[A Case of Prenatal Testicular Torsion].

We report a prenatal case of neonatal testicular torsion. A 0-day-old boy with left scrotal swelling from the time of birth was referred to us. The physical examination revealed left intrascrotal hard mass. The ultrasonography with doppler color flow showed heterogeneous parenchymal echogenicity and the lack of blood flow to the affected testis. Testicular torsion was suspected and emergent surgical exploration was performed. The left testis was necrotic with extravaginal torsion of the spermatic cord. Left high orchiectomy was performed, considering the possibility of inguinal hernia. The histopathological examination confirmed the necrosis of the left testis.

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

OBJECTIVES: The objectives of this study are to present our collective experience with the prenatal diagnosis of testicular torsion and to propose a possible prenatal management scheme. METHODS: We retrospectively collected and reviewed all medical records of cases that were diagnosed with perinatal testicular torsion in our medical center between the years 2002 and 2013. Prenatal torsion was categorized as torsion diagnosed in utero or on immediate newborn examination. RESULTS: A total of five unilateral prenatal torsions were diagnosed. Two fetuses were diagnosed in the third trimester of pregnancy. In both cases, cesarean section was performed immediately upon diagnosis. One newborn underwent immediate orchiectomy with contralateral orchiopexy. Torsion was confirmed by pathological examination. The other was managed conservatively, just as the three newborns who were diagnosed immediately after birth. On follow-up scan, the affected testicle was found atrophied with lack of blood flow on color Doppler examination. The unaffected contralateral testicle remained within the normal size with good blood flow. CONCLUSIONS: 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.

An infant with an ectopic torsed testis in the abdominal wall.

We report a unique case of an infant with testicular torsion in the anterior abdominal wall. In the work-up of acute abdominal pain in a male infant with nonpalpable testes, a careful search for the testes using ultrasound can often identify undescended or ectopic testes. Testicular torsion should remain an important consideration as a potential cause of abdominal pain in this selected group of individuals.

Intravaginal testicular torsion in newborns. To fix or not to fix the contralateral testis?

Scrotal swelling suggesting testicular torsion is a rare urological emergency which requires a clinical urgent evaluation and most of the times must be managed surgically. In newborns it can occur in the postnatal period, usually within the twenty-eighth day of life, or more frequently in utero, during the descent of the testis into the scrotum. Usually its poor fixedness allows the testis an abnormal mobility inside the scrotum, configuring the framework of extravaginal torsion. On the contrary during the perinatal period a twist that takes place inside the tunica vaginalis, known as intravaginal torsion, is extremely uncommon and only few cases are well documented in the literature. Authors present a rare case of intravaginal testicular torsion occurred in perinatal period. In this situation only the early surgical exploration of the scrotum may allow the rescue of the gonad, although in rare cases. Timing of surgical treatment and need for contralateral testicular fixation remain controversial. However since the anatomical defect of the tunica vaginalis can be bilateral the surgical fixation even of the contralateral testis is important, now or later, in order to prevent any future torsion of this gonad. The authors also present a brief review of recent literature on the subject.

[Bilateral perinatal torsion of spermatic cord - a case report and literature review]. / Oboustranná perinatální torze semenného provazce - kazuistika a prehled literatury.

INTRODUCTION: Perinatal spermatic cord torsion represents a less common manifestation of spermatic cord torsion. In newborns, normal fixation between testicular coverings and tunica dartos is not yet well established, and abnormal testicular mobility results in extravaginal type of torsion. Salvage rate of testes after detorsion is low. Management of perinatal torsion still remains a controversial issue. Some authors refuse scrotal exploration as useless, their opponents recommend emergent bilateral surgical exploration for the protection of the healthy gonad. CASE STUDY: Authors report a case of a newborn who underwent scrotal exploration for clinical signs of the right-side perinatal torsion. The right completely necrotic testicle was removed. It was decided to fix the contralateral testis to prevent torsion. However, the exploration of the left testicle revealed ischemic damage corresponding to the asynchronous perinatal torsion after its spontaneous detorsion. The testicle was left (preserved) in scrotum and fixed. The follow-up then confirmed the loss of functional testicular tissue. This is the first case of bilateral perinatal torsion described in the Czech and Slovak literature. CONCLUSIONS: Perinatal spermatic cord torsion may result in a severe complication - bilateral testicular atrophy due to asynchronous torsion of the contralateral testicle. The authors demonstrate that in newborns physical examination and ultrasonography may be not sensitive enough for the assessment of the testis condition. In the light of the case study and literature reviewed they strongly recommend early bilateral scrotal exploration with preventive testes fixation to protect the healthy gonad.

Neonatal testicular torsion: a systematic literature review.

Neonatal testicular torsion (NTT) is rare and reported salvage rates vary widely both in their cited frequency and plausibility. The timing and necessity of surgery is controversial with different centers arguing for the conservative management of all cases while others argue for prompt exploration for all. Confusion also reigns over the need to fix the contralateral testis. In order to clarify the issue the authors reviewed the literature and found 18 case series of NTT, containing 268 operated cases suitable for analysis. This paper reviews the literature on NTT specifically regarding salvage rates and timing/necessity of surgery. Its primary aim is to produce an overall salvage rate in the operated group. Overall salvage rate was 8.96%, 24 testes. When operation is specified as an emergency, salvage may be as high as 21.7%. While salvage of a testis torted at birth is rare, it is reported. Early asynchronous torsion is also rare but reported. Worryingly, bilateral torsion can present with unilateral signs.Given these findings, we would suggest early surgery with fixation of the contralateral side.

New insights into perinatal testicular torsion.

Perinatal testicular torsion is a relatively rare event that remains unrecognized in many patients or is suspected and treated accordingly only after an avoidable loss of time. The authors report their own experience with several patients, some of them quite atypical but instructive. Missed bilateral torsion is an issue, as are partial torsion, possible antenatal signs, and late presentation. These data are discussed together with the existing literature and may help shed new light on the natural course of testicular torsion and its treatment. The most important conclusion is that a much higher index of suspicion based on clinical findings is needed for timely detection of perinatal torsion. It is the authors' opinion that immediate surgery is mandatory not only in suspected bilateral torsions but also in cases of possible unilateral torsions. There is no place for a more fatalistic "wait-and-see" approach. Whenever possible, even necrotic testes should not be removed during surgery because some endocrine function may be retained.

[Bilateral intrauterine testicular torsion in a mature newborn]. / Bilaterale intrauterine Hodentorsion bei einem reifen Neugeborenen.

Bilateral intrauterine testicular torsion is an extremely rare emergency and can be difficult to diagnose due to its diverse manifestation and potential differential diagnoses. In time surgical intervention is crucial for the retention of testicular function. We present a newborn with a bilateral testicular torsion, in which one testicle could be saved after detorsion. The contralateral side showed hemorrhagic infarction and was removed. Since organ preservation is rarely successful, the surgical therapy is discussed controversially.

Bilateral testicular torsion in a 36-week neonate.

A male neonate born after uncomplicated vaginal delivery at 36 weeks' gestation was noted to have large and firm testicles bilaterally on routine examination. A testicular ultrasound scan was subsequently organised that showed detailed appearances consistent with bilateral testicular torsion. This was thought to have taken place antenatally and as such was unfortunately not suitable for intervention. The patient was therefore managed conservatively with the testicles left to involute naturally. He was started on testosterone replacement therapy after follow-up when gonadotrophin levels were found to be raised and testosterone low (suggesting absent testicular function) and will be closely followed up regarding his future development which is normal to this point.

Right testicular necrosis and left vanishing testis in a neonate.

We describe a rare case of right testicular necrosis and left vanishing testis in a neonate. The patient presented with a right swollen testis and left non-palpable testis at birth. Exploratory laparotomy was performed at 23 days after birth, and the right testis was extirpated because of extensive necrosis due to torsion of the spermatic cord. Histopathological examination revealed a massively necrotic testicular structure with hypertrophy of Leydig cells. Hypergonadotropinemia was also recognized before operation. On laparoscopy at the age of 5.3 years, a normal left vas deferens and spermatic vessels exiting through the internal inguinal ring were confirmed, although the patient's left testis was not found in the intraperitoneal cavity. An hCG test demonstrated no response of serum testosterone. These findings suggested a diagnosis of left vanishing testis due to testicular regression. We therefore speculated that bilateral asynchronous testicular torsion had occurred prenatally in this patient.

Intrauterine torsion of a testicular teratoma: a case report.

Neonatal testicular tumors and intrauterine testicular torsions are very rare. The presented case is the first describing intrauterine torsion of a descended testis with a teratomatous tumor. Immediately after birth, right hemiscrotal swelling was seen in a preterm male newborn. Surgical intervention showed extravaginal testicular torsion and a highly differentiated testicular teratoma with haemorrhagic infarction. The testis was removed (orchiectomy). Over a period of twelve months no signs of tumor recurrence were found. While being extremely rare, testicular tumors should be included in the differential diagnosis of neonatal scrotal swelling.

Intrauterine torsion of an intra-abdominal testis.

Intra-abdominal torsion of an undescended testis is a rare surgical problem in the neonate. However, one must consider the possibility of intrauterine torsion in a neonate who presents with an undescended testis and an abdominal mass.

Bilateral synchronous neonatal torsion of spermatic cord.

A case of synchronous bilateral spermatic cord torsion in a neonate is presented. While testicular salvage is variable in this entity, surgical intervention is necessary for any hope of testicular preservation.

Color Doppler ultrasound in newborn testis torsion.

OBJECTIVES: To assess the usefulness of color Doppler ultrasound in evaluating the newborn with suspected antenatal testis torsion. METHODS: Nine newborns with 10 antenatally torsed testes were examined using color Doppler and gray-scale ultrasound. RESULTS: Each examination revealed lack of intratesticular blood flow on the affected side and normal flow within the contralateral testis. In addition, gray-scale sonographic architecture of the affected testes appeared to reflect the duration of in utero torsion. CONCLUSIONS: Color Doppler sonography accurately assesses intratesticular blood flow in newborns with antenatal testis torsion and offers interesting details.

Intrauterine testicular torsion: not an emergency.

A case of intrauterine testicular torison and infarction is described. Urgent exploration of the testis has been advocated in the management of this condition. However, the risks of early anesthesia in the immediate postdelivery period must be weighed against the chances of a successful outcome of the operation in preserving testicular function. Since this salvage rate is poor, we suggest surgical exploration at a time when the infant's condition is stable, unless there are indications that the event is very recent.

Uni- and bilateral torsion of the testes in the neonate; a report of two cases.

One case of unilateral and one case of bilateral torsion of the testes in the neonate are presented together with a review of the literature for bilateral cases. Finally some recommendations are made for the dealing with this rare but important illness of the neonate.

Protection of the solitary testis.

In 15 negative explorations for unilateral cryptorchidism, inspection of the contralateral scrotum revealed a "bell-clapper" deformity in 13 patients. Since the descent of the testis is influenced by the gubernaculum and gubernacular abnormalities are usually bilateral, the data suggest that an inadequate gubernaculum is associated with most instances of antenatal and postnatal torsion. Unilateral absence of the testis is a form of this syndrome; congenital monorchidism is probably due to antenatal torsion rather than hypoplasia or agenesis. When monorchidism is confirmed at operation, exploration and suture fixation of the contralateral testis at the same procedure is recommended to protect the solitary testis from future torsion.

Torsion of an undescended intraabdominal benign testicular teratoma.

A 4-year-old well boy was seen because of an asymptomatic left testicle undescended since birth; the testis was not palpable and the right side was normal. After an episode of left lower quadrant and left hip area pain, with some bladder symptoms and left leg limping, a work-up including a CAT scan showed a calcified retroperitoneal pelvic tumor on the left side. At laparotomy, an infarcted mass was found in the pelvis just above the internal ring. It was a torsion of an undescended intraabdominal testis with a benign testicular teratoma. The tumor was removed and his recovery was uneventful.