Pediatric UrologyDelaying Urgent Exploration in Neonatal Testicular Torsion May Have Significant Consequences for the Contralateral Testis: A Critical Literature Review
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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Perinatal testicular torsion: The clear cut, the controversial, and the "quiet" scenarios
2022, Journal of Pediatric SurgeryCitation 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].
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Conflict of Interest: There are no conflicts of interest.
Financial disclosure: There are no sources of funding available.