Clinical characteristics of testicular torsion in children and analysis of factors influencing testicular preservation.

Background: Testicular torsion is a common urological emergency in children that requires immediate surgical intervention to salvage the testis. Delayed diagnosis and treatment can lead to ischemic necrosis and testicular loss. Identifying clinical and laboratory factors associated with testicular viability is therefore crucial for improving diagnostic accuracy and clinical outcomes. This study aimed to analyze the clinical characteristics, diagnostic findings, and treatment outcomes of pediatric testicular torsion and to evaluate the predictive value of hematological parameters for testicular preservation. Methods: A retrospective analysis was performed on 119 children with suspected testicular torsion who underwent emergency surgical exploration in Anhui Provincial Children's Hospital between May 2015 and December 2024. Based on whether the torsed necrotic testis was removed intraoperatively and intraoperative testicular viability assessment using the Arda classification, patients were classified into the orchiectomy group (n=84) and the orchiopexy group (n=35). Clinical symptoms, color Doppler ultrasonography findings, and hematological parameters were analyzed using independent-sample Results: Color Doppler flow imaging indicated reduced or absent testicular blood flow in all patients, and intraoperative exploration confirmed torsion of varying degrees. Significant differences (P<0.05) were observed between the two groups in terms of age, symptom duration, initial symptoms, torsion angle, and neutrophil-to-lymphocyte ratio (NLR). Multivariate logistic regression revealed that symptom duration [odds ratio (OR) =1.014; P=0.048] and torsion angle (OR =3.709; P=0.005) were independent risk factors for testicular preservation. The optimal cutoff value of symptom duration for predicting testicular necrosis was 22 hours, with an area under the curve (AUC) of 0.686, sensitivity of 78.3%, and specificity of 54.3%. Follow-up showed that 42.4% of salvaged testes developed atrophy. Conclusions: The main manifestation of pediatric testicular torsion is scrotal redness, swelling, and pain, with color Doppler ultrasonography as the preferred diagnostic tool. This study demonstrated that symptom duration is an independent risk factor affecting testicular outcome (OR =1.014; P=0.048), with longer duration associated with higher orchiectomy risk; torsion angle was also an independent predictor (OR =3.709). ROC analysis indicated 22 hours as the optimal cutoff for predicting necrosis (AUC =0.686). Although the "6-hour golden window" is widely accepted, our findings suggest that testes may still be salvageable in some delayed cases. Therefore, surgical exploration should not be withheld solely based on prolonged symptom duration. Even when the testis is preserved, there remains a high risk of atrophy, highlighting the importance of long-term follow-up.