Neonatal Testicular Torsion

Testicular torsion is thankfully rare in male newborns. But what happens if your newborn son is diagnosed with this condition? The following information should help you better understand this serious state of health.

What happens under normal conditions?

The testicles (also called the testes; a single testicle is also called a testis) are part of the male reproductive system. These organs are usually contained within a sac of skin called the scrotum, which hangs beneath the penis.

Late in pregnancy, the testicles descend from the abdomen into the scrotum. At the time of a full-term delivery, all but 3 percent of male babies will have both testicles dropped down into the scrotum. In the process of descent, the testicle is guided by a small attachment known as the gubernaculum testis. After the testicle has moved into the scrotum, it remains there in its normal position because the gubernaculum becomes attached to the surrounding tissues. There are also additional attachments that form between the testicle and its surrounding structures and the inside wall of the scrotum. If the normal attachment process is not yet complete, twisting of the testicular blood supply can occur during pregnancy or around the time of birth.

What is testicular torsion?

The testicles are nourished by the blood vessels, which together with the nerves and the sperm channels pass through the spermatic cord from the abdominal cavity to the scrotum. The testicles hang loose in the scrotum and in rare cases they are twisted resulting in a strangulation of the blood supply and the demise of the testicle.

How is testicular torsion in children diagnosed?

Most often, neonatal testicular torsion is recognized at childbirth. However, it can also occur during the first weeks of life, so the discovery of a firm, enlarged and/or discolored scrotum should lead to an immediate evaluation. Often, such a testicle will not move freely in the scrotum. Other causes of a firm and/or enlarged scrotum include tumors, which are rare in this age group.

After the baby is born, the testicles will be examined as part of the initial physical examination. If one testicle is missing, the cause may be that it has not dropped down into the scrotum, or that it twisted at some time prior to birth and shrunk in size. Most often recent testicular torsion in the newborn is identified by redness and firmness in the scrotum, representing reaction to the testicle after it has died from lack of blood flow. Less often, a change in appearance and subtle firmness might be noticed before the testicle has died. A nuclear scan or an ultrasound might show a lack of blood flow to that testicle as well as other signs to support the diagnosis. However, these tests are sometimes hard to interpret, thus they are not necessarily required for diagnosis and treatment.

How is testicular torsion in children treated?

Because the problem usually is not detected until scrotal reaction calls attention to a dead testicle, for most babies diagnosed with testicular torsion at birth, the testicle cannot be salvaged. However, in cases where the testicle twists shortly after birth, it may be saved if it is untwisted within a few hours. For this reason, a newly recognized firm and enlarged scrotum following an initial physical examination is an emergency and should be evaluated by a surgeon as quickly as possible. Although the testicle may not be saved if the blood supply has been cut off for too long, there is some evidence that surgery to prevent twisting of the other testicle may be useful. However, not all pediatric urologists agree with the need to operate on the normal opposite testis for fixation. There are multiple considerations, including the likelihood of testicular torsion occurring in the opposite testicle as well as risks associated with anesthesia.

What can be expected after treatment for testicular torsion?

Many newborns will need to stay in the hospital overnight after their surgery because of post-anesthesia monitoring of breathing and pulse. The incisions are often painless for several hours because of local anesthetic and afterwards patients need only acetaminophen or ibuprofen for pain.

Frequently asked questions:

How will my son's future fertility be affected after the loss of a testicle?

Only one functioning testicle is necessary for normal fertility potential and full masculinization. A single testicle will produce normal amounts of sperm and testosterone.

Can this condition be prevented?