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Torsion of the Cryptorchid Testis—Can It be Salvaged?

2006; Lippincott Williams & Wilkins; Volume: 175; Issue: 6 Linguagem: Inglês

10.1016/s0022-5347(06)00329-6

1527-3792

Dorit E. Zilberman, Yael Inbar, Zehava Heyman, Danny Shinhar, Ron Bilik, Itamar Avigad, P. Jonas, Jacob Ramon, Yoram Mor,

Testicular diseases and treatments

No AccessJournal of UrologyPediatric urology1 Jun 2006Torsion of the Cryptorchid Testis—Can It be Salvaged? Dorit Zilberman, Yael Inbar, Zehava Heyman, Danny Shinhar, Ron Bilik, Itamar Avigad, Paul Jonas, Jacob Ramon, and Yoram Mor Dorit ZilbermanDorit Zilberman Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel , Yael InbarYael Inbar Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel , Zehava HeymanZehava Heyman Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel , Danny ShinharDanny Shinhar Department of Pediatric Surgery, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel , Ron BilikRon Bilik Department of Pediatric Surgery, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel , Itamar AvigadItamar Avigad Department of Pediatric Surgery, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel , Paul JonasPaul Jonas Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel , Jacob RamonJacob Ramon Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel , and Yoram MorYoram Mor Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel View All Author Informationhttps://doi.org/10.1016/S0022-5347(06)00329-6AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The literature concerning undescended testis mainly concentrates on the increased risks of infertility and development of germ cell tumors. Yet the UDT also appears to be at higher risk for torsion compared to the normally descended testis, and this issue is relatively poorly addressed. We reviewed all cases of torsion of UDTs operated on at our hospital during the last 20 years in an attempt to characterize better this condition and its salvageability. Materials and Methods: In this retrospective clinical study we reviewed and analyzed all cases of testicular torsion involving UDT operated on at our hospital between 1984 and 2004. Results: A total of 11 children were operated on at our hospital for torsion of undescended testis between 1984 and 2004. Patient age ranged from 1 month to 18 years (median 7.5 months). In all cases unilateral torsion of undescended testis was diagnosed, with 73% of cases involving the left side. Clinical symptoms included inguinal swelling and erythema associated with a tender, firm mass palpated in the groin area and an empty ipsilateral hemiscrotum. Doppler ultrasound examination was routinely performed in the last 7 patients to confirm the diagnosis. During inguinoscrotal exploration severe ischemia or overt necrosis of the testis was found in 5 of 11 cases. Three of these 5 cases were managed by orchiectomy, while in the other 2 cases the testis subsequently vanished. In the 6 patients who exhibited some improvement following detorsion and warming of the tissue the testes were preserved and orchiopexy was performed. Followup was available in only 5 patients, with vanishing of the torsed testis observed in 4 and a normal testicle detected 21 years postoperatively in 1 patient who was diagnosed early. Conclusions: This series clearly demonstrates poor rates of surgical salvage, which we mainly attribute to delays in parental response and in primary physician referral to the hospital. Parents, who have a pivotal role in early diagnosis, were usually unaware of this urological emergency, and some were surprisingly unaware of the presence of cryptorchidism. By increasing the awareness regarding this entity among members of the medical community and parents, we hope that torsion of the cryptorchid testis (literally, "hidden testis") will no longer necessarily be synonymous with "crypt-torsion" ("hidden torsion"). References 1 : Pediatric testicular problems. Pediatr Clin North Am1998; 45: 813. Google Scholar 2 : Fertility after cryptorchidism: epidemiology and other outcome studies. Urology2005; 66: 427. Google Scholar 3 : Torsion of the testis and allied conditions. Br J Surg1976; 63: 465. Google Scholar 4 : Cryptorchidism and testicular torsion. Pediatr Clin North Am1993; 40: 1133. Google Scholar 5 : Testicular torsion in undescended testes. Ann Emerg Med1984; 13: 567. Google Scholar 6 : An infant with testicular torsion in the inguinal canal. 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Link, Google Scholar © 2006 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 6June 2006Page: 2287-2289 Advertisement Copyright & Permissions© 2006 by American Urological AssociationKeywordstestisspermatic cord torsioncryptorchidismMetricsAuthor Information Dorit Zilberman Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel More articles by this author Yael Inbar Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel More articles by this author Zehava Heyman Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel More articles by this author Danny Shinhar Department of Pediatric Surgery, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel More articles by this author Ron Bilik Department of Pediatric Surgery, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel More articles by this author Itamar Avigad Department of Pediatric Surgery, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel More articles by this author Paul Jonas Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel More articles by this author Jacob Ramon Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel More articles by this author Yoram Mor Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel More articles by this author Expand All Advertisement PDF downloadLoading ...