Neonatal testicular torsion, defined as torsion occurring within the first 30 days of life, is a rare occurrence . It is most commonly an extravaginal process that involves twisting of the spermatic cord, resulting in compromise to the testes, as the spermatic cord contains the vasculature to the testicle and vas deferens. In neonatal torsion, the tunica vaginalis is not well-fixed to the scrotal wall, and the torsion involves the entire testicle, including the tunica vaginalis investment [2,3]. Neonatal torsion is a distinct entity from testicular torsion in older patients, which typically is caused by intravaginal torsion when the testis twists within its tunica vaginalis (figure 1).
Both extravaginal and intravaginal testicular torsion result in vascular compromise to the testes. If blood flow is not restored in a timely fashion (about four to six hours ), testicular ischemia, infarction, and subsequent atrophy will occur.
The management of neonatal testicular torsion remains controversial, as opinions differ on whether surgery can successfully salvage the torsed testis, which may have occurred in utero, and whether the contralateral side is at increased risk for concomitant (synchronous) or subsequent (asynchronous) torsion.
The clinical presentation and the controversies regarding management of neonatal testicular torsion will be reviewed here. Testicular torsion in children and adolescents is presented separately. (See "Causes of scrotal pain in children and adolescents", section on 'Testicular torsion'.)
Neonatal testicular torsion is defined as torsion that occurs prenatally and up to 30 days after delivery .