Perinatal testicular torsion may be subdivided into prenatal (73%) and postnatal (28%) up to 30 days post birth. Aetiology in the former is universally extra vaginal around the whole of the tunica vaginalis with testicular salvage rate of <5%. Postnatal torsion may be either intra or extravaginal and has a salvage rate of 30-40% if managed as an emergency. This paper analyses a survey of American urologists as to their hypothetical management of either of these conditions as well as that of a boy who has a laparoscopy for an impalpable testis and in whom a blind ending vas and vessels are identified. The survey identified that there is a wide variation amongst paediatric urologists as to whether or not to (and when) to operate, whether or not to fix the normal contralateral side and whether to explore a groin for a ‘nubbin’ if there is the described laparoscopic finding. In a neonate with prenatal torsion, 34% would operate immediately, 26% within 72 hours, 28% electively and 12% not at all. Ninety-three percent would perform a contralateral exploration and fixation. In a neonate with postnatal torsion, 93% would operate immediately, 5% urgently, 1% electively and 1% not at all, with 96% performing a contralateral fixation at the same time. In the laparoscopy case, 28% would perform a contralateral fixation and 12% would explore the groin for a nubbin as there have been cases of residual seminiferous tubules present in nubbins (and these could potentially become malignant in the future). Despite the known rare malignancy in neonatal testicular torsion and the textbook-recommended approach being a groin incision, most would approach the neonatal torsion through a scrotal incision. No reason for this was given.
The current state of surgical practice for neonatal torsion
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