Parameters Predicting Orchiectomy Risk in Acute Testicular Torsion: TMPEV Score

We aimed to determine which parameters other than the time until torsion surgery can predict orchiectomy risk in acute testicular torsion (TT).

The medical records of acute TT who applied to five different health centres in Turkey between 2016 and 2023 were analysed retrospectively. Patients who underwent orchiectomy because blood flow cannot be detected were defined as Group I, and patients with testicles preserved and fixed were defined as Group II. The differences between the two groups and potential predictors of testicular salvage were analysed.

Eighty-three patients with TT were included in the study. Amongst them, 44 (53.01%) were included in Group I and 39 patients (46.99%) in Group II. Time from the onset of pain to surgery and mean platelet volume (MPV) were significantly higher in Group I (p < 0.05). In Group II, the ipsilateral Prehn's sign negativity rates, the rate of normal ipsilateral testicular echogenicity, and the rate of normal volume on ultrasonography were significantly higher than those in Group I (p < 0.05). We created a new scoring system named Time, MPV, Prehn's sign, Echogenicity, and Volume (TMPEV) that can predict the risk of orchiectomy in TT by using the parameters that differed statistically between Groups I and II.

The time until surgery may not be the only factor affecting the possibility of testicular recovery in acute TT. MPV, positivity of Prehn's sign, differentiations in ipsilateral testicular echogenicity and volume changes on ultrasonography, may have significant value in predicting the possibility of orchiectomy after open detorsion surgery. If more comprehensive and clear nomograms similar to our new TMPEV scoring system can be created, more proactive algorithms can also be developed for predicting orchiectomy after TT and managing TT.