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Perinatal Testicular Torsion - Seeking the Timeline and Finding Unexpected Pathologic Evidence
Daria Kozlova1, Ana Foigelman Tobar1, Rabab Naamneh1
1Pathology Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.
Fetal and Pediatric Pathology
|January 29, 2026
Summary
Perinatal testicular torsion causes significant tissue damage, often present for over a week before surgery. Viable tissue alongside necrosis suggests intermittent torsion and ischemia-reperfusion injury as the cause.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Urology
Background:
- Perinatal testicular torsion is a neonatal emergency requiring prompt diagnosis and management.
- Understanding the timing and pathogenesis is crucial for improving outcomes.
Purpose of the Study:
- To determine the onset of perinatal torsion using clinical, sonographic, and histologic features.
- To elucidate the underlying pathogenesis of this condition.
Main Methods:
- Retrospective analysis of 21 neonates (22 testes) who underwent orchiectomy for perinatal testicular torsion (2008-2022).
- Data collected included clinical presentation, ultrasound findings, and postoperative histologic examination.
Main Results:
- Median age at surgery was 13 hours; median ultrasound-to-surgery interval was 2.9 hours.
- All presented with rigid, painless testes. Extravaginal torsion occurred in 17 cases.
- Histology revealed grade 3 tissue damage in 20 testes, with viable tissue coexisting with necrosis and calcifications.
Conclusions:
- Testicular damage often predates surgery by at least one week.
- The presence of viable tissue with necrosis supports an ischemia-reperfusion injury mechanism, likely from intermittent torsion.
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