Division of Pediatric Urology, Children's National Medical Center, Washington, D.C..
Division of Pediatric Urology, Children's National Medical Center, Washington, D.C.
J Urol. 2014 May;191(5 Suppl):1573-7. doi: 10.1016/j.juro.2013.09.013. Epub 2014 Mar 26.
Bell clapper anomaly is associated with an increased risk of intravaginal testicular torsion. However, perinatal torsion is thought to be secondary to an extravaginal process. We quantified the contralateral prevalence of bell clapper anomaly in children found to have atrophic testicular nubbins secondary to presumed torsion during gestation to better define the subsequent risk of metachronous testicular torsion.
Inspection results for the presence of contralateral bell clapper anomaly was recorded by a single surgeon in 50 consecutive cases in which exploration for nonpalpable testes revealed a testicular nubbin. For comparison data were collected in 27 consecutive cases of acute testicular torsion. Anatomy of the normal contralateral testis was compared between the 2 groups.
Average age at surgery in the perinatal torsion group was 15 months vs 12.7 years in the acute torsion group. One case of partial contralateral bell clapper anomaly was discovered in the perinatal torsion group but no complete anomaly was found. In contrast, in older boys with acute testicular torsion complete bell clapper anomaly was found in 21 of the 27 contralateral testes (78%).
In older boys with acute testicular torsion contralateral bell clapper anomaly is highly prevalent, supporting the standard practice of contralateral testicular fixation in this clinical situation. However, the prevalence of contralateral bell clapper anomaly is exceedingly small in cases of monorchism after perinatal torsion, substantiating an insufficient risk of subsequent torsion to justify routine fixation of the solitary testis.
钟摆畸形与阴道内睾丸扭转的风险增加有关。然而，围产期扭转被认为是继发于鞘外过程。我们定量评估了在妊娠期间因疑似扭转而导致萎缩性睾丸残端的儿童对侧钟摆畸形的患病率，以更好地定义随后发生对侧睾丸扭转的风险。
由一位外科医生对 50 例连续病例进行了对侧钟摆畸形的存在检查，这些病例均因不可触及的睾丸而进行了探查，发现了睾丸残端。为了进行比较，收集了 27 例急性睾丸扭转的连续病例数据。比较了两组正常对侧睾丸的解剖结构。
围产期扭转组的平均手术年龄为 15 个月，而急性扭转组为 12.7 岁。在围产期扭转组发现了 1 例部分对侧钟摆畸形，但未发现完全畸形。相比之下，在急性睾丸扭转的大龄男孩中，27 例对侧睾丸中有 21 例（78%）发现完全钟摆畸形。
在急性睾丸扭转的大龄男孩中，对侧钟摆畸形的患病率很高，支持在这种临床情况下对侧睾丸固定的标准做法。然而，在围产期扭转后单睾丸的情况下，对侧钟摆畸形的患病率极低，表明随后发生扭转的风险不足以证明常规固定孤立睾丸的合理性。
