Predictors of testicular salvage failure in pediatric testicular torsion: a retrospective analysis of clinical and imaging risk factors.

Objectives: This study aimed to construct preoperative nomograms for predicting testicular necrosis in pediatric patients with testicular torsion (TT).

Methods: This retrospective study analyzed clinical data from 176 patients diagnosed with TT at the Department of Pediatric Surgery, Ningxia Medical General Hospital, between January 2010 and January 2023. To identify independent risk factors for testicular necrosis, both univariate as well as multivariate logistic regression analyses were used. A predictive nomogram model was then developed based on the coefficients derived from multivariate regression analysis. A receiver operating characteristic (ROC) curve analysis and calibration plot were employed to evaluate the performance of the model.

Results: Surgical management included orchiopexy in 55 patients (31.4%) and orchiectomy in 121 patients (68.6%). Multivariate analysis identified five independent predictors of testicular necrosis: symptom duration, torsion severity (≥ 360°), absence of testicular blood flow on Doppler ultrasound, heterogeneous testicular echogenicity, and an elevated preoperative platelet-to-lymphocyte ratio (PLR). Internal validation demonstrated strong discriminative performance of the nomogram, with the area under the ROC curve values of 0.948 for the training cohort and 0.910 for the validation cohort. The calibration plots demonstrated a strong concordance between predicted probabilities and observed outcomes.

Conclusion: These findings highlight duration of onset, degree of TT, ultrasound characteristics (vascularity loss and heterogeneous echotexture), and systemic inflammatory markers (PLR) as key preoperative indicators of testicular viability. The proposed nomogram serves as an evidence-based tool to guide intraoperative decisions on testicular preservation or resection.