EC Paediatrics

Testicular torsion is an emergency condition that results from twisting of the testis, and tissue ischemia. prenatal testicular torsion "PTT" refers to a type of torsion that happens prenatally, or at any time within the first 30 days after delivery. PTT can be unilateral in most of the cases or bilateral which carries a devastating result of anorchia and its consequence of endocrine insufficiency and infertility.

We are reporting a rare case of a male newborn who presented with a synchronous bilateral testicular swelling immediately after birth without acute inflammatory signs. Doppler ultrasound demonstrated, absent blood flow signal on the right testis and a questionable blood flow in the left testis, features consistent with bilateral PTT. Early exploration done and intraoperative finding revealed the right testis was ischemic, gangrenous and unsalvageable. The left testis was found with extravaginal torsio and de-torsion was done. Right orchidectomy and left orchidopexy were performed hoping that reserving the left testis might help to regain some of its hormonal function in the future. The left testis was atrophied by the age of 3 months. Hormonal samples to assess the testicular function were collected soon after birth, during minipuberty, after hCG stimulation test, and beyond minipuberty confirmed the diagnosis of primary endocrine and exocrine testicular failure. Serial stretched penile length monitoring was done in the endocrinology clinic with a plan to give testosterone injections if there is inadequate growth. Till the last visit he has a normal stretched penile length.

 In conclusion, surgical exploration is the only way to confirm the diagnosis of PTT. Though still there is a lot of controversy in the management of bilateral PTT, orchidectomy of the most affected testis and orchidopexy of the contralateral side remains the most reasonable approach in a trial to maintain the testicular function even if the salvage rate is minimal.

 Keywords: Testicular Torsion; Prenatal Testicular Torsion; Neonate; Newborn; Bilateral Testicular Torsion; Testicular Swelling; Primary Gonadal Failure; Primary Testicular Failure; Endocrine Testicular Function; Exocrine Testicular Function

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