Diagnostic Approaches and Clinical Markers for Testicular Torsion in Non-Neonatal Patients.

BACKGROUND: Prompt and accurate diagnosis of testicular torsion (TT) is essential to prevent irreversible testicular damage and to preserve fertility in pediatric cases of acute scrotum. Ultrasonography combined with color Doppler imaging is considered the first-line diagnostic modality for suspected TT. However, TT cannot be ruled out solely by demonstrating altered blood flow in the testicular vasculature. This study retrospectively analyzed cases of acute scrotum managed in our department with a focus on identifying the relevant diagnostic factors of TT. METHODS: We conducted a retrospective analysis of TT in non-neonatal patients who were hospitalized and treated at our department between January 2013 and November 2024. Patient age, chief complaints, and blood test findings, including white blood cell (WBC) count and C-reactive protein (CRP) levels, were analyzed. RESULTS: 76 cases of non-neonatal acute scrotum patients were conducted to identify accurate diagnostic factors for TT, in addition to ultrasonographic examination. The results showed that TT was significantly associated with patients ≥ 11 years of age (p = 0.022) and extragenital symptoms, such as groin or lower abdominal pain (p < 0.001). An elevated WBC count (≥ 10,100/μL) was identified as a strong predictor (p < 0.001), whereas CRP level showed no diagnostic significance. A multivariate logistic regression analysis confirmed that age and WBC count were independent predictors. CONCLUSION: In addition to ultrasonography, consideration of patient age and WBC count may improve the diagnostic accuracy of TT. We intend to continue to accumulate more cases and conduct further investigations in the future.