Factors Associated With Pediatric Testicular Torsion Leading to Orchiectomy.

Acute scrotal pain, most commonly caused by testicular torsion or epididymo-orchitis, requires rapid differentiation to preserve testicular viability, particularly within the early hours of symptom onset. The systemic immune-inflammation index (SII), derived from platelet, neutrophil, and lymphocyte counts, has emerged as a potential biomarker in inflammatory conditions. In this retrospective study, a total of 283 patients presenting with acute scrotal pain between January 2012 and May 2025 were analyzed, including 139 patients with testicular torsion and 144 with epididymo-orchitis. Demographic characteristics, symptom duration, and complete blood count parameters were evaluated, and neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and SII were calculated. Patients were stratified according to symptom duration (≤ 6 hours vs > 6 hours), and intergroup comparisons were performed. SII, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume levels were significantly higher in patients with testicular torsion (all P < .05). Multivariate logistic regression analysis identified SII, mean platelet volume, and C-reactive protein levels as independent predictors of testicular torsion (P < .05). Among patients presenting within 6 hours of symptom onset, SII demonstrated acceptable discriminative ability, with an optimal cutoff value of 830 (area under the curve: 0.737), yielding 72.0% sensitivity and 75.4% specificity. These findings suggest that SII may serve as a readily available adjunctive biomarker for the early differentiation of testicular torsion from epididymo-orchitis, particularly within the critical 6-hour window. Although not sufficient as a standalone diagnostic tool, its integration with clinical and imaging findings may improve early diagnostic accuracy, and further prospective multicenter studies are warranted to validate these results.

Acute scrotal pain is a common presentation in emergency and urological practice and encompasses a wide spectrum of etiologies ranging from benign conditions to true surgical emergencies. Because testicular torsion carries a narrow therapeutic window with rapid deterioration of testicular viability, early recognition and exclusion of torsion remain the cornerstone of initial evaluation. This protocol provides a structured, evidence-based approach to the assessment and management of acute scrotal pain, integrating anatomical considerations, key clinical features, and the main differential diagnoses.

Preoperative Manual Detorsion in Children With Intravaginal Testicular Torsion: A Single-Center Experience.

To develop a high-accuracy prediction model using hybrid machine learning (ML) and explainable artificial intelligence (XAI) techniques for distinguishing between orchiectomy and detorsion in testicular torsion (TT), and to create an interactive web application and nomogram for clinical use. Data from 117 patients who underwent surgical treatment for TT at our clinic between January 2005 and June 2025 were retrospectively analyzed (detorsion: 83, orchiectomy: 34). From twenty initial features, seven optimal features were selected using a hybrid Particle Swarm Optimization-Grey Wolf Optimization (PSO-GWO) algorithm. Class imbalance was addressed using SVMSMOTE. Four ensemble learning algorithms were compared, and CatBoost was selected as the final model. SHAP, LIME, Partial Dependence Plot (PDP), and Individual Conditional Expectation (ICE) analyses were performed for model interpretability. A seven-feature nomogram was developed using logistic regression. A two-module web application was created using Python Dash. PSO-GWO identified seven optimal features (Age, Symptom Duration, PDW, PCT, MPV, MLR, SII). CatBoost demonstrated the highest performance (AUC: 0.923, Accuracy: 89.5%). XAI analyses identified symptom duration as the strongest predictor (SHAP: 52.72%), followed by MLR (14.24%) and PDW (12.09%). PDW emerged as a novel biomarker with minimal prior investigation in the literature yet demonstrated strong discriminatory power (inverse relationship, cut-off < 17.9 fL). PDP analysis revealed a distinct inflection point at approximately 7h, corroborating the ROC cut-off values. ICE analysis revealed substantial individual heterogeneity (score > 0.36). The nomogram demonstrated good discrimination (AUC: 0.818) and excellent calibration (Hosmer-Lemeshow p = 0.556). A simplified three-feature risk scoring system (0-3 points) was developed. The web application (medicalinformaticsttrc.adiyaman.edu.tr) provided real-time risk calculation (< 50 ms). The CatBoost model developed with hybrid PSO-GWO algorithm and XAI techniques achieved high accuracy in predicting orchiectomy in TT. PDW was identified as a novel, practical, and cost-effective biomarker. The developed web application and risk scoring system may support preoperative counseling, surgical preparedness, and clinical decision-making in the emergency department. The "detorsion" outcome indicates intraoperative non-removal of the testis and does not confirm long-term testicular viability. This exploratory model requires external validation and multicenter prospective studies before clinical adoption.

Pre-pubertal testicular torsion: A critical analysis of outcomes from a tertiary care center.

Chronic ozone exposure does not alter sexual behavior but modulates oxidative stress and early testicular apoptosis in adult male rats.

Mental Health Burden of a Testicular Cancer Diagnosis: Insights From a Large Claims Database.

This study aimed to determine the five most influential publications on first-trimester pregnancy point-of-care ultrasound (POCUS) and the five most influential publications on scrotal POCUS from an emergency medicine perspective. These two POCUS applications were selected, because they address time-sensitive clinical conditions in which early diagnosis is critical for appropriate management. An expert panel of 15 emergency physicians was recruited from the Canadian Association of Emergency Physicians (CAEP) Emergency Ultrasound Committee and the Canadian Ultrasound Fellowship Collaborative. All participants had completed fellowship training in POCUS or possessed equivalent expertise, were actively engaged in scholarly work, and held leadership roles at the institutional or national level. A structured three-round modified Delphi process was conducted to achieve consensus. In each round, panelists independently nominated and ranked papers based on their perceived influence in informing us on how to use POCUS in clinical practice. Responses were discussed and refined across subsequent rounds until agreement was reached. In round one, panelists nominated 40 papers focused on first-trimester pregnancy POCUS and 31 papers on scrotal POCUS. Following round two, 13 papers remained for first-trimester pregnancy POCUS and 10 for scrotal POCUS, with one additional paper added to each category after panel discussion. The final round produced ranked lists of the five most influential papers in each category. These papers emphasize the diagnostic value of POCUS in confirming intrauterine pregnancy and excluding ectopic pregnancy, its role in the timely recognition of testicular torsion, and its contribution to improving efficiency while reducing emergency department length of stay. This expert consensus provides a focused reading list of foundational literature in first-trimester pregnancy and scrotal POCUS. The compilation serves as a practical educational resource for clinicians and trainees and as a framework to support future research, curriculum development, and evidence-informed POCUS implementation.

Protective effects of human umbilical cord-derived exosomes on testicular ischemia-reperfusion injury: Comparison of local versus systemic administration.

Objective: To investigate the factors affecting testicular salvage effect in pediatric patients after testicular torsion. Methods: A retrospective case control analysis was performed on the clinical data of 262 pediatric patients after surgery for testicular torsion from January 2011 to December 2023 at Department of Urology, Children's Hospital Affiliated to Soochow University. Their age (M(IQR)) was 12.0 (5.7) years(range:0.1 to 16.0 years). Based on the type of surgery and follow-up results of more than 6 months, the patients were divided into a testicular salvage success group and testicular salvage failure group (including those who underwent orchiectomy or developed atrophy after orchiopexy). Univariate and multivariate Cox regression analyses were used to screen for independent factors associated with testicular salvage success, and receiver operating characteristic (ROC) curves were used to evaluate the predictive performance of each independent risk factor. Results: A total of 84 children were included in the testicular salvage success group, and 178 were included in the testicular salvage failure group. Univariate and multivariate Cox regression analysis showed that age (HR=0.962, P=0.030), symptom duration (HR=1.005, P<0.01), degree of torsion (HR=1.001, P<0.01), positive intratesticular blood flow signal on ultrasound (HR=0.418, P=0.001), monocyte count (HR=1.716, P=0.021), C-reactive protein (CRP) concentration (HR=1.012, P=0.010), and urine ketone bodies (HR=1.478, P=0.048) were independent factors for testicular salvage effect. ROC curve analysis showed the area under the curve for each factor: symptom duration 0.826 (cut-off value 8 h), degree of torsion 0.773, CRP concentration 0.781, and monocyte count 0.706. Conclusions: Symptom duration, degree of torsion, intratesticular blood flow signal on ultrasound, monocyte count, CRP concentration, and urine ketone bodies are independent factors for predicting the prognosis of testicular torsion. Evaluation of these indicators helps to more accurately assess testicular viability before and during surgery, guide surgical decision-making.

Time-Critical Diagnosis of Pediatric Testicular Torsion in a Tertiary Pediatric Emergency Setting: Integrating Clinical Predictors With Selective Doppler Ultrasound.

Nanoencapsulated quercetin protects against testicular ischemia-Reperfusion injury of the seminiferous tubules in rats:Ultrastructural and biochemical evidence.

Undescended testes (UDTs) are common in male infants. Untreated UDT poses risks such as infertility (IF), testicular cancer (TC), and testicular torsion (TT). Retractile testes (RTs) sporadically ascend from the scrotum. UDT requires early surgical correction, whereas RT requires only periodic follow-up. Differentiating these conditions is challenging, making clinical biomarkers potentially useful. The aim of our study was to examine the use of miRNAs as biomarkers in the differential diagnosis of UDT and RT which are difficult to differentiate. This prospective pilot/exploratory study included 10 boys with UDT (operated), 9 with RT (followed), and 9 controls. Only palpable (unilateral or bilateral) UDT cases were included, excluding nonpalpable types. To ensure accurate RT diagnosis, initial physician examinations were performed in three positions (supine, semi-supine, standing), followed by a 1-month parental examination (twice daily). Only RT patients whose testes spent > 50% of their time in the scrotum were included. The exclusion criteria also included prior inguinal/scrotal surgery, defective datasets, or unsuitable serum samples. Parent consent and serum samples were collected to evaluate miR-210, miR-34c, and miR-449a expression via real-time PCR. Statistical analysis revealed no significant difference in miR-34c (p = 0.157) or miR-210 (p = 0.950) expression. However, the miR-449a level differed significantly between the groups (p = 0.033). Dunn-Bonferroni post hoc correction revealed significantly greater miR-449a in the RT group than in the UDT group (p < 0.05). No difference in miR-449a expression was found between the control and UDT groups (p > 0.05). Serum miR-449a demonstrated significant diagnostic potential in differentiating UDT from retractile testis (AUC: 0.822, p = 0.017) with 90.0% sensitivity and 77.8% specificity. These findings suggest that miR-449a could serve as a promising non-invasive biomarker to distinguish true undescended testis from its clinical mimics. Serum miRNA levels represent a potential tool for differentiating UDT from RT. Our pilot/exploratory study partially corroborates this, but comprehensive prospective randomized trials with larger cohorts are essential to definitively clarify miRNA alterations for precise distinction. This prospective case-control study was registered to clinicaltrials.gov database, 'retrospectively'. The trial registration number is: NCT07315737, the unique protocol ID is: 2022/25.

Is torsion of the undescended testis intrinsically associated with worse salvage? A matched cohort analysis.

Intraoperative indocyanine green near-infrared fluorescence imaging for assessing testicular viability in pediatric testicular torsion: A retrospective study.

The tunica vaginalis flap as a rescue procedure in testicular torsion: Quantifying salvage rates with matched cohorts.

Testicular torsion leads to ischemia reperfusion (I/R) injury, causing germ cell loss and impaired testicular function. Although papaverine and platelet rich plasma (PRP) have shown protective effects in separate models, their comparative efficacy within the same experimental design remains unclear. This study evaluates and compares the histopathological and biochemical effects of papaverine and PRP in a rat torsion detorsion model. Thirty two adult male Wistar rats were assigned to five groups: sham, torsion, torsion + PRP, torsion + papaverine, and healthy control. A 720° torsion was applied for 3h, followed by detorsion. PRP or papaverine (1mg/mL) was injected intratesticularly before detorsion. Necrosis, Cosentino score, fibrosis, interstitial edema, congestion, Johnsen score, apoptosis (TUNEL), and serum testosterone were evaluated. The torsion group exhibited significant increases in necrosis, fibrosis, edema, and apoptosis, with decreased Johnsen scores. Both PRP and papaverine reduced tissue injury. Papaverine showed greater improvement in necrosis and fibrosis, whereas PRP yielded higher testosterone levels and improved spermatogenic activity. Apoptosis decreased significantly in both treatment groups (p < 0.001). Papaverine and PRP provide complementary protective effects against testicular I/R injury through vascular and regenerative mechanisms, respectively. Combined or sequential administration may offer a promising therapeutic strategy following detorsion. Further translational and long-term studies are required.

BackgroundIt is challenging to distinguish between testicular torsion (TT) and epididymorchitis (EO) due to their overlapping symptoms. This study evaluated the diagnostic value of the glucose/potassium ratio (GPR) and a combined model for distinguishing between TT, EO, and non-specific acute scrotal pain. This retrospective study included 373 patients, who were divided into three groups: TT (n = 103), EO (n = 120), and non-specific pain controls (n = 150). GPR and systemic inflammatory indices were calculated from admission blood samples. A combined model incorporating independent predictors (age, GPR, and white blood cell (WBC) count) was constructed using binary logistic regression. Diagnostic performance was assessed using a receiver operating characteristic (ROC) curve and multivariate logistic regression analysis.ResultsThe median GPR was highest in the TT group (23.6), followed by the EO group (21.0) and the control group (20.4) (p < 0.001). A GPR cut-off value of > 21.8 was associated with a 3.52-fold increased risk of testicular torsion (OR: 3.52, 95% CI: 1.97–6.25; p < 0.001). Although the GPR demonstrated the greatest accuracy among the individual markers (AUC: 0.738), the combined model produced superior diagnostic results, with an AUC of 0.839 (sensitivity: 75.6%; specificity: 81.5%; positive predictive value (PPV): 60.9%; negative predictive value (NPV): 89.7%). Multivariate analysis identified the following as independent predictors of testicular torsion: younger age (OR: 0.92); higher WBC count (OR: 1.30); and higher GPR levels (OR: 1.14).ConclusionsGPR appears to be a biomarker that could reflect specific metabolic stress in testicular ischaemia, which is distinct from the inflammatory response in EO. The combined model demonstrated the highest diagnostic accuracy in our cohort, suggesting its potential usefulness as an adjunctive triage tool. However, these findings are preliminary and require external validation in future prospective, multicentre studies before routine clinical implementation.

Feasibility of Pediatric Diagnostic Quality Measurement in All United States Hospitals.