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TÜRKÇE
Poster - 313
SALVAGED BUT LOST: DETORSION, DELAYED ORCHIECTOMY, AND THE LIMITS OF TESTICULAR RESCUE
Hasan Deliağa 1, Mehmet Özer 2, Hakan Özcan 3, Sefer Tolga Okay 3, Esra Özçakır 3, Mete Kaya 4
1 Health Sciences University, Bursa Yüksek İhtisas Training and Research Hospital, Department of Pediatric Urology
2 Health Sciences University, Bursa Yüksek İhtisas Training and Research Hospital, Department of Pathology
3 Health Sciences University, Bursa Yüksek İhtisas Training and Research Hospital, Department of Pediatric Surgery
4 Health Sciences University, Bursa Yüksek İhtisas Training and Research Hospital, Department of Pediatric Urology and Surgery
PURPOSE: In pediatric testicular torsion, detorsion is aimed at salvaging the testis. However, a subset of patients experience delayed atrophy, necessitating secondary orchiectomy. The histological profile of these testes is not well described. We aimed to analyze clinical and histopathological outcomes of patients who underwent initial detorsion but subsequently required orchiectomy due to atrophy.
METHOD: This retrospective study included 19 patients treated between 2019 and 2024. All patients underwent detorsion, followed by orchiectomy due to delayed atrophy. Parameters assessed included age, symptom duration, Doppler vascularity, torsion degree, interval between procedures, and histopathology (Johnsen score).
RESULTS: Mean age was 12.5 years. Median symptom duration was 36 hours. The mean degree of torsion detected in the first operation was 2,5 tours. Post-detorsion Doppler showed absent or severely diminished vascularity in most cases. The median time between detorsion and orchiectomy was 97 days. Histological evaluation revealed Johnsen score of 1 in 84% (16/19) indicating complete spermatogenic arrest. Only 3 patients showed partial spermatogenesis (score >1). The mean Johnsen score across all patients was 1.84.
CONCLUSION: Even after seemingly successful detorsion, a subset of patients may progress to irreversible testicular damage. A Johnsen score of 1 in the majority of these cases indicates early onset germinal epithelium destruction despite salvage attempts. Routine Doppler follow-up and clear surgical criteria for orchiectomy may be essential in preventing unnecessary delay and preserving endocrine and fertility potential.