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Habek D. Traumatic testicular avulsion during amniotomy in vaginal breech delivery. Eur J Obstet Gynecol Reprod Biol 2023; 280:200. [PMID: 36494238 DOI: 10.1016/j.ejogrb.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Dubravko Habek
- School of Medicine, Catholic University of Croatia Zagreb, Croatia; Croatian Academy of Medical Sciences Zagreb, Croatia.
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Sommer-Jörgensen V, Künzli M, Holland-Cunz SG, Gros S, Frech M. A CARE-compliant article successful salvage of bilateral perinatal testicular torsion after delivery out of breech presentation: A case report and review of the literature. Medicine (Baltimore) 2020; 99:e21763. [PMID: 32899004 PMCID: PMC7478688 DOI: 10.1097/md.0000000000021763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Neonatal testicular torsion is a rare condition. There is no consensus about the optimal surgical treatment of neonatal testicular torsions. The salvage rate reported in literature remains poor. Discrimination of the onset of a neonatal testicular torsion seems to have an important impact of the salvage rate. Deliveries out of breech presentation have a risk for neonatal complications including neonatal genital birthtrauma. PATIENT CONCERNS A newborn boy, who was delivered at 40 weeks of gestation out of breech presentation, showed shortly after birth, a painful discoloration and swelling of the scrotum. DIAGNOSIS Clinical examination and ultrasound were highly suspicious for testicular torsion. INTERVENTION Emergency surgery revealed a bilateral testicular torsion with dark coloration of both testicles. The testicles were detorted and left in situ. A bilateral orchidopexy was performed. OUTCOMES Postoperative ultrasound showed reperfusion of both testicles and the boy was discharged from hospital. Follow-up after 2 months showed normal clinical examination and sonographically persistent perfusion of both testicles. Endocrinological investigations during minipuberty revealed normal hormonal values. LESSONS We present this rare case in regard to the current literature and recommend close observation of newborns for genital trauma after delivery out of breech position. We encourage surgeons to carefully consider leaving the testicles in situ.
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Alkhori NA, Barth RA. Pediatric scrotal ultrasound: review and update. Pediatr Radiol 2017; 47:1125-1133. [PMID: 28779199 DOI: 10.1007/s00247-017-3923-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/06/2017] [Indexed: 11/26/2022]
Abstract
In this pictorial essay the authors review the normal sonographic gray-scale and Doppler appearance of the pediatric scrotum with an emphasis on technique. The authors present an update on ultrasound diagnosis and outcomes in testicular torsion and differentiation from other acute scrotal processes, as well as sonographic imaging of testicular microlithiasis and uncommon or atypical scrotal masses including splenogonadal fusion, polyorchidism, meconium peritonitis and epidermoid cyst. Further, the authors discuss testicular neoplasms in the context of testicular microlithiasis.
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Affiliation(s)
- Noor A Alkhori
- Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital at Stanford, 725 Welch Road, Room 1890, Stanford, CA, 94304-5913, USA
| | - Richard A Barth
- Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital at Stanford, 725 Welch Road, Room 1890, Stanford, CA, 94304-5913, USA.
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Abstract
Undescended testis - known as cryptorchidism - is one of the most common congenital abnormalities observed in boys, and is one of the few known risk factors for testicular cancer. The key factors that contribute to the occurrence of cryptorchidism remain elusive. Testicular descent is thought to occur during two hormonally-controlled phases in fetal development - between 8-15 weeks (the first phase of decent) and 25-35 weeks gestation (the second phase of descent); the failure of a testis to descend permanently is probably caused by disruptions to one or both of these phases, but the causes and mechanisms of such disruptions are still unclear. A broad range of putative risk factors have been evaluated in relation to the development of cryptorchidism but their plausibility is still in question. Consistent evidence of an association with cryptorchidism exists for only a few factors, and in those cases in which evidence seems unequivocal the factor is likely to be a surrogate for the true causal exposure. The relative importance of each risk factor could vary considerably between mother-son pairs depending on an array of genetic, maternal, placental and fetal factors - all of which could vary between regions. Thus, the role of causative factors in aetiology of cryptorchidism requires further research.
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Saroha M, Batra P, Dewan P, Faridi M. Genital injuries in neonates following breech presentation. J Neonatal Perinatal Med 2015; 8:421-5. [PMID: 26757006 DOI: 10.3233/npm-15915025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Breech presentation is seen in 3-4% of babies born. Delivering a breech baby through vaginal route is difficult and carries a much higher complication rate than cesarean sections. Breech born babies carry an overall increased risk of maternal morbidity, neonatal mortality, birth asphyxia and birth injuries. Various types of birth injuries to the babies have been reported following breech delivery, but genital injuries are less commonly reported and thus, less anticipated. We report series of five babies with spectrum of genital injuries following breech delivery. These injuries led to significant short and long term morbidity in these babies. Keeping high index of suspicion, an early cesarean section can be an aide in preventing these complications. Once the baby is born, careful examination and early intervention should be done to prevent long term complications.
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Ulanovsky I, Gepstein V, Illivitzki A, Roth E, Makhoul IR. Are some clinicians missing a trick when it comes to gender at birth? (Discussion and diagnosis). Acta Paediatr 2014; 103:455-6. [PMID: 24628105 DOI: 10.1111/apa.12536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 11/28/2013] [Accepted: 12/04/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Irena Ulanovsky
- Department of Neonatology, Technion, Haifa, Israel; Department of Diagnostic Imaging, Rambam Health Care Campus, Technion, Haifa, Israel
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Lardellier F, Varlet F, François M, Audry G, Buisson P, Dubois R, Galinier P, Geiss S, Gorduza D, Kalfa N, Lacreuse I, Leclair MD, Merrot T, Paye-Jaouen A, Ravasse P, Sapin E, Teklali Y, Valla JS, Diraduryan N, Guye E, Lopez M. Traumatisme du testicule chez l’enfant. Basic Clin Androl 2010. [DOI: 10.1007/s12610-010-0097-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Résumé
Introduction
Les traumatismes du testicule sont rares chez l’enfant, et la littérature est très pauvre sur ce sujet. Le but était de les analyser à partir d’une étude multicentrique rétrospective.
Matériel et méthodes
Un questionnaire sur les traumatismes du testicule survenus entre 2000 et 2009 a été envoyé dans les différents centres de chirurgie pédiatrique français. L’analyse a été effectuée à l’aide du questionnaire et du compte rendu opératoire, et n’ont été retenus que les dossiers de traumatisme vrai du testicule, excluant les plaies simples du scrotum, les traumatismes « révélateurs » d’une torsion de testicule ou d’hydatide, ou encore les dossiers incomplets.
Résultats
Quinze centres ont bien voulu nous transmettre leurs observations et parmi ceux-ci, deux ont répondu n’avoir opéré aucun cas; cette étude n’est pas exhaustive, car beaucoup d’équipes ont envoyé des dossiers d’enfants opérés et aucun cas de traumatisme bénin. Parmi les 60 observations reçues, 45 ont été retenues. L’âge moyen était de 12,3 ans (2 jours–18 ans). Les circonstances du traumatisme étaient 23 coups (pied, genou, poing), 13 chutes (vélo, banc, luge), quatre accidents de la voie publique, quatre traumatismes de nature inconnue et un traumatisme obstétrical. Le traumatisme était fermé 41 fois et ouvert quatre fois. L’échographie-doppler couleur a été réalisée dans 34 cas sur 45 (75,5 %); un diagnostic exact a été possible 30 fois, alors qu’il y a eu trois faux-positifs (deux fractures du testicule et un hématome intratesticulaire non confirmés à l’intervention) et un faux-négatif (contusion de l’épididyme non vue à l’échographie). Les lésions testiculaires étaient les suivantes: 15 fractures, huit hématomes intratesticulaires, six contusions testiculaires bénignes (dont une associée à une tumeur), six hématomes du cordon, six contusions de l’épididyme, trois hématocèles isolées et une avulsion. Le traitement a été chirurgical 33 fois et non opératoire 12 fois. Parmi les 15 fractures du testicule, 13 ont été opérées (huit sutures et cinq orchidectomies partielles) et deux ont été surveillées avec de bons résultats, sans atrophie secondaire. Pour les hématomes intratesticulaires, trois ont été surveillés et cinq opérés. Seuls 20 enfants ont été suivis au-delà de quatre mois, essentiellement les fractures testiculaires, et aucune atrophie secondaire n’a été constatée.
Conclusion
Les traumatismes du testicule chez l’enfant sont rares, mais leur pronostic est plutôt bon. L’échographie-doppler permet désormais de faire un diagnostic précis dans un grand nombre de cas, devant permettre d’éviter certaines explorations chirurgicales systématiques; mais l’intervention reste indispensable en cas de doute.
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Coronel Sánchez B, Domínguez Hinarejos C, Serrano Durbá A, Martínez Verduch M, Estornell Moragues F, García Ibarra F. Infarto hemorrágico testicular en neonato: presentación de un caso. Actas Urol Esp 2004; 28:393-5. [PMID: 15270003 DOI: 10.1016/s0210-4806(04)73096-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hemorrhagic infarction of the testicle is an unusual occurrence in the newborn infant. It usually develops as a consequence of torsion of the spermatic cord. We report a case of global testicular infarction in a newborn associated with a tense hydrocele.
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Belfrage P, Gjessing L. The term breech presentation. A retrospective study with regard to the planned mode of delivery. Acta Obstet Gynecol Scand 2002; 81:544-50. [PMID: 12047309 DOI: 10.1034/j.1600-0412.2002.810612.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND To analyze retrospectively a large group of term breech and vertex deliveries, with regard to the influence of the mode of delivery on the frequency of fetal and maternal complications. METHODS All singleton breech deliveries after completed 36 weeks of pregnancy, with a live fetus, delivered at Rogaland Central Hospital, from September 1 1996 to the May 10 2001 were included (n = 575). Correspondingly as a control group, 582 cases in vertex presentation were analyzed. RESULTS Planned vaginal delivery (VD) for the fetus in breech presentation (n = 448) in comparison with elective caesarean section (CS) (n = 127) increased early neonatal morbidity (3.6% vs. 0%). The frequency of Apgar scores < 7 at 5 min also increased (4.2% vs. 0.8%), as well as umbilical artery pH < 7.0 (4.4% vs. 0%), and referrals to the neonatal intensive care unit (NICU) (15.8% vs. 6.3%). Corresponding figures for planned VD of the fetus in vertex presentation were: 0.5% neonatal morbidity, 0.2% Apgar scores < 7 at 5 min, 8.1% admissions to NICU and 1.5% pH < 7.0 in umbilical arteries. Results comparing maternal morbidity in the different breech groups were inconclusive, but there were more maternal complications in the breech group planned for VD than in the corresponding vertex group (5.1% vs. 1.9%). CONCLUSIONS Elective CS for breech presentation will significantly decrease the risks for the fetus in comparison with planned VD.
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Affiliation(s)
- Patrick Belfrage
- Department of Obstetrics and Gynecology, Rogaland Central Hospital, Stavanger, Norway.
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Mathews R, Sheridan ME, Patil U. Neonatal testicular loss secondary to perinatal trauma in breech presentation. BJU Int 1999; 83:1069-70. [PMID: 10368260 DOI: 10.1046/j.1464-410x.1999.00130.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- R Mathews
- Division of Pediatric Urology, Department of Urology, SUNY Health Science Center, Syracuse, NY, USA
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Albrechtsen S, Rasmussen S, Reigstad H, Markestad T, Irgens LM, Dalaker K. Evaluation of a protocol for selecting fetuses in breech presentation for vaginal delivery or cesarean section. Am J Obstet Gynecol 1997; 177:586-92. [PMID: 9322628 DOI: 10.1016/s0002-9378(97)70150-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Our purpose was to evaluate, with respect to obstetric intervention and neonatal outcome, a protocol for selecting fetuses in breech presentation for vaginal delivery or cesarean section. STUDY DESIGN A clinical follow-up study was performed between 1984 and 1992 of all term singleton deliveries in breech presentation. Each case selected for vaginal delivery had a matched control in vertex presentation. RESULTS A total of 1212 infants presented as breech. Vaginal delivery increased from 45% to 57% (p = 0.004), and cesarean section for failure of vaginal delivery declined from 21% to 6% (p < 0.00001). None, however, died or had long-term sequelae because of a complicated or failed vaginal breech delivery. A total of 8.8% of those delivered vaginally in breech versus 5.0% of those in vertex presentation were admitted to the neonatal intensive care unit (p = 0.009). Among those with vaginal delivery, 2.5% in breech presentation were given the clinical diagnosis of birth asphyxia versus none in the vertex position (p = 0.0001). CONCLUSION Breech presentation at term may be selected for vaginal delivery if properly managed.
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Affiliation(s)
- S Albrechtsen
- Department of Obstetrics and Gynecology, University of Bergen, Norway
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Rosegger H, Pusch H, Hauer A. Breech presentation: influence on male fertility? Eur J Pediatr 1994; 153:613-4. [PMID: 7957413 DOI: 10.1007/bf02190674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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