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Higher Orchiectomy Rates in Pre-pubescent Testicular Torsion: A Call for Earlier Recognition and Heightened Awareness
Lisa B Shields1, Kahir Jawad2,3, Eran Rosenberg4
1Norton Neuroscience Institute, Norton Healthcare, Louisville, USA.
Cureus
|October 31, 2025
Summary
Pre-pubescent males with testicular torsion (TT) face a higher risk of orchiectomy. Prompt diagnosis and surgical intervention are crucial for testicular salvage in pediatric emergencies.
Area of Science:
- Pediatric Surgery
- Urology
- Emergency Medicine
Background:
- Testicular torsion (TT) is a critical pediatric emergency requiring immediate diagnosis and surgical intervention to preserve the testicle.
- Pre-pubescent males exhibit a greater risk of orchiectomy (testicle removal) following TT compared to their post-pubescent counterparts.
- Understanding demographic-specific risk factors is essential for optimizing outcomes in pediatric TT.
Purpose of the Study:
- To compare risk factors and surgical outcomes between pre-pubescent and post-pubescent males diagnosed with testicular torsion.
- To identify specific characteristics associated with orchiectomy in younger vs. older boys with TT.
- To inform clinical practice and improve testicular salvage rates in pediatric TT.
Main Methods:
- A retrospective analysis of pediatric TT cases over a 10-year period (2015-2024) at a children's hospital.
- Patients aged 1-20 years with TT were categorized into two groups: pre-pubescent (1-12 years) and post-pubescent (13-20 years).
- Comparison of symptom duration, surgical intervention type, and orchiectomy rates between the two age groups.
Main Results:
- Out of 286 TT patients, 27% were pre-pubescent and 73% were post-pubescent.
- A significant association was found between age group and symptom duration (p=0.03), with more pre-pubescent boys presenting with symptoms <24 hours.
- Pre-pubescent males had a significantly higher orchiectomy rate (46.2%) compared to post-pubescent males (26.4%), being 2.4 times more likely to undergo orchiectomy.
Conclusions:
- Pre-pubescent males treated for testicular torsion have a statistically higher risk of requiring an orchiectomy.
- Increased clinical awareness and expedited surgical exploration are vital for enhancing testicular salvage rates in pediatric TT.
- Targeted interventions and education may be necessary to address the heightened risk in younger boys.
