SynthesisPediatric surgery international2026
Manual detorsion and orchiectomy risk in testicular torsion: an updated systematic review and attempt-based meta-analysis.
Synthesis in Pediatric surgery international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
4 authors.
Funding
Abstract
backgroundTesticular torsion requires urgent restoration of blood flow. Manual detorsion (MD) may reduce ischemic time before surgery, but evidence is observational and vulnerable to treatment-selection bias.
methodsWe searched PubMed, Embase, Web of Science, and the Cochrane Library through April 30, 2026. The primary outcome was orchiectomy comparing attempted MD with no MD attempt, irrespective of technical success. Random-effects odds ratios were pooled using Paule-Mandel estimation and Hartung-Knapp inference. Risk of bias and certainty were assessed using ROBINS-I and GRADE.
resultsEight retrospective comparative studies involving 844 patients were included. Orchiectomy occurred in 17/406 patients (4.2%) after attempted MD and 127/438 (29.0%) without MD attempt. Attempted MD was associated with lower orchiectomy odds (OR 0.13, 95% CI 0.07-0.24; P < 0.001; I²=0%). All studies had serious overall risk of bias, mainly from confounding by indication, and certainty was low. No study directly compared ultrasound-assisted with non-guided MD. Shorter symptom duration was most consistently associated with technical success.
conclusionsAttempted MD was associated with lower orchiectomy odds, but causality is unproven. MD may be used as an adjunct if it does not delay urgent exploration and fixation.
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