Temporal Evolution of Ultrasound Findings and TheirImpact on Testicular Salvage in Acute Scrotum: ARetrospective Observational Study of Testicular Torsion

Background: This study aimed to investigate the temporal evolution of ultrasound signs in patients with testicular torsion (TT) and correlate these delays with testicular salvageability and long-term reproductive outcomes. Methods: This retrospective study included 89 patients with TT treated from 2020 to 2025. Based on time from symptom onset to treatment, patients were divided into three groups: hyperacute (<6 hours), subacute (6–12 hours) and delayed (>12 hours). We collected baseline data, ultrasound findings, testicular salvage rates, reproductive hormones levels and semen analysis. We used Spearman correlation and binary logistic regression to analyse the association of ultrasound features, and time windows, with the salvage rate. Results: The testicular salvage rates of the three groups were 96.8%, 62.1%, and 41.4%, respectively (p < 0.05). Ultrasonographic features evolved with time: the prevalence of heterogeneous parenchymal echo increased while the whirlpool sign decreased (all p < 0.05). The delayed group showed higher follicle stimulating hormone (FSH)/luteinizing hormone (LH) levels and poorer semen quality (p < 0.05). Logistic regression identified a time window <6 hours as an independent protective factor (odds ratio (OR) = 0.036, 95% confidence interval (CI): 0.003–0.473, p = 0.011), whereas uneven testicular echogenicity (OR = 4.451, 95% CI: 1.257–15.763, p = 0.021), a positive whirlpool sign (OR = 4.445, 95% CI: 1.124–17.588, p = 0.033), and absent blood flow (OR = 4.446, 95% CI: 1.091–18.123, p = 0.037) were independent risk factors for salvage failure. The dynamic evolution of ultrasound findings provides an objective risk assessment basis for time sensitive stratified management of acute scrotum, supporting clinical grading and expedited intervention decisions. Conclusions: The 6-hour threshold may be a critical cutoff for both testicular survival and fertility preservation. For suspected torsion, surgical exploration should be prepared alongside ultrasound to minimize the time to treatment.