Retrospective analysis of testicular torsion cases in adult patients presenting at the Emergency Department

Abstract Background Medical emergencies in urology include testicular torsion requiring immediate surgical intervention. In case of a delayed report at the emergency department (ED), there is a risk of irreversible necrosis of the testicle. This study aimed to confirm proven correlations and analyze existing testicular torsion cases to reduce the time to diagnosis and accelerate surgical intervention in future patients. Methods We retrospectively analyzed 32 cases of testicular torsion in men aged 19 to 54 years between Dec. 1, 2019, and Dec. 3, 2024, presenting at the ED and subsequently treated surgically in the urology department. The data included the patient’s age, time of arrival at the hospital and performance of surgery, medical history, physical examination, ultrasound findings, type and side of surgery, and histopathological examination after the orchidectomy. Results The median age of the patients was 26 years (19-54). Nineteen (59.4%) patients underwent orchidectomy, and thirteen (40.6%) patients underwent orchidopexy. Age did not affect the type of surgery performed (p=0.197). Statistically, torsion involved the right testicle more often (p=0.008). Age was found to be moderately positively correlated with time to report to TRIAGE (p=0.016). The three most common physical examination findings were no blood flow on color Doppler (96.9%), scrotal pain (87.5%), and testicular swelling (43.8%). The latest successful orchidopexy was performed after 6 hours and 45 minutes. Only 50.0% of patients underwent surgical treatment within eight hours. The median time to report at the ED was 13 hours and 10 minutes. The median time to perform surgery from arrival to TRIAGE was 3 hours and 5 minutes. Orchidopexy patients reported significantly earlier to TRIAGE (p=0.017). Men undergoing orchidopexy had significantly faster surgery upon arrival to TRIAGE (p=0.026). Conclusions The average ED arrival time disallows saving the torsed testicle in half of the patients. Therefore, it is crucial to educate patients and medical staff about the alarming signs of suspected testicular torsion, especially in elderly men.