Trends in the Management of Testicular Torsion: A Scoping Review of Delays and Outcomes.

Abstract

Testicular torsion is a time-sensitive urological emergency in which delays in diagnosis and treatment can lead to testicular loss. Despite advances in healthcare delivery, delayed presentation and management remain common worldwide and contribute to significant morbidity. This scoping review aimed to explore trends in presentation, diagnosis, and surgical management of testicular torsion across healthcare settings; identify and categorise the causes of delays; assess the impact of these delays on outcomes; highlight predictive factors influencing salvage; and map gaps in the literature to inform future research and interventions. The review was conducted in accordance with the Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. PubMed, Scopus, and Google Scholar were searched for studies published between 2010 and 2025. Eligible studies were original peer-reviewed research articles reporting on delays, predictive factors, or outcomes of testicular torsion. Data were charted on study characteristics, delays, predictive factors, and surgical outcomes. Ten studies were included, representing 1,910 patients with acute scrotal pain, of whom 1,529 had confirmed torsion. Delays in presentation and diagnosis were multifactorial, arising from patient-related, diagnostic, and system-level barriers. Salvage rates varied from 12% to 82%, with an overall salvage rate of 41.5% and orchidectomy rate of 58.5%. Outcomes were closely linked to timing of surgery, with salvage highest within six hours of symptom onset and declining sharply thereafter. Predictive factors included symptom duration, degree of torsion, age, and imaging findings. None of the studies reported long-term functional outcomes. Delays remain the most important determinant of outcome in testicular torsion. Findings are consistent with international guidelines emphasising urgent exploration within six hours. Improved patient education, streamlined referral pathways, and institutional preparedness are essential to reduce preventable testicular loss. Future research should prioritise long-term outcomes and the evaluation of system-level interventions.