Delayed presentation and diagnosis of testicular torsion-insights from 10 years of cases.

INTRODUCTION

Testicular torsion is a common and important cause of scrotal and abdominal pain in men, and delayed diagnosis can result in testicular necrosis necessitating orchidectomy. Delayed presentation of torsion remains a significant issue in the Irish health service. We aimed to report the clinical particulars of patients requiring orchidectomy for torsion for the last 10 years.

METHODS

A retrospective review was performed of all orchidectomy cases from 2014-2024. Histology reports, clinical notes and operative notes were analysed to identify cases of testicular torsion. Patient data, radiologic and laboratory results and operative findings were recorded.

RESULTS

180 patients underwent orchidectomy during this period. 15 (8.33%) cases of orchidectomy for testicular ischaemia due to torsion were identified. Mean (±SD) patient age was 24 (±9) years. In 12 cases (80%), the delay in diagnosis was due to late patient presentation to the emergency department, with a median (±IQR) time to presentation from onset of pain of 72 hours (±54). In 3 cases (20%) the patient had presented in a timely manner and was discharged with a presumed alternative diagnosis (epididymoorchitis in two cases and non-specific abdominal pain in one case). These patients subsequently presented again with ongoing pain and ultrasound revealed an absence of Doppler flow to the affected testis.

DISCUSSION: Delayed presentation of testicular torsion remains a significant problem. All cases of orchidectomy in this review were associated with a duration of pain >6 hours.