Acquired undescended testis and possibly associated testicular torsion in children with cerebral palsy or neuromuscular disease.

Summary Introduction Torsion of an undescended testis (UDT) associated with cerebral palsy (CP) and neuromuscular disease (NMD) is an uncommon condition that is not well recognized by primary care physicians or healthcare providers. Objective The objective of this study was to highlight the clinical importance of torsion of a UDT in children with CP and NMD. Materials and methods Eleven children with testicular torsion of a UDT operated on at the study institute between 1991 and 2015 were identified. The records of seven children (63.6%) associated with CP or NMD were retrospectively reviewed. Clinical findings of testicular torsion were assessed along with the treatment outcome and testicular salvageability. Results All seven children were not identified with a UDT by public health checkup for infant and young children. No children with CP or NMD had torsion of a descended testis during the present study period. Median age at surgery was 15 years (range, 1–20 years). The testis location was at the external inguinal ring in five patients, in the inguinal canal in one, and in the superficial inguinal pouch in one. Of the contralateral testes, four were a UDT, one was a retractile testis, and two were descended testes. Orchiectomy was performed in six patients (85.7%). In the remaining patients, the testis was preserved but became atrophic. Discussion This study demonstrated that children with CP or NMD may be affected with torsion of a UDT with peak at around puberty with the poor salvage rate, even if the testes appear descended in infancy and young children. Shortcomings of this study were the retrospective design and a small series of children undergoing surgery for torsion of a UDT. Conclusion Pediatric urologists need to educate primary care physicians and healthcare providers in the recognition of acquired UDTs and possibly associated testicular torsion in children with CP and NMD. Genital examination should be continued regularly until adolescence in these children to detect acquired UDT. These children should be referred to pediatric urologists to promote surgery as soon as the diagnosis of acquired UDT is carried out. It is believed that it is perhaps the best approach to prevent loss of the testis in children with CP and NMD. Summary Table . Clinical findings and treatment outcomes of testicular torsion of undescended testes in children with cerebral palsy or neuromuscular disease. Patient Diagnosis Age at presentation (years) Side Location of the affected testis Duration of symptoms (h) Degree of testicular torsion Outcome Location of the contralateral testis 1 CP 3 L Intracanal 72 360 Orchiectomy Extracanal 2 CP 11 R Extracanal 48 360 Orchiectomy Retractile 3 CP 15 L Extracanal 96 Undefined Orchiectomy Intracanal 4 CP 16 R Extracanal 48 180 Orchiectomy Extracanal 5 CP 20 L Extracanal 24 360 Orchiectomy Scrotum 6 NMD 1 L Superficial inguinal pouch Incidental 180 Orchiopexy (atrophy) Superficial inguinal pouch 7 NMD 15 R Extracanal 120 360 Orchiectomy Scrotum CP, cerebral palsy; L, left; NMD, neuromuscular disease; R, right.