Yerkes Elizabeth B, Robertson Frank M, Gitlin Jordan, Kaefer Martin, Cain Mark P, Rink Richard C
Department of Urology, Wilford Hall Medical Center, Lackland AFB, Lackland, Texas, USA.
J Urol. 2005 Oct;174(4 Pt 2):1579-82; discussion 1582-3. doi: 10.1097/01.ju.0000179542.05953.11.
Management of perinatal testicular torsion is a highly controversial issue. Despite uncommon salvage of the affected gonad, exploration for ipsilateral orchiectomy and empiric contralateral orchiopexy have been recommended due to the unlikely but unfortunate possibility of asynchronous torsion. Observation with serial examination is the alternative. Risk of general anesthesia must be weighed against the risk of anorchia. We describe our collective experience with bilateral perinatal torsion, solidifying our recommendation for early exploration in all cases of perinatal torsion.
All cases of perinatal torsion from 3 practices during a 3-year period were reviewed. All practices were at an academic center or in a major metropolitan area. Early exploration for contralateral orchiopexy was performed in all cases.
In 18 patients examination was consistent with unilateral perinatal torsion. Contralateral torsion was discovered at the time of exploration in 4 cases (22%). Despite orchiopexy of the better perfused gonad, atrophy was universal in these 4 cases. Findings potentially related to contralateral torsion were identified in 2 additional cases. No anesthetic or operative complications occurred.
Bilateral asynchronous perinatal torsion is an uncommon but serious event. In our experience torsion of the contralateral gonad was not associated with signs or symptoms of acute torsion. Observation and serial examinations are then a challenging proposition. Due to the consistently poor outcome from bilateral asynchronous torsion, we continue to recommend early exploration and empiric contralateral orchiopexy for all cases of perinatal torsion. Parents must be counseled regarding the relative risks of exploration and anesthesia versus observation.
围产期睾丸扭转的处理是一个极具争议的问题。尽管患侧性腺得以挽救的情况并不常见，但由于存在异步扭转这种不太可能但不幸的可能性，仍建议进行同侧睾丸切除术探查及经验性对侧睾丸固定术。另一种选择是进行系列检查观察。必须权衡全身麻醉的风险与无睾症的风险。我们描述了我们在双侧围产期扭转方面的总体经验，强化了我们对所有围产期扭转病例进行早期探查的建议。
回顾了3家医疗机构在3年期间所有围产期扭转的病例。所有医疗机构均位于学术中心或大城市地区。所有病例均进行了早期对侧睾丸固定术探查。
18例患者的检查结果与单侧围产期扭转相符。4例（22%）在探查时发现对侧扭转。尽管对血供较好的性腺进行了睾丸固定术，但这4例均出现了普遍萎缩。另外2例发现了可能与对侧扭转相关的表现。未发生麻醉或手术并发症。
双侧异步围产期扭转是一种罕见但严重的情况。根据我们的经验，对侧性腺扭转与急性扭转的体征或症状无关。因此，观察和系列检查是一项具有挑战性的任务。由于双侧异步扭转的预后始终很差，我们继续建议对所有围产期扭转病例进行早期探查及经验性对侧睾丸固定术。必须就探查和麻醉与观察的相对风险向家长提供咨询。
