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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?


Reviewed January 2011

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Neonatal Testicular Torsion Glossary
  • abdomen: Also referred to as the belly. It is the part of the body that contains all of the internal structures between the chest and the pelvis.

  • abdominal: in the abdomen, the cavity of this part of the body containing the stomach, intestines and bladder.

  • anesthesia: Loss of sensation in any part of the body induced by a numbing or paralyzing agent. Often used during surgery to put a person to sleep.

  • anesthetic: A substance that causes lack of feeling or awareness.

  • diagnosis: The process by which a doctor determines what disease or condition a patient has by studying the patient's symptoms and medical history, and analyzing any tests performed (e.g., blood tets, urine tests, brain scans, etc.).

  • fertility: The ability to conceive and have children.

  • incision: Surgical cut for entering the body to perform an operation.

  • ions: Electrically charged atoms.

  • liver: A large, vital organ that secretes bile, stores and filters blood, and takes part in many metabolic functions, for example, the conversion of sugars into glycogen. The liver is reddish-brown, multilobed, and in humans is located in the upper right part of the abdominal cavity.

  • neonatal: Newborn baby.

  • nuclear scan: Also called nuclear medicine scan. A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses X-rays to monitor its progress through the kidneys.

  • penis: The male organ used for urination and sex.

  • pregnancy: The condition of being pregnant.

  • scrotal: Relating to the scrotum, the sac of tissue that hangs below the penis and contains the testicles.

  • scrotal: Relating to the scrotum, the sac of tissue that hangs below the penis and contains the testicles.

  • scrotum: Also referred to as the scrotal sac. The sac of tissue that hangs below the penis and contains the testicles.

  • sperm: Also referred to as spermatozoa. Male germ cells (gametes or reproductive cells) that are produced by the testicles and that are capable of fertilizing the female partner's eggs. Cells resemble tadpoles if seen by the naked eye.

  • spermatic cord: A cord by which a testis is suspended in the scrotum.

  • testes: Also known as testicles. Paired, egg-shaped glands contained in a pouch (scrotum) below the penis. They produce sperm and the male hormone testosterone.

  • testicle: Also known as testis. Either of the paired, egg-shaped glands contained in a pouch (scrotum) below the penis. They produce sperm and the male hormone testosterone.

  • testicular: Relating to the testicle (testis).

  • testicular torsion: A twisting of the testicles and the spermatic cord (the structure extending from the groin to the testicles that contains nerves, ducts and blood vessels).

  • testis: Also known as testicle. Either of the paired, egg-shaped glands contained in a pouch (scrotum) below the penis. They produce sperm and the male hormone testosterone.

  • testosterone: Male hormone responsible for sexual desire and for regulating a number of body functions.

  • tissue: Group of cells in an organism that are similar in form and function.

  • torsion: Twisting.

  • tumor: An abnormal mass of tissue or growth of cells.

  • ultrasound: Also referred to as a sonogram. A technique that bounces painless sound waves off organs to create an image of their structure to detect abnormalities.

  • urge: Strong desire to urinate.

  • urologist: A doctor who specializes in diseases of the male and female urinary systems and the male reproductive system. Click here to learn more about urologists. (Download the free Acrobat reader.)

  • urology: Branch of medicine concerned with the urinary tract in males and females and with the genital tract and reproductive system of males.

Neonatal Testicular Torsion Anatomical Drawings

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