Clinical characteristics of testicular torsion and factors influencing testicular salvage in children: A 12-year study in tertiary center

Table 1 Comparisons of clinical parameters between the orchiectomy group and salvage group, n (%)

Characteristic	Orchiectomy (n = 32)	Salvage (n = 43)	Total (n = 75)	P value
Age (yr), median (range)	12.53 ± 3.29 (2-18)	14.42 ± 2.41 (9-18)	13.61 ± 2.97 (2-18)	0.347
BMI (kg/m2), mean ± SD	18.75 ± 1.57	20.10 ± 1.97	19.53 ± 1.92	P < 0.01
Initial symptom				0.662
Testicular pain	25 (78.13)	38 (88.37)	63 (84.00)
Oscheocele	5 (15.63)	3 (6.97)	8 (10.66)
Nausea and vomiting	1 (3.12)	1 (2.33)	2 (2.67)
Others	1 (3.12)	1 (2.33)	2 (2.67)
Previous history of testicular torsion				0.417
No	29 (90.63)	41 (95.35)	70 (93.33)
Yes	3 (9.37)	2 (4.65)	5 (6.67)
Time from the event to the hospitalization (min), median (range)	42 (4-115)	37 (4-105)	41 (4-115)	0.791
The side of the twisted testicle				0.888
Left	25 (78.13)	33 (76.74)	58 (77.33)
Right	7 (21.87)	10 (23.26)	17 (22.67)
Intratesticular blood flow				0.657
Invisible	28 (87.50)	39 (90.70)	67 (89.33)
Visible	4 (12.50)	4 (9.30)	8 (10.66)
Testicular parenchymal echotexture				0.761
Nonhomogeneous	30 (93.75)	41 (95.35)	71 (94.67)
Homogeneous	2 (6.25)	2 (4.65)	4 (5.37)
Location of testicular torsion				0.739
Intrathecal	31 (96.88)	41 (95.35)	72 (96.00)
Extrathecal	1 (3.12)	2 (4.65)	3 (4.00)
Torsion angle	540 (90-1080)	360 (45-720)	540 (45-1080)	0.49
Testicular color of the affected testis				P < 0.01
Black	32 (100)	30 (69.77)	62 (82.67)
Maroon	0	7 (16.27)	7 (9.33)
Bright red	0	5 (11.63)	5 (6.67)
Other	0	1 (2.33)	1 (1.33)
Normal testicular fixation				0.289
No	1 (3.12)	4 (9.30)	5 (6.67)
Yes	31 (96.88)	39 (90.70)	70 (93.33)
Hospital stay time, median (range)	4 (2-8)	5 (1-9)	5 (1-9)	0.309
Red blood cell count (109/L), mean ± SD	4.58 ± 0.33	4.76 ± 0.35	4.69 ± 0.35	0.028
White blood cell count (109/L), median (range)	11.235 (5.16-19.31)	11.06 (5.00-22.08)	11.06 (5.00-22.08)	0.894
NLR, median (range)	3.055 (0.96-8.90)	5.28 (1.11-9.15)	4.23 (0.96-9.15)	0.014
LMR, median (range)	2.81 (0.49-6.14)	2.89 (1.25-6.36)	2.82 (0.49-6.36)	0.894

BMI: Body mass index; NLR: Neutrophil-to-lymphocyte ratio; LMR: Lymphocyte-to-monocyte ratio.

Table 2 Comparisons of natural and sociological characteristics between the orchiectomy group and salvage groups, n (%)

Characteristic	Orchiectomy (n = 32)	Salvage (n = 43)	Total (n = 75)	P value
Season of events				0.933
Spring	7 (21.87)	11 (25.58)	18 (24.00)
Summer	5 (15.63)	6 (13.95)	11 (14.67)
Autumn	6 (18.75)	6 (13.95)	12 (16.00)
Winter	14 (43.75)	20 (46.52)	34 (45.33)
Patient's residence				0.689
Rural area	9 (28.12)	14 (32.56)	23 (30.67)
Urban area	23 (71.88)	29 (67.44)	52 (69.33)
Patient's guardian				0.749
Father	13 (40.63)	16 (37.21)	29 (38.67)
Mother	10 (31.25)	17 (39.53)	27 (36.00)
Other	9 (28.12)	10 (23.26)	19 (25.33)
Initial presenting institution				P < 0.01
Primary hospital	18 (56.25)	8 (18.60)	26 (34.67)
Tertiary hospital	14 (43.75)	35 (81.49)	49 (65.33)
Median treatment cost [United States dollars, median (range)]	764.085 (526.75-1266.32)	726.19 (381.04-1363.83)	736.79 (381.04-1363.83)	0.739

Table 3 Univariate and multivariate logistic regression analyses of related factors related to testicular salvage

Characteristic	Univariate analysis		Multivariate analysis
	OR (95%CI)	P value	OR (95%CI)	P value
Age (yr), median (range)	1.16 (0.977-1.378)	0.09
BMI (kg/m2), mean ± SD	1.54 (1.14-2.06)	< 0.01	1.24 (0.46-3.39)	0.669
Initial symptom
Testicular pain	Ref
Scrotal swelling	0.39 (0.09-1.80)	0.230
Nausea and vomiting	0.66 (0.04-11.01)	0.771
Other	0.66 (0.04-11.01)	0.771
Previous history of testicular torsion
No	Ref
Yes	0.72 (0.14-3.85)	0.706
Time from the event to the hospitalization (min), median (range)	0.99 (0.97-1.01)	0.423
The side of the twisted testicle
Left	Ref
Right	1.08 (0.36-3.24)	0.888
Intratesticular blood flow
Invisible	Ref
Visible	0.72 (0.17-3.12)	0.658
Testicular parenchymal echotexture
Nonhomogeneous	Ref
Homogeneous	0.73 (0.10-5.49)	0.761
Operative time (min), median (range)	0.98 (0.95-1.00)	0.073
Location of testicular torsion
Intrathecal	Ref
Extrathecal	1.51 (0.13-17.44)	0.740
Torsion angle	1.00 (0.99-1.00)	< 0.05
Testicular color of the affected testis
Black	Ref
Maroon	123358712.82 (0.00-Inf)	0.994
Bright red	123358712.25 (0.00-Inf)	0.995
Other	123358712.35 (0.00-Inf)	0.998
Normal testicular fixation
No	Ref
Yes	0.31 (0.03-2.96)	0.312
Hospital stay time, median (range)	1.18 (0.96-1.44)	0.112
Red blood cell count (109/L), mean ± SD	5.27 (1.18-23.57)	< 0.05	6.00 (0.10-348.34)	0.387
White blood cell count (109/L), median (range)	0.98 (0.86-1.13)	0.811
NLR, median (range)	1.34 (1.08-1.67)	< 0.01	3.78 (0.96-14.91)	0.057
LMR, median (range)	1.21 (0.85-1.73)	0.285
Season of events
Spring	Ref
Summer	0.76 (0.17-3.49)	0.728
Autumn	0.64 (0.15-2.78)	0.548
Winter	0.91 (0.28-2.92)	0.873
Patient's residence
Rural area	Ref
Urban area	0.81 (0.30-2.20)	0.681
Patient's guardian
Father	Ref
Mather	1.38 (0.47-4.03)	0.554
Other	0.90 (0.28-2.88)	0.863
Initial diagnosis institution
Primary hospital	Ref		Ref
Tertiary hospital	5.62 (1.99-15.88)	< 0.01	12.58 (1.12-141.05)	< 0.05
Median treatment cost [United States dollars, median (range)]	1.00 (1.00-1.00)	0.650

BMI: Body mass index; NLR: Neutrophil-to-lymphocyte ratio; LMR: Lymphocyte-to-monocyte ratio; OR: Odds ratio.