Validation of a TWIST Score In Diagnosis of Testicular Torsion – Single-Center Experience

Bašković, Marko; Župančić, Božidar; Vukasović, Ivo; Ivan, Štimac-Rojtinić; Ježek, Davor

doi:10.1055/a-0826-4885

Cited by 9 publications

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“…MADTA of prospective and retrospective studies excluding nonphysician examiners and adult patients was performed, consisting of 9 studies. 8,19–21,23,26–28 The summary ROC AUC was 0.912 (0.867, 0.942). A TWIST score of 1 corresponded to a sensitivity of 0.981 and a specificity of 0.241, while a score of 7 corresponded to a sensitivity of 0.204 and specificity of 0.996.…”

Section: Resultsmentioning

confidence: 99%

“…17 The remaining 13 articles met the inclusion criteria and were included in the final analysis. 8,9,18–28…”

Section: Resultsmentioning

confidence: 99%

“…There were 527 cases of TT with an unadjusted torsion rate of 22%. Ten studies were restricted to boys, 8,9,19–23,26–28 1 study focused on males >16 years 18 and 2 studies included males of any age group. 24,25 TWIST was administered by physicians including urologists, 8,28 general surgeons, 18 pediatric surgeons, 22,26 emergency physicians 20,27 and surgical residents.…”

Section: Resultsmentioning

confidence: 99%

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Diagnosing with a TWIST: Systematic Review and Meta-Analysis of a Testicular Torsion Risk Score

Qin

2022

Journal of Urology

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Purpose:The Testicular Workup for Ischemia and Suspected Torsion (TWIST) score is a 7-point tool to evaluate acute scrotal pain. Parameters include testicular swelling (2 points), hard testis (2), high-riding testis (1), absent cremasteric reflex (1) and nausea/vomiting (1). This review aimed to determine the diagnostic utility of TWIST and its role in risk stratification.Materials and Methods:A systematic review and meta-analysis of diagnostic test accuracy was conducted. Five risk stratification systems were explored, including the Barbosa (0–2, 3–4, 5–7) and Sheth (0, 1–5, 6–7) scoring systems, to obtain sensitivity, specificity and area under the receiver operating curve.Results:Thirteen studies were identified, 9 prospective studies proceeded to meta-analysis of diagnostic test accuracy and 5 pediatric studies (1,060 patients, 199 torsions) were included in the primary analysis. The most accurate risk stratification system was Barbosa (0–2, 3–4, 5–7), with an AUC of 0.924 (95% CI: 0.865, 0.956). Barbosa showed favorable sensitivity in low-risk patients (0.984), facilitating rule out of torsion, and favorable specificity (0.975) in high-risk patients, facilitating urgent surgical exploration. Sensitivity and specificity in intermediate-risk patients were 0.922 and 0.682, respectively, indicating a need for further workup with ultrasound. Using this stratification, 65.2% of patients were low-risk, 19.9% were intermediate-risk and 14.9% were high-risk. Per 100 presentations of acute scrotum, there was a missed torsion rate of 1.6/100, ultrasound rate of 19.9/100 and negative exploration rate of 2.5/100.Conclusions:TWIST is an effective tool for suspected testicular torsion and is appropriate for widespread adoption. The Barbosa scoring system is reliable and reduces reliance on scrotal ultrasound.

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Section: Resultsmentioning

confidence: 99%

“…17 The remaining 13 articles met the inclusion criteria and were included in the final analysis. 8,9,18–28…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Diagnosing with a TWIST: Systematic Review and Meta-Analysis of a Testicular Torsion Risk Score

Qin

2022

Journal of Urology

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“…У 422 выявлен ПЯ, что составило 17,7% случаев. Оценку симптомов проводили специалисты экстренного приёма [5,19,22], урологи [15,23], хирурги [24], детские хирурги [20,25], врачи общей практики [17], в остальных статьях не указано [12,16,18,21].…”

Section: Introductionunclassified

Diagnostics of testicular torsion using the TWIST scale (Testicular Workup for Ischemia and Suspected Torsion)

et al. 2023

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Introduction. Testicular torsion (TT) is the most common pediatric emergency urological pathology. To reduce the duration of the diagnostic stage, systems for assessing the risks of testicular torsion based on anamnesis and clinical symptoms were proposed. In 2013, Barbosa et al. proposed the TWIST system (testicular examination for ischemia and suspected torsion), which became the most well-known and widespread. This system makes it possible to identify groups of patients who do not require scrotal ultrasound, which reduces the number of stages in the diagnosis of TT.Objective. To evaluate the experience of using and diagnostic significance of the TWIST scale based on available data in scientific publications.Materials & methods. Review and analysis of literature data on the use of the TWIST scale.Results. We conducted an analysis of 13 publications, in which the results of using TWIST with statistical analysis were published. In all articles, the final diagnosis was established according to Doppler scrotal ultrasound or intraoperatively. Analysis of publications shows that even in large foreign medical centers there is a problem of emergency scrotal ultrasound, which increases the time of testicular ischemia with ТТ. To use the TWIST scale, only history and physical examination data are needed. Any specialist can use the scale in his practise. The low probability of TT in the low-risk group makes it possible not to perform routine scrotal revision, and, consequently, material and human resources are saved.Conclusion. Literature analysis has shown that the use of the original TWIST scale proposed by J.A. Barbosa, in case of suspected testicular torsion, has sufficient diagnostic accuracy, high sensitivity and specificity of TT detection, which significantly reduces the need for ultrasound, reduces the diagnostic time before surgery, that increases testicular survival.

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“…Nausea, vomiting, and diffuse pain in the lower abdomen may be associated with this condition. The classic clinical finding is an asymmetrically (transversely) highly laid testis [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Astaxanthin Relieves Testicular Ischemia-Reperfusion Injury—Immunohistochemical and Biochemical Analyses

Bašković

Krsnik

Himelreich-Perić

et al. 2022

JCM

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Testicular torsion potentially leads to acute scrotum and testicle loss, and requires prompt surgical intervention to restore testicular blood flow, despite the paradoxical negative effect of reperfusion. While no drug is yet approved for this condition, antioxidants are promising candidates. This study aimed to determine astaxanthin’s (ASX), a potent antioxidant, effect on rat testicular torsion−detorsion injury. Thirty-two prepubertal male Fischer rats were divided into four groups. Group 1 underwent sham surgery. In group 2, the right testis was twisted at 720° for 90 min. After 90 min of reperfusion, the testis was removed. ASX was administered intraperitoneally at the time of detorsion (group 3) and 45 min after detorsion (group 4). Quantification of caspase-3 positive cells and oxidative stress markers detection were determined immunohistochemically, while the malondialdehyde (MDA) value, superoxide dismutase (SOD), and glutathione peroxidase (GPx) activities were determined by colorimetric assays. The number of apoptotic caspase-3 positive cells and the MDA value were lower in group 4 compared to group 2. A significant increase in the SOD and GPx activity was observed in group 4 compared to groups 2 and 3. We conclude that ASX has a favorable effect on testicular ischemia-reperfusion injury in rats.

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Validation of a TWIST Score In Diagnosis of Testicular Torsion – Single-Center Experience

Cited by 9 publications

References 0 publications

Diagnosing with a TWIST: Systematic Review and Meta-Analysis of a Testicular Torsion Risk Score

Diagnosing with a TWIST: Systematic Review and Meta-Analysis of a Testicular Torsion Risk Score

Diagnostics of testicular torsion using the TWIST scale (Testicular Workup for Ischemia and Suspected Torsion)

Astaxanthin Relieves Testicular Ischemia-Reperfusion Injury—Immunohistochemical and Biochemical Analyses

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