title: Torsion of the cryptorchid testis--can it be salvaged?
abstract: OBJECTIVE
  The literature concerning undescended testis mainly concentrates on the increased risks of infertility and development of germ cell tumors. Yet the UDT also appears to be at higher risk for torsion compared to the normally descended testis, and this issue is relatively poorly addressed. We reviewed all cases of torsion of UDTs operated on at our hospital during the last 20 years in an attempt to characterize better this condition and its salvageability.
  
  
  METHODS
  In this retrospective clinical study we reviewed and analyzed all cases of testicular torsion involving UDT operated on at our hospital between 1984 and 2004.
  
  
  RESULTS
  A total of 11 children were operated on at our hospital for torsion of undescended testis between 1984 and 2004. Patient age ranged from 1 month to 18 years (median 7.5 months). In all cases unilateral torsion of undescended testis was diagnosed, with 73% of cases involving the left side. Clinical symptoms included inguinal swelling and erythema associated with a tender, firm mass palpated in the groin area and an empty ipsilateral hemiscrotum. Doppler ultrasound examination was routinely performed in the last 7 patients to confirm the diagnosis. During inguinoscrotal exploration severe ischemia or overt necrosis of the testis was found in 5 of 11 cases. Three of these 5 cases were managed by orchiectomy, while in the other 2 cases the testis subsequently vanished. In the 6 patients who exhibited some improvement following detorsion and warming of the tissue the testes were preserved and orchiopexy was performed. Followup was available in only 5 patients, with vanishing of the torsed testis observed in 4 and a normal testicle detected 21 years postoperatively in 1 patient who was diagnosed early.
  
  
  CONCLUSIONS
  This series clearly demonstrates poor rates of surgical salvage, which we mainly attribute to delays in parental response and in primary physician referral to the hospital. Parents, who have a pivotal role in early diagnosis, were usually unaware of this urological emergency, and some were surprisingly unaware of the presence of cryptorchidism. By increasing the awareness regarding this entity among members of the medical community and parents, we hope that torsion of the cryptorchid testis (literally, "hidden testis") will no longer necessarily be synonymous with "crypt-torsion" ("hidden torsion").
authors.affiliation: Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Dorit
authors.initials: D
authors.lastname: Zilberman
authors.forename: Yael
authors.initials: Y
authors.lastname: Inbar
authors.forename: Zehava
authors.initials: Z
authors.lastname: Heyman
authors.forename: Danny
authors.initials: D
authors.lastname: Shinhar
authors.forename: Ron
authors.initials: R
authors.lastname: Bilik
authors.forename: Itamar
authors.initials: I
authors.lastname: Avigad
authors.forename: Paul
authors.initials: P
authors.lastname: Jonas
authors.forename: Jacob
authors.initials: J
authors.lastname: Ramon
authors.forename: Yoram
authors.initials: Y
authors.lastname: Mor
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003456:Cryptorchidism / Q000150:complications* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D013086:Spermatic Cord Torsion / Q000150:complications* / Q000601:surgery*