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

Komarowska, Marta; Pawelczyk, Alicja; Matuszczak, Ewa; Dębek, Wojciech; Hermanowicz, Adam

doi:10.3389/fped.2020.575741

Cited by 9 publications

(14 citation statements)

References 38 publications

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“…[ 17 ] In children presenting with abdominal groin pain and empty ipsilateral scrotum, torsion of undescended testis should be considered. [ 18 ] Torsion of cryptorchidism is accounted for about 5% in all testicular torsion cases, [ 19 ] and the incidence of torsion of cryptorchidism appears to be higher than torsion of normally descended testis. [ 20 , 21 ] Physical examination is crucial in diagnosing testicular torsion.…”

Section: Discussionmentioning

confidence: 99%

“…About 40% of boy undergoing surgery for testicular torsion performed orchiectomy, [ 3 ] and rate of orchiectomy is higher in torsion of cryptorchidism than in torsion of descended testis. [ 19 , 29 ] Another study revealed poor rates of surgical salvage in torsion of cryptorchidism. [ 30 ] It was because the atypical presentations made parents underestimate the children’s condition.…”

Section: Discussionmentioning

confidence: 99%

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Atypical symptoms of testicular torsion in a 7-year-old child: A case report

Guo

2023

Medicine

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Rationale: Testicular torsion accounting for 25% of acute scrotal disease, is an acute surgical condition. Atypical presentations of testicular torsion may lead delay diagnosis. Patient concerns: A 7-year-old boy was admitted to the pediatric emergency department with continuous and progressive left scrotal pain for 2 days, associated symptoms and signs included left scrotal swelling and erythema. The pain started 4 days ago as left lower abdominal pain which then migrated to the left scrotum. Diagnoses: Physical examination showed left scrotum skin redness, swelling, local heat, tenderness, high-riding testis, absence of the left side cremasteric reflex and a negative Prehn’s sign. Subsequent point of care ultrasound of scrotum revealed increased volume of the left testicle, inhomogeneous hypo-echoic left testis, and no detectable flow in the left testis. Left testicular torsion was diagnosed. Interventions: Surgical examination confirmed testicular torsion showing 720° counterclockwise rotation of the spermatic cord with ischemic changes in the left testis and epididymis. Outcomes: The patient was stabilized and discharged after left orchiectomy, right orchiopexy and antibiotic therapy. Lessons: Symptoms of testicular torsion may be atypical, especially in prepubertal age. Detailed history, physical examination, point of care ultrasound usage and timely urologist consultation and intervention are important for prompt rescue to prevent testicular loss, testicular atrophy, and eventual impairment of fertility.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Atypical symptoms of testicular torsion in a 7-year-old child: A case report

Guo

2023

Medicine

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“…These patients required a high index of suspicion of TT, and then an urgent ultrasound scan was performed. Moreover, about 5% of patients who presented with torsion suffered from cryptorchidism, which may be explained by incorrect spasm or contraction of cremasteric muscle ( 21 , 22 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and identification of risk factors of testicular torsion in children: A retrospective study in a single institution

Zhang

Zhang²,

Chen³

2023

Front. Surg.

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BackgroundTesticular torsion (TT) is a common urological emergency posing serious health problem in children. Prompt diagnosis and treatment of TT are very important for children to protect the affected testis. The aim of this study was to evaluate the historical features, physical examination findings, laboratory tests, and ultrasound examinations in children with TT, as well as to identify the predictors of testicular salvage in children.Materials and methodsWe conducted a retrospective record of clinical findings, laboratory data, ultrasound findings, operating results, and the results of follow-up in hospitalized children with TT from November 2004 to December 2021. A multivariable logistic regression model was used to identify predictors of testicular salvage.ResultsA total 102 hospitalized children who presented with TT were included. Patients were aged from 1 month to 16 years, with a median age of 7.71 years. TT is significantly more common in the winter. Of these patients, 77 torsions were left-sided, 24 were on the right side, and only 1 was on bilateral sides. Meanwhile, we detected that 88 children suffering from TT had intravaginal torsion of the spermatic cord, and the rest were outside. Anticlockwise torsion was found in 65 cases (63.73%) and clockwise torsion in 37 (36.27%). As a result, 60 underwent orchidectomy, while 42 had a scrotal exploration with fixation of the testis. Multivariate analysis showed that cause of TT, time to intervention, white blood cell (WBC), and mean platelet volume (MPV) were correlated with the risk of a surgical outcome.ConclusionOnly a small proportion of TT children received timely surgical management. Testicular salvage can be predicted by cause of TT, time to intervention, WBC, and MPV. Early scrotal exploration based on careful physical examination decreases the risk of misdiagnosis of spermatic cord torsion. A certain percentage of children with TT presenting with scrotal trauma or epididymo-orchitis should have their testicles checked to make sure that they do not have torsion, especially those who visit in the cold season.

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“…Testicular torsion of cryptorchidism can occur at all ages ( 5 ). Cases of cryptorchid testicular torsion have been reported in patients ranging in age from 16 days to 14 years ( 6 , 12 , 13 ). In our study, the age of onset was mostly before puberty, specifically during infancy and early childhood.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and treatment of cryptorchid testicular torsion in children: A 12-year retrospective study

et al. 2022

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PurposeTo investigate the clinical characteristics, treatment, and prognosis of cryptorchid testicular torsion in children.MethodsThe clinical data of 25 children who received treatment for cryptorchid testicular torsion between January 2010 and December 2021 were retrospectively reviewed. The median age of the patients was 64.5 months (range: 2 months to 15 years). All patients had unilateral torsion, and the duration of symptoms ranged from 3 to 192 h.ResultsAmong the 25 patients, five underwent orchidopexy, while the remaining 20 underwent orchiectomy. After 6 months to 8 years of follow up, the 20 patients who had undergone orchiectomy had a well-developed testis on the healthy side. Four of the five patients who had undergone orchidopexy of the affected testis had well-developed testes bilaterally, while one experienced testicular atrophy.ConclusionCryptorchid testicular torsion is a rare urological emergency that displays a delayed presentation and is often misdiagnosed. Clinicians need to carefully review the patient's medical history and ultrasound findings and perform a thorough physical examination to make a correct diagnosis. Active testicular exploration is required for patients suspected to have cryptorchid testicular torsion, and the decision to perform orchidopexy or orchiectomy depends on the intraoperative situation.

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

Cited by 9 publications

References 38 publications

Atypical symptoms of testicular torsion in a 7-year-old child: A case report

Atypical symptoms of testicular torsion in a 7-year-old child: A case report

Clinical characteristics and identification of risk factors of testicular torsion in children: A retrospective study in a single institution

Diagnosis and treatment of cryptorchid testicular torsion in children: A 12-year retrospective study

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