Higher Orchiectomy Rates in Pre-pubescent Testicular Torsion: A Call for Earlier Recognition and Heightened Awareness

Background: Testicular torsion (TT) is a pediatric emergency that requires a prompt diagnosis and surgical intervention to increase the likelihood of testicular salvage. Pre-pubescent males have a heightened risk of undergoing an orchiectomy compared to post-pubescent males with TT. We sought to identify specific factors characteristic of pre-pubescent males compared to post-pubescent males. Materials and methods: This retrospective analysis of a pediatric TT dataset over a 10-year period (January 1, 2015, to December 31, 2024) was conducted at a pediatric acute care children's hospital in a metropolitan community. Males ages 1-20 years with TT were divided into two age groups: the pre-pubescent group ages 1-12 years and the post-pubescent group ages 13-20 years. Results: A total of 286 patients were diagnosed with TT, including 208 (73%) post-pubescent males and 78 (27%) pre-pubescent males. There was a significant association between the pre- and post-pubescent patients and duration of TT symptoms (p=0.03). Of the 193 patients whose symptom duration was <24 hours, 148 (77%) were pre-pubescent compared to 45 (23%) who were post-pubescent. There was also a significant association between the two age groups and the type of surgery (p =0.001). The prevalence of orchiectomy in the younger group was 46.2% compared to 26.4% in the older group. Post-pubescent males had a 59% lower odds of undergoing an orchiectomy compared to pre-pubescent patients. The younger boys were 2.4 times more likely to have an orchiectomy compared to older boys. Conclusions: Among children treated for TT, pre-pubescent males are at a higher risk for orchiectomy than post-pubescent males. Higher levels of awareness, as well as prompt evaluation and surgical exploration, are needed to increase the rates of salvageable testes.