Multicenter Retrospective Analysis of Acute Scrotum in the Kyushu–Okinawa Region: Diagnostic Practices, Management Patterns, and Predictors of Testicular Salvage

Background Acute scrotum is a common pediatric urological emergency, with testicular torsion requiring prompt surgical intervention to prevent irreversible ischemic damage. In Japan, large‐scale multicenter data on diagnostic and management practices remain limited. Methods This multicenter retrospective study reviewed pediatric patients (aged 0–21 years) presenting with acute scrotal pain across 15 institutions in the Kyushu–Okinawa region between 2014 and 2023. Clinical characteristics, diagnostic workup, initial facility type, specialty of first‐contact physician, and care pathway were analyzed. Univariate and multivariable logistic regression analyses were performed to identify factors associated with testicular salvage. Results A total of 906 patients were included (median age, 11 years). Final diagnoses were epididymitis (41.9%), testicular torsion (26.8%), torsion of the testicular appendage (12.1%), and other causes (19.2%). Among torsion patients ( n = 243), ultrasonography was performed in 98.8%, TWIST scoring in 31.7%, and inter‐facility transfer was required in 66.7%. Multivariable analysis identified three independent predictors of testicular salvage: Time from symptom onset to skin incision < 6 h (OR 3.38, 95% CI 1.56–7.36, p = 0.002), age ≥ 10 years (OR 2.77, 95% CI 1.28–5.75, p = 0.009), and same‐hospital treatment (OR 2.74, 95% CI 1.23–6.07, p = 0.013). Conclusions Frequent inter‐facility transfers significantly reduce testicular salvage rates, underscoring the importance of timely surgical management within the same hospital. Regional standardized protocols, provider education, and public health awareness campaigns are warranted to minimize preoperative delay and improve outcomes for pediatric testicular torsion.