A 10-Year Single Center Analysis: Is There a Need to Reconsider Our Approach to the Management of Neonatal Testicular Torsion?

The management of neonatal testicular torsion lacks consensus. Arguments in favor of emergency bilateral exploration and fixation include a salvage rate and the incidence of bilateral torsion. We performed a retrospective single-center analysis of all cases of neonatal torsion in our unit between 2012 and 2022 to assess whether our data supports this approach and to publish further data on a disease on which there remains a paucity. During this period, there were 28 neonates with suspected torsion - 24 had torsion. The majority, 25 (89%), of patients were explored, with 12 (48%) of these as an emergency (<6 hrs of surgical review). Nineteen (95%) of those who had the symptomatic side explored also had a contralateral exploration. Three (15%) of operated testes were salvaged - one atrophied. None of the contralateral fixed testicles atrophied and there were no anesthetic complications. One patient (4%) had bilateral torsion - one testicle was asymptomatic and chronically infarcted, and the symptomatic testis was not salvageable, leading to anorchia. We conclude that neonatal torsion has a salvage rate, and bilateral exploration and fixation are low risk. Moreover, we present a rare case of bilateral torsion and an asymptomatic contralateral torsion - pediatric surgeons must be made aware of such cases as delaying treatment of the symptomatic testicle could result in the devastating outcome of anorchia.