Management of neonatal testicular torsion

* The birth examination occurs either at delivery or the initial newborn examination within 24 hours of delivery.

¶ An early prenatal event (occurring >10 days before birth) typically presents as an absent testicle or very small pea-sized nubbin. A late prenatal event (occurring <10 days prior to birth) generally presents as a painless scrotal mass.

Δ For a late prenatal event, surgery consists of bilateral scrotal exploration with removal of the atrophic testicle and contralateral orchiopexy. This surgery avoids the small risk that the contralateral testicle will have a torsion event (asynchronous). In shared decision-making with the family, this risk must be balanced against the risk of surgery and anesthesia.

◊ In cases with bilateral involvement, when feasible, we detorse and fix the testicles rather than perform orchiectomy since the attenuated testes may retain some residual Leydig cell function.