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Indocyanine green near-infrared fluorescence (ICG-NIRF) imaging significantly improves intraoperative testicular preservation rates and postoperative outcomes compared to conventional visual assessment in pediatric testicular torsion. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

May 17, 2026Open Access

Intraoperative Indocyanine Green Near-Infrared Fluorescence Imaging for Assessing Testicular Viability in Pediatric Testicular Torsion: A Retrospective Study

Key Points

To evaluate the efficacy of ICG-NIRF imaging compared to conventional surgery for assessing testicular viability in pediatric patients with testicular torsion.
Retrospective analysis of 225 pediatric patients undergoing scrotal exploration for testicular torsion from January 2019 to January 2025.
Comparison of outcomes between conventional surgery (n=118) and ICG-NIRF imaging (n=107) groups.
Primary outcomes assessed included intraoperative testicular preservation rates and postoperative success rates.
ICG-NIRF group showed a higher intraoperative preservation rate (74.77% vs. 61.02%, p=0.028).
Postoperative success rate was significantly higher in the ICG-NIRF group (88.75% vs. 69.44%, p=0.003).
ICG-NIRF group had lower rates of secondary orchiectomy (1.25% vs. 9.72%, p=0.027) and testicular atrophy (7.59% vs. 23.08%, p=0.02).

Abstract

Objective To evaluate the clinical efficacy of indocyanine green near-infrared fluorescence (ICG-NIRF) imaging versus conventional surgery for assessing testicular viability and guiding decision-making in pediatric testicular torsion (TT). MethodsA retrospective analysis was performed on 225 pediatric patients undergoing emergency scrotal exploration for TT between January 2019 and January 2025.Patients were categorized into a conventional surgery group (n=118) relying on visual grading and an ICG-NIRF imaging group (n=107).Primary outcomes included intraoperative testicular preservation rates and postoperative success rates.Multivariate Cox regression was utilized to identify factors influencing testicular preservation.Results Baseline characteristics were comparable between groups.The ICG-NIRF group demonstrated a significantly higher intraoperative preservation rate (74.77% vs. 61.02%,p=0.028) and postoperative success rate (88.75% vs. 69.44%,p=0.003) compared to the conventional group.Additionally, the ICG-NIRF group exhibited significantly lower rates of secondary orchiectomy (1.25% vs. 9.72%, p=0.027) and 6-month testicular atrophy (7.59% vs. 23.08%,p=0.02).Multivariate analysis confirmed ICG-NIRF application as an independent protective factor for testicular preservation (HR=0.556,p<0.001).Conclusion ICG-NIRF imaging provides an objective, real-time assessment of testicular perfusion, significantly improving testicular preservation rates and postoperative outcomes. J o u r n a l P r e -p r o o fThis technique overcomes the subjectivity of conventional visual methods, offering substantial clinical value for fertility preservation in pediatric TT.

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