Fetal diagnosis of testicular torsion: what shall we tell the parents?

Abstract

Prenatal diagnosis of unilateral testicular torsion is a coincidental rare finding. Because the twisted testicle cannot be salvaged, induced delivery and prompt surgery are not recommended.

Sonographic evaluation of fetal scrotum, testes and epididymis

“…However, treatment of prenatal torsion is controversial. Most of the authors have reported that antenatal torsion represents an irreversible intrauterine phenomenon with a salvation rate of less than 5% and termination of pregnancy should be considered urgently after the diagnosis of acute cases [ 6 , 110 ]. Bilateral torsion is considered a true emergency due to the risk of an abnormality, indicating urgent surgery in the newborn [ 6 , 111 ].…”

“…Consequently, there is a trend of significant differences between prenatal findings and postnatal prevalence, as observed in the case of benign testicular tumors, cysts, and epididymal appendages or testicular microlithiasis [ 18 , 116 ]; absence of studies about more detailed structures such as the epididymis [ 124 ]; scarce and heterogeneous normative data [ 4 , 22 ]; and a lack of management of findings such as hydrocele or undescended testicles [ 27 , 55 ]. IUTT could be the main exception to this trend, with studies focused on its diagnosis and management [ 6 , 108 , 125 ]. There are several benefits of evaluation of the scrotum and internal structures.…”

“…In cases of IUTT at more than 34 gestational weeks, Melcer et al [ 6 ] recommend immediate delivery and surgical intervention in unilateral affection of less than 24 hours of evolution or bilateral affection to save the compromised testicles. A meta-analysis by Monteilh et al [ 125 ] suggested that urgent surgery should be considered if testicular viability is suspected.…”

“…A probable reason is that testicular descent does not occur until the 24th week of gestation, leading to a missed opportunity to review them in the mid-trimester ultrasound [ 4 , 5 ]. However, the testes play an important role in male fetal development and there are several significant pathologies that can be diagnosed during pregnancy including meconium periorchitis (MPO), intrauterine testicular torsion (IUTT), inguinoscrotal hernia, or cryptorchidism, which is the most common congenital anomaly in male newborns [ 6 – 10 ]. The objective of this study was to review the current knowledge about prenatal diagnosis of pathologies related to the scrotum and internal structures, with discussion regarding ultrasonography, morphometry, pathology, and clinical management.…”

Testis Torsiyonlu Olgularda 4.5 Yıllık Deneyimlerimiz / 4.5 Years’ Experiences In Cases With Testicular Torsion

“…Testis torsiyonlu olgularda cerrahi operasyon esnasında karşı testisin fiksasyonu konusunda literatürde değişik bilgiler olmakla beraber genel eğilim karşı tarafın eksplorasyonu şeklin-dedir. Aynı şekilde orşidopeksi sonrasında atrofiye giden testislerde antisperm antikorlarının karşı testisin sperm üretimi üzerindeki olumsuz etkileri nedeniyle eksize edilmesi gerekliliği; ya da atrofik de olsa hormonal aktivitenin devam edeceği için yerinde bırakılması gerektiği hususunda literatürde de henüz bir fikir birliği oluşmamıştır (4,(15)(16)(17). Bu çalışmanın yapıldığı dönem; eğitim kliniği olmamızın ilk yılları olması ve kliniğimizdeki, uzmanların farklı merkezlerden uzmanlıklarını almaları nedeniyle ilk operasyonda karşı testisin fiksasyonu, geç dönemde atrofiye giden testisin eksizyonu veya çıkarılmaması konusunda hastaya yaklaşımlarda farklılıklar olabilmekteydi.…”