Management of perinatal torsion: today, tomorrow or never?

PURPOSE

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.

MATERIALS AND METHODS

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.

RESULTS

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.

CONCLUSIONS

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.