When is surgical intervention most critical for testicular torsion to ensure gonad survival?

In cases of testicular torsion, the urgency of surgical intervention directly correlates with the viability of the affected testicle. The blood supply to the testicle is compromised during torsion, which can lead to ischemia and, if not corrected, eventual necrosis.

When torsion occurs, the testicle can typically survive without blood flow for about six hours. After this timeframe, the risk of irreversible damage rises significantly. Surgical detorsion and subsequent fixation of the testicle (orchidopexy) are essential within this six-hour period to maximize the chance of saving the gonad.

After six hours, the chances of salvageable tissue decrease dramatically, and by 12 to 24 hours, the likelihood of preserving the testicle substantially diminishes, making prompt intervention critical. Interventions beyond this period typically lead to increased rates of testicular atrophy and loss.

Therefore, recognizing that the six-hour window is crucial for the survival of the testicle underscores why this timeframe is considered the most critical for surgical intervention in testicular torsion cases.