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Testicular Torsion Salvage at 24 Hours?

November 30, 2017

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Consider testicular torsion a surgical emergency even if it is past the usual 6-8 hour mark, which is traditionally taught as the outer limit of testicular viability.  This study found that the testicle could still be salvaged over half the time from 13-24 hours from onset.

Why does this matter?
Testicular torsion is a surgical emergency.  But many ED clinicians, even urologists, lose a sense of urgency if the time from onset is over 6-8 hours.  This is the time frame typically taught, beyond which the testicle is thought to be no longer salvageable.  This systematic review suggests that time frame is far too short, and we should treat all these cases as emergent, even if the time from onset is delayed.

This is a new twist
This was a systematic review of 30 studies, 2116 patients with testicular torsion.  They stratified testicle survival time in 6 hour increments: “0 to 6 hours was 97.2%; 7 to 12 hours, 79.3%; 13 to 18 hours, 61.3%; 19 to 24 hours, 42.5%; 25 to 48 hours, 24.4%; and greater than 48 hours, 7.4%.”  This is a radical paradigm change.  To think that one quarter could be salvaged even 1-2 days out is not what I was taught.  This confronts a dogmatic assertion that testicular survival time is 6-8 hours max.  These patients deserve emergent workup and surgical consultation even if beyond 6-8 hours.  Bear in mind, the longer the torsion, the greater the risk of atrophy, decreased spermatogenesis, or impaired endocrine function even if the testicle is viable at the time of surgery – over one third of testes atrophied if >18 hours.

A Systematic Review of Testicle Survival Time After a Torsion Event.  Pediatr Emerg Care. 2017 Sep 25. doi: 10.1097/PEC.0000000000001287. [Epub ahead of print]

Peer reviewed by Thomas Davis, MD.

What are your thoughts?