Is an empty left hemiscrotum and XXXX right descended testis predictive of perinatal torsion?

@entity1184 @entity1
PURPOSE: We determine whether the finding of a nonpalpable left testis and @entity1184 (2 cc or greater) right testis is predictive of an atrophic (perinatal torsion) left testis. MATERIALS AND METHODS: Prospectively, all @entity1 with a nonpalpable left testis and @entity1184 right testis seen between May 2000 and May 2002 were included in the study. Testicular measurement was performed preoperatively with an orchidometer. In 19 of 22 @entity1 size was also confirmed intraoperatively. Surgical exploration was done initially through a scrotal incision. Diagnostic laparoscopy was performed in @entity1 in whom intrascrotal tissue that was consistent with a "nubbin" was not found. All tissue removed was submitted for histological evaluation. RESULTS: In 19 of 22 @entity1 tissue was found in the left hemiscrotum that was clinically consistent with a scrotal nubbin, and histological confirmation was absolute in 18. In 1 @entity1 a hollow oval mass attached to a cord extending to the external inguinal ring was found without the other classic histological features of torsion. In 3 cases scrotal exploration was negative and diagnostic laparoscopy was performed. Of this group the pathognomonic findings of a closed internal ring with hypoplastic vas and vessels were noted in 2 cases, and normal vas and vessels were seen to exit an open internal inguinal ring in 1. Inguinal exploration demonstrated an enlarged intracanalicular testis measuring 3 cc in volume, comparable in size to the descended right testicle. CONCLUSIONS: The combination of a nonpalpable left testis and an enlarged right testis is highly predictive of perinatal testicular torsion. When both criteria were met 20 of 22 (91%) consecutive @entity1 had histological or laparoscopically confirmed perinatal torsion and 1 had only clinical features. This finding supports the concept of scrotal exploration as the initial procedure in the @entity1 who has an empty left hemiscrotum and @entity1184 descended right testis. Laparoscopy should be reserved for @entity1 in whom a distinct remnant is not found on scrotal exploration.
