Predictors of Testicular Salvage and Loss in Pediatric Testicular Torsion: A Systematic Review

Authors

  • Izhar Ali
  • Javed Miandad
  • Waqar Hameed Ghazi
  • Hikmat Yar
  • Abdullah

Keywords:

testicular torsion, pediatric urology, testicular salvage, orchiectomy, diagnostic predictors

Abstract

Introduction: Testicular torsion is a time-critical pediatric urological emergency in which delayed diagnosis and surgical intervention can result in irreversible ischemic injury, testicular loss, and impaired future fertility. This systematic review synthesized the current evidence on clinical, radiological, and biochemical predictors of testicular salvage and testicular loss in children and adolescents.

Methodology: A systematic review was conducted according to PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, Web of Science, Embase, and the Cochrane Library were searched for observational studies published between January 2014 and December 2024. Studies involving patients younger than 18 years that evaluated predictors of orchiopexy, orchiectomy, or postoperative testicular atrophy were included. Methodological quality was assessed using the Newcastle–Ottawa Scale.

Results: Eighteen studies comprising 4,326 pediatric patients fulfilled the eligibility criteria, with 12 studies rated as high quality. Symptom duration was the strongest predictor of outcome, with testicular salvage rates exceeding 90% when surgical intervention occurred within six hours of symptom onset and declining markedly after 12 hours. Additional predictors of testicular loss included spermatic cord torsion exceeding 720°, absent intratesticular blood flow, heterogeneous echotexture on Doppler ultrasonography, delayed referral or inter-hospital transfer, and atypical clinical presentation. Elevated inflammatory biomarkers, particularly C-reactive protein and the neutrophil-to-lymphocyte ratio, were associated with non-viable testes but require further validation.

Conclusion: Early recognition and prompt surgical exploration remain the most important determinants of testicular salvage in pediatric testicular torsion. Integrating clinical assessment, Doppler ultrasonography, and validated prediction tools such as the TWIST score may improve risk stratification and reduce avoidable orchiectomy. Prospective multicenter studies are needed to validate comprehensive prediction models and evaluate long-term endocrine and reproductive outcomes.....

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References

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Published

2026-04-30

How to Cite

1.
Ali I, Miandad J, Ghazi WH, Yar H, Abdullah A. Predictors of Testicular Salvage and Loss in Pediatric Testicular Torsion: A Systematic Review. J Neonatal Surg [Internet]. 2026 Apr. 30 [cited 2026 Jul. 24];14(9S):1178-84. Available from: https://jneonatalsurg.com/index.php/jns/article/view/10449

Issue

Vol. 14 No. 9S (2025): Journal of Neonatal Surgery

Section

Original Article

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