Perinatal testicular torsion: literature review and local experience

Abstract

Introduction Perinatal testicular torsion includes intrauterine testicular torsion (IUTT) and postnatal testicular torsion (PTT). IUTT includes cases of vanished testis and testicular mass presenting at birth. Controversies exist regarding the need for urgent exploration and contralateral orchiopexy. The aim of this study is to review our local experience in the management of these cases.
Patients and methods From May 2000 to May 2010, all files of patients with perinatal testicular torsion and operated cases of undescended testes (UDT) were reviewed retrospectively.
Results Seven patients presented with a unilateral nonacute testicular mass at birth. Six of these patients required elective inguinal exploration and orchiectomy, whereas one was treated conservatively. All patients underwent urgent radiological investigations. None of the cases had synchronous or asynchronous contralateral involvement. Two patients with PTT presented acutely and required immediate bilateral scrotal exploration and testicular fixation without preoperative radiological investigations. Of 450 patients with UDT, there were 13 vanished testes (2.9%). Thirteen patients with torsion of the undescended testes (TUDT) presented acutely and required immediate inguinal exploration. Most of the TUDT cases (85%) presented between 5 weeks and 6 months. None of them could be saved.
Conclusion Patients with IUTT did not present acutely, whereas patients with PTT presented acutely and required immediate bilateral scrotal exploration and fixation. The prognosis in TUDT is guarded and contralateral fixation was not practiced, except in a 5-week-old infant. Early orchiopexy at 3–6 months is recommended. Cooperation between surgeons, neonatologists, and parents is mandatory to avoid time delay. 

Keywords: intrauterine testicular torsion, postnatal testicular torsion, torsion of undescended testis