Clinical and epidemiological profile of testicular torsion in a tertiary public urological emergency service in Brazil: a retrospective descriptive case series

Testicular torsion is a time-dependent urological emergency in which delays in presentation, diagnosis, referral, and surgery may reduce the likelihood of testicular salvage. Evidence describing care pathways for testicular torsion in Brazilian public emergency services remains limited. This study described the clinical and epidemiological profile of patients with surgically confirmed testicular torsion treated at a tertiary public urological emergency service and the recorded timing of initial and specialized care. This retrospective descriptive case series reviewed medical records of patients treated at a tertiary public referral hospital in Pernambuco, Brazil, from December 2019 to December 2021, a period that overlapped with the COVID-19 pandemic. Patients were included when testicular torsion was confirmed intraoperatively. Variables were summarized descriptively. Categorical variables are reported as n/N with available data (%) and continuous variables as median (interquartile range); care intervals were cross-tabulated against intraoperative findings without inferential testing. Missing data were reported explicitly and not imputed. Of 70 records screened, 66 met the eligibility criteria. Median age was 17 years (range 14–62), and 40 of 66 patients (60.6%) were younger than 18 years. Among 65 patients with available information (one missing), 40 (61.5%) sought the first medical service more than 24 h after pain onset. The first visit occurred at a general public service in 58 of 66 cases (87.9%). Testicular edema was the most frequent finding at the first (55/66; 83.3%) and specialized (59/66; 89.4%) assessments. Intraoperative necrosis was identified in 41 of 66 patients (62.1%), whereas potentially reversible ischemia was observed in 24 (36.4%). Contralateral orchiopexy was performed in 65 patients (98.5%). Adolescents and young adults predominated, delays exceeding 24 h from pain onset before first medical care were common, and testicular necrosis was the main intraoperative finding. Because the study period overlapped with the COVID-19 pandemic, and the interval between first assessment and referral and the time to surgery were unavailable, the stage of the care pathway responsible for delays could not be identified. Prospective studies with standardized recording of care intervals are needed.