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Erlich T, Ghazzaoui AE, Pokarowski M, O'Kelly F, Lorenzo AJ, Bagli DJ, Koyle MA. Perinatal testicular torsion: The clear cut, the controversial, and the "quiet" scenarios. J Pediatr Surg 2022; 57:288-297. [PMID: 34753560 DOI: 10.1016/j.jpedsurg.2021.10.003] [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] [Received: 08/15/2021] [Revised: 09/17/2021] [Accepted: 10/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Perinatal testicular torsion (PTT) is a catastrophic event that occurs in utero or up to 30 days postnatally, with testicular loss being the most common outcome. OBJECTIVE To assess clinical evaluation, surgical management and clinical outcomes in patients with PTT in a quaternary referral pediatric center, to determine testicular salvageability and propose future management options. METHODS We retrospectively reviewed a cohort of males born outside the quaternary center with a diagnosis of PTT, from May 2000 to July 2020. Data collection included mode of delivery, gestational age, birth weight, testicular examination at birth, clinical presentation, ultrasound results at diagnosis, surgical management and findings, perioperative complications, and follow-up. RESULTS 62 patients, including 2 patients with bilateral asynchronous PTT, were identified. Median (IQR) gestational age and birth weight were 39 (38-39.4) weeks and 3.4 (3.1-3.72) kg, respectively. Abnormal testicular examination at birth was found in 69% (Table 1). Doppler ultrasound was performed in all but 1 patient. 59 patients underwent surgery, 21 within 4 h, with bilateral exploration in 44 cases. Affected and non-affected testicles were explored in 76% and 98% of cases, respectively. 3 "nubbins" were found, of which 2 were excised. 3 nonsurgical complications were identified. During a median (IQR) follow-up of 3 (3-3) months, 63 testicles were removed or found to be non-functional, with compensatory hypertrophy in 38% of patients. CONCLUSION Given that 3% of our patients presented with asynchronous bilateral PTT, as well as the safety of general anesthesia in a referral pediatric hospital, early bilateral scrotal exploration of PTT is recommended. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Tomer Erlich
- Division of Pediatric Urology, The Hospital for Sick Children, SickKids, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Surgery, University of Toronto, Toronto, Canada.
| | - Ali El Ghazzaoui
- Division of Pediatric Urology, The Hospital for Sick Children, SickKids, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Surgery, University of Toronto, Toronto, Canada
| | - Martha Pokarowski
- Division of Pediatric Urology, The Hospital for Sick Children, SickKids, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
| | - Fardod O'Kelly
- Division of Pediatric Urology, The Hospital for Sick Children, SickKids, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Pediatric Urology, Beacon Hospital, Dublin, and School of Medicine, University College Dublin, Ireland
| | - Armando J Lorenzo
- Division of Pediatric Urology, The Hospital for Sick Children, SickKids, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Surgery, University of Toronto, Toronto, Canada
| | - Darius J Bagli
- Division of Pediatric Urology, The Hospital for Sick Children, SickKids, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Surgery, University of Toronto, Toronto, Canada
| | - Martin A Koyle
- Division of Pediatric Urology, The Hospital for Sick Children, SickKids, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Surgery, University of Toronto, Toronto, Canada
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Tasci A, Uguralp S, Akatli AN, Arslan AK, Karabulut AB. Long-term effects of orchiopexy and orchiectomy on the testes of rats with testicular torsion. J Pediatr Urol 2022; 18:376.e1-376.e7. [PMID: 35568660 DOI: 10.1016/j.jpurol.2022.04.007] [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] [Received: 05/20/2021] [Revised: 03/19/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Ischemia/reperfusion injury occurs after testicular torsion, levels of free oxygen radicals and inflammatory cytokines are increased in both the torsional and contralateral testis, leading to testicular injury. OBJECTIVE The present study investigated whether orchiopexy or orchiectomy after testicular torsion was superior in terms of fertility potential in the long term. STUDY DESIGN Following 720°, 4 h left testicular torsion, orchiectomy or orchiopexy was performed on 84 rats, which were then sacrificed and evaluated for testicular function at day 1, at 3 months and 6 months (n = 14 per group). An additional 14 rats were in the control group. RESULTS Follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels were significantly lower in the orchiopexy group than the orchiectomy and control groups after 3 months. However, there were no significant differences in hormone parameters among the three groups after 6 months. The hormone levels, Johnsen score, seminiferous tubule diameter, and inducible nitric oxide synthase (iNOS) expression at 3 and 6 months were not significantly different between the orchiectomy group and controls. Histopathological analyses at 3 and 6 months indicated significant decreases in Johnsen score and seminiferous tubule diameter in the ipsilateral testis in the orchiopexy group. At 3 months, the level of iNOS expression in the contralateral testis was significantly lower in the orchiopexy group than in other groups. At 6 months, however, it was not significantly different between the orchiopexy and control groups. There were no significant differences in iNOS expression at 3 or 6 months in the orchiectomy group compared to controls. DISCUSSION The ipsilateral testis in the orchiopexy group began to atrophy at 3 months, and the degree of atrophy became more evident at 6 months. The level of iNOS expression was low in the bilateral testis at 3 months in the orchiopexy group, and sperm in the contralateral testis were not yet functionally healthy. The level of iNOS expression in the ipsilateral testis decreased further at 6 months in the orchiopexy group, while that in the contralateral testis returned to the normal level. CONCLUSION Testicular functions were restored faster after orchiectomy compared to orchiopexy following testicular torsion. However, follow-up of the rats for 6 months demonstrated that orchiopexy or orchiectomy procedures conducted on the testicular torsion had no effect on future fertility potential after 4 h of torsion.
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Affiliation(s)
- Aytac Tasci
- Department of Pediatric Surgery, Turgut Ozal Medical Center, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Sema Uguralp
- Department of Pediatric Surgery, Turgut Ozal Medical Center, Faculty of Medicine, Inonu University, Malatya, Turkey.
| | - Ayse Nur Akatli
- Department of Pathology, Turgut Ozal Medical Center, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Ahmet Kadir Arslan
- Department of Biostatistics and Medical Informatics, Turgut Ozal Medical Center, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Aysun Bay Karabulut
- Department of Biochemistry, Turgut Ozal Medical Center, Faculty of Medicine, Inonu University, Malatya, Turkey
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Xiaofei L, Benzhang Z. Case Report: Testicular Torsion in Unilateral Supernumerary Testis. Front Pediatr 2022; 10:823374. [PMID: 35479762 PMCID: PMC9035904 DOI: 10.3389/fped.2022.823374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Supernumerary testis (SNT), or polyorchidism, is a rare congenital anomaly of the genitourinary tract, described as the presence of more than two testicles. Testicular torsion (TT) in unilateral SNT is extremely rare. We report a case of unilateral SNT in a 16-year-old boy accompanied by TT, which was diagnosed preoperatively based on the outcomes of physical examination and ultrasound and confirmed intraoperatively. We opted for orchiectomy of this SNT because of the long-time hypoperfusion. And as for the normal testis, orchidopexy was performed. His clinical presentation subsided after surgery, and the patient was discharged 3 days later.
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Affiliation(s)
- Lu Xiaofei
- Department of Urology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Zhou Benzhang
- Department of Urology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China
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Kylat RI. Perinatal testicular torsion. Arch Pediatr 2020; 28:75-79. [PMID: 33277134 DOI: 10.1016/j.arcped.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/27/2020] [Accepted: 10/31/2020] [Indexed: 10/22/2022]
Abstract
Testicular torsion (TT) occurs when the testis rotates around the axis of the spermatic cord attachments and prevents blood flow to the testis, resulting in tissue ischemia. If this occurs in the first month of life it is referred to as "perinatal TT" (PTT) or "neonatal TT" (NTT). PTT has an incidence of 6.1 per 100,000 live births. Some of these cases occur prenatally. It can be missed on the initial newborn examination, as it can be asymptomatic. Hence, the true incidence is much higher since it is underdiagnosed. The types of TT include extravaginal, intravaginal, and mesorchial. Most cases of PTT are extravaginal. The diagnosis can generally be made on physical examination. Ultrasonography (US) can help exclude other rare diagnoses as long as surgical intervention is not delayed. There has been some debate regarding the timing of surgery. Although the torsed testicle may not be salvageable, the likelihood of asymptomatic bilateral TT has to be borne in mind and contralateral orchiopexy done at the time of exploration would prevent an asynchronous torsion. Nonoperative maneuvers to detorse in PTT are not recommended. The evaluation, diagnostic approach, and management of this relatively rare condition are described.
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Affiliation(s)
- R I Kylat
- Department of Pediatrics, University of Arizona, College of Medicine, PO BOX 245073, 1501 N Campbell Avenue, Tucson, AZ 85724, USA.
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