Abstract

Testicular torsion (TT) is a time-sensitive emergency in which delayed diagnosis and treatment can result in testicular loss and impaired fertility. This systematic review aimed to discuss diagnostic approaches, emergency management strategies, and treatment outcomes of TT. A search of PubMed, Scopus, Web of Science, and Google Scholar was conducted according to PRISMA guidelines. Ten original studies, including more than 6,700 patients in multiple countries, were included. The majority of cases occurred in adolescents and young adults, although older adults were also represented. Clinical predictors such as acute scrotal pain, swelling, and testicular elevation were consistent but nonspecific. Doppler ultrasonography showed high sensitivity, and point-of-care ultrasounds improved diagnostic efficiency in some studies. “Door-to-detorsion time” emerged as a critical determinant of outcomes, with every 10-minute surgical delay increasing the risk of non-viability. Testicular salvage rates varied, ranging from 41% in adults to over 70% in adolescents, with resource-limited settings experiencing orchiectomy rates exceeding 60%. Manual detorsion and accelerated care pathways were associated with improved outcomes. Minimizing diagnostic delays and optimizing institutional efficiency are central to reducing orchiectomy rates and preserving testicular function.

Key words: Testicular torsion, emergency management, testicular salvage, door-to-detorsion time, systematic review