Journal of pediatric surgery · 2026
Is torsion of the undescended testis intrinsically associated with worse salvage? A matched cohort analysis.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Ahmad Ihtisham, Khondker Adree, Rickard Mandy, Santos Joana Dos, Romao Rodrigo L P, Pippi Salle Joao Luiz, Lorenzo Armando J, Chua Michael E
Аннотация
BACKGROUND: Testicular torsion in undescended testes (UDT) has poor salvage rates, but it remains unclear if the cryptorchid state itself confers an intrinsic disadvantage. We aimed to compare testicular salvage between UDT and descended torsion while controlling for presentation variables.
METHODS: In a single-institutional retrospective cohort (2010-2024), using propensity score matching, 25 UDT torsion cases were matched 1:2 to 129 descended torsion controls on age, ischemia time, and testicular volume. The primary outcome was salvage on post-operative imaging (≥50% volume of contralateral testis). Conditional and multivariable logistic regression was employed on the matched cohort to test for associations of clinical factors with testicular salvage.
RESULTS: After matching, 69 patients were included (24 UDT; 45 descended). Baseline characteristics were balanced between groups, including age, ischemia time, and testicular volume. Salvage rates were lower between UDT and descended torsion (13% vs. 27%), although this did not reach statistical significance (p = 0.229). Conditional regression confirmed UDT status was not an independent predictor of salvage (OR 0.43, 95% CI 0.11-1.69; p = 0.231). In a multivariable model, only ischemia time independently predicted against salvage (OR 0.73 per hour, 95% CI 0.53-0.87; p = 0.011). Just 4% of UDT cases presented within 6 h of symptom onset.
CONCLUSION: After controlling for presentation factors, salvage in UDT torsion was numerically lower than in descended torsion, although this difference did not reach statistical significance. We identified delayed intervention as the main driver of poorer outcomes in our cohort. Improving salvage requires heightened suspicion and expedited surgical referral for any boy with a history of cryptorchidism and acute inguinal pain.
METHODS: In a single-institutional retrospective cohort (2010-2024), using propensity score matching, 25 UDT torsion cases were matched 1:2 to 129 descended torsion controls on age, ischemia time, and testicular volume. The primary outcome was salvage on post-operative imaging (≥50% volume of contralateral testis). Conditional and multivariable logistic regression was employed on the matched cohort to test for associations of clinical factors with testicular salvage.
RESULTS: After matching, 69 patients were included (24 UDT; 45 descended). Baseline characteristics were balanced between groups, including age, ischemia time, and testicular volume. Salvage rates were lower between UDT and descended torsion (13% vs. 27%), although this did not reach statistical significance (p = 0.229). Conditional regression confirmed UDT status was not an independent predictor of salvage (OR 0.43, 95% CI 0.11-1.69; p = 0.231). In a multivariable model, only ischemia time independently predicted against salvage (OR 0.73 per hour, 95% CI 0.53-0.87; p = 0.011). Just 4% of UDT cases presented within 6 h of symptom onset.
CONCLUSION: After controlling for presentation factors, salvage in UDT torsion was numerically lower than in descended torsion, although this difference did not reach statistical significance. We identified delayed intervention as the main driver of poorer outcomes in our cohort. Improving salvage requires heightened suspicion and expedited surgical referral for any boy with a history of cryptorchidism and acute inguinal pain.