2026 Volume 62 Issue 1 Pages 43-48
Purpose: Testicular torsion is a common pediatric urological emergency requiring prompt diagnosis and intervention. The Testicular Workup for Ischemia and Suspected Torsion (TWIST) score, based solely on physical findings, has been proposed as a rapid diagnostic tool. Although its utility has been evaluated in several studies, reports from Japan remain limited. In this study, we aimed to assess the usefulness of the TWIST score in patients with testicular torsion treated at our institution.
Methods: We retrospectively reviewed 43 patients who underwent surgical treatment for testicular torsion between 2016 and 2024. Clinical background, TWIST score and individual components, surgical procedures, and outcomes were analyzed. Patients were classified into the good-prognosis group (G group: orchiopexy without atrophy) and the poor-prognosis group (P group: testicular atrophy or orchiectomy). Findings were compared between the two groups.
Results: Testicular swelling was documented in 42 cases (97.6%), hard testis was observed in 31 (72.1%), and absent cremasteric reflex, nausea/vomiting, and high-riding testis were found in 33 (76.7%) each of these symptoms. TWIST scores were calculable in 25 cases; 5 patients had a score of 2. No significant difference in overall TWIST scores was observed between the G and P groups. Testicular swelling (p = 0.004) and hard testis (p = 0.036) were significantly less frequent in the G group. Even in the absence of testicular swelling, at least one other positive finding was present.
Conclusions: Testicular torsion may occur with low TWIST scores, warranting careful evaluation. However, the TWIST-score-based assessment may help reduce missed diagnoses, even in atypical cases lacking testicular swelling.
