Background: While testicular torsion is a common pediatric urology condition, recurrence of testicular torsion after orchiopexy is rare. The exact rate of recurrent testicular torsion is not well defined. Some studies from Europe and Australia have postulated rates of recurrence and factors affecting recurrence but other studies, including North American studies, have been primarily case series. Previous research has looked at factors such as orchiopexy unilateral versus bilateral, orchiopexy with two or more points of fixation, and use of absorbable versus non-absorbable sutures and their effect on the rate of recurrence and found low rates of testicular torsion recurrence. This study endeavors to evaluate the incidence of testicular torsion, testicular torsion recurrence, treatment methods, and how they affect recurrence rate within a single US state. We hypothesize that recurrence of testicular torsion is a rare occurrence after orchiopexy and different aspects of surgical technique may affect the rate of recurrence. Methods: This is an IRB-approved retrospective chart review examining patients within a single state with a diagnosis of testicular torsion from 1/1/2012 to 2/14/2024. The healthcare system utilized covers the majority of a New England state and likely captures the majority of testicular torsion within the state. Male patients aged 0-35 years who presented with a diagnosis of testicular torsion were included. Clinical data was extracted from patient electronic medical records. Descriptive statistics as well as logistic regression and chi-square analysis were analyzed using R version 4.3.1. Results: In this study, 201 cases of testicular torsion with a median patient age of 14 years (range: 5 months - 35 years) were treated by 32 urologists across 6 hospitals were identified. To date, data from 130 patients’ charts have been manually extracted and analyzed. Of these patients, 0.77% (1/130) experienced a recurrence of testicular torsion after orchiopexy. 84.8% (106/125) of these patients underwent bilateral orchiopexy, 3.2% (4/125) underwent unilateral orchiopexy and 12.0% (15/125) underwent orchiectomy with contralateral orchiopexy. 64.8% (79/122) of orchiopexies were performed with 3 points of fixation while 35.3% (43/122) were performed with 2 points of fixation. Absorbable sutures (PDS or Vicryl) were used in 45.9% (56/122) of cases and nonabsorbable sutures (Prolene, Ethibond and Silk) were used in 54.1% (66/122) of cases. In the case of torsion recurrence, 5-0 Prolene sutures and 2-point fixation at the upper and lower poles were utilized. Rare complications included sepsis (0.77%) and complex hydrocele/hydrocelectomy (2.31%). Conclusions: This is the first US study using comprehensive state-wide healthcare data to evaluate testicular torsion treatment and recurrence based on current practice trends. Our data shows that the rate of testicular torsion is about 6.3 cases per 100,000 males less than 35 years of age and the rate of recurrence after orchiopexy is less than 1%. The majority of testicular torsion treatment employed bilateral orchiopexy but the use of 2-point fixation versus 3-point fixation or absorbable versus nonabsorbable suture varied. This study confirms the rarity of testicular torsion recurrence after initial treatment regardless of 2-point or 3-point fixation and absorbable or nonabsorbable suture utilization.
