Editorial Comment on A nomogram for predicting risk factors of testicular salvage after testicular torsion in children

Abstract

Testicular torsion is a disease that causes testicular ischemia and, if the torsion is not resolved within a certain period of time, irreversible testicular necrosis. The most important factors that determine testicular prognosis are thought to be the torsion angle and ischemia time, and if the testicular torsion angle is >360°and the ischemia time exceeds 24 h, it is said that all testes become necrotic.Other predictors of testicular prognosis have also been investigated, including ultrasound findings and several blood inflammatory markers. As a marker for predicting testicular prognosis, He et al. reported mean platelet volume (MPV) 1 and Jang et al. reported neutrophil-lymphocyte ratio (NLR). 2 Yilmaz et al. reported that monocyte counts predict testicular preservation, 3 but evidence regarding blood markers is still lacking and controversial.In this study, Chen et al performed a multivariate analysis using ultrasound findings and blood markers such as NLR, MPV, and monocyte count, in addition to traditional risk factors such as ischemia time and torsion angle. 4 They discovered that monocytes were an independent risk factor and created a nomogram that included this. This result reinforced previous evidence of monocyte as a blood marker. Monocytes are a largest type of white blood cell, and when tissue injury or infection occurs, monocytes are rapidly recruited to tissues where they differentiate into tissue macrophages or dendritic cells. Several reports have shown that monocyte count was a better biomarker of cardiovascular disease than other inflammatory markers such as C-reactive protein. 5 Considering the pathogenesis of testicular ischemia, which has similarities with cardiovascular disease, monocyte counts may be a promising marker.The data from this study are not without question. This study was conducted in Shenzhen, a rapidly developing city in China, using a population with a testicular preservation rate of only 28% (58/203). 4 There may be differences in the time it takes to visit the hospital and the method of ultrasound evaluation compared with our daily clinical practice. It is unclear whether the monogram using monocyte count can be applied in populations with higher testicular preservation rates. In the future, further validation using data from other countries is required.