micah Jacobs, Bruce Schlomer, Irina Stanasel and Craig A. Peters
Journal of pediatric urology, Vol.22(3), 105824
06/2026
DOI: 10.1016/j.jpurol.2026.105824
PMID: 41850030

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Abstract

Pre-pubertal testicular torsion has typically been associated with high rates of orchiectomy, but there are scarce data on postoperative atrophy in salvaged testicles. To study testicular salvage rates in pre-pubertal boys undergoing surgery for acute testicular torsion in a large, tertiary care academic center to assess true ‘testicle loss rate’. We performed a retrospective review of all pre-pubertal (aged 3 months-10 years) patients treated for acute testicular torsion over a 9-year study period (2015-2023). Patients underwent surgery by one of seven fellowship trained pediatric urologists over the study period. Variables extracted were age, duration of symptoms, laterality, presence of atypical symptoms or ipsilateral undescended testicle, TWIST score and degrees of torsion. Follow up was assessed in days since surgery. We hypothesized that age and longer duration of symptoms would be associated with likelihood of orchiectomy and postoperative atrophy (defined as ≥50% difference in size compared to contralateral testicle at last follow-up ≥3 months postoperatively). Of 85 pre-pubertal patients with acute testicular torsion with median (interquartile range [IQR]) age 5.0 (2-7.8) years, 76 (89.4%) were left-sided, median (IQR) TWIST score was 5 (4-6) and median (IQR) duration of symptoms prior to surgery was 28.5 (9.4-65.4) hours. Overall, 47 (55.3%) underwent ipsilateral orchiectomy. Compared to patients undergoing orchiopexy, those undergoing orchiectomy had statistically longer duration of symptoms (median 60 vs. 16.2 hours, odds ratio [OR] 1.03, p<0.01). Among patients undergoing orchiopexy with available follow-up, 16/30 (53.3%) had atrophy 6-12 months postoperatively. Patients with atrophy were younger (median age 3.3 vs. 6 years; OR 0.6, p=0.01) and had higher TWIST scores (median 5 vs. 3; OR 2.2, p=0.02) compared to patients without atrophy. Among all patients who either had orchiectomy or available follow-up post orchiopexy (n=77), overall testicle loss rate (sum of orchiectomy and postoperative atrophy, divided by all patients undergoing surgery) was 81.8%, ranging from 57% for patients <12 hours of symptoms, 72% for 12-24 hours of symptoms and 88% for patients with >24 hours of symptoms (p=0.06). In this single-center cohort of pre-pubertal patients with acute testicular torsion, over half of orchiopexied testicles underwent atrophy (regardless of symptom duration), contributing to a high global testicular loss rate of approximately 80%. Younger patients were more likely to undergo atrophy following orchiopexy. Pre-pubertal testicular torsion was a distinctly left-sided phenomenon. These data can allow tailored counseling and setting families’ expectations in boys diagnosed with acute testicular torsion.
 acute atrophy orchiectomy prepubertal testicular torsion

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