To observe the clinical efficacy and safety of optimized clinical procedures combined with N-acetylcysteine (NAC) tablets in the diagnosis and treatment of testicular torsion.

Patients diagnosed with testicular torsion in our hospital from January 2020 to January 2022 were enrolled as control group and received routine diagnosis and treatment. Patients treated from January 2023 to January 2024 who underwent optimized clinical procedures combined with postoperative oral NAC tablets were enrolled as treatment group. The treatment group implemented optimized clinical procedures (including health education, fast track pathway, simplified evaluation and surgical preparation, etc.) and started oral NAC tablets on the second day after surgery (200 mg each time, 3 times daily, for 1 consecutive week). The two groups were compared in terms of time from symptom onset to hospital arrival (T1), time from hospital arrival to surgery start (T2), total ischemia time (T3), orchiectomy rate and testicular atrophy rate at 6 months postoperatively.

T1 in treatment group and control group were 8.00 (5.00, 12.00) and 62.00 (51.00, 72.00) min, respectively; T2 were 52.00 (48.00, 57.00) and 109.00 (85.00, 135.50) min, respectively; and T3 were 60.00 (56.00, 64.00) and 171.50 (149.00, 199.00) min, respectively. The differences in the above indicators between the two groups were statistically significant (all P<0.001). The orchiectomy rate was 65.00% in treatment group and 82.00% in control group, with a statistically significant difference (P<0.001, RR=0.78, 95%CI: 0.66-0.91). At 6 months postoperatively, among patients who underwent testicular salvage, the testicular atrophy rate was 11.43% in treatment group and 33.33% in control group, with a statistically significant difference (P<0.05, RR=0.30, 95%CI: 0.10-0.94). Multivariate logistic regression analysis showed that the combined intervention was an independent protective factor for reducing orchiectomy rate (P=0.001, OR=0.31, 95%CI: 0.15-0.64). In terms of safety, only 3 (3.00%) patients in treatment group reported mild nausea, with no serious adverse drug reactions; no related adverse reactions occurred in control group.

The application of optimized clinical procedures combined with N-acetylcysteine tablets shows significant clinical benefits in the treatment of testicular torsion, helping to shorten treatment time, reduce testicular injury, improve testicular survival rate, and exhibits a favorable safety profile.