Elsevier

Urology

Volume 153, July 2021, Pages 277-284
Urology

Pediatric Urology
Delaying Urgent Exploration in Neonatal Testicular Torsion May Have Significant Consequences for the Contralateral Testis: A Critical Literature Review

https://doi.org/10.1016/j.urology.2020.10.064Get rights and content

Objective

To assess the optimal management strategy for boys with neonatal testicular torsion (NTT) in the first 30 days of life, and to stratify outcomes for prenatal, postnatal, unilateral, synchronous, and asynchronous events

Methods

All articles including case reports published between 1946 and 2020 in Embase/Scopus/Medline/Pubmed and Web of Science that had a defined diagnosis of NTT within the first 30 days of life were reviewed. Data and outcomes were analyzed individually, and together as pooled data, using a random effect model.

Results

There was a total of 152 studies representing 1336 patients. Outcome data was available on 974 patients (1121 testes). NTT was unilateral in 829 cases, synchronous bilateral in 80 cases, and asynchronous in 66 cases. There were a total of 1107 orchiectomies, and 229 salvage orchiopexies. A total of 2.5% synchronous NTT underwent successful salvage. A total of 95.7% of prenatal unilateral torsions underwent orchiectomy, compared with 92% postnatal torsions. 11.8% of all NTT events were asynchronous with a median time to second torsion of 1 day (Range 1-8). The contralateral orchiectomy rate in this group was 31.8%, with a 40% atrophy rate following orchiopexy. The number needed to treat to avoid bilateral orchiectomy was 1.6, and the number needed to treat to avoid solitary atrophy was 2.6.

Conclusion

NTT is an important condition carrying a significant risk for testicular loss and endocrine insufficiency. Given the potential catastrophic risk of asynchronous extravaginal torsion, we recommend urgent, safe, surgical intervention with both unilateral and bilateral NTT.

Section snippets

METHODS

Institutional research and ethics board approval was waived for this study. A systematic search of the English literature was performed on February 1, 2020 to identify any peer-reviewed publications focusing on NTT (within the first 30 days of postnatal life) from January 1, 1946 to January 31, 2020. An electronic search was performed using Pubmed, Medline, Scopus, Web of Science and Embase databases (Accessed through Royal College of Surgeons in Ireland Library, and University of Toronto

RESULTS

There were a total of 152 studies (incl. 86 case reports) representing 1336 patients which met inclusion criteria for this analysis. Many of the papers prior to 1966 were not available, and 31.7% papers were excluded as they were not relevant to the topic on full manuscript review. The final total reflected 34.9% of the screened literature. Interobserver agreement was substantial with a kappa score of 0.83. There is a steady increase in the number of overall publications across each decade

DISCUSSION

NTT is clearly an uncommon entity that is a diagnostic and management conundrum since it may occur prenatally or postnatally. The outcomes from prenatal events are usually poor with orchiectomy being performed >95% cases. This fits well with anecdotal evidence. What is novel, and unexpected, identified in this review, was the data provided from published peer-review case reports which suggested that, in addition to existing case series, the risk of asynchronous torsion was much higher than

CONCLUSION

NTT is an important condition carrying with it a significant risk for testicular loss and endocrine insufficiency. Given the potential catastrophic risk of asynchronous extravaginal torsion, and the beneficial effect of contralateral orchiopexy during unilateral torsion, we recommend urgent surgical intervention as soon as medically feasible, allowing for medical stabilization, and adherence to patient safety, with both unilateral and bilateral NTT. If the patient is in a unit without pediatric

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Cited by (5)

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

    2022, Journal of Pediatric Surgery
    Citation Excerpt :

    These disparities in clinical management have also been demonstrated among pediatric urologists regarding clinical presentation of the perinatal testicular torsion spectrum [17,19,20]. In a recent literature review conducted by our team, 14.9% (146/947) of all reported cases had bilateral PTT [21]. Based on this review and the above data, we hypothesize that bilateral PTT is not negligible, and small fraction of the cases might be salvaged, especially in postnatal scenarios [21].

Conflict of Interest: There are no conflicts of interest.

Financial disclosure: There are no sources of funding available.

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