Evaluation of Impact of Transfer and Transfer Time on Testicular Salvage in Children With Testicular Torsion

Introduction: Timely detorsion is critical for testicular salvage in cases of testicular torsion (TT). Delays in surgical intervention significantly reduce salvage rates. In the United Kingdom, the Royal College of Surgeons of England recommends that pediatric TT cases be managed at the presenting hospital, regardless of pediatric subspecialty certification. In the United States, nonpediatric urologists/surgeons frequently transfer pediatric TT cases. The objectives of this study were to examine transfer time's effect on TT outcomes and compare TT outcomes for direct and transfer patients to determine whether evidence supports the European standard of care for TT in children/adolescents in the United States. Methods: Patients aged 18 years or younger who received surgical treatment for TT at Nemours Children's Health from 2020 to 2024 were included in this IRB-approved retrospective chart review. After excluding neonatal/perinatal torsions, 81 direct and transfer patients were identified. Surgical outcome is based on testicular viability; thus, a negative outcome (NO) includes testicular removal or atrophy. Results: Transfer time significantly influenced outcomes: NO rates increased with longer transfers—short (<1 hour) 9.09%, medium (1-1.75 hours) 30.43%, and long (>1.75 hours) 66.67% ( P = .012). Long transfers had worse NO rates than short ( P = .016) and trended worse than medium ( P = .089). Atrophy rates rose with transfer time. Conclusions: Our findings support the UK model, showing that longer transfer times significantly increase the risk of NO rates. Transfer patients, despite not being medically complex, faced worse outcomes. Further collaborative studies are needed to support changes in the current management of pediatric TT in the United States.