Testicular Torsion in Infants
Yes, an infant can be born with testicular torsion, which is known as perinatal testicular torsion (PTT) and can occur prenatally or perinatally. 1, 2
Understanding Perinatal Testicular Torsion
- Perinatal testicular torsion is primarily caused by an extravaginal twisting of the spermatic cord that often occurs before or around the time of birth, compromising blood flow to and from the testicle 1
- PTT accounts for approximately 10% of all testicular torsion cases in children 1
- The incidence of PTT is estimated to be 6.1 per 100,000 live births, though the true incidence is likely higher as it is often underdiagnosed 2
- Testicular torsion has a bimodal distribution, occurring more frequently in neonates and postpubertal boys 1, 3
Clinical Presentation and Diagnosis
- PTT can be asymptomatic and missed during initial newborn examination 2
- Diagnosis can generally be made through physical examination, with findings such as scrotal discoloration and tenderness 4
- Ultrasound with Doppler is the first-line imaging modality for evaluation 3
- The "whirlpool sign" (spiral twist of the spermatic cord) is the most specific ultrasound sign of torsion 1, 3
- Key ultrasound findings include decreased or absent blood flow to the affected testicle and an enlarged heterogeneous testis that may be hypoechoic 3
Management Considerations
- Immediate surgical intervention is recommended when testicular torsion is suspected in an infant 1, 3
- Surgical exploration within 6-8 hours of symptom onset is essential to prevent testicular loss in cases of acute torsion 1, 3
- Non-operative maneuvers to detorse the testicle in PTT are not recommended 2
- The salvage rate for the affected testicle depends on the degree of torsion and duration of ischemia, but is generally poor (less than 1% for prenatal torsion) 1, 5
Bilateral Involvement Concerns
- Bilateral PTT, though rare, is being reported with increasing frequency and carries the risk of anorchia 4, 6
- Assessment of the contralateral testis through physical examination and imaging can be inaccurate in cases of perinatal torsion 7
- Contralateral orchiopexy is recommended at the time of exploration to prevent asynchronous torsion of the unaffected testicle 2, 5
- Metachronous (occurring at different times) bilateral torsion can happen with only hours separating the torsion events 4
Clinical Pearls and Pitfalls
- A common pitfall is delayed diagnosis due to the asymptomatic nature of some cases of PTT 2
- Even with poor salvage rates for the affected testicle, surgical exploration is warranted to assess viability and perform contralateral orchiopexy 5, 4
- Failure to surgically explore can lead to misdiagnosis of bilateral involvement, potentially resulting in infertility and psychological consequences 5
- In rare cases, testicular viability may be preserved in pre-term infants with bilateral torsion 6