Introduction: Testicular torsion is an acute medical emergency that adolescent males are particularly at risk of. Although excellent surgical treatment for torsion exists, early identification and presentation to a healthcare facility remains an issue. Orchiectomies can have devastating psychosocial effects on teens, and rates of loss have not shown any notable improvements over recent years. 

Methods: A retrospective review was conducted of surgical and emergency department (ED) charts for all patients aged 1–17 who were surgically treated for torsion at the Stollery Children’s Hospital in Edmonton, Alberta between 2010 and 2020. Neonatal torsions were excluded. Time to initial presentation, time to Stollery ED presentation, time to operating room (OR), ultrasound results, testicular salvageability, and post-surgical outcomes were reviewed. Groups were compared using Fisher’s exact test.

Results: A total of 164 patients presented with testicular torsion and underwent surgical treatment in this time. The mean age of patients was 13.4 years, with a range of 3–17 years. Mean time to initial presentation was 14.5 hours, and mean time to the OR was 22.2 hours. Of the 164 cases of torsion, 12.2% (n=20) resulted in orchiectomy. Rates of orchiectomy were significantly higher when time to surgical treatment was greater than six hours (p=0.0001). In children under 10 years old, 55.6% of cases resulted in orchiectomy (n=5). Complete followup data was available for 115 patients; of those, post-surgical testicular atrophy occurred in 15.8% (n=15), with possible atrophy occurring in an additional 8.4% (n=8).

Conclusions: Testicular torsion remains a common issue, with delays to presentation being a significant barrier to appropriate revascularization and testicular salvage. More education and outreach initiatives are needed to inform adolescents and the general public about the importance of urgent presentation to an ED when testicular pain arises.