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Neonatal torsion: a 14-year experience and proposed algorithm for management
Jonathan D Kaye1, Selwyn B Levitt, Steven C Friedman
1Division of Pediatric Urology, Schneider Children's Hospital of the North Shore-Long Island Jewish Health System, New Hyde Park, New York, USA.
The Journal of Urology
|April 25, 2008
Summary
Neonatal testicular torsion is often prenatal and results in irreversible infarction, making salvage impossible. Postnatal torsion, however, may be salvageable with prompt surgical intervention.
Area of Science:
- Pediatric Surgery
- Neonatal Urology
- Reproductive Medicine
Background:
- Neonatal testicular torsion management is debated due to anesthesia risks versus salvage potential.
- Stratifying neonatal torsion by presentation time is crucial for determining salvageability.
Purpose of the Study:
- To analyze a large series of neonatal torsion cases, stratified by presentation time.
- To determine the potential for testicular salvage in neonatal torsion.
Main Methods:
- Classified neonatal torsion as prenatal (at delivery) or postnatal (after birth, before 1 month).
- Reviewed patient charts for demographics, history, examination, imaging, intraoperative findings, complications, and pathology.
- Collected follow-up data for patients undergoing detorsion and orchiopexy.
Main Results:
- 16 neonatal torsions in 15 patients (1993-2007); 81% prenatal, 19% postnatal.
- All 13 prenatal torsions (100%) resulted in infarction; 11 managed by orchiectomy.
- Only 1 of 3 postnatal torsions (33%) was salvaged; prenatal complications noted in 50% of cases.
Conclusions:
- Complicated pregnancies and vaginal deliveries are associated with neonatal testicular torsion.
- Prenatal torsions are non-salvageable and do not require emergent intervention.
- Postnatal torsions have a salvageable rate, necessitating judicious surgical exploration.
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