Ovarian Preservation Before Puberty: Surgical Management of Adnexal Torsion in Prepubertal and Prepubertal-Predominant Paediatric Cohorts—A Systematic Review and Meta-Analysis
- 1Obstetrics and Gynecology Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh 11564, Saudi Arabia
- 2Department of Obstetrics and Gynecology, King Abdullah bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh 13412, Saudi Arabia
Abstract
Background/Objectives: Adnexal torsion is a gynaecological emergency in which ovarian preservation or removal is decided intraoperatively. Prepubertal girls have the longest reproductive and endocrine horizon, yet they are commonly pooled with postmenarchal adolescents. This review estimated how often torsion episodes in prepubertal and prepubertal-predominant paediatric cohorts are managed by oophorectomy, together with imaging findings after ovarian-sparing surgery, recurrence and diagnosed malignancy. Methods: A PRISMA 2020 systematic review and meta-analysis (PROSPERO CRD420261496245) searched Europe PMC (including MEDLINE), OpenAlex, preprint servers, ClinicalTrials.gov and citation networks to 2 September 2026, with an update search to 12 October 2026; Embase, Scopus, Web of Science, CINAHL and CENTRAL were not searched. Eligible cohorts documented premenarchal status (direct evidence) or had a central age of 12.0 years or younger (indirect evidence). Proportions were pooled with a binomial–normal generalised linear mixed model; JBI appraisal and GRADE were applied. Results: Thirty studies were included. Across 14 cohorts (1011 episodes), 42.8% (95% CI 28.1–58.9) were managed by oophorectomy, with extreme heterogeneity (I2 = 94.0%; 95% prediction interval 6.0–89.9%); the estimate was 33.4% (8.5–69.8) in the 4 cohorts with documented premenarchal status and 24.8% (14.4–37.3) in the 7 cohorts meeting all appraisal items. Follicular activity or normal morphology was seen on follow-up imaging in 89.9% (81.9–95.9) of 234 imaged adnexa after ovarian-sparing surgery. Recurrence was 12.9% (6.6–21.0; 11 cohorts) and diagnosed malignancy 2.7% (1.0–4.6; 7 cohorts). Certainty was very low for ovarian loss and imaging findings and low for recurrence and malignancy. Conclusions: Reported oophorectomy rates in prepubertal-predominant cohorts vary widely and often exceed the low prevalence of diagnosed malignancy, but these data cannot establish how many removals were avoidable. The findings support alignment with existing ovarian-conservation guidance and better reporting of menarchal status, indications for removal and functional follow-up.
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BibTeX
@article{bakhsh2026ovarian,
title = {{Ovarian Preservation Before Puberty: Surgical Management of Adnexal Torsion in Prepubertal and Prepubertal-Predominant Paediatric Cohorts—A Systematic Review and Meta-Analysis}},
author = {Hanadi Bakhsh},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218678},
url = {https://www.mdpi.com/2077-0383/15/21/8678},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Ovarian Preservation Before Puberty: Surgical Management of Adnexal Torsion in Prepubertal and Prepubertal-Predominant Paediatric Cohorts—A Systematic Review and Meta-Analysis
AU - Hanadi Bakhsh
PY - 2026
DA - 2026/11/06
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218678
UR - https://www.mdpi.com/2077-0383/15/21/8678
AB - Background/Objectives: Adnexal torsion is a gynaecological emergency in which ovarian preservation or removal is decided intraoperatively. Prepubertal girls have the longest reproductive and endocrine horizon, yet they are commonly pooled with postmenarchal adolescents. This review estimated how often torsion episodes in prepubertal and prepubertal-predominant paediatric cohorts are managed by oophorectomy, together with imaging findings after ovarian-sparing surgery, recurrence and diagnosed malignancy. Methods: A PRISMA 2020 systematic review and meta-analysis (PROSPERO CRD420261496245) searched Europe PMC (including MEDLINE), OpenAlex, preprint servers, ClinicalTrials.gov and citation networks to 2 September 2026, with an update search to 12 October 2026; Embase, Scopus, Web of Science, CINAHL and CENTRAL were not searched. Eligible cohorts documented premenarchal status (direct evidence) or had a central age of 12.0 years or younger (indirect evidence). Proportions were pooled with a binomial–normal generalised linear mixed model; JBI appraisal and GRADE were applied. Results: Thirty studies were included. Across 14 cohorts (1011 episodes), 42.8% (95% CI 28.1–58.9) were managed by oophorectomy, with extreme heterogeneity (I2 = 94.0%; 95% prediction interval 6.0–89.9%); the estimate was 33.4% (8.5–69.8) in the 4 cohorts with documented premenarchal status and 24.8% (14.4–37.3) in the 7 cohorts meeting all appraisal items. Follicular activity or normal morphology was seen on follow-up imaging in 89.9% (81.9–95.9) of 234 imaged adnexa after ovarian-sparing surgery. Recurrence was 12.9% (6.6–21.0; 11 cohorts) and diagnosed malignancy 2.7% (1.0–4.6; 7 cohorts). Certainty was very low for ovarian loss and imaging findings and low for recurrence and malignancy. Conclusions: Reported oophorectomy rates in prepubertal-predominant cohorts vary widely and often exceed the low prevalence of diagnosed malignancy, but these data cannot establish how many removals were avoidable. The findings support alignment with existing ovarian-conservation guidance and better reporting of menarchal status, indications for removal and functional follow-up.
SN - 2077-0383
ER -