Arena Francesco, Nicòtina Piero Antonio, Romeo Carmelo, Zimbaro Giovanni, Arena Salvatore, Zuccarello Biagio, Romeo Giuseppe
Department of Medical and Surgical Pediatric Surgery, University of Messina, Italy.
Int J Urol. 2006 Feb;13(2):135-41. doi: 10.1111/j.1442-2042.2006.01247.x.
To highlight the ultrasonographic features of prenatal torsion of the testis in utero (IUTT) at presentation, the neonatal management and the histological findings postorchiectomy or biopsy.
Seven newborns underwent emergency exploration for IUTT. All patients underwent a sonography and real-time color Doppler ultrasound study of the scrotum before any surgical procedure. A histological examination was performed in the removed specimens.
Sonography of the scrotum revealed enlarged, heterogeneous testes. In all cases the color and power Doppler did not reveal any flow signal on the affected side. Four newborn with unilateral testicular torsion underwent orchiectomy and contralateral orchidopexy. In one neonate after detorsion and with the absence of gangrenous changes and a reassuring biopsy, a twisted testis could be treated conservatively with orchidopexy. In another case, the parents, acknowledging the inviability of the affected testis, gave consent only for a biopsy of the testis. In the neonate with bilateral IUTT, bilateral testicular biopsies were performed. Histology of the removed testes variably showed interstitial red cell extravasion and coagulation or hemorrhagic necrosis. Light microscopy of the preserved testis highlighted surviving seminiferous tubules, with gonocytes, spermatogonia and fetal Sertoli cells.
An early diagnosis and treatment in IUTT is essential. Surgical exploration should be always performed through the inguinal route. In bilateral IUTT testes should be left to try to assure, as long as possible, a residual Leydig cell function.
强调产前睾丸宫内扭转（IUTT）在就诊时的超声特征、新生儿管理以及睾丸切除术后或活检的组织学发现。
7例新生儿因IUTT接受急诊探查。所有患者在任何外科手术前均接受了阴囊超声及实时彩色多普勒超声检查。对切除标本进行组织学检查。
阴囊超声显示睾丸增大、回声不均匀。所有病例中，患侧彩色及能量多普勒均未显示任何血流信号。4例单侧睾丸扭转新生儿接受了睾丸切除术及对侧睾丸固定术。1例新生儿在扭转复位后，无坏疽改变且活检结果令人放心，扭转的睾丸可通过睾丸固定术进行保守治疗。在另一例中，父母承认患侧睾丸无法存活，仅同意对睾丸进行活检。对于双侧IUTT的新生儿，进行了双侧睾丸活检。切除睾丸的组织学检查不同程度地显示间质红细胞外渗、凝固性或出血性坏死。保留睾丸的光镜检查显示存活的生精小管，伴有生殖母细胞、精原细胞和胎儿支持细胞。
IUTT的早期诊断和治疗至关重要。手术探查应始终通过腹股沟途径进行。对于双侧IUTT，应尽可能保留睾丸，以确保残留的 Leydig 细胞功能。
