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Controversies in the management of neonatal testicular torsion: A meta-analysis.

Abstract：

OBJECTIVE:This meta-analysis seeks to discern the optimal management strategy in neonatal testicular torsion (NTT). METHODS:Reviewed all English-language articles published between 2005 and 2015 in Medline/Pubmed that had a defined diagnosis of NTT within the first thirty days of life, and discussed specific surgical and nonsurgical management. Exclusion criteria were non-English literature, case reports, case studies, and failure to clearly describe the management of NTT. Data from 9 studies were analyzed, individually and together as pooled data, 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®. RESULTS:9 publications met criteria for this analysis with a total of 196 patients. Bilateral testicular torsions (n = 14) were less common as compared to right/left testicular torsion (n = 85/97). Asynchronous NTTs (n = 9) were more common than synchronous NTTs (n = 2). There was a higher incidence of NTT in neonates delivered by vaginal delivery (n = 110) as compared to those delivered by c-section (n = 25). Extravaginal torsion (n = 54) is far more common than intravaginal torsion (n = 2). Full-term neonates (n = 122) have a higher incidence of NTT as compared to preterm neonates (n = 9). A total of 15 testicles were salvaged. Of the salvaged testicles 2 were documented as prenatal, 10 postnatal and 3 were undocumented. A strategy of bilateral exploration allows for salvage of about 7% of ipsilateral testicles and prevent asynchronous torsion in about 4% of neonates. CONCLUSIONS:Based on our population, between 8-12% of patients would benefit from bilateral exploration at the time of diagnosis. We recommend urgent bilateral exploration with orchiopexy of the contralateral testicle in order to avert anorchia. TYPE OF STUDY:Systematic review. LEVEL OF EVIDENCE:Level 5 meta-synthesis (Evidence from systematic reviews of qualitative and descriptive studies).

journal_name

J Pediatr Surg

journal_title

Journal of pediatric surgery

authors

Monteilh C,Calixte R,Burjonrappa S

doi

10.1016/j.jpedsurg.2018.07.006

subject

Has Abstract

pub_date

2019-04-01 00:00:00

pages

815-819

issue

4

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(18)30436-6

journal_volume

54

pub_type

杂志文章,meta分析

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