LAUSR

The evaluation of acute scrotum needs to be carried out in a timely fashion. A delay or error in diagnosis might lead to irreversible damage or ischemic necrosis of the testes due to testicular torsion (TT). Immediate surgical exploration is mandatory when TT is suspected. However, universal exploration for acute scrotum causes unnecessary surgical interventions, because up to 70% of patients with acute scrotum do not require surgery. Color Doppler ultrasonography (CDUS) has become the standard imaging method for patients with suspicion of TT. It gives excellent imaging of anatomical details and intratesticular blood flow with a reported sensitivity of 69–100% and specificity of 75–100%. However, CDUS is not always available at every institution. Additionally, it is an operatordependent diagnostic tool. Therefore, several scoring systems based on symptoms and physical findings have been reported to confirm or rule out TT without CDUS. The Testicular Workup for Ischemia and Suspected Torsion score was developed by Barbosa et al. to help physicians in the clinical evaluation of acute scrotum. Patients were divided into low(0–2), intermediate(3–4) or high(5–7) risk groups according to the total score. Their study had a 100% negative predictive value for the low-risk group, and a 100% positive predictive value for the high-risk group. However, other studies on validation of the Testicular Workup for Ischemia and Suspected Torsion score did not show a negative predictive value of 100% for the low-risk group. The affected testes are not swollen or hard if patients present with acute scrotum immediately after the onset or the affected testis is mildly twisted. That might lead to underestimation of the Testicular Workup for Ischemia and Suspected Torsion score, because 2 points are assigned to “testicular swelling” and “hard testicle,” respectively. Takeshita et al. developed a nomogram based on physical findings and environmental conditions for predicting TT in Japanese patients with acute scrotum. The nomogram would be helpful for physicians who are not familiar with scrotal examination or CDUS when they manage patients with acute scrotum. However, application of this nomogram needs to be careful, because climate and temperature are not always the same in Japan.