Diagnostic Value of immature granulocytes and neutrophil-to-lymphocyte ratio in differentiating epididymo-orchitis from testicular torsion.

BACKGROUND

Testicular torsion is an important urologic emergency, and early identification is crucial. This study aimed to evaluate the diagnostic value of hematological parameters-particularly immature granulocytes (IGs) in differentiating epididymo-orchitis from testicular torsion in patients presenting with acute scrotal pain.

METHODS

This retrospective cohort study included 301 male patients presenting with acute scrotal pain between January 2020 and December 2024. Diagnoses were confirmed by Doppler ultrasonography or surgical exploration. Patients were classified into epididymo-orchitis (n=200), testicular torsion (n=37), and control (n=64) groups. Complete blood count parameters (WBC, neutrophil, lymphocyte, platelet, IG, NLR, PLR) were analyzed. Nonparametric tests were used for group comparisons, and ROC curve analyses were performed to determine diagnostic performance. Multivariable logistic regression adjusted for age identified independent predictors.

RESULTS

NLR (cut-off=2.19, AUC=0.644, p<0.001) and IG count (cut-off = 0.06, AUC=0.590, p=0.011) were significantly elevated in epididymo-orchitis compared with controls. No parameter showed diagnostic significance for testicular torsion. In the epididymo-orchitis vs torsion comparison, NLR (AUC=0.781, p<0.001) and IG count (AUC=0.730, p<0.001) demonstrated the best discriminative ability. Multivariable regression confirmed NLR (OR=1.17, 95% CI 1.05-1.31, p=0.005) and IG (OR=2.26, 95% CI 1.10-4.63, p=0.027) as independent predictors of epididymo-orchitis.

CONCLUSION

Immature granulocyte count and NLR are valuable and accessible hematological biomarkers that can assist in differentiating epididymo-orchitis from testicular torsion. Their integration into diagnostic evaluation may enhance clinical decision-making in the emergency management of acute scrotum.