Management of Perinatal Torsion: Today, Tomorrow or Never?

Yerkes, Elizabeth B.; Robertson, Frank; Gitlin, Jordan; Kaefer, Martin; Cain, Mark P.; Rink, Richard C.

doi:10.1097/01.ju.0000179542.05953.11

Cited by 80 publications

(63 citation statements)

References 11 publications

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“…Although our survey showed a trend toward surgical intervention in newborns with PTT, this indication is still empirical, and risks and benefits of both approaches should be fully discussed with the parents. 17 Some limitations of our study were identified. Our survey was conducted on 4 cases of PTT and 11 questions; however, this may not represent comprehensively the scenarios that are seen in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Management of neonatal testicular torsion: Which way to turn?

Guerra

Wiesenthal

Pike

et al. 2013

CUAJ

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Objective: Perinatal testicular torsion (PTT) is a rare event with controversies surrounding its etiology, presentation, surgical management and sequelae. Our survey assessed the preferences of pediatric urologists with regard to its management.Methods: Four cases of unilateral PTT and a questionnaire containing 11 questions about management of common clinical scenarios were mailed to 26 pediatric urologists. The answers were received anonymously and they were analyzed blindly.Results: The response rate was 80% (21/26), with 90% (19/21) of respondents holding academic appointments. In the 2 first cases of PTT with a typical unilateral nonviable testis, 76% (16/21) and 67% (14/21), respectively, opted for surgery. A case of acute postnatal torsion resulted in 100% agreement to urgent scrotal exploration. In the case of an atrophic testis, none of the respondents opted for immediate surgery; yet, 38% (8/21) said they would proceed with a delayed orchiopexy of the contralateral testicle. In the question section, 10% (2/21) responded that they preferred to explore PTT immediately; whereas, 57% (12/21) would delay surgical exploration for a few days until the neonate was better stabilized. One-third of participants (7/21) would not perform a surgical exploration but would just follow the child clinically. A scrotal incision for contralateral orchiopexy was preferred by 52% (11/21), while 48% (10/21) prefer a scrotal approach but would switch to an inguinal incision if a hydrocele were present. Operative intervention was favoured by 80% (8/10) and 46% (5/11) of those with less than and greater than 10 years of practice, respectively.Conclusion: This survey revealed that 67% (14/21) of respondents preferred immediate exploration of a torted testis and contralateral orchiopexy, compared with the nonoperative approach. Scrotal incision for the exploration was preferred by most respondents. There was a trend to choose less aggressive treatment as the years of practice increase. Studies of more robust design, such as randomized controlled trials, are necessary to determine the natural history and outcomes of this uncommon type of testicular torsion.

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Section: Discussionmentioning

confidence: 99%

Management of neonatal testicular torsion: Which way to turn?

Guerra

Wiesenthal

Pike

et al. 2013

CUAJ

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“…[7][8][9][10][11][12] Hoewel het beleid bij perinatale torsio controversieel is, wordt steeds vaker een spoedexploratie geadviseerd. 13,14 Aan de hand van de bevindingen in de literatuur willen wij als Nederlandse kinderurologen de huidige inzichten bespreken en tot een eenduidig beleidsadvies komen.…”

Section: 2unclassified

“…[7][8][9][10][11][12][13][28][29][30] Verondersteld kan worden dat de werkelijke kans op redding veel lager ligt omdat de meeste casus zonder redding niet gepubliceerd worden ('publication bias'). Bij een prenatale torsio testis ligt het moment van torderen meestal zo ver vóór de geboorte dat het redden van de aangedane testis niet meer mogelijk is.…”

Section: Literatuur: Veranderende Inzichtenunclassified

Perinatale torsio testis: nieuwe inzichten en beleidsadvies

Toorn¹,

Horst²,

Gier³

et al. 2009

KIND

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“…Absence of pain is usual due to non development of pain pathway by that time. 10 Pain and tenderness can be present in postnatal torsion. Presentation in such patients can be: …”

Section: Case Report Asian Journal Of Medical Sciencesmentioning

confidence: 99%