Comparison of hematological markers between testicular torsion and epididymo-orchitis in acute scrotum cases

Objective: In this study, we aimed to investigate the benefit of hematological results in determining the differential diagnosis between testicular torsion (TT) and epididymo-orchitis (EO) in patients presenting with acute scrotum, and to determine its predictive value for the diagnosis of TT. Material and Methods: We retrospectively analyzed 98 patients who applied to our institute’s urology clinics or emergency service with complaints of acute scrotum. Thirty-two patients who underwent orchiectomy or detorsion due to TT and 48 patients with EO were included in the study. The control group consisted of 80 healthy men. Groups were compared in terms of hematological parameters such as age, white blood cell (WBC), mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), and platelet/lymphocyte ratio (PLR). Results: WBC, MPV and NLR were found to be statistically significant in distinguishing TT group from other groups, respectively; (AUC = 0.732, 95% CI: 0.647-0.816 and p<0.001), (AUC = 0.720, 95% CI: 0.615-0.825 and p<0.001), (AUC = 0.629, 95% CI: 0.519-0.739 and p=0.024). In the comparison between the detorsion and orchiectomy subgroups within the TT group, the first had a statistically lower monocyte count (p=0.005) and MLR level (p=0.038). Conclusion: Hematological parameters; that is, WBC, MPV and NLR, which can be easily determined from complete blood count analysis, had high sensitivity and specificity similar to Doppler ultrasonography to predict TT. In addition, we think that monocyte and MLR levels may be beneficial in patients who have difficulty in the decision of orchiectomy or detorsion in TT surgery. Keywords: Acute scrotum, testicular torsion, epididymo-orchitis, mean platelet volume, neutrophil/lymphocyte ratio