# Optimizing Management of Testicular Torsion at Bronglais General Hospital: Assessing the Testicular Workup for Ischemia and Suspected Torsion (TWIST) Score and Ultrasound for Effective Time Intervention

## TL;DR

This study examines how testicular torsion is managed at a UK hospital, aiming to improve diagnosis and reduce delays in treatment.

## Contribution

The study introduces a local protocol to streamline testicular torsion management and highlights gaps in using diagnostic tools like the TWIST score and ultrasound.

## Key findings

- Only 38% of patients with suspected testicular torsion had confirmed cases.
- The TWIST score was used in just 6% of cases, and ultrasound in 9%.
- A local protocol was developed to improve timely intervention and reduce delays.

## Abstract

Background: Testicular torsion (TT) is a urological emergency requiring timely surgical intervention to prevent testicular loss. Different assessment approaches were suggested to improve overall patient outcomes, as the Testicular Workup for Ischemia and Suspected Torsion (TWIST) score, which has been integrated with ultrasound findings to enhance diagnostic accuracy in suspected cases of testicular torsion. Additionally, Doppler ultrasound is recommended in accordance with recently updated national and international guidelines.

Methodology: This is a retrospective study conducted at Bronglais General Hospital (BGH), Aberystwyth, United Kingdom, from January 2019 to January 2024 of patients who had undergone scrotal exploration for suspected TT. A total of 34 patients were included in the study.

Objective: The study aims to review the management of all patients who present to BGH with suspected “testicular torsion” as per available national & international guidelines, aiming to develop a local protocol. Also, the study aims to investigate the potential causes of the delay in management of patients presented with scrotal pain and to structure a local management pathway for patients presented with scrotal pain at BGH.

Results: Out of 34 patients in our study, 67.64% (n=23) were in the age group of 11 to 20 years. Only 38% (n=13) had confirmed TT. Of these 13 patients, 69.23% (n=9) of the testes were viable, and in 30.77% (n=4), the testis was not viable. The TWIST score was applied in only 6% (n=2) of cases. Ultrasound was performed in only 9% (n=3) of cases.

Conclusion: To improve surgical outcomes for scrotal pain exploration and reduce delays in intervention, it is important to address existing documentation gaps and the inconsistent use of diagnostic tools such as the TWIST score and ultrasound, even though TT is generally managed in a timely manner at BGH. However, a local protocol has been developed that includes direct referral to the on-call surgical registrar to further decrease time to theatre. It also includes the TWIST score to guide diagnosis. Raising awareness of children and their carers/parents is of paramount importance. A proposed pathway for the management of patients with scrotal pain and suspected of TT at BGH was developed and will be followed up on in future practice.