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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 10, 2021
Accepted:
October 1,
2021
Received in revised form:
September 17,
2021
Received:
August 15,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
