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).
Key words
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Article info
Publication history
Published online: August 08, 2018
Accepted:
July 3,
2018
Received in revised form:
May 10,
2018
Received:
March 2,
2018
Footnotes
☆Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
☆☆Funding: The author(s) received no financial support for the research, authorship, and publication of this article.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
