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Alsaffaf Y, Arab H, Jaafar J, Shehadeh M. A 7-year-old with extravaginal torsion of an undescended testicle in the left inguinal region: The first case report from Syria. Clin Case Rep 2024; 12:e9013. [PMID: 38808196 PMCID: PMC11130230 DOI: 10.1002/ccr3.9013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 05/30/2024] Open
Abstract
The incidence of undescended testicles torsion in a 7-year-old is rare, making it a clinically unusual occurrence. Emphasizing the importance of thorough urogenital assessments in children, particularly in underserved communities, is critical to prevent serious complications like testicular gangrene.
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Affiliation(s)
| | - Hazem Arab
- Faculty of MedicineHama UniversityHamaSyria
| | - Jaafar Jaafar
- Department of UrologyNational Hama HospitalHamaSyria
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Hou J, Feng W, Liu Q, Wang Y, Guo Z, Liu W. Can we preserve the necrotic testis caused by incarcerated inguinal hernia in infants under 3 months? Pediatr Surg Int 2023; 40:16. [PMID: 38042759 DOI: 10.1007/s00383-023-05592-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/04/2023]
Abstract
PURPOSE This study aims to investigate whether necrotic testis resulting from incarcerated inguinal hernias can be preserved in infants under 3 months old. METHODS A retrospective analysis was conducted on data collected from infants under 3 months old who had necrotic testis caused by incarcerated inguinal hernias between 2016 and 2020. They were divided into two groups: the orchiectomy group and the testicular preservation group. The control group consisted of normal male children of the same age. Data regarding bilateral testicular volume, dihydrotestosterone, inhibin B, and antisperm antibodies were collected. RESULTS The study included 42 cases, with 18 patients being followed up for 6-54 months after the operation. In the testicular preservation group, 2 children did not experience testicular atrophy. There was no significant difference in the volume of the contralateral testes between the testicular preservation group and the control group; however, both groups had smaller testicular volumes compared to the orchiectomy group. There was no significant difference in the levels of inhibin B between the testicular preservation group and the orchiectomy group, although both were lower than the control group. Furthermore, no significant difference was observed in the levels of dihydrotestosterone and the positivity rate of antisperm antibodies among the three groups. CONCLUSION Preserving the necrotic testis may allow it to survive without impacting the contralateral testis. Therefore, a more conservative approach should be considered for orchiectomy when dealing with testicular necrosis caused by incarcerated inguinal hernias in infants.
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Affiliation(s)
- Jinfeng Hou
- Department of General Surgery and Neonatal Surgery, Children's Hospital of Chongqing Medical University, Liangjiang Wing, Yubei District, Chongqing, 401122, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Feng
- Department of General Surgery and Neonatal Surgery, Children's Hospital of Chongqing Medical University, Liangjiang Wing, Yubei District, Chongqing, 401122, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Qingshuang Liu
- Department of General Surgery and Neonatal Surgery, Children's Hospital of Chongqing Medical University, Liangjiang Wing, Yubei District, Chongqing, 401122, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Wang
- Department of General Surgery and Neonatal Surgery, Children's Hospital of Chongqing Medical University, Liangjiang Wing, Yubei District, Chongqing, 401122, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhenhua Guo
- Department of General Surgery and Neonatal Surgery, Children's Hospital of Chongqing Medical University, Liangjiang Wing, Yubei District, Chongqing, 401122, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Liu
- Department of General Surgery and Neonatal Surgery, Children's Hospital of Chongqing Medical University, Liangjiang Wing, Yubei District, Chongqing, 401122, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
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Guo BC, Wu HP. Atypical symptoms of testicular torsion in a 7-year-old child: A case report. Medicine (Baltimore) 2023; 102:e33709. [PMID: 37144991 PMCID: PMC10158923 DOI: 10.1097/md.0000000000033709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/17/2023] [Indexed: 05/06/2023] Open
Abstract
RATIONALE Testicular torsion accounting for 25% of acute scrotal disease, is an acute surgical condition. Atypical presentations of testicular torsion may lead delay diagnosis. PATIENT CONCERNS A 7-year-old boy was admitted to the pediatric emergency department with continuous and progressive left scrotal pain for 2 days, associated symptoms and signs included left scrotal swelling and erythema. The pain started 4 days ago as left lower abdominal pain which then migrated to the left scrotum. DIAGNOSES Physical examination showed left scrotum skin redness, swelling, local heat, tenderness, high-riding testis, absence of the left side cremasteric reflex and a negative Prehn's sign. Subsequent point of care ultrasound of scrotum revealed increased volume of the left testicle, inhomogeneous hypo-echoic left testis, and no detectable flow in the left testis. Left testicular torsion was diagnosed. INTERVENTIONS Surgical examination confirmed testicular torsion showing 720° counterclockwise rotation of the spermatic cord with ischemic changes in the left testis and epididymis. OUTCOMES The patient was stabilized and discharged after left orchiectomy, right orchiopexy and antibiotic therapy. LESSONS Symptoms of testicular torsion may be atypical, especially in prepubertal age. Detailed history, physical examination, point of care ultrasound usage and timely urologist consultation and intervention are important for prompt rescue to prevent testicular loss, testicular atrophy, and eventual impairment of fertility.
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Affiliation(s)
- Bei-Cyuan Guo
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Han-Ping Wu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
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Paiva Ferreira I, Alba D, Fernandes S, Tuna T, Branco T, Abreu Ferreira J. Torsion of undescended testicle in an adolescent: A rare challenging surgical emergency ☆. Pediatr Neonatol 2023:S1875-9572(23)00037-2. [PMID: 36872196 DOI: 10.1016/j.pedneo.2022.12.012] [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: 11/07/2022] [Revised: 12/15/2022] [Accepted: 12/30/2022] [Indexed: 02/18/2023] Open
Affiliation(s)
- Inês Paiva Ferreira
- Department of Pediatrics, Centro Hospitalar Do Tâmega e Sousa, Penafiel, Portugal.
| | - Diana Alba
- Department of Pediatrics, Centro Hospitalar Do Tâmega e Sousa, Penafiel, Portugal
| | - Sara Fernandes
- Department of Pediatric Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Tiago Tuna
- Department of Pediatric Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Tiago Branco
- Department of Pediatrics, Centro Hospitalar Do Tâmega e Sousa, Penafiel, Portugal
| | - Jorge Abreu Ferreira
- Department of Pediatrics, Centro Hospitalar Do Tâmega e Sousa, Penafiel, Portugal
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Zhang K, Zhang Y, Chao M. Clinical characteristics and identification of risk factors of testicular torsion in children: A retrospective study in a single institution. Front Surg 2023; 9:1040487. [PMID: 36760669 PMCID: PMC9904406 DOI: 10.3389/fsurg.2022.1040487] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/13/2022] [Indexed: 01/09/2023] Open
Abstract
Background Testicular torsion (TT) is a common urological emergency posing serious health problem in children. Prompt diagnosis and treatment of TT are very important for children to protect the affected testis. The aim of this study was to evaluate the historical features, physical examination findings, laboratory tests, and ultrasound examinations in children with TT, as well as to identify the predictors of testicular salvage in children. Materials and methods We conducted a retrospective record of clinical findings, laboratory data, ultrasound findings, operating results, and the results of follow-up in hospitalized children with TT from November 2004 to December 2021. A multivariable logistic regression model was used to identify predictors of testicular salvage. Results A total 102 hospitalized children who presented with TT were included. Patients were aged from 1 month to 16 years, with a median age of 7.71 years. TT is significantly more common in the winter. Of these patients, 77 torsions were left-sided, 24 were on the right side, and only 1 was on bilateral sides. Meanwhile, we detected that 88 children suffering from TT had intravaginal torsion of the spermatic cord, and the rest were outside. Anticlockwise torsion was found in 65 cases (63.73%) and clockwise torsion in 37 (36.27%). As a result, 60 underwent orchidectomy, while 42 had a scrotal exploration with fixation of the testis. Multivariate analysis showed that cause of TT, time to intervention, white blood cell (WBC), and mean platelet volume (MPV) were correlated with the risk of a surgical outcome. Conclusion Only a small proportion of TT children received timely surgical management. Testicular salvage can be predicted by cause of TT, time to intervention, WBC, and MPV. Early scrotal exploration based on careful physical examination decreases the risk of misdiagnosis of spermatic cord torsion. A certain percentage of children with TT presenting with scrotal trauma or epididymo-orchitis should have their testicles checked to make sure that they do not have torsion, especially those who visit in the cold season.
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Chen P, Yang Z, Chen N, Liu L, Su J, Sun M, Li S. Diagnosis and treatment of cryptorchid testicular torsion in children: A 12-year retrospective study. Front Pediatr 2022; 10:968997. [PMID: 36071885 PMCID: PMC9441697 DOI: 10.3389/fped.2022.968997] [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: 06/14/2022] [Accepted: 08/01/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To investigate the clinical characteristics, treatment, and prognosis of cryptorchid testicular torsion in children. METHODS The clinical data of 25 children who received treatment for cryptorchid testicular torsion between January 2010 and December 2021 were retrospectively reviewed. The median age of the patients was 64.5 months (range: 2 months to 15 years). All patients had unilateral torsion, and the duration of symptoms ranged from 3 to 192 h. RESULTS Among the 25 patients, five underwent orchidopexy, while the remaining 20 underwent orchiectomy. After 6 months to 8 years of follow up, the 20 patients who had undergone orchiectomy had a well-developed testis on the healthy side. Four of the five patients who had undergone orchidopexy of the affected testis had well-developed testes bilaterally, while one experienced testicular atrophy. CONCLUSION Cryptorchid testicular torsion is a rare urological emergency that displays a delayed presentation and is often misdiagnosed. Clinicians need to carefully review the patient's medical history and ultrasound findings and perform a thorough physical examination to make a correct diagnosis. Active testicular exploration is required for patients suspected to have cryptorchid testicular torsion, and the decision to perform orchidopexy or orchiectomy depends on the intraoperative situation.
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Affiliation(s)
- Pengyu Chen
- Department of Urology, Shenzhen Children's Hospital, China Medical University, Shenzhen, China
| | - Zhilin Yang
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, China
| | - Nana Chen
- Department of Urology, Shenzhen Children's Hospital, China Medical University, Shenzhen, China
| | - Lei Liu
- Department of Urology, Shenzhen Children's Hospital, China Medical University, Shenzhen, China
| | - Jiahong Su
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, China
| | - Mengkui Sun
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, China
| | - Shoulin Li
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, China
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Ali MA, Oyortey M, Maalman RS, Donkor OY, Quarshie H. Testicular torsion in a catheterized geriatric 73-year-old patient, making an early diagnosis: a case report. J Surg Case Rep 2021; 2021:rjab191. [PMID: 34025976 PMCID: PMC8130873 DOI: 10.1093/jscr/rjab191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/13/2021] [Accepted: 04/18/2021] [Indexed: 11/13/2022] Open
Abstract
Testicular torsion is a urologic emergency that requires surgical intervention. Its diagnosis is rarely made in elderly men especially the subset of men on urethral catheter. As a result, delayed diagnosis and surgical exploration occur leading to testicular infarction with necrosis, abscess formation and ultimately orchidectomy. We report a 73-year-old urologic patient referred with a 2-month history of transurethral catheterization to relieve retention of urine with subsequent scrotal pains and fever. Physical examination showed left hemi-scrotal swelling and normal right hemi-scrotal findings. A Doppler scan done showed an intratesticular fluid collection with no blood flow in the left testes. This case illustrates the need to include testicular torsion when diagnosing geriatric men with transurethral catheter presenting with any acute scrotal pains. We, therefore, recommend a detailed history and physical examination in addition to a colour Doppler ultrasound scan in making a diagnosis.
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Affiliation(s)
- Mahamudu A Ali
- Department of Surgery, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Mawuenyo Oyortey
- Department of Surgery, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Raymond S Maalman
- Department of Basic Medical Sciences, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Otchere Y Donkor
- Department of Basic Medical Sciences, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
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