Controversies in the management of neonatal testicular torsion: A meta-analysis

Cecilia Monteilh, Rose Calixte, Sathyaprasad Burjonrappa

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Objective: This meta-analysis seeks to discern the optimal management strategy in neonatal testicular torsion (NTT). Methods: Reviewed all English-language articles published between 2005 and 2015 in Medline/Pubmed that had a defined diagnosis of NTT within the first thirty days of life, and discussed specific surgical and nonsurgical management. Exclusion criteria were non-English literature, case reports, case studies, and failure to clearly describe the management of NTT. Data from 9 studies were analyzed, individually and together as pooled data, using a random effect model with a random intercept to estimate the pooled proportions of interest. Results are presented with 95% confidence interval. All analyses were done in SAS 9.4®. Results: 9 publications met criteria for this analysis with a total of 196 patients. Bilateral testicular torsions (n = 14) were less common as compared to right/left testicular torsion (n = 85/97). Asynchronous NTTs (n = 9) were more common than synchronous NTTs (n = 2). There was a higher incidence of NTT in neonates delivered by vaginal delivery (n = 110) as compared to those delivered by c-section (n = 25). Extravaginal torsion (n = 54) is far more common than intravaginal torsion (n = 2). Full-term neonates (n = 122) have a higher incidence of NTT as compared to preterm neonates (n = 9). A total of 15 testicles were salvaged. Of the salvaged testicles 2 were documented as prenatal, 10 postnatal and 3 were undocumented. A strategy of bilateral exploration allows for salvage of about 7% of ipsilateral testicles and prevent asynchronous torsion in about 4% of neonates. Conclusions: Based on our population, between 8–12% of patients would benefit from bilateral exploration at the time of diagnosis. We recommend urgent bilateral exploration with orchiopexy of the contralateral testicle in order to avert anorchia. Type of study: Systematic review. Level of evidence: Level 5 meta-synthesis (Evidence from systematic reviews of qualitative and descriptive studies).

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
StateAccepted/In press - Jan 1 2018

Keywords

  • Neonatal testicular torsion
  • Neonatal torsion
  • Perinatal torsion

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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