Testicular atrophy following torsion in pediatric patients. Results of a long-term follow-up.

Objectives: To assess torsion outcomes and evaluates the rate of testicular atrophy.

Methods: The study was done over the 2000-2024 period during which 103 patients of average age 12.9± 3.0 were echosonographically followed up after operative detorquation and testicular salvage. The study included three groups based on the timing of intervention: Group 1 "<6h", Group 2 "6-12h" and Group 3 ">12h". The median follow up for all groups was 65 (60-84) months.

Results: The presence of a detorsed testis was significantly higher in the Group 1 where all cases had existing testis, compared to 64.7% in the Group 2 and only 20.8% in the Group 3 (p<0.001). The detorsed testis volume was significantly larger in the Group 1 compared to the Group 2 and the Group 3 (p<0.001 for both comparisons). The analysis of blood flow through the testis revealed significant differences between the groups (p<0.001). The structure homogenousness was present in 20 (55.6%) patients in the Group 1, and non-existent in all the patients in the Group 2 and the Group 3, (p<0.001).

Conclusions: The risk of testicular atrophy after many years of follow-up is significantly higher compared to the current literature. Testicular salvage is not possible if more than 6 hours have passed since the onset of symptoms. The high incidence of heterogeneous presentation on ultrasound of salvaged testes, which did not show signs of atrophy, raises the question of the possible harmful impact of salvaged testes on male fertility.