[Independent factors for testicular salvage failure after pediatric testicular torsion surgery].

Objective: To investigate the factors affecting testicular salvage effect in pediatric patients after testicular torsion. Methods: A retrospective case control analysis was performed on the clinical data of 262 pediatric patients after surgery for testicular torsion from January 2011 to December 2023 at Department of Urology, Children's Hospital Affiliated to Soochow University. Their age (M(IQR)) was 12.0 (5.7) years(range:0.1 to 16.0 years). Based on the type of surgery and follow-up results of more than 6 months, the patients were divided into a testicular salvage success group and testicular salvage failure group (including those who underwent orchiectomy or developed atrophy after orchiopexy). Univariate and multivariate Cox regression analyses were used to screen for independent factors associated with testicular salvage success, and receiver operating characteristic (ROC) curves were used to evaluate the predictive performance of each independent risk factor. Results: A total of 84 children were included in the testicular salvage success group, and 178 were included in the testicular salvage failure group. Univariate and multivariate Cox regression analysis showed that age (HR=0.962, P=0.030), symptom duration (HR=1.005, P<0.01), degree of torsion (HR=1.001, P<0.01), positive intratesticular blood flow signal on ultrasound (HR=0.418, P=0.001), monocyte count (HR=1.716, P=0.021), C-reactive protein (CRP) concentration (HR=1.012, P=0.010), and urine ketone bodies (HR=1.478, P=0.048) were independent factors for testicular salvage effect. ROC curve analysis showed the area under the curve for each factor: symptom duration 0.826 (cut-off value 8 h), degree of torsion 0.773, CRP concentration 0.781, and monocyte count 0.706. Conclusions: Symptom duration, degree of torsion, intratesticular blood flow signal on ultrasound, monocyte count, CRP concentration, and urine ketone bodies are independent factors for predicting the prognosis of testicular torsion. Evaluation of these indicators helps to more accurately assess testicular viability before and during surgery, guide surgical decision-making.