Research progress on testicular torsion secondary to inguinal cryptorchidism

Inguinal cryptorchidism, a common congenital anomaly in pediatric patients, is a major risk factor for testicular torsion. Its abnormal anatomical location and atypical clinical manifestations frequently lead to delayed diagnosis and misdiagnosis. This study aims to systematically review existing evidence to clarify the epidemiology, pathophysiology, diagnostic and therapeutic key points, and prognosis of testicular torsion secondary to inguinal cryptorchidism, with the goal of providing robust, evidence-based references for clinical practice.

This narrative review synthesizes and summarizes recent clinical studies, case reports, and related discussions on testicular torsion secondary to inguinal cryptorchidism, comprehensively analyzing current research findings on this condition.

Children with inguinal cryptorchidism have approximately a 10-fold higher risk of testicular torsion compared with those with normally descended testes in the scrotum. Typical clinical manifestations include an acute painful inguinal mass and an empty ipsilateral scrotum, which can easily be confused with incarcerated indirect inguinal hernia and other acute groin disorders. Missed diagnosis is a leading cause of increased testicular necrosis and orchiectomy rates. Color Doppler ultrasound is the preferred first-line imaging modality. The core therapeutic principle adheres to "Time is testis," and urgent surgical exploration is indicated in cases with high clinical suspicion. Intraoperatively, testicular repositioning and fixation or orchiectomy are performed according to the evaluation of testicular viability. Prophylactic contralateral orchiopexy is strongly recommended. Long-term management mainly focuses on monitoring for testicular atrophy, reproductive function, and the risk of malignant transformation.

The core principles for diagnosing and treating testicular torsion secondary to inguinal cryptorchidism are early recognition, imaging confirmation, emergent surgery, and long-term follow-up. Clinicians should maintain high vigilance for acute inguinal masses in infants and young children and regard an ipsilateral empty scrotum as a key differential diagnostic clue. Surgical delay caused by atypical symptoms must be avoided. Enhanced routine screening, optimized emergency assessment protocols, and standardized long-term follow-up can effectively improve the prognosis of affected children.