Clinical Report: Outcomes and Healthcare Roles in Suspected Testicular Torsion

Overview

This nationwide German study analyzed 81,899 males undergoing surgical exploration for suspected testicular torsion from 2005 to 2021. Findings reveal that 38% had testicle-preserving detorsion, 14% required orchiectomy, and 48% had no torsion identified, with significant differences in comorbidities and outcomes based on surgical department.

Background

Suspected testicular torsion is a urological emergency requiring prompt surgical exploration to preserve testicular viability. The diagnosis relies primarily on clinical assessment, with Doppler ultrasound aiding but not replacing surgery. Testicular salvage rates decrease sharply with delayed intervention. Despite its urgency, many patients are operated on outside urology departments, potentially affecting outcomes. Comprehensive epidemiological data on management trends and perioperative outcomes have been lacking until now.

Data Highlights

Key Findings

• Among 81,899 males undergoing surgical exploration, 14% required orchiectomy, 38% had successful detorsion with testicle preservation, and 48% had no torsion identified.
• Patients undergoing orchiectomy had significantly higher rates of diabetes, chronic kidney disease, hypertension, obesity, and history of cryptorchidism compared to other groups.
• Torsion of the appendix testis and epididymitis were common alternative diagnoses in patients without testicular torsion.
• The total number of surgical explorations for suspected torsion decreased from 5,235 in 2005 to 4,900 in 2021 (p < 0.001).
• Hospital revenues were higher for patients undergoing orchiectomy compared to other surgical outcomes.
• Non-urological departments also perform surgeries for suspected torsion, but detailed perioperative outcomes by department were assessed to explore differences.

Clinical Implications

Early recognition and prompt surgical exploration remain critical to maximize testicular salvage in suspected torsion. Awareness of patient comorbidities such as diabetes and cryptorchidism may inform risk stratification and perioperative management. Given that nearly half of explorations reveal no torsion, differential diagnoses like appendix testis torsion and epididymitis should be considered. The involvement of urology specialists may improve perioperative outcomes, underscoring the importance of specialized care pathways.

Conclusion

This large-scale analysis highlights the distribution of surgical outcomes in suspected testicular torsion and identifies key patient factors associated with orchiectomy. The findings support prioritizing timely urological intervention and comprehensive evaluation to optimize patient outcomes.

References

1. GRAND Study / German Institute for the Hospital Remuneration System / 2005-2021 -- Nationwide inpatient data on suspected testicular torsion