Testicular Puncture and Aspiration as an Intraoperative Adjunct in Pediatric Testicular Torsion: A Case Report with Long-Term Follow-Up

Introduction: Assessing testicular viability during surgical exploration of an acute scrotum is challenging, especially when the testis appears discolored. The decision between orchiectomy and orchiopexy often relies on subjective intraoperative judgment. We report a case in which testicular puncture and aspiration were used as a therapeutic adjunct to reduce intratesticular pressure during surgery for testicular torsion. Case Presentation: A 3-year-old boy presented with right inguinal pain and nausea. After delayed recognition of acute scrotum, he was referred 10 hours later with right scrotal discoloration. Ultrasound showed absent Doppler flow and homogeneous echogenicity. Surgical exploration revealed 180° intravaginal torsion and a black, firm testis. Bilateral bell clapper deformity was noted. The affected testis was punctured and aspirated using a 27-gauge needle, resulting in decompression and softening of the testis and avoidance of orchiectomy. Follow-up imaging over seven years showed stable right-sided atrophy but preserved echogenicity and comparable MRI signal and ADC values. At age 15, the patient reached Tanner stage 4, indicating normal pubertal progression. Conclusion: Testicular puncture and aspiration may offer a simple, minimally invasive therapeutic adjunct in the management of torsed testes. Although atrophy developed, structural preservation was suggested by imaging, and the patient experienced normal pubertal progression. Further studies are needed to clarify long-term functional and fertility outcomes.