The impact of health care on outcomes of suspected testicular torsion: results from the GRAND study

Category	Detail
Condition	Suspected testicular torsion
Key Mechanisms	Acute twisting of the spermatic cord causing ischemia; requires immediate surgical exploration for testicular salvage
Target Population	Males, predominantly younger than 25 years
Care Setting	Hospital inpatient surgical departments, primarily urology but also pediatric and general surgery

Testicular torsion is a urological emergency with a testicular salvage rate of ~90% if detorsion occurs within 6 hours of symptom onset.
Among patients undergoing surgical exploration, 38% had detorsion with testicle preservation, 14% required orchiectomy, and 48% had no torsion identified.
Doppler ultrasound has high sensitivity (100%) and negative predictive value (100%) but surgical exploration remains the definitive exclusion method.

Diagnosis is primarily clinical based on acute severe testicular pain and signs.
Doppler ultrasound can aid diagnosis with high sensitivity and specificity but cannot definitively exclude torsion without surgery.
Surgical exploration is mandatory to confirm or exclude testicular torsion.

Immediate surgical exploration and detorsion with orchidopexy if torsion is confirmed.
Orchiectomy is required if testicular necrosis is present.
Patients without torsion may have alternative diagnoses such as torsion of appendix testis or epididymitis.

Monitor perioperative outcomes including length of hospital stay, transfusion requirements, and surgical wound infections.
Adjust management based on patient comorbidities such as diabetes, obesity, and cryptorchidism.

Delayed detorsion beyond 6 hours significantly reduces testicular salvage rates.
Higher rates of orchiectomy are associated with comorbidities including diabetes, chronic kidney disease, hypertension, obesity, and cryptorchidism.
Non-urological departments may have different perioperative outcomes compared to urology.

81,899 males undergoing surgical exploration for suspected testicular torsion in Germany (2005–2021), median age 16 years

38% underwent detorsion with testicle preservation; 14% required orchiectomy; 48% had no torsion. Comorbidities influenced risk of orchiectomy.

Prioritize rapid surgical exploration within 6 hours of symptom onset to maximize testicular salvage.
Use Doppler ultrasound as an adjunct but do not delay surgery if clinical suspicion is high.
Consider patient comorbidities in perioperative risk assessment and management planning.
Prefer treatment in urology departments due to greater surgical expertise with male genitalia.
Recognize alternative diagnoses in patients without torsion to guide appropriate care.

Clinical Scorecard: Evaluating the Role of Healthcare in Outcomes for Suspected Testicular Torsion: Findings from the GRAND Study