Neonatal testicular torsion: a single-center 14-year experience in diagnosis and management

Objective: To 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. Methods: A 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). Results: In 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. Conclusion: NTT 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.