Journal of pediatric urology · 2026
Enhancing diagnostic accuracy of pediatric testicular torsion: The role of the neutrophil-to-lymphocyte ratio.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Kikkawa Kazuro, Yokoyama Satoshi, Kanai Risa, Maruno Kouhei, Nakayasu Ryota, Takahashi Toshifumi, Yamada Yuya, Nakashima Masakazu, Tamaki Masahiro, Ito Noriyuki
Аннотация
INTRODUCTION: Acute scrotal pain in children and adolescents is a common urological emergency, with testicular torsion (TT) being the most critical cause due to the risk of ischemic injury and testicular loss. Although color Doppler ultrasonography (CDUS) and the Testicular Workup for Ischemia and Suspected Torsion (TWIST) score are standard diagnostic tools, both have limitations, especially in early or ambiguous cases. The neutrophil-to-lymphocyte ratio (NLR), an inflammation-based marker reflecting the balance between acute stress-related neutrophilia and relative lymphopenia, has been used as an adjunctive diagnostic tool in various ischemic conditions.
OBJECTIVE: This study aimed to assess the diagnostic value of NLR and its combination with the TWIST score in differentiating TT from other causes of acute scrotum in pediatric patients.
METHODS: We retrospectively reviewed 85 patients under 18 years who underwent emergency surgery for acute scrotal pain between December 2009 and February 2025. Clinical findings, laboratory data, and CDUS results were analyzed. NLR and platelet-to-lymphocyte ratio (PLR) were calculated from preoperative blood samples. TT was confirmed intraoperatively by ≥ 180° spermatic cord torsion. Diagnostic accuracy was evaluated using receiver operating characteristic (ROC) analysis, and optimal cut-offs were determined by Youden's index.
RESULTS: Of 85 patients, 59 (69.4 %) had TT and 26 (30.6 %) had other diagnoses. Compared with non-TT cases, TT patients had higher white blood cell counts, neutrophil counts, and NLR (median 3.80 vs. 1.47, p < 0.001). NLR achieved an AUC of 0.87 with a cutoff of 2.0 (sensitivity 79.7 %, specificity 80.0 %). The TWIST score alone yielded an AUC of 0.86, and the combination with NLR ≥2.0 improved diagnostic accuracy (AUC 0.90; sensitivity 84.7 %, specificity 84.6 %). Lowering the cutoff to NLR ≥1.8 further increased sensitivity to 89.8 %.
DISCUSSION: NLR demonstrated comparable diagnostic accuracy to the TWIST score and enhanced performance when combined, improving both sensitivity and specificity. Elevated NLR reflects acute ischemic stress and systemic inflammation in TT. Integrating NLR into TWIST may reduce misdiagnosis and expedite surgical decisions, particularly when imaging is delayed or inconclusive. NLR is inexpensive, rapidly available, and suitable for use in resource-limited settings.
CONCLUSIONS: NLR is a simple, reliable biomarker that significantly improves the diagnostic accuracy of the TWIST score in children and adolescents with acute scrotal pain. Combining NLR with clinical scoring can support early recognition of testicular torsion and timely intervention, potentially improving testicular salvage outcomes.
OBJECTIVE: This study aimed to assess the diagnostic value of NLR and its combination with the TWIST score in differentiating TT from other causes of acute scrotum in pediatric patients.
METHODS: We retrospectively reviewed 85 patients under 18 years who underwent emergency surgery for acute scrotal pain between December 2009 and February 2025. Clinical findings, laboratory data, and CDUS results were analyzed. NLR and platelet-to-lymphocyte ratio (PLR) were calculated from preoperative blood samples. TT was confirmed intraoperatively by ≥ 180° spermatic cord torsion. Diagnostic accuracy was evaluated using receiver operating characteristic (ROC) analysis, and optimal cut-offs were determined by Youden's index.
RESULTS: Of 85 patients, 59 (69.4 %) had TT and 26 (30.6 %) had other diagnoses. Compared with non-TT cases, TT patients had higher white blood cell counts, neutrophil counts, and NLR (median 3.80 vs. 1.47, p < 0.001). NLR achieved an AUC of 0.87 with a cutoff of 2.0 (sensitivity 79.7 %, specificity 80.0 %). The TWIST score alone yielded an AUC of 0.86, and the combination with NLR ≥2.0 improved diagnostic accuracy (AUC 0.90; sensitivity 84.7 %, specificity 84.6 %). Lowering the cutoff to NLR ≥1.8 further increased sensitivity to 89.8 %.
DISCUSSION: NLR demonstrated comparable diagnostic accuracy to the TWIST score and enhanced performance when combined, improving both sensitivity and specificity. Elevated NLR reflects acute ischemic stress and systemic inflammation in TT. Integrating NLR into TWIST may reduce misdiagnosis and expedite surgical decisions, particularly when imaging is delayed or inconclusive. NLR is inexpensive, rapidly available, and suitable for use in resource-limited settings.
CONCLUSIONS: NLR is a simple, reliable biomarker that significantly improves the diagnostic accuracy of the TWIST score in children and adolescents with acute scrotal pain. Combining NLR with clinical scoring can support early recognition of testicular torsion and timely intervention, potentially improving testicular salvage outcomes.