BILATERAL SYNCHRONOUS NEONATAL TORSION OF SPERMATIC CORD j. L. W E I N G A R T E N , M.D. F. A. GAROFALO, M.D. W. J. C R O M I E , M.D. F r o m the Division of Urological Surgery, Albany Medical Center Hospital, Albany, New York
~~F--A case oJ synchronous bilateral spermatic cord torsion in a neonate is presented. ~ ~ s t i c u l a r salvage zs variable m this entity, surgical intervention is necessary Jot any hope of ~ ~ preservatzon.
atic cord m a y occur as an aatal p h e n o m e n o n which entity distinctly different patients. Intrauterine totcord was first described in later the first 2 cases of bimatic cord torsion were renal case of bilateral neonad herein.
ploration was performed. Bilateral extravaginal spermatie cord torsion was present. T h e right testis was black and gelatinous. After detorsion and inspection, the left testis was thought to be viable. A right orchiectomy and left orchiopexy were performed. His postoperative recovery was uneventful. Examination of the child at age four months revealed no evidence of viable testicular tissue.
se Report m white male infant was tion to a twenty-four-yearToman. The newborn apexcept for enlarged, hard .rig. 1). He was transferred our institution for further ment. He was afebrile and )rmal. G e n i t o u r i n a r y ex~rkable for slight mottling The testes were both deum. They were both moender, hard, and nontransJr examination of the testes as. A technetium-99m per:-scrotal scan revealed no :icle (Fig. 2). brought to the operating here bilateral inguinal ex-
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FIGURE 1. Enlarged and discolored appearance o] scrotum at birth.
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FIGURE 2. Scintiphoto demonstrating decreased tracer uptake in region of testicles bilaterally (arrows) with reference markers located below testicu•lar area bilaterally. Comments Neonatal torsion is exceeded in frequency only by tlhat occurring in the adolescent period. 4 U n u s u a l m o b i l i t y of t h e n e o n a t a l hemiserotal contents may predispose to extravaginal torsion resulting in an isehemie rotation of the entire hemiserotal contents2 In most eases, the torsion event has occurred antenatally, and the infant with neonatal torsion is asymptomatie. Diagnosis is established by physical examination w h i c h reveals an enlarged, firm, nontender, and nontransilluminating purple-black serotal mass composed of ischemic structures and surrounding reactive hematocele. Adjunctive tests in this setting are generally not necessary for diagnosis, although Doppler examination and testieular-scrotal scan aid in confirmation. The most likely secondary differential lesion is an incarcerated inguinal hernia with a variety of less likely diagnoses including tumor, hematocele or testieular hematoma, inflammatory conditions such as epididymitis or orchitis, torsion of a tes-
136
tieular appendage, and ect these conditions is rare in l Management of neonatal sion is controversial. When situation, the urologist's threefold. First, the decisi( based on prompt preoper the process and overall co born infant. An inguinal a when one considers the ferential diagnosis. Secon, advanced testieular isehel ability to preserve endoerir ductive function must be 1 presence of systemic toxieit ing infarcted tissue in the t act age at which fixation ( to the serotal wall occurs is ehronous extravaginal t~ Therefore, management o: torsion should inetude con Despite the outcome ot herein, in the rare ease of t n e o n a t a l t o r s i o n of th, emergent surgical intervel and replacement of at lea eared in hope of preserving function. 43 New Scotland ~
Albany, New References 1. Taylor MD: A case of testicle s tion; recovery, Br Med J !: 458 (189 9.. Frederick PL, Dushku N, and lateral torsion of the testes in a newN (1967). 3. Papadatos C, and Moutsouris ( in the newborn, J Pediatr 71:249 (] 4. Skoglung RW, McRoberts JW, spermatic cord: a review of the lite new eases, J Urol 104:604 (1970). 5. Campbell MF: The male ge urethra, in Campbell MF, and Harri Philadelphia, WB. Saunders, 1970, 6. Watson RA: Torsion of sperma 5:439 (1975). 7. Backhouse KM: Embryology oJ testis, in Fonkalsrud EW, and Menge Testis, Chicago, Year Book Medical:
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~~F--A case oJ synchronous bilateral spermatic cord torsion in a neonate is presented. ~ ~ s t i c u l a r salvage zs variable m this entity, surgical intervention is necessary Jot any hope of ~ ~ preservatzon.
atic cord m a y occur as an aatal p h e n o m e n o n which entity distinctly different patients. Intrauterine totcord was first described in later the first 2 cases of bimatic cord torsion were renal case of bilateral neonad herein.
ploration was performed. Bilateral extravaginal spermatie cord torsion was present. T h e right testis was black and gelatinous. After detorsion and inspection, the left testis was thought to be viable. A right orchiectomy and left orchiopexy were performed. His postoperative recovery was uneventful. Examination of the child at age four months revealed no evidence of viable testicular tissue.
se Report m white male infant was tion to a twenty-four-yearToman. The newborn apexcept for enlarged, hard .rig. 1). He was transferred our institution for further ment. He was afebrile and )rmal. G e n i t o u r i n a r y ex~rkable for slight mottling The testes were both deum. They were both moender, hard, and nontransJr examination of the testes as. A technetium-99m per:-scrotal scan revealed no :icle (Fig. 2). brought to the operating here bilateral inguinal ex-
~bGY
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FIGURE 1. Enlarged and discolored appearance o] scrotum at birth.
VOLUMEXXXV, NUMBER 2
135
FIGURE 2. Scintiphoto demonstrating decreased tracer uptake in region of testicles bilaterally (arrows) with reference markers located below testicu•lar area bilaterally. Comments Neonatal torsion is exceeded in frequency only by tlhat occurring in the adolescent period. 4 U n u s u a l m o b i l i t y of t h e n e o n a t a l hemiserotal contents may predispose to extravaginal torsion resulting in an isehemie rotation of the entire hemiserotal contents2 In most eases, the torsion event has occurred antenatally, and the infant with neonatal torsion is asymptomatie. Diagnosis is established by physical examination w h i c h reveals an enlarged, firm, nontender, and nontransilluminating purple-black serotal mass composed of ischemic structures and surrounding reactive hematocele. Adjunctive tests in this setting are generally not necessary for diagnosis, although Doppler examination and testieular-scrotal scan aid in confirmation. The most likely secondary differential lesion is an incarcerated inguinal hernia with a variety of less likely diagnoses including tumor, hematocele or testieular hematoma, inflammatory conditions such as epididymitis or orchitis, torsion of a tes-
136
tieular appendage, and ect these conditions is rare in l Management of neonatal sion is controversial. When situation, the urologist's threefold. First, the decisi( based on prompt preoper the process and overall co born infant. An inguinal a when one considers the ferential diagnosis. Secon, advanced testieular isehel ability to preserve endoerir ductive function must be 1 presence of systemic toxieit ing infarcted tissue in the t act age at which fixation ( to the serotal wall occurs is ehronous extravaginal t~ Therefore, management o: torsion should inetude con Despite the outcome ot herein, in the rare ease of t n e o n a t a l t o r s i o n of th, emergent surgical intervel and replacement of at lea eared in hope of preserving function. 43 New Scotland ~
Albany, New References 1. Taylor MD: A case of testicle s tion; recovery, Br Med J !: 458 (189 9.. Frederick PL, Dushku N, and lateral torsion of the testes in a newN (1967). 3. Papadatos C, and Moutsouris ( in the newborn, J Pediatr 71:249 (] 4. Skoglung RW, McRoberts JW, spermatic cord: a review of the lite new eases, J Urol 104:604 (1970). 5. Campbell MF: The male ge urethra, in Campbell MF, and Harri Philadelphia, WB. Saunders, 1970, 6. Watson RA: Torsion of sperma 5:439 (1975). 7. Backhouse KM: Embryology oJ testis, in Fonkalsrud EW, and Menge Testis, Chicago, Year Book Medical:
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