Intra‐uterine testicular torsion: early diagnosis and treatment

Al-Salem, Ahmed H.

doi:10.1046/j.1464-410x.1999.00099.x

Cited by 31 publications

(13 citation statements)

References 14 publications

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“…In man, testicular degeneration is usually secondary to ischaemia, which is often the result of testicular torsion (Harris et al 1982;Lamesch 1994). Testicular torsion predominantly affects descended testes of adolescents, but can occur in adults (Daehlin and Servoll 1997) and neonates (Al-Salem 1999). Neonatal testicular torsion is thought to occur in utero and has been diagnosed by fetal ultrasonography (Herman et al 2002).…”

Section: Aetiologymentioning

confidence: 99%

Laparoscopic‐assisted diagnosis of monorchidism in a horse

Kelmer

Kramer

Miller

2006

Equine Veterinary Education

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Section: Aetiologymentioning

confidence: 99%

Laparoscopic‐assisted diagnosis of monorchidism in a horse

Kelmer

Kramer

Miller

2006

Equine Veterinary Education

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“…Testicular torsion presents in a bimodal age presentation, with extravaginal torsion occurring in the perinatal period and intravaginal torsion peaking in puberty, although the latter can be seen at any age. [1][2][3] It is unusual to see testicular torsion in the first few months of life, but it is still possible and it should be on the differential diagnosis list. At this age the diagnosis is difficult, as physical findings may be subtle.…”

Section: Discussionmentioning

confidence: 99%

Incarcerated inguinal hernia in infancy associated with testicular infarction: Case report and review of the literature

Alyami

Whelan

2013

CUAJ

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One of the most common urgent urologic problems seen in young patients in the emergency department is the acute scrotum. Testicular infarction from an incarcerated inguinal hernia is an unusual presentation and often not considered in the initial evaluation. We present an interesting case of a 28-day-old boy who presented with an acute scrotum and was found to have a testicular infarction and an incarcerated inguinal hernia. The management of similar cases in young males may vary depending on which surgical service is consulted initially and a scrotal ultrasound should be done without any delay. Case reportA 28-day-old boy with right scrotal swelling was brought in to the emergency department (ED) by his parents. His mother noticed he was irritable and crying on the morning of the presentation. He was breastfeeding with no vomiting, diarrhea or other symptoms. He saw his family physician at noon and had a normal exam. His mother later noticed right-sided scrotal swelling while changing his diaper and he started to be more irritable. There was no history of trauma. His medical history revealed an uncomplicated delivery and normal neonatal physical exam. His family history was unremarkable.He was seen in the ED by the emergency physician within 3 hours of the scrotal swelling. Urology was consulted to rule out testicular torsion.He was comfortable and not in distress. His vital signs were within the normal ranges and he was well-hydrated. Chest exam was normal. The abdomen was soft and nontender. The right scrotum was swollen and tender. There was no change in the scrotal skin colour. The left testicle was easy to feel and felt normal in the scrotum. It was difficult to palpate the right testicle as there was palpable right swelling suggestive of inguinoscrotal hernia. Scrotal transillumination was negative. He was uncircumcised with a normal phimotic foreskin. The cremasteric reflex was absent on the right side and present on the left side. The rest of the examination was unremarkable.The scrotal ultrasound showed evidence of bowel contents in the right scrotum, no blood flow to the right testicle and a reactive hydrocele. There was normal blood flow to the left testicle (Fig. 1). The patient was immediately taken to the operating room. The general surgery team was consulted and reduction of the hernia was done under anesthetic before the scrotal exploration. We used bilateral transverse scrotal incisions for exposure because of surgeon preference. Intraoperative examination revealed an ischemic looking right testicle with torsion of the spermatic cord (Fig. 2). The right testicle was detorted and wrapped in warm gauze. We proceeded with performing an orchidopexy on the left testicle. The left testicle was normal. After 30 minutes we inspected the right testicle again and it was still black in colour. The tunica albuginea was incised and it did not bleed. As a result, it was felt that the testicle was non-viable and a right orchiectomy was performed. The general surgery team decided not to repair the hern...

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“…found one patient's contralateral testicle also ischemic during the delayed operation 5 . For that reason, early exploration, including fixation of the contralateral testicle to the scrotum by suturing it to the tunica dartos, will protect the remaining gonad from possible torsion in the future 2,6,7 4 …”

Section: Discussionmentioning

confidence: 99%

“…Bilateral PTT is managed as a true urological emergency by us and by others 8 because it may result in functional anorchia. However, not all authors recommend urgent surgery for bilateral PTT because of the lack of viability of the testes, with a salvage rate of only 5% (when prenatal and neonatal cases are combined) 7,9 . Furthermore, optimal treatment of macroscopically necrotic testes at the time of surgery is not clearly established.…”

Section: Discussionmentioning

confidence: 99%

Bilateral perinatal testicular torsion in an infant: A rare neonatal emergency

Bağcı¹,

Bachour

Woelfle

et al. 2010

Pediatrics International

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Perinatal testicular torsion (PTT) is almost exclusively extravaginal and often presents nontender unilateral scrotal enlargement. 1 The torsion occurs outside the tunica vaginalis when the testes and gubernacula are not fixed and are free to rotate. Bilateral spermatic cord torsion in the newborn is an extremely rare event, and emergency exploration is indicated because of the risk of anorchia. 2,3 We present here a case with bilateral testicular torsion. Case reportA 32-year-old woman, gravida 1 para 0, was referred to our institution because of a fetal tachyarrhythmia at 33 weeks of gestation. Fetal echocardiography showed an atrial flutter with regular atrial wall motion of 410 b.p.m. at a rate of 2 : 1 to ventricular wall motion. The fetus was not hydropic and no structural cardiac abnormality was detected. Transplacental digoxin therapy successfully converted the atrial flutter in two days to a normal sinus rhythm without evidence of maternal or fetal side-effects. Routine prenatal ultrasonography showed no pathology.At 39 weeks of gestation, a 4020-g, large-for-gestational-age male infant was born by cesarean section. The physical examination revealed a bilateral swelling of the scrotum, which was negative to transillumination, and mobile, firm and tender testes. No discoloration of the scrotum was noted. Color Doppler ultrasound examination of the testicles showed a homogeneous structure without intratesticular Doppler signal. The laboratory evaluation disclosed normal white blood cell count and acute phase reactants, including C-reactive protein and interleukin-6.Within 3 h, the infant underwent emergency exploration by bilateral inguinal incision. At operation, both testes were black, hemorrhagic and necrotic with extratunical twists in the cords bilaterally, confirming the clinical suspicion of advanced infarction. The left testicle was atrophic (Fig. 1). Although a capsular bleed test was negative after detorsion, the testes were returned into the scrotum for any possible return of viability. The postoperative course of the patient was uneventful.At 12-month follow up, ultrasound examination showed bilateral atrophic testes and clear calcification with no intratesticular color Doppler signal. Hormone assay revealed a high level of basal follicle-stimulating hormone and low testosterone level. A human chorionic gonadotropin (hCG) stimulation test (5000 IE/m 2 ) demonstrated no response of serum testosterone. Inhibin B, an established marker of Sertoli cell function, was 7 pg/mL (reference range: 68-630 pg/mL). A bilateral orchiectomy with placement of testicular prostheses and supportive hormonal therapy at puberty was planned. DiscussionThe management of unilateral PTT is somewhat controversial due to the poor salvage rate and the low risk of contralateral torsion. 4,5 Controversy exists with regard to timing of the operation and the necessity of contralateral exploration and orchiopexy, and treatment of necrotic testes.Experimental studies of testicular ischemia in dogs have shown a loss of spermatog...

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Intra‐uterine testicular torsion: early diagnosis and treatment

Abstract: The early diagnosis and treatment of intra-uterine torsion of the testis is essential.

Cited by 31 publications

References 14 publications

Laparoscopic‐assisted diagnosis of monorchidism in a horse

Laparoscopic‐assisted diagnosis of monorchidism in a horse

Incarcerated inguinal hernia in infancy associated with testicular infarction: Case report and review of the literature

Bilateral perinatal testicular torsion in an infant: A rare neonatal emergency

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