Introduction. Testicular torsion (TT) is the most common emergency urologic pathology of children. Detorsion within 4-8 hours is crucial to prevent irreversible changes in testicular tissue. Ultrasound investigation plays a major role in the diagnosis of testicular torsion, but its performance is prolonging the diagnostic period and, consequently, the time of testicular ischemia. For selection of patients who really need ultrasound examination among all patients with acute diseases of the scrotum organs (ADSO), the TWIST (Testicular Workup for Ischemia and Suspected Torsion) diagnostic scale was proposed. The results of its application in the conditions of emergency care of boys in several surgical centers of Russia formed the basis of our study.
Purpose. To evaluate the results of using the TWIST scale in the diagnosis of acute diseases of scrotum organs and to clarify the possibility of using additional criteria for selection of patients of medium risk group according to the TWIST scale.
Materials and Methods. We prospectively analyzed the results of using TWIST scale in the diagnosis of ADSO of boys with suspected TT in five Russian clinics from 1.09.2022 to 1.01.2024. The study included 421 boys.
Results. A total of 243 children were categorized as low risk group (0-2 points) according to TWIST scale, 3 (1,2%) of them were diagnosed with TT. 71 patients were categorized as high-risk group (5-7 points) according to TWIST scale, 44 (62%) of them were found to have TT. The mediumrisk group included 107 (25,4%) patients, 16 of whom were teenagers aged 13 years and older. Among the patients in the medium-risk group according to TWIST scale TT was detected in 7 (6%) boys and all of them were aged 13 years and older. Using the Pearson chi-square test, it was found that age 13 years and older is a reliably significant prognostic factor for the detection of ТТ. Analysis of ROC curves shows that the probability of TT occurrence in the medium-risk group is high already from the age of 11 («excellent» accuracy of the model).
Conclusions. The data obtained in this multicenter study demonstrate the expediency of using the scale TWIST at the stage of forming therapeutic and diagnostic tactics, provided that a differentiated approach is applied in the treatment of patients with ADSO to reduce the time of testicular ischemia by avoiding unnecessary ultrasound of the scrotal organs in patients with low and high risk according to the TWIST scale. In the group of medium-risk patients aged 11 years and older, there is a high risk of TT and, consequently, it is reasonable to perform revision scrototomy without ultrasound examination in these patients.
