C. Monteilh2, R. Calixte2, S. Burjonrappa1,2 1Montefiore Medical Center,Surgery/Pediatric Surgery,Bronx, NY, USA 2Winthrop University Hospitals,Surgery/Pediatric Surgery,Mineola, NY, USA
Introduction: Management of neonatal testicular torsion (NTT) is controversial. Since NTT is detected late many surgeons adopt a wait and watch approach as testicular salvage is unlikely in this setting. There are others who however strongly believe in immediate exploration and perform an orchiopexy on the opposite side simultaneously or after a few months. We performed a meta-analysis to evaluate the optimal management strategy.
Methods: We reviewed all English language articles published between 2005-2015 in Medline, Pubmed and SCOPUS that had a defined diagnosis of NTT within the first thirty days of life, and discussed surgical and non-surgical management. Exclusion criteria were non-English literature, case reports, case studies, and failure to clearly describe management of NNT. The main characteristics of the studies evaluated were mode of delivery, laterality, and management of ipsilateral and contralateral testes. Data from selected studies were analyzed 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®. Each study was evaluated separately as well as pooled together to form combined data. All studies included in the meta-analysis were used to estimate pooled confidence intervals (CI).
Results:
9 studies with 196 patients were included in the analysis. The pooled proportion of neonates with right testicular torsion was 0.43 ( 95% CI= 0.34 to 0.53). The pooled proportion for left testicular torsion was 0.49 (95% CI= 0.39- 0.59). 7% of patients in the included studies had bilateral testicular torsion (95%CI=3%-15%). Synchronous testicular torsion occurred in 1% of those patients ( 95% CI= 0% -5%). Asynchronous testicular torsion occurred in 4% of those patients (95% CI=1% to 11%). The pooled vaginal delivery rate was 54% (95% CI= 17% -87%) vs. a rate of 12% (95% CI= 6% -23%) for c-section delivery. Diagnosis at birth was made in 56% (CI 0.13-0.92) and post natal diagnosis was made in 10% (CI 0.03-0.31). NTT was seen in full term infants in 70% of studied patients (CI 0.07-0.99) and in 2% of premature infants (CI 0.01-0.10). In patients who had both testicles explored soon after diagnosis 75% underwent ipsilateral orchiectomy (CI 0.49-0.90) and testicle was salvaged in 6% (CI 0.02-0.14). There were no reports of contralateral torsion in this group. In patients who had ipsilateral exploration only, salvage was possible in 1% (CI 0-0.06) and no contralateral torsion on follow up was reported in this group. Only one study reported contralateral exploration only with no reported contralateral torsion in follow up. Two studies reported observation only with no reported contralateral torsion.
Conclusions: Testicular salvage after NTT is rare. Unless the event is clearly diagnosed post-nataly, observation alone would be a judicious choice for management of the ipsilateral (affected side) NTT.