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Omran K, Ali SA, Ahmad E, Matta H, Al Tamr WJ. Neonatal Testicular Torsion with Hydrocele: A Case Report Underscoring the Need for Early Recognition and Management. Case Rep Surg 2023; 2023:9979543. [PMID: 38115955 PMCID: PMC10728354 DOI: 10.1155/2023/9979543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/23/2023] [Accepted: 11/25/2023] [Indexed: 12/21/2023] Open
Abstract
Neonatal testicular torsion (NTT) is a rare but significant condition occurring within the first 30-day postbirth, leading to vascular compromise and potential testicular loss. This paper presents a case of NTT detected incidentally in a neonate with bilateral hydrocele, emphasizing the challenge of early diagnosis and management complexities. The infant underwent surgical intervention involving detorsion and bilateral orchiopexy but eventually required right orchiectomy due to necrosis. The paper highlights the prevalence of NTT in conjunction with hydrocele and stresses the importance of parent education and vigilant follow-up. Various diagnostic methods, primarily ultrasonography, and a range of management strategies are discussed, considering factors such as salvage potential, risk to the contralateral testicle, and surgical intervention's risks and benefits. The paper argues for individualized management, taking into account specific neonate conditions and parental preferences, underlining the essential role of informed and empathetic consultation. The case reinforces the urgent need for increased awareness, early detection, and carefully considered therapeutic approaches to prevent devastating outcomes like infertility and the necessity for lifelong hormone supplementation.
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Affiliation(s)
- Kareem Omran
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 1TN, UK
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2
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A case of intra-vaginal intrauterine testicular torsion. CASE REPORTS IN PERINATAL MEDICINE 2023. [DOI: 10.1515/crpm-2022-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Objectives
Intrauterine testicular torsion is extremely rare and the exact cause remains largely unknown. It is the result of an ischemic insult intrauterine, which presents as either extra-vaginal or intravaginal testicular torsion. Urgent surgical exploration and fixating the contralateral testis is key in the management of this condition.
Case presentation
We present here the case of a two-day old neonate with in-born right scrotal swelling admitted at Children’s hospital. The patient was born at term via cesarean section at a private hospital. Upon arrival in the emergency department, he was well hydrated, pink at room temperature with good perfusion. Upon examination, the right testis was found to be enlarged, tense, non-tender visibly reddish with overlying skin excoriation. Trans-illumination was negative in right but positive in the contralateral testis. Both hernial orifices were normal. Doppler ultrasound of the inguinoscrotal area found the right testis to be enlarged (15.6*9.4 mm) and showed heterogeneous hypoechoic texture with prominent rete testis and no flow on color doppler analysis. An urgent scrotal exploration was undertaken. Intra-operatively there was frank necrotic right testis with intravaginal torsion of the testis and minimal hydrocele. A right orchidectomy and contralateral orchidopexy were performed.
Conclusions
Intrauterine testicular torsion should be treated as a surgical emergency. We advocate early recognition of intrauterine testicular torsion, alongside surgical exploration and simultaneous contralateral orchidopexy.
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3
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Yadav P, Erlich T, Zlotnik M, Khondker A, O'Kelly F, Traubici J, Chua ME, Koyle MA. Ultrasonographical features of perinatal testicular torsion: an assessment of interobserver variability among radiologists and pediatric urologists. Pediatr Surg Int 2022; 38:2053-2058. [PMID: 36261731 DOI: 10.1007/s00383-022-05260-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To retrospectively compare interpretations of Doppler ultrasound (US) in newborns with confirmed perinatal testicular torsion (PTT) by an experienced faculty (staff) pediatric radiologist (SPR), pediatric radiology fellow (PRF), pediatric urology fellow (PUF) and staff pediatric urologist (SPU). METHODS US images of 27 consecutive males with PTT between May 2000 and July 2020 were retrieved. The testicles were classified as affected or non-affected by PTT. We performed a blinded comparison of interpretation by four assessors (SPR, PRF, PUF, SPU), with respect to the US features of PTT. Paired inter-rater agreement was calculated using Cohen's Kappa (κ) and overall agreement was assessed using Fleiss' kappa. RESULTS Overall comparison using Fleiss' kappa found fair agreement for most features except testicular echogenicity and echogenic foci at interface for which there was poor agreement. Paired comparisons revealed better agreement between the SPR and PRF compared to the remaining two pairs, suggesting a need for the pediatric urologists (PUF and SPU) to acquaint themselves with testicular ultrasonography as this may have an impact on patient risk stratification and the quality of information given to parents. CONCLUSION This study highlights the need for focused training program for pediatric urologists to attain similar agreement as the radiologists, suggesting a need for the pediatric urologists (PUF and SPU) to acquaint themselves with testicular ultrasonography as this may have an impact on patient risk stratification and the quality of information given to parents.
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Affiliation(s)
- Priyank Yadav
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. .,Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
| | - Tomer Erlich
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Margalit Zlotnik
- Division of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Adree Khondker
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Fardod O'Kelly
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Pediatric Urology, Beacon Hospital, Dublin, and School of Medicine, University College Dublin, Dublin, Ireland
| | - Jeffrey Traubici
- Division of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Michael E Chua
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines
| | - Martin A Koyle
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Sonographic evaluation of fetal scrotum, testes and epididymis. Obstet Gynecol Sci 2021; 64:393-406. [PMID: 34176256 PMCID: PMC8458611 DOI: 10.5468/ogs.21040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 06/15/2021] [Indexed: 11/16/2022] Open
Abstract
External male genitalia have rarely been evaluated on fetal ultrasound. Apart from visualization of the penis for fetal sex determination, there are no specific instructions or recommendations from scientific societies. This study aimed to review the current knowledge about prenatal diagnosis of the scrotum and internal structures, with discussion regarding technical aspects and clinical management. We conducted an article search in Medline, EMBASE, Scopus, Google Scholar, and Web of Science databases for studies in English or Spanish language that discussed prenatal scrotal pathologies. We identified 72 studies that met the inclusion criteria. Relevant data were grouped into sections of embryology, ultrasound, pathology, and prenatal diagnosis. The scrotum and internal structures show a wide range of pathologies, with varying degrees of prevalence and morbidity. Most of the reported cases have described incidental findings diagnosed via striking ultrasound signs. Studies discussing normative data or management are scarce.
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Osemlak P, Jędrzejewski G, Woźniak M, Nachulewicz P. Ultrasound evaluation of long-term outcome in boys operated on due to testicular torsion. Medicine (Baltimore) 2021; 100:e26057. [PMID: 34032733 PMCID: PMC8154497 DOI: 10.1097/md.0000000000026057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/30/2021] [Indexed: 11/16/2022] Open
Abstract
We aimed at verifying the usefulness of spectral Doppler ultrasonography in determining development of the testis after torsion in boys.The study involved 28 patients and 30 control cases divided into 3 developmental groups: pre-pubertal, early pubertal, and pubertal. It presented surgical management in testicular torsion (TT), volume, and echogenicity of testes, as well as peak-systolic velocity (PSV), end-diastolic velocity (EDV), and vascular resistance index (RI) in the capsular and intra-testicular arteries, regarding developmental groups, detorsed testes, uninvolved ones, and testes in the control group.Orchiectomy was performed in 13 boys with complete TT, in 11 lasting for over 24 hours, and in 2 lasting for 9 and 10 hours, respectively. Orchiectomy mainly involved patients aged up to 6 years, who at the time of the follow-up ultrasound belonged to the pre-pubertal group.There is no clear correlation between the type of testicular torsion, its duration, and the echogenicity of the testis. Testicular torsion has a negative effect on the volume of detorsed testis with compensatory hypertrophy of the uninvolved testis. The study represents a new approach to the issue of long-term gonadal blood supply abnormalities after treatment of testicular torsion in childhood.
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Affiliation(s)
- Paweł Osemlak
- The Department of Pediatric Surgery and Traumatology
| | - Grzegorz Jędrzejewski
- The Department of Pediatric Radiology, University Children's Hospital of Lublin, Medical University of Lublin, Lublin, Poland
| | - Magdalena Woźniak
- The Department of Pediatric Radiology, University Children's Hospital of Lublin, Medical University of Lublin, Lublin, Poland
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6
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Monteilh C, Calixte R, Burjonrappa S. Controversies in the management of neonatal testicular torsion: A meta-analysis. J Pediatr Surg 2019; 54:815-819. [PMID: 30098810 DOI: 10.1016/j.jpedsurg.2018.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/10/2018] [Accepted: 07/03/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This meta-analysis seeks to discern the optimal management strategy in neonatal testicular torsion (NTT). METHODS Reviewed all English-language articles published between 2005 and 2015 in Medline/Pubmed that had a defined diagnosis of NTT within the first thirty days of life, and discussed specific surgical and nonsurgical management. Exclusion criteria were non-English literature, case reports, case studies, and failure to clearly describe the management of NTT. Data from 9 studies were analyzed, individually and together as pooled data, using a random effect model with a random intercept to estimate the pooled proportions of interest. Results are presented with 95% confidence interval. All analyses were done in SAS 9.4®. RESULTS 9 publications met criteria for this analysis with a total of 196 patients. Bilateral testicular torsions (n = 14) were less common as compared to right/left testicular torsion (n = 85/97). Asynchronous NTTs (n = 9) were more common than synchronous NTTs (n = 2). There was a higher incidence of NTT in neonates delivered by vaginal delivery (n = 110) as compared to those delivered by c-section (n = 25). Extravaginal torsion (n = 54) is far more common than intravaginal torsion (n = 2). Full-term neonates (n = 122) have a higher incidence of NTT as compared to preterm neonates (n = 9). A total of 15 testicles were salvaged. Of the salvaged testicles 2 were documented as prenatal, 10 postnatal and 3 were undocumented. A strategy of bilateral exploration allows for salvage of about 7% of ipsilateral testicles and prevent asynchronous torsion in about 4% of neonates. CONCLUSIONS Based on our population, between 8-12% of patients would benefit from bilateral exploration at the time of diagnosis. We recommend urgent bilateral exploration with orchiopexy of the contralateral testicle in order to avert anorchia. TYPE OF STUDY Systematic review. LEVEL OF EVIDENCE Level 5 meta-synthesis (Evidence from systematic reviews of qualitative and descriptive studies).
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Affiliation(s)
- Cecilia Monteilh
- Department of Pediatrics, NYU-Winthrop Hospital, Mineola, New York, USA
| | - Rose Calixte
- Department of Biostatistics, NYU-Winthrop Hospital, Mineola, New York, USA
| | - Sathyraprasad Burjonrappa
- Department of Pediatric Surgery, NYU-Winthrop Hospital, Mineola, New York, USA; Department of Pediatric Surgery, Montefiore Medical Center, Bronx, New York, USA.
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7
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Sangüesa Nebot C, Llorens Salvador R, Picó Aliaga S, Garcés Iñigo E. Perinatal testicular torsion: Ultrasound assessment and differential diagnosis. RADIOLOGIA 2017. [DOI: 10.1016/j.rxeng.2017.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Nistal M, Paniagua R, González-Peramato P, Reyes-Múgica M. Perspectives in Pediatric Pathology, Chapter 19. Testicular Torsion, Testicular Appendix Torsion, and Other Forms of Testicular Infarction. Pediatr Dev Pathol 2017; 19:345-359. [PMID: 25105275 DOI: 10.2350/14-06-1514-pb.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Among the most frequent specimens at the pediatric surgical pathology bench, orchiectomy performed after testicular torsion deserves significant attention. Multiple implications, including fertility, legal complications, possibility of occult lesion, and others, need to be considered. Furthermore, torsion of testicular and other appendices represents common urological emergencies frequently encountered in surgical pathology. Here we present a review of testicular torsion and infarction, including theories about their pathogenesis and the appropriate handling by the diagnostic pathologist.
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Affiliation(s)
- Manuel Nistal
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Madrid 28029, Spain
| | - Ricardo Paniagua
- 2 Department of Cell Biology, Universidad de Alcala, Madrid, Spain
| | - Pilar González-Peramato
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Madrid 28029, Spain
| | - Miguel Reyes-Múgica
- 3 Department of Pathology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15224, USA
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9
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Kehoe JE, Christman MS. To ‘Pex or Not to ‘Pex: What to Do for the Contralateral Testis When a Nubbin Is Discovered. Curr Urol Rep 2017; 18:9. [DOI: 10.1007/s11934-017-0657-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Sangüesa Nebot C, Llorens Salvador R, Picó Aliaga S, Garcés Iñigo E. Perinatal testicular torsion: ultrasound assessment and differential diagnosis. RADIOLOGIA 2017; 59:391-400. [PMID: 28117098 DOI: 10.1016/j.rx.2016.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 11/08/2016] [Accepted: 11/09/2016] [Indexed: 10/20/2022]
Abstract
Perinatal testicular torsion, defined as torsion occurring in the prenatal period or in the first month after birth, accounts for 10% of all cases of testicular torsion in pediatric patients. Most are extravaginal, and intravaginal torsion is rare. Its management is controversial, due to the low viability of the testis and the possibility of bilateral torsion. Ultrasonography is the method of choice to study testicular torsion. Combining B-mode and power Doppler imaging facilitates a fast reliable diagnosis. We review the ultrasonographic appearance of neonatal testicular torsion for each presentation, the differential diagnosis with other causes of increased scrotal volume in neonates, and its treatment.
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Affiliation(s)
- C Sangüesa Nebot
- Área de Imagen médica, Sección de Pediatría, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - R Llorens Salvador
- Área de Imagen médica, Sección de Pediatría, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - S Picó Aliaga
- Área de Imagen médica, Sección de Pediatría, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - E Garcés Iñigo
- Área de Imagen médica, Sección de Pediatría, Hospital Universitario y Politécnico La Fe, Valencia, España
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11
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Dangle P, Salgado C, Reyes-Mugica M, Schneck F, Ost M, Sims-Lucas S. Testicular Hypoplasia Is Driven by Defective Vascular Formation. Urology 2016; 101:94-98. [PMID: 27765594 DOI: 10.1016/j.urology.2016.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 09/28/2016] [Accepted: 10/03/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine if vanishing testis could result from a fault in embryological development as a result of an arrest in endothelial cell migration rather than secondary to just a random physical torsion/twist. A testicular nubbin or vanishing testis is considered to be secondary to a neonatal torsion and is usually associated with a hemosiderin deposit. MATERIALS AND METHODS Cases of vanishing testis excision were compared with age-matched controls from cadaveric testes without known genitourinary pathology. To assess the testis microvasculature, we performed immunohistochemistry using an automated staining platform with controlled and standardized conditions and positive and negative controls. We used cluster of differentiation (CD) 34 to stain blood vessel endothelium, stem cells, and interstitium; CD31 (all endothelium); and D2-40 for lymphatic endothelium. Morphometric analysis was carried out, % of the total tissue with CD31 and CD34 positive stain was assessed, and the number of the lymphatic vessels (D2-40) per mm2 was counted. RESULTS Of the 10 cases, 7 had evidence of hemosiderin deposit and calcification. The % distribution of CD34 in controls was higher, 13.4 ± 3.1 (mean ± standard deviation), compared to nubbin cases, 4.5 ± 2.9 (P ≤ .001). The % distribution of CD31 was 2.8 ± 0.83 in controls compared to 1.31 ± 0.60 in cases (P ≤ .001). The lymphatic distribution was similar in both groups, cases (6.4 ± 4.3 n/mm2) and controls (6.4 ± 1.7 n/mm2) (P = .99) CONCLUSION: This histopathological study suggests that disturbances in endothelial development may be a contributing factor leading to testicular hypoplasia and a resultant nubbin testis, independent of a physical torsion event.
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Affiliation(s)
- Pankaj Dangle
- Division of Pediatric Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Cláudia Salgado
- Department of Pathology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Miguel Reyes-Mugica
- Department of Pathology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Francis Schneck
- Division of Pediatric Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Michael Ost
- Division of Pediatric Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Sunder Sims-Lucas
- Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
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12
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Bombiński P, Warchoł S, Brzewski M, Majkowska Z, Dudek-Warchoł T, Żerańska M, Panek M, Drop M. Ultrasonography of Extravaginal Testicular Torsion in Neonates. Pol J Radiol 2016; 81:469-472. [PMID: 27757176 PMCID: PMC5051550 DOI: 10.12659/pjr.897066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 02/23/2016] [Indexed: 11/23/2022] Open
Abstract
Background Extravaginal testicular torsion (ETT), also called prenatal or perinatal, occurs prenatally and is present at birth or appears within the first month of life. It has different etiology than intravaginal torsion, which appears later in life. Testicular torsion must be taken into consideration in differential diagnosis of acute scrotum and should be confirmed or ruled out at first diagnostic step. Ultrasonography is a basic imaging modality, however diagnostic pitfalls are still possible. There is still wide discussion concerning management of ETT, which varies from immediate orchiectomy to conservative treatment resulting in testicle atrophy. Material/Methods In this article we present ultrasonographic spectrum of ETT in neonates, which were diagnosed and treated in our hospital during the last 8 years (2008–2015), in correlation with clinical and intraoperative findings. Results Thirteen neonates with ETT were enrolled in the study – 11 patients with a single testicle affected and 2 patients with bilateral testicular torsion. Most common signs on clinical examination were: hardened and enlarged testicle and discoloration of the scrotum. Most common ultrasonographic signs were: abnormal size or echostructure of the affected testicle and absence of the blood flow in Doppler ultrasonography. In 3 patients ultrasound elastography was performed, which appeared very useful in testicle structure assessment. Conclusions Testicular torsion may concern boys even in the perinatal period. Ultrasonographic picture of acute scrotum in young boys may be confused. Coexistence of the abnormal size or echostructure of the torsed testicle with absence of the blood flow in Doppler ultrasonography appear as very specific but late ultrasonographic sings. Ultrasound elastography may be a very useful tool for visualisation of a very common clinical sign – hardening of the necrotic testicle.
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Affiliation(s)
| | - Stanisław Warchoł
- Department of Pediatric Surgery and Urology, Medical University of Warsaw, Warsaw, Poland
| | - Michał Brzewski
- Department of Pediatric Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Zofia Majkowska
- Department of Pediatric Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Teresa Dudek-Warchoł
- Department of Pediatric Surgery and Urology, Medical University of Warsaw, Warsaw, Poland
| | - Maria Żerańska
- Department of Pediatric Surgery and Urology, Medical University of Warsaw, Warsaw, Poland
| | - Małgorzata Panek
- Department of Pediatric Surgery and Urology, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Drop
- Department of Pediatric Radiology, Medical University of Warsaw, Warsaw, Poland
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13
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Xiao H, Gao Y, Li Y, Tang Y, Zhu L, Xu J, Mou F, Huang Y. Ultrasound assessment of perinatal testicular torsion. Br J Radiol 2016; 89:20151077. [PMID: 27278088 DOI: 10.1259/bjr.20151077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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 = 0.01) and echogenicity (p = 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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Affiliation(s)
- Huan Xiao
- 1 Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China.,2 Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,3 Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,4 Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Yang Gao
- 1 Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China.,2 Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,3 Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,4 Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Yingliang Li
- 2 Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,3 Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,4 Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China.,5 Department of Pediatric Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Tang
- 1 Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China.,2 Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,3 Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,4 Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Lirong Zhu
- 1 Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China.,2 Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,3 Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,4 Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Juan Xu
- 1 Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China.,2 Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,3 Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,4 Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Fangting Mou
- 1 Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China.,2 Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,3 Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,4 Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Yingle Huang
- 1 Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China.,2 Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,3 Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,4 Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
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14
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Melcer Y, Mendlovic S, Klin B, Keidar R, Lysyy O, Herman A, Maymon R. Fetal diagnosis of testicular torsion: what shall we tell the parents? Prenat Diagn 2014; 35:167-73. [DOI: 10.1002/pd.4512] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 09/22/2014] [Accepted: 09/26/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Y. Melcer
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center; Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - S. Mendlovic
- Department of pathology, Assaf Harofeh Medical Center; Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - B. Klin
- Department of Pediatric Surgery, Assaf Harofeh Medical; Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - R. Keidar
- Department of Neonatology, Assaf Harofeh Medical Center; Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - O. Lysyy
- Department of Diagnostic Imaging, Assaf Harofeh Medical Center; Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - A. Herman
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center; Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - R. Maymon
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center; Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
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Ultrasound prenatal diagnosis of inguinal scrotal hernia and contralateral hydrocele. Case Rep Obstet Gynecol 2013; 2013:764579. [PMID: 24455356 PMCID: PMC3876836 DOI: 10.1155/2013/764579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 11/11/2013] [Indexed: 11/17/2022] Open
Abstract
Fetal inguinal scrotal hernia is a rare condition resulting in an abnormal embryonic process of the tunica vaginalis. We report a case of ultrasound prenatal diagnosis of inguinal scrotal hernia associated with contralateral hydrocele in a woman at 37 weeks of gestation, referred to our clinic for a scrotal mass. Differential diagnosis includes hydrocele, teratoma, hemangiomas, solid tumours of testis, bowel herniation, and testicular torsion. Bowel peristalsis is an important ultrasound sign and it allowed us to make diagnosis of inguinal scrotal hernia. Diagnosis was confirmed at birth and a laparoscopic hernia repair was performed without complications on day 10. During surgery, a bilateral defect of canal inguinal was seen and considered as the cause of scrotal inguinal hernia and contralateral hydrocele observed in utero.
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16
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Khatib N, Goldstein I, Vitner D, Ganem N, Livoff A, Wiener Z. Prenatal diagnosis of scrotal-inguinal hernia: two case reports and review of the English literature. Eur J Obstet Gynecol Reprod Biol 2013; 171:9-11. [DOI: 10.1016/j.ejogrb.2013.07.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/25/2013] [Accepted: 07/13/2013] [Indexed: 11/29/2022]
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17
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Ganni P, Vachhani N, Udayasankar U. Intrauterine testicular torsion. J Urol 2013; 191:217-8. [PMID: 24120724 DOI: 10.1016/j.juro.2013.10.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2013] [Indexed: 11/27/2022]
Affiliation(s)
| | - Neil Vachhani
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio
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18
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Mano R, Livne PM, Nevo A, Sivan B, Ben-Meir D. Testicular torsion in the first year of life--characteristics and treatment outcome. Urology 2013; 82:1132-7. [PMID: 24001706 DOI: 10.1016/j.urology.2013.07.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 06/28/2013] [Accepted: 07/10/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To review the characteristics and treatment outcome of testicular torsion in infants, aged 1 month to 1 year, and compare them with those seen in neonates. METHODS The study group included 30 patients aged younger than 1 year who were treated for testicular torsion at a tertiary pediatric medical center between 1993 and 2012. Medical records were retrospectively reviewed for clinical characteristics and treatment outcome. Findings were compared between patients who presented before age 1 month (neonate group, n = 17) or later (infant group, n = 13). RESULTS The common clinical presentation in the neonate group was a solid, nontender scrotal mass apparent in 13 of 17 patients (76%). In the infant group, 11 of 13 patients (85%) presented with restlessness and 12 of 13 (92%) with a tender scrotal or inguinal mass. Torsion of an undescended testis was significantly more prevalent in infants, 7 of 13 (54%), than neonates, 1 of 17 (6%; P = .009). Although extravaginal torsion was documented in 5 of 6 neonates (83%), 8 of 9 infants (89%) had an intravaginal torsion (P = .011). Orchiectomy was performed in 14 of 17 neonates (82%) and 6 of 13 infants (46%; P = .056). Of the 29 patients with follow-up data, testicular salvage was documented in 1 of 17 neonates (6%) and 2 of 12 infants (17%), at a minimum follow-up of 5 months (P = .55). CONCLUSION Testicular torsion in the first year of life is a diverse condition. Although neonatal torsions were predominantly extravaginal, infantile torsions were mostly intravaginal, involving undescendent testes in more than half of the cases. Despite fewer orchiectomies performed on the infant group, testicular salvage rates in both groups were similarly low.
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Affiliation(s)
- Roy Mano
- Pediatric Urology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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19
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Mneimneh WS, Nazeer T, Jennings TA. Torsion of the gonad in the pediatric population: spectrum of histologic findings with focus on aspects specific to neonates and infants. Pediatr Dev Pathol 2013; 16:74-9. [PMID: 23286326 DOI: 10.2350/12-07-1221-oa.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Histopathologic findings of gonadal torsion in neonates and infants (GTNI) are poorly defined in the literature. We describe herein the histopathologic spectrum of GT with emphasis on the pediatric population and on features specific for NI (≤1 year of age). Twenty-four cases of GTNI (6 females/18 males), 33 cases of GT in an older pediatric population (OPP) (19 females/14 males), and 43 cases of GT in adults (35 females/8 males) were found in our pathology files between 2003 and 2011. Our findings disclosed 2 categories of GT: 1) the group of NI, and 2) that of OPP and adults who share a similar presentation as acute hemorrhagic necrosis of the gonad. Although findings in NI were rather uniform, a few differences were demonstrated between the 2 genders. All GTNI revealed calcifications, fibrosis, siderophages, and extensive necrosis. However, prominent necrotizing palisaded granulomatas were seen in most (4 of 6) cases of ovarian torsion but not in the testicular counterpart. Furthermore, complete gonad regression was encountered exclusively in neonatal testicular torsion cases. In conclusion, 1) pathologic findings in GT are distinctly different between NI and OPP, the latter being more comparable to adults, presenting with acute hemorrhagic necrosis; 2) the distinctive findings in GTNI of both genders include calcifications, siderophages, and fibrosis, in addition to background necrosis; 3) of particular note, complete gonadal regression is seen only in the testis in GTNI; and 4) necrotizing palisaded granulomatas are unique to the ovarian subgroup and are often extensive, obscuring the nature of the process.
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Affiliation(s)
- Wadad S Mneimneh
- Pathology Department, Albany Medical Center, Albany NY 12208, USA.
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20
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Saxena AK, Castellani C, Ruttenstock EM, Höllwarth ME. Testicular torsion: a 15-year single-centre clinical and histological analysis. Acta Paediatr 2012; 101:e282-6. [PMID: 22385478 DOI: 10.1111/j.1651-2227.2012.02644.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM This study reviewed the demographic, epidemiological and clinical factors of boys seen at a single centre who underwent surgical exploration for testicular torsion. METHODS Retrospective single-centre review of boys with testicular torsion between 1996 and 2011 was made. RESULTS Testicular torsion (right n = 43, left n = 60, bilateral n = 1) was identified in 104 boys between 0 and 18 years. Ten newborns presented with 11 intrauterine torsions. Nine torsions presented in undescended inguinal testes (one intrauterine). In 94 boys with descended testes, presentation included pain (76%), scrotal swelling (65%) and abdominal symptoms (22%). Ultrasonography was performed in 85 patients with false-negative results in 4 (4.7%). Orchiectomy was performed during initial exploration in 41, with significantly higher rates of orchiectomies in patients with late (>6 h) versus patients with early referrals (<6 h) (56% vs. 9.1%). Histological evaluation was carried out in 68 testes, with 43 resected testes demonstrating haemorrhagic necrosis. In 25 biopsied testes, histology revealed acute parenchymal bleeding (n = 14), onset of parenchymal infarction (n = 8), orchitis (n = 1) and normal tissue (n = 2). Eighty-two patients were followed up with pathological findings in four patients: testicular atrophies requiring orchiectomy (n = 2), testicular autolysis (n = 1) and small testicular vein thrombosis (n = 1). CONCLUSION Chances of testicular salvage after torsion are higher if patients present early. The majority of patients presenting late (>6 h) require orchiectomy owing to testicular necrosis.
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Affiliation(s)
- A K Saxena
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Austria.
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21
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Singhal A, Agarwal A, Metuge J, Olsavsky T. Neonatal testicular torsion with an unusual sonographic feature. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:243-246. [PMID: 22287067 DOI: 10.1002/jcu.21889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 12/14/2011] [Indexed: 05/31/2023]
Abstract
Neonatal testicular torsion is a rare entity, the exact etiology of which is not elucidated. Imaging is performed using color Doppler ultrasound and scintigraphic studies with typically diminished testicular flow on the side with torsion. We present a case of testicular torsion in a newborn with increased testicular vascularity demonstrated by ultrasound and suggesting a torsion-detorsion sequence. Management of patients with torsion involves assessing the risks of neonatal surgery versus the possibility of finding viable testicular tissue at surgical exploration.
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Affiliation(s)
- Aparna Singhal
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, Connecticut, USA
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22
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Nandi B, Murphy FL. Neonatal testicular torsion: a systematic literature review. Pediatr Surg Int 2011; 27:1037-40. [PMID: 21739126 DOI: 10.1007/s00383-011-2945-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2010] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Biplab Nandi
- Department of Paediatric Urology and Surgery, St George's NHS Hospital, Blackshaw Road, London, SW17 0QT, UK
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23
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Cho YM, Pu HF, Huang WJ, Ho LT, Wang SW, Wang PS. Role of serum- and glucocorticoid-inducible kinase-1 in regulating torsion-induced apoptosis in rats. ACTA ACUST UNITED AC 2010; 34:379-89. [PMID: 20738430 PMCID: PMC3170482 DOI: 10.1111/j.1365-2605.2010.01091.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Serum- and glucocorticoid-inducible kinase-1 (SGK1) is a serine/threonine protein kinase that responds to various stimuli and mediates cell survival. Although it is known that testicular torsion leads to testicular damage and male infertility, the role of SGK1 in torsion remains unclear. This study investigated whether torsion-induced apoptosis is associated with changes in phosphoinositide-dependent protein kinase-1 (PDK1), SGK1 and forkhead transcription factor FOXO3a expression and/or phosphorylation in rats. Sprague-Dawley rats were divided into four groups: sham (control), 1, 2 and 4 h of unilateral torsion. Bilateral testes, testicular interstitial fluid (TIF) and blood samples were collected immediately after torsion. Our results revealed that SGK1 protein and mRNA were abundantly present in testes and were induced by 2 h of torsion, but that phosphorylation of SGK1, PDK1 and FOXO3a decreased simultaneously. After 2 h of torsion, the testosterone secretion capacity of the primary Leydig cells and testicular interstitial cells (TICs) was impaired and apoptotic spermatogonia and TICs were observed; in addition, the mean seminiferous tubular diameter was decreased. Torsion increased plasma corticosterone levels, but decreased plasma luteinizing hormone and testosterone levels. However, the testosterone levels of the TIF in the ipsilateral testes were significantly enhanced after 2 h of torsion, but suppressed in the contralateral testes. This animal study suggests that PDK1, SGK1 and FOXO3a are involved in torsion-induced apoptosis and that medical therapy should be performed as early as 2 h after the occurrence of torsion to prevent further damage.
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Affiliation(s)
- Y-M Cho
- Department of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Bagci S, Bachour H, Woelfle JF, Mueller A, Bartmann P, Franz AR. Bilateral perinatal testicular torsion in an infant: a rare neonatal emergency. Pediatr Int 2010; 52:e227-8. [PMID: 20958873 DOI: 10.1111/j.1442-200x.2010.03139.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Soyhan Bagci
- Department of Neonatology, Children's Hospital, University of Bonn, Bonn, Germany.
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25
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Djahangirian O, Ouimet A, Saint-Vil D. Timing and surgical management of neonatal testicular torsions. J Pediatr Surg 2010; 45:1012-5. [PMID: 20438944 DOI: 10.1016/j.jpedsurg.2010.02.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Accepted: 02/03/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND The timing and surgical management of neonatal testicular torsions (NTTs) remain controversial, varying from immediate orchiectomy with empirical contralateral orchiopexy to expectant management with resulting atrophy of the affected testicle. The goal of the present study is to review the management of this entity at our institution. MATERIALS AND METHODS A retrospective study of all patients with NTT from 1989 to 2007 was undertaken. The age, clinical presentation, investigation, management, and short- and long-term outcomes were noted. RESULTS Forty-four patients were included. Most presented with a firm testicular mass, scrotal discoloration, and hydrocele (42), whereas a few presented with testicular atrophy (2). The median age at presentation was 1 day of age (range, 0-84 days), with NTT occurring on the right side in 22 patients and the left side in 20. Two patients (5%) had bilateral torsion at presentation. In 33 patients, the diagnosis was confirmed by Doppler ultrasonography, whereas 11 patients did not undergo any additional investigation. Surgical management included ipsilateral orchiectomy and contralateral orchiopexy (IOCO) (27), orchiopexy of the contralateral testis (CO) (7), bilateral orchiopexy (4), orchiectomy of the ipsilateral testis (1), orchiopexy of the ipsilateral testis (2), and observation (1). The 2 bilateral torsions underwent bilateral orchiectomy (2). The median age at surgery was 25 days (range, 1-912 days). Postoperative complications occurred in 8 patients (18%), mainly in those with IOCO (4) and CO (4) operated before 12 days of age, and included recurrent hydrocele (3), wound infection (2), urinary tract infection (1), and others (2). Upon follow-up, patients who underwent CO developed ipsilateral testicular atrophy (6). No patients were readmitted for recurrence of torsion or other complications. CONCLUSION At our institution, the most frequent management of unilateral neonatal testicular torsions is IOCO or CO, but this carries an 18% complication rate, particularly if surgery is performed early. There seems to be no advantage to early intervention, and the need for orchiectomy is debatable because torsion leads to ipsilateral testicular atrophy. Contralateral orchiopexy done to decrease the incidence of bilateral asynchronous torsion should, at the very least, be deferred until the risks of anesthesia and surgery are improved, given its rarity. Given the fact that most patients underwent IOCO or CO, we cannot conclude which strategy is the best for neonatal testicular torsions. A prospective study is welcomed.
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Affiliation(s)
- Orchidée Djahangirian
- Division of Pediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada H3T 1C5
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26
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Testicular torsion: sonomorphological appearance as a predictor for testicular viability and outcome in neonates and children. Pediatr Surg Int 2010; 26:281-6. [PMID: 19921212 DOI: 10.1007/s00383-009-2534-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Testicular torsion in children is found both in neonates [perinatal testicular torsion (PTT), <30th day of life] and in older children [testicular torsion (TT)]. Prediction of testicular viability is essential for deciding whether to perform emergency exploration surgery. The aim of the present study, therefore, was to investigate the sonomorphological parameters as predictors for testicular viability. MATERIALS AND METHODS All our cases of sonographically diagnosed and surgically confirmed testicular torsion (n = 25) in a 7.5-year period were reviewed. We evaluated the overall group and two subgroups, PTT (n = 9) and TT (n = 16), and assessed the following sonomorphological parameters: normal echogenicity (homogeneous), diffuse hyper-/hypoechogenicity (homogeneous) and focal hyper-/hypoechogenicity (heterogeneous). These findings were correlated with the testicular recovery rate. RESULTS In both groups, we found the highest recovery rates in testes with normal, homogeneous echogenicity and a zero recovery rate in testes with heterogeneous echogenicity (p = 0.0117). CONCLUSIONS By using the sonomorpohological criteria presented here, testicular viability can be appraised in all age groups to help determine the prognosis for testicular outcome. In PTT, a nonperfused, homogeneously appearing testis represents the initial phase of torsion. Only for this type is there hope for salvage. In addition to the intraoperative appearance, a testis that is preoperatively heterogeneous in appearance can support the decision for orchiectomy.
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27
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Abstract
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.
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28
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Chan JL, Knoll JM, Depowski PL, Williams RA, Schober JM. Mesorchial Testicular Torsion: Case Report and a Review of the Literature. Urology 2009; 73:83-6. [DOI: 10.1016/j.urology.2008.06.053] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 06/12/2008] [Accepted: 06/28/2008] [Indexed: 11/29/2022]
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Kaye JD, Levitt SB, Friedman SC, Franco I, Gitlin J, Palmer LS. Neonatal Torsion: A 14-Year Experience and Proposed Algorithm for Management. J Urol 2008; 179:2377-83. [DOI: 10.1016/j.juro.2008.01.148] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Indexed: 11/28/2022]
Affiliation(s)
- Jonathan D. Kaye
- Division of Pediatric Urology, Schneider Children's Hospital of the North Shore–Long Island Jewish Health System, New Hyde Park, New York
| | - Selwyn B. Levitt
- Division of Pediatric Urology, Schneider Children's Hospital of the North Shore–Long Island Jewish Health System, New Hyde Park, New York
| | - Steven C. Friedman
- Division of Pediatric Urology, Schneider Children's Hospital of the North Shore–Long Island Jewish Health System, New Hyde Park, New York
| | - Israel Franco
- Division of Pediatric Urology, Schneider Children's Hospital of the North Shore–Long Island Jewish Health System, New Hyde Park, New York
| | - Jordan Gitlin
- Division of Pediatric Urology, Schneider Children's Hospital of the North Shore–Long Island Jewish Health System, New Hyde Park, New York
| | - Lane S. Palmer
- Division of Pediatric Urology, Schneider Children's Hospital of the North Shore–Long Island Jewish Health System, New Hyde Park, New York
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Abstract
Torsion of the testis is a medical emergency that is most commonly encountered in adolescents. Patients usually present with sudden onset scrotal pain associated with nausea and vomiting. On physical examination the involved testis is tender, high riding and usually horizontal. The cremasteric reflex is usually absent. If left untreated irreversible ischaemia starts appearing in 6 h. Doppler ultrasound is the diagnostic imaging of choice. The ideal treatment is surgical exploration and orchidectomy with contralateral orchidopexy or bilateral orchidopexy depending on the condition of the affected testis. If surgical options are delayed then manual detorsion should be attempted.
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Baglaj M, Carachi R. Neonatal bilateral testicular torsion: a plea for emergency exploration. J Urol 2007; 177:2296-9. [PMID: 17509343 DOI: 10.1016/j.juro.2007.02.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2006] [Indexed: 11/21/2022]
Abstract
PURPOSE Bilateral testicular torsion is a rare condition. Most authors present single case reports. Therefore, the clinical and surgical aspects of bilateral torsion in a neonate have not been subjected to detailed analysis. We performed a retrospective analysis of our experience in the management of bilateral perinatal torsion as well as a collective review of the medical literature. MATERIALS AND METHODS All cases of neonatal testicular torsion managed at our neonatal surgical center during the last 2 decades (1986 to 2005) were reviewed, and 3 cases of bilateral torsion were identified. In addition, 45 neonatal cases of bilateral torsion were found through the literature search. In all cases data regarding clinical presentation, imaging studies, surgical management, intraoperative and pathological findings, and final outcome were analyzed. RESULTS Synchronous torsion occurred in 32 of 48 newborns (67%), while asynchronous pathology was reported in 16 (33%), including the 3 presented in this report. All except 1 patient were full-term newborns with normal or above average birth weight. Difficult delivery was noted in 33% of the cases. Despite prompt surgical intervention in 46 infants, the salvage rate was low, with arterial flow confirmed postoperatively in only 3 gonads (3.1%). Four gonads in 3 additional patients were reported to be of normal size on followup. CONCLUSIONS Asynchronous torsion is not as rare an event as previously reported, and it may pose a diagnostic challenge. In the majority of these cases torsion of the left testis seems to occur later than torsion of the right testis. The role of imaging studies in newborns with bilateral torsion seems to be limited, especially in cases of asynchronous pathology. Urgent bilateral exploration is strongly advised in all newborns presenting with either unilateral or bilateral torsion. Such policy carries diagnostic, potential therapeutic and prognostic implications.
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Affiliation(s)
- Maciej Baglaj
- Department of Paediatric Surgery, Royal Hospital for Sick Children, Glasgow, Scotland
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Wax JR, Pinette MG, Cartin A, Blackstone J. Prenatal sonographic diagnosis of meconium periorchitis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:415-7. [PMID: 17324997 DOI: 10.7863/jum.2007.26.3.415] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Joseph R Wax
- Department of Obstetrics and Gynecology, Maine Medical Center, Portland, ME, USA.
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