O4354: Pediatric Testicular Torsion: A Retrospective Cohort of Risk Factors for Orchiectomy versus Orchiopexy

Background: Testicular torsion is a surgical emergency that requires prompt surgical evaluation. The purpose of the study is to identify risk factors associated with testicular torsion that results in orchiectomy or orchiopexy in pediatric patients.

Methods: A single-institution retrospective chart review of patients aged 6 to 18 years with testicular torsion (ICD-10 code N44.0x) from 2016-2024 was performed. The primary outcome was the proportion of orchiectomy versus orchiopexy. Secondary outcomes collected were demographics, comorbidities, symptoms at presentation, urologic history, insurance status, Child Opportunity Index (COI), transfer status, and time to surgery. Mann-Whitney U tests were used to compare continuous variables and Fisher’s exact tests for categorical variables. A Cochran-Armitage test was performed to determine trends. Logistic regression modeling was used to identify independent associations for orchiectomy.

Results: Among the 380 included patients, 87 (22.9%) underwent orchiectomy and 293 (77.1%) underwent orchiopexy. The median age in the total cohort was 14 years (interquartile range (IQR): 12.0-15.0) and median weight was 58.9 kilograms (IQR: 50.0-71.0). There was no change over time in the proportion of orchiectomies performed for patients presenting with torsion from 2016 to 2024 (p=0.34). There were significant differences for patients who underwent orchiectomies versus orchiopexies regarding payor status (p=0.0007), testicular swelling at presentation (p < 0.0001), urologic history of testicular trauma (p=0.0003), and transfer status (p=0.02) (Table). The pain duration from symptom onset to initial emergency department (ED) evaluation of those who underwent orchiectomy (48 hours (IQR 24.0-72.0) was higher than those who underwent orchiopexy (4 hours (IQR 2.0-11.0)) (p < 0.0001). No differences were seen in weight, race, ethnicity, COI, language, history of intellectual and developmental delays, prior urologic surgery, or ASA Class between the two cohorts. Operative time for orchiectomy was longer at median 48 minutes (IQR: 42.0-57.0) compared to orchiopexy at median 39 minutes (IQR: 30.5-52.0) (p=0.0001). No differences were seen in 30-day outcomes including return to ED and subsequent testicular surgery. Independent factors associated with increased odds of orchiectomy were non-English primary language (odds ratio (OR) 3.4; (95% confidence interval (CI)); 1.3-8.5), testicular swelling at presentation (OR 2.7; CI 1.5-5.0) and hourly duration of pain to operative room (OR 1.04; CI 1.03-1.05). Insurance status was significantly associated with undergoing an orchiectomy (uninsured OR 0.14; CI 0.03-0.71 and private insurance OR 0.7; CI 0.38-1.29 compared to public insurance).

Conclusion: In addition to established associations of hourly duration of pain to operative room and testicular swelling at presentation, primary language was also associated with increased risk for orchiectomy in patients with testicular torsion. Further research is needed to investigate solutions to mitigate the language association and explore educational interventions on testicular torsion in the pediatric populations to prevent delays in diagnosis.