Spin on perinatal testicular torsion

Abstract

We describe a recent case of perinatal testicular torsion at our institution. The presentation, management and outcome of perinatal testicular torsion are quite different to testicular torsion in the general paediatric population. The literature describes a variety of management options for perinatal testicular torsion and these are briefly reviewed. In cases of unilateral perinatal testicular torsin, there is controversy over whether surgery to fix the contralateral testis is required, and if so, the appropriate timing for the surgery. A good understanding of the issues unique to perinatal torsion will facilitate appropriate counseling of parents of affected neonates.

Development of the Gubernaculum During Testicular Descent in the Rat

“…The appearance of a dense fibrous attachment between gubernaculum and scrotum at the completion of migration, as seen here, suggests that the ''fibrous barrier'' in children may be just the normal process developing after migration has ended prematurely. Another key implication of the fibrous adherence occurring at the end of descent is that it provides some experimental support for the view that perinatal testicular torsion in babies is caused by the gubernaculum becoming twisted within the scrotum before adherence has occurred (Samnakay et al, 2006). The twisting itself may be innate, secondary to spiral migration, or may be extrinsic, and caused by bumping by the thigh of the fetus during the last few weeks of pregnancy.…”

New insights into perinatal testicular torsion

“…However, bilateral torsion was reported for the first time in 1967 by Papadatos and Moutsouris, but by 1995, 16 cases of bilateral PTT had been reported and more than 45 cases by 2007 [4, 5, 7, 9, 16, 28, 30, 32–35, 37, 42, 43, 45, 49, 50]. Based on compilations of these reports, it was estimated that approximately 10% to 22% of PTT are bilateral [19, 49].…”

“…In addition, in the acute phase, signs of inflammation will be more marked with some redness, swelling, and fixation of the overlying skin and sometimes clear tenderness. In children of darker races, diagnosis may be more difficult because redness of the scrotum is less conspicuous [42]. Hydroceles and edema may mask clinical presentation of PTT.…”

Neonatal testicular torsion: Is it time for consensus?

“…[8] In a further review of bilateral torsion, when scrotal exploration was done, on the same day as diagnosis, the authors found that all infants had bilateral testicular atrophy. [9] They tried to differentiate between urgent surgery done within few hours and early surgery done within days and concluded that the literature does not offer a consensus. [9] Djahangirian et al, argues that there seems to be no advantage to early intervention and that there is no need for orchiectomy, as torsion leads to ipsilateral testicular atrophy and contralateral orchiopexy should be deferred until the risks of anesthesia and surgery are improved.…”

“…[9] They tried to differentiate between urgent surgery done within few hours and early surgery done within days and concluded that the literature does not offer a consensus. [9] Djahangirian et al, argues that there seems to be no advantage to early intervention and that there is no need for orchiectomy, as torsion leads to ipsilateral testicular atrophy and contralateral orchiopexy should be deferred until the risks of anesthesia and surgery are improved. [10] Kaye devised a management algorithm and opined that if the findings of unilateral torsion are present at birth, it is likely prenatal in origin and the chance of salvaging the testis is low.…”