Diagnosing Testicular Torsion before Urological Consultation and Imaging: Validation of the TWIST Score

Abstract

TWIST score assessed by nonurologists, such as emergency medical technicians, is accurate. Low risk patients do not require ultrasound to rule out torsion. High risk patients can proceed directly to surgery, with more than 50% avoiding ultrasound. In the future emergency medical technicians and/or emergency room triage personnel may be able to calculate TWIST score to guide radiological evaluation and immediate surgical intervention at initial assessment long before urological consultation.

Common urological problems in children: inguinoscrotal pathologies

“…47 The salvage rates differ, ranging from 75.7% to 29%. 48,49 The diagnosis of torsion depends mostly on clinical evaluation. Diffuse testicular tenderness, hydrocoele, high-lying testis with transverse lie, and absent cremasteric reflex are clinical signs of torsion.…”

“…Scrotal exploration should be the management of choice in clinically suspect cases. As exploration may be negative, many clinicians have tried adjunctive methods such as the TWIST (Testicular Workup for Ischemia and Suspected Torsion) clinical scoring system, 49 Doppler USG, nuclear scintigraphy, MRI, or evaluation of testicular oxygen saturation with near-infrared spectroscopy. 50 For Doppler USG, accuracy depends on the skill of the radiologist.…”

Neonatal testicular torsion: Is it time for consensus?

“…[18,23,25] The testicular workup for ischemia and suspected torsion score, which uses urological history and physical examination to assess risk of torsion, has been validated for older children but is not useful in NTT. [26] There is no literature in the newborn of successful nonoperative maneuvers being performed.…”

"The prostate is the sun around which all satellites of urology orbit, except pediatric urology"

“…Interested readers should consult some recent evidence that can help us all make decisions in this anxiety-provoking situation. 2 This excellent and succinct review by Guerra and Leonard should be required reading for all urologists. In addition, download it and send it along to your referring primary care physicians.…”