Neonatal testicular torsion and infarction: aetiology and management

Thirty neonates presented with signs of testicular ischaemia over a 20-year period. Eighteen children had primary exploration revealing extravaginal torsion (10), intravaginal torsion (3), infarction without torsion (2) and torsion of the appendix testis (1). The other two children had simple biopsy of necrotic testes. In two instances the testis was untwisted and retained but both subsequently atrophied. The remainder underwent orchiectomy. Twelve children did not have initial exploration and 11 of these had subsequent testicular atrophy. At contralateral testis fixation, performed in 17 cases, signs of contralateral involvement in the ischaemic process were found in seven, suggesting that the primary event in the condition is infarction, with torsion occurring secondarily.