Neonatal Torsion: A 14-Year Experience and Proposed Algorithm for Management

Abstract

Complicated pregnancies and vaginal deliveries seem to predispose patients to testicular torsion. Contrary to previous series, neonatal torsions do not appear to favor one side or the other. Prenatal torsions are never salvageable, and, therefore, do not warrant emergent intervention. Postnatal torsions are sometimes salvaged, and a judicious approach to surgical exploration should be taken.

Timing and surgical management of neonatal testicular torsions

“…It is therefore preferable to postpone surgery until these risks diminish. Kaye et al [11] suggested a different approach in relation to the type of NTT. Prenatal NTT are never salvageable; therefore, emergent intervention should be reserved for postnatal torsions, where a minute possibility of salvage exists [11].…”

“…Kaye et al [11] suggested a different approach in relation to the type of NTT. Prenatal NTT are never salvageable; therefore, emergent intervention should be reserved for postnatal torsions, where a minute possibility of salvage exists [11]. Sorensen et al [12] showed that emergently operated NTT, in patients less than 1 month old, had a 40% to 50% salvage rate.…”

Testicular Torsion in Neonate: A Rare Pathology

“…Following opinion that surgery should be postponed in case of prenatal testicular torsion (In utero) which are never salvageable [5,17]. Contrariwise Roth et al have adopted the strategy of emergent surgical exploration in cases of prenatal torsion.…”

“…So that the other testicle could be saved in case of bilateral asynchronous torsion [18]. In case of postnatal testicular torsion, it is unanimously agreed to operate in an emergency in the hope of saving what can be saved [4,5,12,14,17]. Urgent surgery is recommended in cases of postnatal torsion, but the chance of saving the testis remains poor [14,18,19].…”

Neonatal testicular torsion

“…These features present neonatologists with a clinical dilemma owing to uncertainty about the need for urgent surgical referral and the benefits (if any) of emergent scrotal exploration and the appropriate management of the contralateral "healthy" testis. There is a lack of consensus in the literature to make firm recommendations with regard to evidence-based practice [1,4]. So, to contribute to the debate, we report the current view of the management of neonatal torsion as reflected in a survey of opinion of consultant paediatric surgeons and urologists working in the United Kingdom (UK) and Ireland.…”