Depriving an organ of its blood supply is invariably fatal in the local context. And, just as supposedly “time is brain”, “time is testicle” in the case of torsion. But, while we have our various time-based targets and thresholds for the acute treatment of cerebral ischemia, how long ought we be urgently concerned about the potential for testicle salvage after the onset of symptoms?
These authors undertook a systematic review of case series reports of testicular salvage following torsion, stratified by time of symptom onset. The quality of their evidence is, admittedly, low, and subject to the flaws of retrospective series and publication bias. That said, however, they identified a cumulative accounting of outcomes for 2,114 patients undergoing surgical exploration for potential salvage.
Earlier is, obviously, better. It is reasonable to estimate the likelihood of finding a salvageable testicle at ~95% if symptoms have been present for six hours or fewer. As time ticks by, rates of salvage decreased: ~77% between 6-12 hours, ~50% in the 13-24 hour timeframe, and, finally, ~25% and below in smaller samples beyond 24 hours. Even though these rates of salvage are lower, they remain substantial, and certainly beyond the traditional 6-8 hour viability teaching.
The authors do not have a conclusive unifying hypothesis as to why many cases were still salvageable despite extended time windows, but simply use these weak data to suggest timely evaluation and consultation remains important even beyond acute symptom onset.
“A Systematic Review of Testicle Survival Time After a Torsion Event”