12 years of experience in intrauterine testicular torsion management

Intrauterine testicular torsion is a rare pathology and there is no consensus on how to treat and follow-up these patients. This study aims to evaluate the surgical indications, findings, testicular viability rate, and management approaches of intrauterine testicular torsion cases in our center over a 12-year period.

17 patients diagnosed with intrauterine testicular torsion and operated on between January 2010 and 2023 were included in the study. The patients' age at birth, mode of birth, weight, maternal age, genetic diagnosis, presence of other anomalies, complaints upon presentation, physical examination findings, laboratory results, preoperative ultrasound and Doppler imaging findings, surgery date, surgery weight, torsion side, surgery method and findings, torsion type (intravaginal, extravaginal), degree of torsion, length of hospital stay, complications, pathology results, testicular status in postoperative follow-up and ultrasonography and Doppler findings were examined.

The median age of the cases was one day. Orchiectomy was performed in fourteen cases (82.4%), while three cases (17.6%) were managed with detorsion and orchiopexy. Prophylactic contralateral orchiopexy was performed in four (23.5%) cases, and undescended testicle surgery was performed in one (5.9%) case. None of the testes managed with detorsion and orchiopexy remained viable during follow-up.

The etiology, risk factors, and optimal management approach of intrauterine testicular torsion are not fully elucidated. Based on the current literature, the salvage rates are close to zero in our study as well as many others despite the efforts to promptly diagnose and operate intrauterine torsion cases. Creating management algorithms based on the data gathered from multiple centers over the years can yield better outcomes for this devastating pathology.