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Martin Kaefer, MD, Deepak Agarwal, MD, Rosalia Misseri, MD, Benjamin Whittam, MD, Katherine Hubert, MD, Richard Rink, MD, Mark Cain, MD.
Indiana University, Indianapolis, IN, USA.

Treatment of neonatal testicular torsion consists of two objectives: salvage of the involved testicle (which is rarely achieved) and preservation of the contralateral gonad. The second goal universally involves contralateral testicular scrotal fixation in order to prevent the future occurrence of contralateral torsion. However, controversy exists in regards to management of a synchronous contralateral hydrocele. It has been our policy not to address the contralateral hydrocele through an inguinal incision in order to minimize potential injury to the spermatic cord. We review our experience with neonatal testicular torsion in order to determine whether foregoing formal inguinal hydrocele repair is a sound strategy for managing this clinical scenario.
We reviewed all cases of neonatal testicular torsion occurring at our institution between the years 1999 and 2006. Age at presentation, laterality, ultrasonographic and intraoperative findings were recorded. Treatment of the contralateral hydrocele was limited to the scrotum regardless of whether the processes vaginalis was patent or closed. Patients were followed after initial surgical intervention to determine the likelihood of developing a subsequent hydrocele or hernia.
Thirty-Seven patients were identified as presenting with neonatal torsion. Age of presentation averaged 3.5 days (range 1-14 days). Left sided pathology was seen more commonly than the right with a 25:12 distribution. All torsed testicles were nonviable. Twenty-two patients were noted to have a contralateral hydrocele at presentation. All hydroceles were opened through a scrotal approach at the time of contralateral scrotal fixation. No patient underwent an inguinal exploration to examine for a patent process vaginalis. None of the patients have developed a hydrocele or hernia after an average 7.5 years (range 4.3-11.2) follow up.
Contralateral hydrocele is commonly seen in cases of neonatal testicular torsion. In our experience this is a condition of minimal clinical significance and does not warrant formal inguinal exploration for treatment. This conservative management strategy minimizes the potential of contralateral spermatic cord injury in the neonate.

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