Neonatal Testicular Torsion

August 1, 2008

On examination, the left testicle was noted to be much smaller than the right. There was no change in color, and the testicle was firm and nontender. The physical findings were otherwise unremarkable.

Figure

Figure A baby boy born via normal spontaneous vaginal delivery to a 26-year-old gravida 4, para 1 was brought for routine 2-week hospital follow-up. There were no prenatal complications. Birth weight was 4600 g. The newborn's development was appropriate for gestational age.

On examination, the left testicle was noted to be much smaller than the right. There was no change in color, and the testicle was firm and nontender. The physical findings were otherwise unremarkable.

On a Doppler color flow ultrasonogram, the left testicle had abnormal parenchymal echogenicity, consistent with testicular torsion, and measured 0.5 0.40.5 cm; there was minimal internal blood flow (A). The right testicle was normal and measured 1.5 0.6 0.7 cm; there was a large right hydrocele (B).

The incidence of neonatal testicular torsion is 6.1 in 100,000 live births.1 Vaginal deliveries and complicated pregnancies seem to place patients at a higher risk. Both testicles are equally affected. Testicular torsion can be bilateral. A testicular ultrasonogram with Doppler color flow should be performed in every child with suspected torsion.

Torsions that occur before delivery and are noted at birth are usually non-salvageable. However, they should all be examined with Doppler color flow ultrasonography. When there is blood flow, the condition should be treated as an emergency. Some prenatal torsions might have occurred during delivery and might therefore be salvageable.2 Postnatal torsions are more often salvageable and require emergent evaluation. Patients with viable testicular tissue require emergency testicular exploration. If Doppler ultrasonography indicates the absence of blood flow, the recommended course of action is surgical removal of the affected testicle.

In this case, after consultation with the radiologist and urologist, the testicle was determined to be nonsalvageable, and the patient was referred for an orchiectomy. His older brother had the same condition, and the mother was instructed to schedule an appointment for him also.

References:

  •  Mathews John C, Kooner G, Mathew DE, et al. Neonatal testicular torsion-a lost cause? Acta Paediatr. 2008;97:502-504.

  •  Baglaj M, Carachi R. Neonatal bilateral testicular torsion: a plea for emergency exploration. J Urol. 2007;177:2296-2299.