Predicting Testicular Loss in Pediatric Torsion: Clinical and Laboratory Indicators

Abstract Background Pediatric testicular torsion (TT) requires emergency surgical intervention to prevent testicular loss. This study aimed to examine clinical and laboratory parameters that predict intraoperative orchidectomy and testicular atrophy (TA) in a one-year follow-up period, with a focus on symptom duration and inflammatory biomarkers. Methods A retrospective cohort study included 90 pediatric patients with surgically confirmed TT. Patients were classified based on intraoperative testicular viability into orchidectomy and orchidopexy groups. At one-year follow-up, the orchidopexy group was further subdivided into two subgroups: Testicular salvage (TS) and TA. Multivariate logistic regression identified independent predictors of intraoperative orchidectomy and TA. Results Forty patients underwent orchidectomy and 50 underwent orchidopexy. Among those treated with orchidopexy, TS at one-year follow-up was achieved in 36 patients (72%). Age and type of vascularization were significantly different between patients from the orchidectomy and orchidopexy groups. There was a notably larger number of patients experiencing scrotal redness, swelling, or hardness in the orchidectomy group in comparison to the orchidopexy group. CRP levels were significantly higher in the orchidectomy group (p = 0.002). Multiple logistic regression indicated considerably increased odds ratios of orchidectomy with symptom duration > 12 hours, younger age, longer preoperative preparation times, and elevated CRP. Conclusion Delayed presentation, younger age, elevated CRP, and longer preoperative preparation time significantly increase the risk of orchidectomy and TA in pediatric TT. Symptom duration > 12 hours is the most critical predictor of failed TS. Timely recognition and prompt surgical treatment for TT are crucial for improving results and maintaining TS.