A 2‐day‐old male, born at 40 weeks 5 days by emergent caesarean section due to umbilical cord prolapse (Apgar scores 4/9, birth weight 3,740g), was noted to have a right enlarged firm testicle without tenderness and discoloration on routine examination prior to discharge. Following urologic consultation and ultrasound showing heterogeneity and absent arterial flow in the parenchyma of right testicle, right testicular torsion was diagnosed. Subsequently, urgent orchiectomy for a right necrotic testicle and orchiopexy for a left viable testicle were performed.
There are controversial issues regarding the management of neonatal testicular torsion because of a lack of prospective data secondary to the nature of this rare entity (6.1 per 100,000 live births). Most pediatric urologists agree with emergent surgery for prenatal bilateral torsion to assess viability and consider leaving testicles in situ with the hope of averting anorchia and sex steroid deficiencies. The poor salvage rates, the risk of surgical and anesthetic complications in the neonate, and potential testicular injury when operating on a contralateral healthy testicle have led to debate on when and if surgery should be performed in the case of prenatal unilateral testicular torsion. A recent survey of pediatric urologists in Canada shows a trend to choose less aggressive treatment in those with more years of practice. Over half of surgeons would delay scrotal exploration until the neonate was better stabilized, similar to the results of another survey among members of two pediatric urology societies. Although a retrospective review of 44 cases of neonatal testicular torsion revealed that postoperative complications occurred mainly in those operated before 12 days of age, all complications were mild and no patients were readmitted for recurrence of torsion or complications. Bagkaj reviewed 16 cases of neonatal asynchronous bilateral torsions. Though imaging studies were performed in 11 of 16 patients, diagnosis of bilateral torsion was made preoperatively in only 6 patients. Even in the case of prenatal unilateral testicular torsion, urgent bilateral exploration is suggested for confirmation of diagnosis in addition to examination and fixation of the contralateral testis for the following reasons: (1) Clinical diagnosis of prenatal vs. postnatal torsion can be difficult. (2) Salvage of testes at birth and early asynchronous bilateral torsion have been reported. (3) Bilateral torsion can present with signs of unilateral torsion on examination and imaging. (4) Neonatal anesthesia is now safer.
Neonatal testicular torsion may present without acute signs. All male infants should be thoroughly examined as early as possible after birth for early detection of torsion. Timely intervention may prevent morbidity associated with undiagnosed neonatal testicular torsion.
To cite this abstract:Ogimi C, Folsom B, Rhee D, Rauch D. Prenatal Unilateral Testicular Torsion. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 274. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/prenatal-unilateral-testicular-torsion/. Accessed March 28, 2020.