Neonatal Torsion

Perinatal torsion, also referred to as neonatal or prenatal torsion, is usually secondary to lack of gubernacular adherence to the scrotal wall and results in extravaginal torsion, involving the entire spermatic cord and its associated tunica layers. It may occur prior to, or around delivery, and patients typically present with an enlarged, discolored, nontender hemiscrotum (Fig. 8.42). Some believe that prenatal torsion can occur very early in gestation and results in the majority of cases of unilateral testicular agenesis (Gong et al. 1996). Contemporary high-frequency Doppler US is generally accurate in confirming the diagnosis.

Controversy persists regarding the optimal management of neonatal torsion: some advocate early exploration in order to avoid potentially synchronous or me-tachronous bilaterality while others feel that, because the torsion occurs prenatally, operative exploration is redundant and simple observation is all that is required (Yerkes et al. 2005; Dewan and Walton 1987). However, since the gubernaculum dehydrates and fixates to the scrotal wall over the first 6-8 weeks postnatally, pa tients are at a theoretically increased risk of metachro-nous bilateral torsion during that time; therefore, urgent exploration and contralateral orchiopexy is not an unreasonable treatment option. Beyond this timeframe, the risk of contralateral torsion appears to decrease, and conservative observational therapy alone is warranted thereafter.

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