Neonatal Bilateral Testicular Torsion: A Plea for Emergency Exploration

Bagłaj, Maciej; Carachi, Robert

doi:10.1016/j.juro.2007.02.005

Cited by 76 publications

(67 citation statements)

References 17 publications

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“…There may be a few possible mechanisms for the etiology of testicular hypoplasia like in this case. Testicular torsion has been reported to lead to [5]. Although the mechanism of testicular hypoplasia in chimeric males remains unknown, chimerism might have led to the testicular hypoplasia of our patient.…”

Section: Discussionmentioning

confidence: 70%

Testicular hypoplasia in monochorionic dizygous twin with confined blood chimerism

Choi

Kwon

Lee

et al. 2013

J Assist Reprod Genet

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Section: Discussionmentioning

confidence: 70%

Testicular hypoplasia in monochorionic dizygous twin with confined blood chimerism

Choi

Kwon

Lee

et al. 2013

J Assist Reprod Genet

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“…Furthermore, up to 33% of these are asynchronous (onset of symptoms separated over time), usually with normal appearance of the contralateral testis on initial presentation. However, the timing of secondary torsion is unpredictable and has been reported as quickly as 48 h following initial torsion [4]. Although the risk is small, this raises this question of whether early surgery is recommended in all perinatal torsions in order to reduce the risk of contralateral torsion and anorchia.…”

Section: Discussionmentioning

confidence: 99%

Successful Outcome in Perinatal Intravaginal Torsion of Testis in Neonate: Long-Term Outcome

Chauhan¹,

Bown²,

Davies³

et al. 2016

Int J Clin Pediatr

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Perinatal testicular torsion can be intravaginal or extravaginal. Extravaginal torsion can be managed in an elective manner. Intravaginal torsion needs an urgent operation to maximize the viability of the testis. The history is vital to distinguish between the two diagnoses. We report a case in which a perinatal intravaginal torted testicle was successfully salvaged due to a timely exploration. This was a retrospective review of a case and literature review of perinatal testicular torsion. A term baby was transferred to a tertiary pediatric surgical unit in the United Kingdom for surgical management of exomphalos minor. The child was noted to have normal testes. On the seventh day of life, he was noted to have a firm swelling in his right scrotum with purple discoloration. He was promptly reviewed by the surgical team. A perinatal torsion of intravaginal type was suspected and he was booked for emergency exploration. The surgical findings were 1) significant edema of the right scrotal wall, 2) a thickened tunica vaginalis and small volume of hemolyzed fluid, and 3) a bluish and congested torted testicle in intravaginal plane. Testis was de-rotated and color returned within 5 minutes. A three-point testicular fixation was performed bilaterally. He was reviewed in clinic for the following 2 years and found to have equal growth of the testicles, both of which were appropriately positioned within the scrotum. This case highlights the importance of being aware that perinatal torsion can be extravaginal or intravaginal. The patient history is important to distinguish between the two diagnoses as proven by the above case. A positive outcome can be achieved with judicious assessment and emergent management of perinatal intravaginal torsions. Clinicians should maintain a high level of suspicion of intravaginal torsion in all cases of perinatal testicular torsion.

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“…Bilateral cases of torsion are even more rare, [8][9][10][11] and the salvage rate of the affected testes is extremely low. Baglaj and Carachi 12 recently reviewed the literature and found 48 cases of bilateral PTT. Despite prompt surgical intervention in 46 cases, only 3 testicles had postoperative arterial flow based on Doppler ultrasonography.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the recent literature strongly recommends early scrotal exploration and contralateral orchiopexy. 12 The decision for intervention may be influenced in part by the level of uncertainty with regard to a possible contralateral torsion and in part to a result of the litigious medical environment in which pediatric urologists 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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Neonatal Bilateral Testicular Torsion: A Plea for Emergency Exploration

Cited by 76 publications

References 17 publications

Testicular hypoplasia in monochorionic dizygous twin with confined blood chimerism

Testicular hypoplasia in monochorionic dizygous twin with confined blood chimerism

Successful Outcome in Perinatal Intravaginal Torsion of Testis in Neonate: Long-Term Outcome

Management of neonatal testicular torsion: Which way to turn?

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