AUA Summit - What is Neonatal Testicular Torsion?


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What is Neonatal Testicular Torsion?

Testicular Torsion is when a loose testicle twists around the spermatic chord. When this happens, it cuts off the blood flow to the testicle. It should be treated as a medical emergency.

This is thankfully a rare problem, especially in newborns. But, if your newborn son is diagnosed with it, we offer information that can help.

If the testes do not properly attach to the scrotum (as a birth defect), they can move and twist. They can twist around the blood supply, and cut it off. Without its blood supply, a testicle could "die." This problem can occur during pregnancy, before delivery, or around the time of birth.

What happens under normal conditions?

The testicles (also called testes) are part of the male reproductive system. One testicle is called a testis. Normally, these organs are found within a sac of skin called the scrotum, hanging below the penis.

Late in pregnancy, the testes move down from the abdomen into the scrotum. At birth, all but 3% of male babies will have both testicles drop. As this happens, a small cord known as the gubernaculum guides the testes down.

After the testes have moved into the scrotum, they become attached. The gubernaculum connects to nearby tissue. Other tissues grow to keep the testes in place. Blood vessels and nerves pass through the spermatic cord to the scrotum. They "feed" the testicles to keep them alive and well.


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. If one testicle is "missing," this is a sign.

With testicular torsion, the scrotum will be very tender, red, and either 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 chord 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. 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 that it has died from lack of blood flow.

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

A nuclear scan or an ultrasound might be done. They can show a lack of blood flow and other signs for diagnosis. Still, these tests 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. There are risks with all surgeries, so it’s important to consider risks before going forward.

After Treatment

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

Frequently Asked Questions

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

Only one healthy testicle is needed for normal fertility and full masculinization. A single testicle will produce enough sperm and testosterone. It is imperative to talk with your child about the importance of wearing a cub in contact sports as a protective measure from testicular injuries.

Can this condition be prevented?


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