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

Cecilia Monteilh, Rose Calixte, Sathyaprasad Burjonrappa

Research output: Contribution to journalArticle

4 Citations (Scopus)

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

Fingerprint

Spermatic Cord Torsion
Meta-Analysis
Testis
Newborn Infant
Orchiopexy
Literature
Incidence
PubMed
Publications
Language
Confidence Intervals

Keywords

  • Neonatal testicular torsion
  • Neonatal torsion
  • Perinatal torsion

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Controversies in the management of neonatal testicular torsion : A meta-analysis. / Monteilh, Cecilia; Calixte, Rose; Burjonrappa, Sathyaprasad.

In: Journal of Pediatric Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Monteilh, Cecilia ; Calixte, Rose ; Burjonrappa, Sathyaprasad. / Controversies in the management of neonatal testicular torsion : A meta-analysis. In: Journal of Pediatric Surgery. 2018.
@article{47ba09d2972e4d0db9dd2f7f94606449,
title = "Controversies in the management of neonatal testicular torsion: A meta-analysis",
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{\circledR}. 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).",
keywords = "Neonatal testicular torsion, Neonatal torsion, Perinatal torsion",
author = "Cecilia Monteilh and Rose Calixte and Sathyaprasad Burjonrappa",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.jpedsurg.2018.07.006",
language = "English (US)",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Controversies in the management of neonatal testicular torsion

T2 - A meta-analysis

AU - Monteilh, Cecilia

AU - Calixte, Rose

AU - Burjonrappa, Sathyaprasad

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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).

AB - 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).

KW - Neonatal testicular torsion

KW - Neonatal torsion

KW - Perinatal torsion

UR - http://www.scopus.com/inward/record.url?scp=85051074385&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85051074385&partnerID=8YFLogxK

U2 - 10.1016/j.jpedsurg.2018.07.006

DO - 10.1016/j.jpedsurg.2018.07.006

M3 - Article

C2 - 30098810

AN - SCOPUS:85051074385

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

ER -