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Yadav P, Erlich T, Zlotnik M, Khondker A, O'Kelly F, Traubici J, Chua ME, Koyle MA. Ultrasonographical features of perinatal testicular torsion: an assessment of interobserver variability among radiologists and pediatric urologists. Pediatr Surg Int 2022; 38:2053-2058. [PMID: 36261731 DOI: 10.1007/s00383-022-05260-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To retrospectively compare interpretations of Doppler ultrasound (US) in newborns with confirmed perinatal testicular torsion (PTT) by an experienced faculty (staff) pediatric radiologist (SPR), pediatric radiology fellow (PRF), pediatric urology fellow (PUF) and staff pediatric urologist (SPU). METHODS US images of 27 consecutive males with PTT between May 2000 and July 2020 were retrieved. The testicles were classified as affected or non-affected by PTT. We performed a blinded comparison of interpretation by four assessors (SPR, PRF, PUF, SPU), with respect to the US features of PTT. Paired inter-rater agreement was calculated using Cohen's Kappa (κ) and overall agreement was assessed using Fleiss' kappa. RESULTS Overall comparison using Fleiss' kappa found fair agreement for most features except testicular echogenicity and echogenic foci at interface for which there was poor agreement. Paired comparisons revealed better agreement between the SPR and PRF compared to the remaining two pairs, suggesting a need for the pediatric urologists (PUF and SPU) to acquaint themselves with testicular ultrasonography as this may have an impact on patient risk stratification and the quality of information given to parents. CONCLUSION This study highlights the need for focused training program for pediatric urologists to attain similar agreement as the radiologists, suggesting a need for the pediatric urologists (PUF and SPU) to acquaint themselves with testicular ultrasonography as this may have an impact on patient risk stratification and the quality of information given to parents.
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Affiliation(s)
- Priyank Yadav
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. .,Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
| | - Tomer Erlich
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Margalit Zlotnik
- Division of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Adree Khondker
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Fardod O'Kelly
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Pediatric Urology, Beacon Hospital, Dublin, and School of Medicine, University College Dublin, Dublin, Ireland
| | - Jeffrey Traubici
- Division of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Michael E Chua
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines
| | - Martin A Koyle
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Prenatally Diagnosed Testicular Torsion: A Rare Condition That Causes Dilemma in Management. Case Rep Pediatr 2021; 2021:8825763. [PMID: 33532107 PMCID: PMC7834823 DOI: 10.1155/2021/8825763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/25/2020] [Accepted: 01/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background Prenatal testicular torsion (PTT) is exceedingly rare in intrauterine development, often diagnosed at the time of birth and very rarely diagnosed in utero during routine gestational ultrasound. As a result, incidence is unknown, and there exists no consensus regarding the pathophysiology of this phenomenon nor universally recognized algorithms and guidelines regarding its diagnosis and management. Case Presentation. We present the case of an antenatally diagnosed torsion and our subsequent management which included ipsilateral orchiectomy and prophylactic contralateral orchiopexy via a scrotal approach. Conclusion While controversy regarding surgical intervention in patients with unilateral PTT exists due to poor salvage rates-estimated to be less than 1%-the risk of anorchia is higher in affected patients due to limitations in the accuracy of detecting bilateral testicular involvement. Risk of misdiagnosis of bilaterality may lead to lasting sequelae such as infertility and devastating psychological consequences for affected patients, supporting the need for surgical exploration, as was performed in our case.
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Prenatal Testicular Torsion: Not Always in the Late Third Trimester. Urology 2015; 89:132-3. [PMID: 26657689 DOI: 10.1016/j.urology.2015.11.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/15/2015] [Accepted: 11/18/2015] [Indexed: 11/22/2022]
Abstract
Prenatal testicular torsion is a very rare morbid entity, described in the literature to occur when the testicle is intrascrotal, around the 34th week of gestation. Here we report a case of early testicular necrosis. This male fetus was the product of a medical abortion at 27 weeks. During evisceration, a left testicular nubbin free in the peritoneal cavity was found. Histologically, it was extensively necrotic. Because of the location, the size, and the histological features of this necrotic testicle, we conclude that it was the result of torsion of the pedicle that occurred around the 20th week of pregnancy.
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Abstract
Perinatal testicular torsion is a relatively rare event that remains unrecognized in many patients or is suspected and treated accordingly only after an avoidable loss of time. The authors report their own experience with several patients, some of them quite atypical but instructive. Missed bilateral torsion is an issue, as are partial torsion, possible antenatal signs, and late presentation. These data are discussed together with the existing literature and may help shed new light on the natural course of testicular torsion and its treatment. The most important conclusion is that a much higher index of suspicion based on clinical findings is needed for timely detection of perinatal torsion. It is the authors' opinion that immediate surgery is mandatory not only in suspected bilateral torsions but also in cases of possible unilateral torsions. There is no place for a more fatalistic "wait-and-see" approach. Whenever possible, even necrotic testes should not be removed during surgery because some endocrine function may be retained.
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Ji EK, Yoon CS, Pretorius DH. Prenatal diagnosis of an inguinoscrotal hernia: sonographic and magnetic resonance imaging findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2005; 24:239-242. [PMID: 15661958 DOI: 10.7863/jum.2005.24.2.239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Eun-Kyung Ji
- Department of Diagnostic Radiology, Cha General Hospital, College of Medicine, Pochon Cha University, Seoul, Korea.
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Gililland A, Carlan SJ, Greenbaum LD, Levy MC, Rich MA. Undescended testicle and a meconium-filled hemiscrotum: prenatal ultrasound appearance. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 20:200-202. [PMID: 12153675 DOI: 10.1046/j.1469-0705.2002.00663.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We report a case of a meconium-filled hemiscrotum detected by prenatal ultrasound and misdiagnosed as in-utero testicular torsion. Over the 2 months that the mass was followed, the ultrasound characteristics and size changed significantly. Imaging immediately after birth and early surgical treatment resulted in a favorable outcome.
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Affiliation(s)
- A Gililland
- Department of Obstetrics and Gynecology and Fetal Diagnostic Center, Arnold Palmer Hospital for Children and Women, Orlando, Florida 32806, USA.
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Abstract
Inguinal hernia repair is one of the most common surgeries performed on children. However, the value of routine histologic examination of hernia sac tissues continues to be debated. Although the surgical pathology of herniorrhaphy tissues is usually simple, occasional examples have unexpected findings that potentially lead to inappropriate management or that have added clinical implications. These along with surgical-quality assurance issues need to be considered in cost-benefit arguments. This article reviews basic histology, common potential pitfalls, and significant unexpected conditions encountered in the surgical pathology of the inguinal hernia sac in children.
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Affiliation(s)
- G P Taylor
- Department of Pathology and Laboratory Medicine, University of British Columbia and Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Vancouver, British Columbia V6H 3V4, Canada
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