Delayed presentation and diagnosis of testicular torsion-insights from 10 years of cases.

Abstract

Introduction: Testicular torsion is a common and important cause of scrotal and abdominal pain in men, and delayed diagnosis can result in testicular necrosis necessitating orchidectomy. Delayed presentation of torsion remains a significant issue in the Irish health service. We aimed to report the clinical particulars of patients requiring orchidectomy for torsion for the last 10 years.

Methods: A retrospective review was performed of all orchidectomy cases from 2014-2024. Histology reports, clinical notes and operative notes were analysed to identify cases of testicular torsion. Patient data, radiologic and laboratory results and operative findings were recorded.

Results: 180 patients underwent orchidectomy during this period. 15 (8.33%) cases of orchidectomy for testicular ischaemia due to torsion were identified. Mean (±SD) patient age was 24 (±9) years. In 12 cases (80%), the delay in diagnosis was due to late patient presentation to the emergency department, with a median (±IQR) time to presentation from onset of pain of 72 hours (±54). In 3 cases (20%) the patient had presented in a timely manner and was discharged with a presumed alternative diagnosis (epididymoorchitis in two cases and non-specific abdominal pain in one case). These patients subsequently presented again with ongoing pain and ultrasound revealed an absence of Doppler flow to the affected testis.

Discussion: Delayed presentation of testicular torsion remains a significant problem. All cases of orchidectomy in this review were associated with a duration of pain >6 hours.