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Perinatal testicular torsion: The clear cut, the controversial, and the "quiet" scenarios

  • Tomer Erlich
    Correspondence
    Corresponding author at: Division of Pediatric Urology, The Hospital for Sick Children, SickKids, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
    Affiliations
    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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  • Ali El Ghazzaoui
    Affiliations
    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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  • Martha Pokarowski
    Affiliations
    Division of Pediatric Urology, The Hospital for Sick Children, SickKids, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
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  • Fardod O'Kelly
    Affiliations
    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
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  • Armando J. Lorenzo
    Affiliations
    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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  • Darius J. Bagli
    Affiliations
    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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  • Martin.A. Koyle
    Affiliations
    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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      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

      Keywords

      Abbreviations:

      EUA (examination under anesthesia), CPAP (continuous positive airway pressure), IQR (interquartile range), PSDP (pre surgeon's decision period), PTT (perinatal testicular torsion), SK (quaternary referral pediatric center), US (ultrasound), UTI (urinary tract infection)
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