Clinical score for surgical treatment of acute scrotum in pediatric age
Abstract
Acute scrotum is a set of signs and symptoms that should lead the patient to go to a first aid center. There are different causes of these signs and symptoms, but testicular torsion is identified as the main ones and can be suspected thanks to a careful history, physical examination and testicular ultrasound. It is important to quickly differentiate the various conditions associated with acute scrotum in order to optimize surgery times and preserve testicular vitality.
Often the radiological study is essential to identify the causes of acute scrotum, in particular the testicular Doppler ultrasound is sensitive and specific for testicular torsion, infact it is considered the gold standard for diagnosis. However, the radiological study can delay surgical treatment and reduce testicular vitality.
So TWIST score was proposed. It is based on the identification of signs and symptoms that can lead at clinical diagnosis of testicular torsion.
Our narrative of literature review analyzes TWIST score validity and shows the utility of an adequate clinical examination obtaining a diagnosis of torsion cord, reducing the costs and the time of surgical treatment resulting in a higher likelihood of preserving testicular vitality
Keywords
Full Text:
PDFReferences
1. J.A., Tiseo, B.C., Barayan, G.A., et al, (2013) Development and initial validation of a scoring system to diagnose testicular torsion in children. J Urol. 189(5):1859-64. doi: 10.1016/j.juro.2012.10.056. Erratum in: J Urol. 2014 Aug;192(2):619.
2. Afsarlar, C.E., Ryan, S.L., Donel, E., et al, (2016) Standardized process to improve patient flow from the Emergency Room to the Operating Room for pediatric patients with testicular torsion. J Pediatr Urol. 12(4):233.e1-4. doi: 10.1016/j.jpurol.2016.04.019.
3. Sheth, K.R., Keays, M., Grimsby, G.M., et al, (2016) Diagnosing Testicular Torsion before Urological Consultation and Imaging: Validation of the TWIST Score. J Urol. 195(6):1870-6. doi: 10.1016/j.juro.2016.01.101.
4. Pogorelić, Z., Mustapić, K., Jukić, M., et al, (2016) Management of acute scrotum in children: a 25-year single center experience on 558 pediatric patients. Can J Urol. 23(6):8594-8601.
5. Frohlich, L.C., Paydar-Darian, N., Cilento, B.G. Jr, et al, (2017) Prospective Validation of Clinical Score for Males Presenting With an Acute Scrotum. AcadEmerg Med. 24(12):1474-1482. doi: 10.1111/acem.13295.
6. Manohar, C.S., Gupta, A., Keshavamurthy, R., et al, (2018) Evaluation of Testicular Workup for Ischemia and Suspected Torsion score in patients presenting with acute scrotum. Urol Ann. 10(1):20-23. doi: 10.4103/UA.UA_35_17.
7. Huang, A., Delozier, S., Lauderdale, C.J., et al, (2019) Do repeat ultrasounds affect orchiectomy rate in patients with testicular torsion treated at a pediatric institution? J Pediatr Urol. 15(2):179.e1-179.e5. doi: 10.1016/j.jpurol.2018.12.002.
8. Ridgway, A., Hulme, P., (2018) BET 2: Twist score in cases of suspected paediatric testicular torsion. Emerg Med J. 35(9):574-575. doi: 10.1136/emermed-2018-208024.3. PMID: 30115779.
9. Bašković, M., Župančić, B., Vukasović, I., et al, (2019) Validation of a TWIST Score In Diagnosis of Testicular Torsion – Single-Center Experience. KlinPadiatr. 231(4):217-219. doi: 10.1055/a-0826-4885.
10. Chan, E.P., Wang, P.Z.T., Myslik, F., et al, (2019) Identifying systems delays in assessment, diagnosis, and operative management for testicular torsion in a single-payer health-care system. J Pediatr Urol. 15(3):251.e1-251.e7. doi: 10.1016/j.jpurol.2019.03.017.
11. Lim, X., Angus, M.I., Panchalingam, V., et al, (2020) Revisiting testicular torsion scores in an Asian healthcare system. J Pediatr Urol. 16(6):821.e1-821.e7. doi: 10.1016/j.jpurol.2020.09.023.
12. Sieger, N., Di Quilio, F., Stolzenburg, J.U., (2020) What is beyond testicular torsion and epididymitis? Rare differential diagnoses of acute scrotal pain in adults: A systematic review. Ann Med Surg (Lond). 29;55:265-274. doi: 10.1016/j.amsu.2020.05.031.
13. Aquila, I., Abenavoli, L., Sacco, M.A., et al, (2021) The limits of diagnosis of testicular torsion in the child: Medicolegal implications in clinical practice. Clin Case Rep. 9(12):e05180. doi: 10.1002/ccr3.5180.
14. Wright, H.G., Wright, H.J., (2021) Ultrasound use in suspected testicular torsion: an association with delay to theatre and increased intraoperative finding of non-viable testicle. N Z Med J. 134(1542):50-55.
15. Coles, V., Elagami, H., Bhandarker, K., et al, (2021) The acute scrotum in infancy: A retrospective regional study. J Pediatr Urol. 18(2):226-231. doi: 10.1016/j.jpurol.2021.08.008.
16. Shunmugam, M., Goldman, R.D., (2021) Testicular torsion in children. Can Fam Physician. 67(9):669-671. doi: 10.46747/cfp.6709669.
17. Roberts, C.E., Ricks, W.A., Roy, J.D., et al, (2021) Testicular Workup for Ischemia and Suspected Torsion in Pediatric Patients and Resource Utilization. J Surg Res. 257:406-411. doi: 10.1016/j.jss.2020.08.008.
18. Pinar, U., Duquesne, I., Lannes, F., et al, (2022) The Use of Doppler Ultrasound for Suspected Testicular Torsion: Lessons Learned from a 15-Year Multicentre Retrospective Study of 2922 Patients. EurUrol Focus. 8(1):105-111. doi: 10.1016/j.euf.2021.02.011.
19. Gkalonaki, I., Patoulias, I., Anastasakis, M., et al, (2022) The challenging diagnosis of acute scrotum: remaining difficulties and further insights. Folia Med Cracov. 62(3):91-100. doi: 10.24425/fmc.2022.142371.
20. Qin, K.R., Qu, L.G., (2022) Diagnosing with a TWIST: Systematic Review and Meta-Analysis of a Testicular Torsion Risk Score. J Urol. 208(1):62-70. doi: 10.1097/JU.0000000000002496.
21. Kyaw, L., Choo, C.S., Ong, L.Y., et al, (2022) Management of acute testicular pain in children: changing trends with improvements in scrotal ultrasonography over 18 years. Singapore Med J. doi: 10.11622/smedj.2022032.
Lim, Y., Hwang, J., Park, J., et al, (2022) A simplified ultrasound approach to diagnose testicular torsion and predict unsalvageable testis. Med Ultrason. 24(3):305-313. doi: 10.11152/mu-3507.
DOI: https://doi.org/10.13129/1828-6550/APMB.111.1.2023.SD1
Refbacks
- There are currently no refbacks.
Copyright (c) 2023 Roberta Bonfiglio, Fabiola Cassaro, Chiara Cambiaso, Santi D'Antoni, Angela Simona Montalto, Salvatore Arena, Carmelo Romeo, Pietro Impellizzeri

This work is licensed under a Creative Commons Attribution 4.0 International License.