Two primary goals in diagnosis and management of testicular torsion: 1. Preserve the ipsilateral testis, when it remains viable. 2. Prevent contralateral torsion. Secondary goals include the following: 1. Avoidance of risk factors for infertility. 2. Maintain a normal scrotal appearance. Evidence for these aims-perinatal torsion: Most case series report no ipsilateral testis salvage from neonatal surgery. One reported 2 of 30 explored testes had normal size at follow-up. Risk for contralateral postnatal torsion is not well defined, but case series report neonatal ultrasound to be unreliable to exclude vascular compromise. Our review found no data regarding fertility or psychologic impact of asymmetric scrotal appearance after perinatal torsion. Evidence for these aims-torsion in children and teenagers: Few objective criteria are described to guide orchiopexy versus orchiectomy, and there is no agreed-upon definition for atrophy after orchiopexy. Two retrospective studies that defined atrophy as ≥15 % or >50 % volume loss reported 27 and 13 % occurrence. We found one case of simultaneous bilateral torsion, and none of asynchronous torsion, after the neonatal period. Contralateral orchiopexy is done based on potential risks. One retrospective review reported recurrent torsion in 4 % of patients after orchiopexy. There are few data regarding fertility in men after torsion. Semen analyses most often are normal, with oligospermia in 0-35 %. Antisperm antibodies reported in three studies were positive in only 2/80 patients. Our review found no article regarding psychologic impact of orchiectomy or testicular atrophy after orchiopexy for torsion.
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