Testicular torsion study finds most Brazilian patients arrived too late to save the testicle

Testicular torsion is a race against the clock, and a new retrospective case series from a tertiary public urological emergency service in Pernambuco, Brazil, suggests that many patients in that system lose the race before they ever reach a specialist. The study, published in BMC Urology, reviewed medical records from December 2019 to December 2021, a window that overlapped with the COVID-19 pandemic, and included only patients whose torsion was confirmed during surgery. Of 70 records screened, 66 met the eligibility criteria, giving the researchers a surgically verified snapshot of who develops the condition, when they seek help, and what surgeons find when they operate.

The demographic picture was dominated by young patients. Median age was 17 years, with a range spanning 14 to 62, and 40 of the 66 patients, or 60.6 percent, were younger than 18.

The timing data were striking. Among 65 patients with available information, one record was missing, 40 patients, or 61.5 percent, sought their first medical service more than 24 hours after the onset of pain. The first visit occurred at a general public service in 58 of 66 cases, or 87.9 percent, meaning most patients entered the health system through facilities that then had to recognize the emergency and refer them onward to specialized urological care.

Clinical findings at both levels of care told a consistent story. Testicular edema, swelling of the scrotal tissue, was the most frequent finding at the first assessment, present in 55 of 66 patients, or 83.3 percent, and at the specialized assessment, present in 59 of 66, or 89.4 percent.

What surgeons found in the operating room was the study’s sobering endpoint. Intraoperative necrosis, meaning the testicular tissue had already died, was identified in 41 of 66 patients, or 62.1 percent. Potentially reversible ischemia was observed in 24 patients, or 36.4 percent.

Surgical management followed a standard protective pattern. Contralateral orchiopexy, the fixation of the unaffected testicle to prevent a future torsion on the other side, was performed in 65 of 66 patients, or 98.5 percent.

The authors are careful about what the data cannot show. Because the study period overlapped with the COVID-19 pandemic, and because the interval between the first assessment and referral and the time to surgery were unavailable in the records, the stage of the care pathway responsible for the delays could not be identified. The delays may have accumulated at presentation, at the general service, during referral, or before the operation, but the retrospective design and missing timing variables make that attribution impossible. Missing data were reported explicitly and not imputed, and care intervals were cross-tabulated against intraoperative findings without statistical testing, so the figures should be read as a descriptive profile rather than as evidence of causal effects.

Methodologically, the series is a retrospective descriptive case series at a single tertiary public referral hospital, which limits generalizability beyond that service and its catchment area. The authors conclude that adolescents and young adults predominated, that delays exceeding 24 hours from pain onset before first medical care were common, and that testicular necrosis was the main intraoperative finding. They call for prospective studies with standardized recording of care intervals, which would allow future researchers to pinpoint where in the pathway time is lost and to test interventions that shorten it.

The study does not evaluate treatments or claim that any particular intervention would have changed outcomes, and it does not report salvage rates by delay interval. What it does provide is a documented baseline for a Brazilian public emergency service, showing where patients first appear, what clinicians see, and how often the operation confirms irreversible damage, a foundation the authors argue is needed before anyone can design and evaluate fixes for the delays.

Subject of Research: Clinical and epidemiological profile of surgically confirmed testicular torsion cases at a tertiary public urological emergency service in Brazil

Article Title: Clinical and epidemiological profile of testicular torsion in a tertiary public urological emergency service in Brazil: a retrospective descriptive case series

Article References: de Farias, R. B., da Costa, K. G., Melo, L. D. A. V., de Oliveira, M. S., Wagner, H. F., Lins, T. H. S., Henriques, F. G. D. O. T., Calado, A. A., & Vasconcelos, R. A. L. (2026). Clinical and epidemiological profile of testicular torsion in a tertiary public urological emergency service in Brazil: a retrospective descriptive case series. BMC Urology. https://doi.org/10.1186/s12894-026-02406-9

Image Credits: AI Generated

DOI: 10.1186/s12894-026-02406-9

Keywords: testicular torsion, urological emergency, Brazil, retrospective case series, testicular necrosis, care delays, adolescents, orchiopexy, public health, emergency care, BMC Urology, Pernambuco