In neonatal testicular torsion, emergent surgery yields low salvage rates but prevents contralateral torsion.

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Frontiers in Medicine Published April 16, 2026 Medically reviewed April 28, 2026 DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

Key Takeaway

Note that emergent surgery in neonatal torsion rarely salvages the testis but prevents contralateral torsion.

This retrospective cohort study examined 31 neonates with testicular torsion treated at the Department of Pediatric Urology at the Children's Hospital of Soochow University. The primary outcome assessed testicular viability or salvage, with secondary outcomes including contralateral torsion, testicular atrophy, and blood supply status. The median follow-up period was 72 months.

In cases of unilateral involvement, 29 neonates were identified, while 2 cases involved bilateral torsion. The mean birth weight for unilateral cases was 3.33 kg, and the median age at diagnosis was 3.00 days. Preoperative ultrasonography demonstrated absent intratesticular blood flow in 28 of 29 affected testes. Consequently, nonviable testes necessitated orchiectomy in 28 cases, resulting in a testicular salvage rate of only 3.45%.

Regarding contralateral management, prophylactic orchidopexy was completed in 23 of 29 unilateral cases. During follow-up, no contralateral torsion was observed in the cohort. Two specific cases of bilateral torsion were noted: one involved asynchronous torsion where the left testis required orchiectomy and the right was preserved, while the other involved synchronous torsion where bilateral orchidopexy was performed. The latter case resulted in bilateral testicular atrophy at follow-up.

The study was limited to a single-center experience, and no p-values or confidence intervals were reported for the primary outcomes. While the data supports prompt diagnosis and surgery, the low salvage rate and potential for atrophy highlight the severity of the condition. These findings are specific to this cohort and may not be generalizable to other settings.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedApr 2026

View Original Abstract ↓

ObjectiveTo delineate the clinical characteristics, diagnostic approaches, and therapeutic strategies for neonatal testicular torsion (NTT), while synthesizing a single-center 14-year management experience to refine protocols for early recognition and intervention.MethodsA retrospective analysis was conducted on 31 neonates with NTT managed in the Department of Pediatric Urology at the Children's Hospital of Soochow University between October 2010 and October 2024. Clinical data encompassed birth weight, body length, age at diagnosis, mode of delivery, presenting symptoms, preoperative ultrasonography, intraoperative findings, and follow-up outcomes. All patients underwent emergent surgical exploration, with orchidopexy or orchiectomy performed based on intraoperative assessment of testicular viability; contralateral prophylactic orchidopexy was undertaken in select cases. Statistical analysis was performed using SPSS version 21.0. Continuous variables were expressed as mean ± standard deviation or median (interquartile range), and categorical variables as frequencies (percentages).ResultsIn this retrospective series of 31 neonates with NTT, unilateral involvement occurred in 29 cases and bilateral in 2 (6.45%). In the 29 neonates with unilateral NTT, the mean birth weight was 3.33 ± 0.65 kg, with a median age at diagnosis of 3.00 days (IQR: 1.00–10.00). Left-sided torsion predominated (62.07%, 18/29). Predominant manifestations included scrotal erythema (82.76%, 24/29) and induration (62.07%, 18/29). Preoperative color Doppler ultrasonography revealed absent intratesticular blood flow in 96.55% (28/29) of affected testes. Intraoperatively, 96.55% (28/29) of testes were nonviable and necessitated orchiectomy, yielding a salvage rate of only 3.45% (1/29). The median degree of torsion was 630° (IQR: 360.00°–720.00°), with extravaginal torsion accounting for 75.86% (22/29). Contralateral prophylactic orchidopexy was completed in 79.31% (23/29) of cases. Over a median follow-up of 72 months, no contralateral torsion was observed. In the bilateral cases, Case 1 was asynchronous bilateral torsion: the left testis showed 360° torsion with ischemic necrosis requiring orchiectomy, while the right testis had viable perfusion after detorsion and was preserved with orchidopexy; follow-up showed no atrophy and good blood supply. Case 2 was synchronous bilateral torsion with obvious bilateral ischemia and necrosis intraoperatively; bilateral orchidopexy was performed to preserve potential Leydig cell function, but follow-up revealed bilateral testicular atrophy.ConclusionNTT predominantly manifests as unilateral, extravaginal torsion, posing challenges to early detection and resulting in low testicular salvage rates. Color Doppler ultrasonography emerges as a pivotal diagnostic modality. Emergent surgical exploration coupled with contralateral prophylactic orchidopexy may help reduce the risk of complications. This study provides data supporting prompt diagnosis and surgery in NTT.

In neonatal testicular torsion, emergent surgery yields low salvage rates but prevents contralateral torsion.

Study Details

Standardized formal resuscitation training likely reduces neonatal mortality in low- and middle-income countries compared to no training or basic training.

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In neonatal testicular torsion, emergent surgery yields low salvage rates but prevents contralateral torsion.

Study Details

Standardized formal resuscitation training likely reduces neonatal mortality in low- and middle-income countries compared to no training or basic training.

A Simple Training Program Is Saving Newborn Lives in Poor Countries

Clinical research that matters. Delivered to your inbox.

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