Torsion of an undescended testis — A surgical pediatric emergency

Kargl, Simon; Haid, Bernhard

doi:10.1016/j.jpedsurg.2019.06.018

Cited by 22 publications

(27 citation statements)

References 25 publications

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“… 7 Testicular torsion in patients with cryptorchidism accounts for 6.8%–9.7% of all testicular torsion cases. 6 7 8 9 10 11 In contrast, the incidence rate of cryptorchid testicular torsion, which mainly occurs in infancy and puberty, accounted for 13.0% of all testicular torsion cases in our series. Cryptorchidism mainly occurs in infancy and adolescence.…”

Section: Discussioncontrasting

confidence: 52%

“…However, cryptorchid testicular torsion often initially manifests as atypical clinical symptoms, such as abnormal abdominal or groin pain, nausea and vomiting, restlessness, and fever, which may cause delays in medical attention seeking or result in misdiagnosis. 2 7 9 10 11 12 In the present study, the data showed that restlessness was significantly more prevalent in the prepubertal group than that in the postpubertal group. Generally, due to unclear language expression, the symptoms of early-stage testicular torsion in infants and young children manifest as inconsolable crying or restlessness.…”

Section: Discussionsupporting

confidence: 47%

“…Therefore, inguinal swelling is a manifestation of UDT torsion after a period of time, but not immediately. 11 Furthermore, necrosis of the torsioned testis led to local inflammation and subsequently inguinal erythema and fever in two of our patients. Notably, this is of little significance in differentiating UDT torsion from inguinal incarcerated hernia, so for both, emergency surgical exploration through an inguinal incision should be performed.…”

Section: Discussionmentioning

confidence: 59%

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Cryptorchid testicular torsion in children

Zhong

Tang

2021

Asian Journal of Andrology

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This study aimed to review and compare the characteristics and treatment outcomes of cryptorchid testicular torsion in pre- and postpubertal children. We reviewed the clinical data of 22 patients with testicular torsion complicated by cryptorchidism who were treated between January 2010 and December 2019. Patients were categorized into prepubertal (1 month to 9 years; n = 12) and postpubertal groups (10–16 years; n = 10). The age at presentation, clinical presentations, physical examination, and operation outcomes were assessed. The common clinical presentations in both groups were inguinal pain and a tender inguinal mass. Patients in the prepubertal group were significantly more likely to present with restlessness (33.3%) than those in the postpubertal group (0%; P = 0.044). After detorsion, testicular blood flow recovered during surgery in 25.0% of the prepubertal and 80.0% of the postpubertal patients ( P = 0.010). Orchiectomy was required in 50.0% of the prepubertal and 20.0% of the postpubertal patients ( P = 0.145). Of the 22 patients with follow-up data, the rates of testicular salvage were significantly different, at 16.7% in the prepubertal patients and 60.0% in the postpubertal patients ( P = 0.035). Cryptorchid testicular torsion has various manifestations. Although an empty hemiscrotum and a painful groin mass were common in both groups, restlessness was more prevalent in the prepubertal patients during early testicular torsion onset than that in the postpubertal patients. Notably, the testicular salvage rate was significantly lower in the prepubertal patients than that in the postpubertal patients.

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Section: Discussioncontrasting

confidence: 52%

Section: Discussionsupporting

confidence: 47%

Section: Discussionmentioning

confidence: 59%

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Cryptorchid testicular torsion in children

Zhong

Tang

2021

Asian Journal of Andrology

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“…Patients with torsion of undescended gonads were selected and included into the study. Additionally, we compared our case series with the data from the literature, including similar case series, excluding case reports and one study with unavailable data (10).…”

Section: Methodsmentioning

confidence: 99%

Is Testicular Torsion a Real Problem in Pediatric Patients With Cryptorchidism?

et al. 2021

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Purpose: To present management and outcomes of patients with cryptorchidism suffering from testicular torsion.Methods: This is a retrospective review of pediatric patients with torsion of undescended testes, who were treated between 2009 and 2019. We recorded: the age, symptoms, duration of torsion, results of physical examination, surgery findings, and additional treatment. Additionally, an extensive online literature search, from 2015–2020, was performed to identify other similar case series.Results: We identified 9 boys with torsion of the undescended gonad, which represented 4.7% of all 192 boys with testicular torsion. The mean age of boys with torsion of undescended testis was 8.7 years. The mean duration of symptoms in our study group was long and it was up to 28.5 h. All patients had inguinal canal exploration. In eight cases, testicular necrosis and primary orchidectomy was performed. Furthermore, 45 cases were identified in the literature and reviewed.Conclusion: According to clinical experience and available studies, torsion of male undescended gonads is a comparatively rare condition. Nevertheless, diagnosis is still delayed and connected with inevitable orchidectomy.

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“…Ultrasonography is not helpful to differ entiate between incarcerated inguinal hernia and torsion of undescended testis; rather, urgent referral and surgical explora tion are required. 55) Undescended testis and fertility…”

Section: Surgical Therapymentioning

confidence: 99%

Comparison of diagnostic and treatment guidelines for undescended testis

Shin

Jeon

2020

Clin Exp Pediatr

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Cryptorchidism or undescended testis is the single most com mon genitourinary disease in male neonates. In most cases, the testes will descend spontaneously by 3 months of age. If the testes do not descend by 6 months of age, the probability of spontaneous descent thereafter is low. About 1%-2% of boys older than 6 months have undescended testes after their early postnatal descent. In some cases, a testis vanishes in the abdomen or reascends after birth which was present in the scrotum at birth. An inguinal undescended testis is sometimes mistaken for an inguinal hernia. A surgical specialist referral is recommended if descent does not occur by 6 months, unde scended testis is newly diagnosed after 6 months of age, or testicular torsion is suspected. International guidelines do not recommend ultrasonography or other diagnostic imaging because they cannot add diagnostic accuracy or change treat ment. Routine hormonal therapy is not recommended for undescended testis due to a lack of evidence. Orchiopexy is recommended between 6 and 18 months at the latest to pro tect the fertility potential and decrease the risk of malignant changes. Patients with unilateral undescended testis have an infertility rate of up to 10%. This rate is even higher in patients with bilateral undescended testes, with intraabdominal un de scended testis, or who underwent delayed orchiopexy. Pa tients with undescended testis have a threefold increased risk of testicular cancer later in life compared to the general pop ulation. Selfexamination after puberty is recommended to facilitate early cancer detection. A timely referral to a surgical specialist and timely surgical correction are the most important factors for decreasing infertility and testicular cancer rates.

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Torsion of an undescended testis — A surgical pediatric emergency

Cited by 22 publications

References 25 publications

Cryptorchid testicular torsion in children

Cryptorchid testicular torsion in children

Is Testicular Torsion a Real Problem in Pediatric Patients With Cryptorchidism?

Comparison of diagnostic and treatment guidelines for undescended testis

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