Neonatal Testicular Torsion

The testes should be about the same size. If a baby's testicle is firm or very red, this suggests a problem. If it is firm or does not move, this is a sign of potential torsion. If the testis twisted some time before birth, the testicle may have already shrunken down to a very small size. It may be so small that may be considered missing.

With testicular torsion, the scrotum will be very tender, red and swollen or firm. The baby will be very uncomfortable.

Testicular torsion is a medical emergency. Since all blood for the testis comes through the spermatic cord, a twisted cord cuts the blood supply. The testis will shrink ("atrophy") if blood flow isn’t quickly restored.

It is not clear why this happens, and it is not something that can be prevented.

Most often, neonatal testicular torsion is seen right away, at birth. As part of a baby’s first exam, the testicles will be examined. A twisted testicle will not move freely in the scrotum and the scrotum may be red and swollen. Or, if one testicle is missing, there can be two reasons:

• It has not dropped down into the scrotum, or
• It twisted before birth and shrunk in size.

Sometimes the testicles change in color or size during the first weeks of life. If the parent or pediatrician sees a firm, swollen or discolored scrotum an alarm should go off. With these signs, the baby should be checked as soon as possible. Other causes of a firm and/or enlarged scrotum include tumors. But, tumors are very rare in this age group.

Most often, a baby born with a firm, red testicle means the testicle may have already “died” due to lack of blood flow.

Less often, changes in the testicle may be noticed before it dies. Urgent surgical treatment may save it.

An ultrasound might be done. This can show a lack of blood flow and other signs for diagnosis. Still, an ultrasound may not show enough detail, so they are not always used. A simple physical exam is all that may be used for diagnosis.

Most often, the testicle will die before anything can be done for a newborn. Unfortunately, the testicle cannot be saved. If the other testicle is fine, your baby boy can still grow to be healthy and fertile.

In cases where the testicle twists after birth, it may be saved if it is untwisted within a few hours. A pediatric urologist can help. If torsion is seen shortly after birth, talk with a pediatric surgeon immediately. Even if one testicle can’t be saved, surgery may help prevent the other testicle from twisting.

Not all pediatric urologists agree with the need to operate on the opposite testis, though there are some reports of the other testicle twisting as well. There are risks with all surgeries, so it is of great value to think about the risks and talk about all your concerns with your health care team before going forward.

If surgery is offered to save a testicle, the newborn will need to stay in the hospital overnight. The health care team will carefully monitor the baby after anesthesia and check for normal breathing and pulse. The incisions (cuts) are tiny and often painless. If needed, a very small dose of Tylenol may be given for pain.

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

Only one healthy testicle is needed for normal fertility. A single testicle will make enough sperm and testosterone. It is vital to talk with your child about the importance of protective measures to prevent testicular injuries in the future. For example, wearing a protective cup when playing contact sports may be helpful.

Can this condition be prevented?

No, this condition cannot be prevented.

Updated October 2024.