Abstract: Objective To explore the risk factors for failed manual reduction under ultrasonic monitoring in children with testicular torsion. 
Methods A retrospective analysis was conducted on the clinical data of 87 children with testicular torsion admitted to the Department of Urology, Hebei Children′s Hospital from January 2019 to October 2024. All children underwent manual reduction under color Doppler ultrasonic monitoring, and were divided into the success group (n=36) and the failure group (n=51) based on the reduction results. Age, duration of onset, hematological parameters, and ultrasound imaging results were compared between the two groups. Multivariate Logistic regression analysis was performed on the predictive factors with significant differences (P＜0.05) in univariate analysis. 
Results Compared with the failure manual reduction groups under ultrasonic monitoring, there were significant differences in age ［(7.53±3.09) years vs. (5.61±2.47) years］, duration of onset (9.0 h vs. 17.0 h), scrotal wall thickness (3.8 mm vs. 4.8 mm), degree of spermatic cord torsion (360 ° vs. 540 °), and testicular survival rate (80.6% vs. 52.9%) in the success group (P＜0.05). There was no significant difference in the left and right sides, white blood cell count, mean platelet volume, and neutrophil/lymphocyte ratio (P＞0.05).Multivariate Logistic regression analysis showed that younger age (OR=0.178, P=0.043), longer duration of onset (OR=3.957, P=0.019), and higher degree of spermatic cord torsion (OR=1.020, P=0.023) were risk factors for failure in manual reduction under ultrasonic monitoring. 
Conclusion Age, duration of onset, and degree of spermatic cord torsion are all risk factors affecting the outcome of manual reduction under ultrasonic monitoring. Manual reduction under ultrasonic monitoring is an effective treatment strategy. Therefore, it is recommended that patients with testicular torsion undergo manual reduction to maximize the possibility of testicular survival. 

Key words: spermatic cord torsion, child, hospitalized, manual reduction