Prenatal bilateral extravaginal testicular torsion?a case presentation

Abstract

A newborn male presented at birth with findings consistent with bilateral testicular torsion. Preoperative ultrasound demonstrated no flow to either testicle, and he underwent surgery, during which bilateral extravaginal testicular torsion was confirmed. The right testicle was grossly necrotic and orchidectomy was performed, whereas the left testicle was indeterminate and underwent detorsion and orchidopexy. At 6-month follow-up, the left testicle remained within normal clinical limits with good flow on ultrasound examination.

Testicular torsion in the inguinal region in an extremely low birth weight infant

“…Intravaginal torsion is seen mostly in older children and adult, which is related with tunica vaginalis that not only surrounds the testicle and most of the epididymis, but also surrounds the spermatic cord allowing free ration of the structures within the tunica3). On the other hand, extravaginal torsion is seen mainly in neonates3), which is associated with the lack of tunica vaginalis attachment to the scrotum4), occurring at the level of the spermatic cord5). However, one distinctive feature of intravaginal torsion of our case is that it is observed in an ELBWI and at 23 days of age.…”

“…In the experimental models of testicular ischemia, spermatogenesis is lost after 6 hours and endocrine secretion ceases at 10 hours4, 7). Besides, when patients with testicular torsion were followed up without immediate surgery, affected testis showed progressive atrophy3, 5).…”

Perspectives in Pediatric Pathology, Chapter 19. Testicular Torsion, Testicular Appendix Torsion, and other Forms of Testicular Infarction

“…Taylor [46] described the first case of neonatal testicular torsion in 1897, and Frederick reported the first cases of neonatal bilateral testicular torsion in 1907. Bilateral forms comprise between 12% and 21% of neonatal torsions [42,47]. Neonatal cases account for 57% of testicular torsions in males below 1 year of age.…”

“…Histological changes evolve in time from hemorrhage with extensive necrosis to fibrosis with dystrophic calcification ). The salvage rate for testicular torsion in newborns and in older boys is estimated at between 22% and 50% [47].…”

Testicular torsion: a race against time

“…However, rarely it may be bilateral (13). For instance, Sorensen et al (14) recently reported the case of a male newborn who developed bilateral extravaginal testicular torsion. In extravaginal torsion, the torsion occurs outside the tunica vaginalis while in intravaginal torsion, it occurs within the tunica vaginalis.…”