Perinatal extravaginal torsion of the testis in the first month of life is a salvageable event

Sorensen, Mathew D.; Galansky, Stanley H.; Striegl, Amanda M.; Mevorach, Robert A.; Koyle, Martin A.

doi:10.1016/s0090-4295(03)00402-3

Cited by 64 publications

(33 citation statements)

References 11 publications

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“…Patients with postnatal torsion have more favourable salvage rates of 30% to 40% and should undergo emergent surgical intervention. 4 It is controversial whether a contralateral orchidopexy is needed as it is an extravaginal process. One must weigh the risk of injuring a healthy, uninvolved contralateral testicle when proceeding with a prophylactic maneuver to prevent potential future torsion.…”

Section: Discussionmentioning

confidence: 99%

Incarcerated inguinal hernia in infancy associated with testicular infarction: Case report and review of the literature

Alyami

Whelan

2013

CUAJ

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One of the most common urgent urologic problems seen in young patients in the emergency department is the acute scrotum. Testicular infarction from an incarcerated inguinal hernia is an unusual presentation and often not considered in the initial evaluation. We present an interesting case of a 28-day-old boy who presented with an acute scrotum and was found to have a testicular infarction and an incarcerated inguinal hernia. The management of similar cases in young males may vary depending on which surgical service is consulted initially and a scrotal ultrasound should be done without any delay. Case reportA 28-day-old boy with right scrotal swelling was brought in to the emergency department (ED) by his parents. His mother noticed he was irritable and crying on the morning of the presentation. He was breastfeeding with no vomiting, diarrhea or other symptoms. He saw his family physician at noon and had a normal exam. His mother later noticed right-sided scrotal swelling while changing his diaper and he started to be more irritable. There was no history of trauma. His medical history revealed an uncomplicated delivery and normal neonatal physical exam. His family history was unremarkable.He was seen in the ED by the emergency physician within 3 hours of the scrotal swelling. Urology was consulted to rule out testicular torsion.He was comfortable and not in distress. His vital signs were within the normal ranges and he was well-hydrated. Chest exam was normal. The abdomen was soft and nontender. The right scrotum was swollen and tender. There was no change in the scrotal skin colour. The left testicle was easy to feel and felt normal in the scrotum. It was difficult to palpate the right testicle as there was palpable right swelling suggestive of inguinoscrotal hernia. Scrotal transillumination was negative. He was uncircumcised with a normal phimotic foreskin. The cremasteric reflex was absent on the right side and present on the left side. The rest of the examination was unremarkable.The scrotal ultrasound showed evidence of bowel contents in the right scrotum, no blood flow to the right testicle and a reactive hydrocele. There was normal blood flow to the left testicle (Fig. 1). The patient was immediately taken to the operating room. The general surgery team was consulted and reduction of the hernia was done under anesthetic before the scrotal exploration. We used bilateral transverse scrotal incisions for exposure because of surgeon preference. Intraoperative examination revealed an ischemic looking right testicle with torsion of the spermatic cord (Fig. 2). The right testicle was detorted and wrapped in warm gauze. We proceeded with performing an orchidopexy on the left testicle. The left testicle was normal. After 30 minutes we inspected the right testicle again and it was still black in colour. The tunica albuginea was incised and it did not bleed. As a result, it was felt that the testicle was non-viable and a right orchiectomy was performed. The general surgery team decided not to repair the hern...

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Section: Discussionmentioning

confidence: 99%

Incarcerated inguinal hernia in infancy associated with testicular infarction: Case report and review of the literature

Alyami

Whelan

2013

CUAJ

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“…5 Other authors present the advantages of immediate surgical exploration, which include salvaging of the testis in some newborns, prevention of the development of autoantibodies against spermatogenesis, ability to perform a simultaneous contralateral orchidopexy, and the definitive exclusion of a diagnostically missed testicular tumor. 3 In a study by Sorensen et al 6 on 10 newborns with extravaginal testicular torsion, 40% of the concerned testes were salvaged by immediate surgical intervention. 6 Meanwhile, a general consent has been reached to perform contralateral orchidopexy in children with unilateral testicular torsion, as otherwise anorchidy might be risked in view of a contralateral torsion rate of 5%, even though literature documents cases of testicular atrophy as a result of orchidopexy.…”

Section: Das and Singermentioning

confidence: 99%

“…3 In a study by Sorensen et al 6 on 10 newborns with extravaginal testicular torsion, 40% of the concerned testes were salvaged by immediate surgical intervention. 6 Meanwhile, a general consent has been reached to perform contralateral orchidopexy in children with unilateral testicular torsion, as otherwise anorchidy might be risked in view of a contralateral torsion rate of 5%, even though literature documents cases of testicular atrophy as a result of orchidopexy. 7 Testicular tumors mostly appear as painless scrotal swelling and resemble testicular torsion in the neonatal period.…”

Section: Das and Singermentioning

confidence: 99%

Intrauterine Torsion of a Testicular Teratoma: A Case Report

et al. 2005

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“…The salvage rate for postnatal cases is comparable with previous reports. 8,10,14,15,[23][24][25][26] Our study had several limitations including its retrospective nature and the limited number of cases. In addition, we did not explore how the use of ultrasound can reduce the surgical exploration rate, an important topic for future studies.…”

Section: -11mentioning

confidence: 99%

Ultrasound assessment of perinatal testicular torsion

Xiao

Gao

et al. 2016

BJR

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contributed equally to this study.Objective: The goal of this study was to elucidate the different sonographic features of prenatal and postnatal testicular torsion (TT) using high-frequency colour Doppler ultrasound (HCDU) in an effort to increase diagnostic accuracy. Methods: 29 patients (average age, 7.5 days) with perinatal TT were divided into patients with postnatal (acute) TT vs patients with prenatal (chronic) TT and their clinical characteristics, imaging features on HCDU and surgical pathology results were retrospectively analyzed. Results: Significant differences were observed between prenatal and postnatal TT cases with regard to testicular size (p 5 0.01) and echogenicity (p 5 0.007). All 17 prenatal cases had non-homogeneous testicular parenchymal echo patterns compared with only 9 (64.3%) postnatal TT cases. Five postnatal TT cases presented with homogeneous echo patterns compared with none of the prenatal TT cases. Testicular blood supply was absent in 25 (80.7%) of 31 testes on colour Doppler flow imaging, with the majority occurring in the prenatal TT cases [i.e. 16 (94.1%) cases]. 1 affected testis out of a total 17 testes from 16 patients with prenatal TT was salvaged, with a salvage rate of 1/17 or 0.06%. 7 affected testes out of a total 16 testes from 13 patients with postnatal neonatal TT were salvaged, with a salvage rate of 7/16 or 43.8%. Conclusion: In neonates with acute scrotal symptoms, the possibility of perinatal TT should be considered and HCDU examination should be performed in a timely manner. HCDU examination could aid in testicular salvage by prompting quick surgical intervention. Advances in knowledge: This study underlined the clinical contribution of HCDU in evaluating postnatal (acute) vs prenatal (chronic) TT. The sonographic features of postnatal TT with salvageable testes were compared with prenatal torsion and the relative salvage rates in both cases were discussed.

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Perinatal extravaginal torsion of the testis in the first month of life is a salvageable event

Cited by 64 publications

References 11 publications

Incarcerated inguinal hernia in infancy associated with testicular infarction: Case report and review of the literature

Incarcerated inguinal hernia in infancy associated with testicular infarction: Case report and review of the literature

Intrauterine Torsion of a Testicular Teratoma: A Case Report

Ultrasound assessment of perinatal testicular torsion

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