Clinical characteristics and management strategies of testicular torsion in children with cryptorchidism: a comprehensive analysis.

Background: Cryptorchidism increases the risk of testicular torsion, a condition requiring urgent intervention. However, the atypical presentation in these cases makes diagnosis challenging, necessitating improved clinical awareness and management strategies. This study aims to analyze the clinical characteristics, diagnostic methods, and treatment outcomes of testicular torsion in children with cryptorchidism. The goal is to enhance the understanding of this rare condition and provide valuable insights into its diagnosis and management, based on clinical and surgical findings.

Methods: A retrospective analysis was conducted on the clinical data of 21 children with cryptorchidism who experienced testicular torsion and were treated at Anhui Provincial Children's Hospital from January 2015 to June 2024. Among the 21 patients, five had bilateral cryptorchidism, all of which involved unilateral testicular torsion, with 16 cases on the left side and five on the right side. The median age of the patients was 48 months [interquartile range (IQR): 8.5-117.5 months]. The median onset time, defined as the time interval between the onset of symptoms and surgical intervention, was 24 hours (IQR: 12-72 hours).

Results: All patients underwent surgical exploration. The average surgery time was 60.9 [standard deviation (SD): 25.1] minutes, with an average blood loss of 4.5 (SD: 2.3) mL. The median torsion angle was 540° (IQR: 270°-720°). Intraoperatively, 18 testes were found to have irreversible necrosis and were removed, while three were successfully detorsed and preserved with good blood supply. Postoperative follow-up for an average of 50.4 (SD: 18.3) months showed no atrophy in the surviving testes, and the contralateral fixed testes developed well without recurrent torsion.

Conclusions: Testicular torsion in children with cryptorchidism is rare and often presents with subtle symptoms. Early diagnosis and treatment are crucial. Ultrasound plays a significant role in the diagnosis of testicular torsion in cryptorchidism. The degree of torsion and the time of onset are critical factors for improving testicular survival rates. It is recommended that surgical intervention be performed early in cryptorchid patients older than six months to reduce the risk of testicular torsion.