When a Newborn's Testicle Twists: What Three New Reports Tell Families

How Ayvaz et al. 2025 (Istanbul), Sun et al. 2026 (Suzhou) and Abu-Sharikh et al. 2026 (Hebron) explain a rare problem, the surgery that follows, and the questions doctors still debate

A rare problem, explained gently

Very rarely, a baby boy's testicle twists on its cord before or shortly after birth, cutting off its blood supply. Three recent reports from Türkiye, China and Palestine show that the twisted testicle can almost never be saved, but that doctors still disagree about how quickly to operate and whether to secure the other testicle with stitches. Here is what the research found and what it means for families.

What testicular torsion is, and why timing matters

Each testicle hangs in the scrotum (the skin pouch below the penis) on a cord that carries its blood vessels. If the testicle turns around on that cord, a problem doctors call torsion, the blood supply is pinched off, much like a garden hose that has been kinked. In older boys, torsion is usually painful and noticed quickly. In newborns it is different: the twist may happen quietly before birth, and by the time anyone notices, the testicle has usually been without blood for too long.

Three hospitals, three different views

Three reports look at this problem from different angles. In Istanbul, Türkiye, surgeons led by Dr. Ayvaz reviewed the records of 17 newborns operated on for a testicle thought to have twisted before birth, a problem called intrauterine testicular torsion ("intrauterine" means inside the womb). None of the 17 testicles could be saved, so the team questioned whether rushing to surgery helps [1]. In Suzhou, China, a team led by Dr. Sun reviewed 14 years of care for 31 newborn boys with torsion, starting in October 2010. Every baby had emergency surgery, and since 2014 the hospital has routinely stitched the other testicle in place during the same operation. They saved 2 of 33 twisted testicles and believe their approach is worthwhile [2]. In Hebron, Palestine, Dr. Abu-Sharikh and colleagues described a single baby whose torsion was discovered at 16 hours of age, while he was in hospital for jaundice (yellowing of the skin) [3]. All three agree that saving the testicle is rare. They do not fully agree on what to do next. For context, torsion around birth affects about 6 in every 100,000 births [4].

How doctors have thought about this problem over the years

Doctors have puzzled over newborn torsion for decades. In 1987, a surgeon named Burge suggested that pressure inside the womb late in pregnancy, and pressure during a vaginal birth, might trigger a small muscle reflex that twists a testicle not yet firmly attached inside the scrotum [5]. In the 2000s, the titles of research papers showed how unsure doctors were. One asked whether surgery should happen "today, tomorrow or never?" [6], and another asked whether a twisted newborn testicle was "a lost cause?" [7]. A team reporting 14 years of experience found that half of their cases had risk factors such as diabetes in pregnancy or a difficult birth, and proposed a step-by-step plan for doctors [8]. Another team found that two babies who seemed to have a problem on only one side actually had both testicles twisted when surgeons looked [9]. Over time, the most common approach became urgent surgery to remove the dead testicle and stitch the healthy one in place, a pattern described in a 2013 survey of children's urologists (surgeons who specialize in the urinary and genital organs) [7],[6],[10]. A later study that pooled 196 cases estimated that operating on both sides might save about 7 in 100 affected testicles and prevent about 4 in 100 later twists on the other side [11]. One review warned that waiting could put the other testicle at risk [12], and another estimated that only about 5 in 100 twisted newborn testicles are saved [13]. Twisting is also hard to detect during pregnancy: one review found that only 6 of 59 cases were diagnosed before birth [14].

What the three reports found

The Istanbul babies were mostly operated on at one day old. Fourteen of the 17 testicles were removed because they had died. In the other three, surgeons untwisted and stitched the testicle because they saw a little blood flow, but all three later shrank away [1]. The signs were a hard, red or swollen scrotum, and, importantly, the babies did not seem to be in pain. The team stitched the other testicle in only 4 of the 17 babies, on purpose, because they worried that operating on the healthy testicle could damage it and leave a boy with no working testicles.

In Suzhou, 29 babies had torsion on one side and 2 on both sides. Of the 29 one-sided cases, 28 testicles had no blood flow on ultrasound (a painless scan using sound waves) and were removed; only 1 was saved [2]. That baby was in hospital for low blood sugar and a chest infection, had no scrotal signs at all, and his twist was found on a routine scan. His testicle had turned only half a turn, much less than most. The other testicle was stitched in place in 23 of the 29 one-sided cases, and over about six years of follow-up, no baby's other testicle twisted.

The Hebron baby had a firm, enlarged right side of the scrotum. An ultrasound showed no blood flow, and surgery began about two hours later. The right testicle was dark and dead and was removed, and the left was stitched in place. He went home a week after surgery and recovered well, and his hormone tests at later check-ups were reported as normal [3].

Why the reports disagree

The Istanbul team studied only babies whose testicle was thought to have twisted before birth, and even surgery on the first day of life saved none of those testicles [1]. The Suzhou team treated many babies who were diagnosed days after birth, when the twist may have been more recent, and could not always tell whether a twist had happened before or after birth [2]. The two testicles saved in Suzhou had only small twists. Taken together with the Hebron baby, whose testicle was already dead even though he was operated on quickly, the reports suggest that the chance of saving a testicle may depend largely on how recently it twisted. The title of a 2022 review describes "clear cut", "controversial" and "quiet" situations [13]. The Suzhou and Hebron babies, found by chance while in hospital for other reasons, show how torsion can be caught by a careful routine check, even when a baby is in hospital for something else.

The biggest disagreement is about the other testicle. Stitching it in place is meant to stop it from twisting later, which would leave a boy with no working testicles. Suzhou does this routinely and saw no later twists [2]. Istanbul does it only sometimes, to avoid harming a healthy testicle [1]. The Hebron doctors note that the evidence either way is still limited and that hospitals do this differently [3]. Because the pooled study estimated that operating on both sides prevents only about 4 in 100 later twists on the other side [11], small studies like these cannot yet say which approach is better.

What this means for your family

Every newborn should have the scrotum checked at the first baby examination, and again whenever a baby is examined in hospital for other reasons, as the Hebron case shows [3]. If a doctor or nurse finds a hard, swollen or discolored scrotum, the usual next step is an ultrasound and a visit from a surgeon. The operation is done under general anesthesia (the baby is fully asleep) through a small cut in the groin or scrotum, and in Suzhou the typical operation took about 39 minutes [2]. During the operation, the surgeon untwists the cord and watches whether color and blood flow return. In Suzhou, when the testicle stayed dark, surgeons made a tiny cut into it and timed whether it bled, a simple way of judging whether it was still alive [2]. If the testicle has died, it is usually removed, and the other testicle may be stitched in place. Parents can ask the surgeon which approach they recommend and why. After surgery, babies are seen again for check-ups; the Hebron baby was reviewed at 2 weeks and 6 months [3]. If a damaged testicle is left in place, follow-up scans matter, because in Istanbul all three testicles that were kept later shrank [1].

Families understandably worry about the future. The Hebron authors point out that one healthy testicle usually makes enough hormones for normal development and usually allows a man to father children, and their patient's hormone tests were normal [3]. Still, none of these studies followed boys into adulthood, so doctors cannot yet give exact figures.

What researchers are working on next

Both research teams call for studies that pool babies from many hospitals and follow them over time [1],[2]. The Istanbul team hopes that scans during pregnancy and closer teamwork with obstetricians (doctors who care for pregnant women) might one day allow an earlier delivery when a twist seems to have happened just before birth [1]. The Suzhou team wants to track hormones and fertility as boys grow up, and to test new ways of measuring blood flow in the testicle, such as a dye-based technique called indocyanine green angiography [2].

The bottom line

Newborn testicular torsion is rare, and the twisted testicle usually cannot be saved. Doctors agree on careful checks and quick ultrasound, but they still debate how urgently to operate and whether to stitch the other testicle. The best thing families can do is ask questions and share in these decisions.

References

  1. Ayvaz OD, Cansaran S, Celayir A, Erol ZE. 12 years of experience in intrauterine testicular torsion management. Pediatr Surg Int. 2025;41(1):187. doi:10.1007/s00383-025-06093-9 ↩
  2. Sun Y, Tu X, Wang Z, et al. Neonatal testicular torsion: a single-center 14-year experience in diagnosis and management. Front Pediatr. 2026;14:1749065. doi:10.3389/fped.2026.1749065 ↩
  3. Abu-Sharikh G, Altell K, Najjar R, Karaki A. Neonatal unilateral testicular torsion in the first 16 hours of life: a case report and literature review. Medicine (Baltimore). 2026;105(37):e50720. doi:10.1097/MD.0000000000050720 ↩
  4. Kylat RI, Ahmed MN. Neonatal testicular torsion. Afr J Paediatr Surg. 2022;19(1):1-4. doi:10.4103/ajps.AJPS_153_20 ↩
  5. Burge DM. Neonatal testicular torsion and infarction: aetiology and management. Br J Urol. 1987;59(1):70-73. doi:10.1111/j.1464-410X.1987.tb04583.x ↩
  6. Yerkes EB, Robertson FM, Gitlin J, Kaefer M, Cain MP, Rink RC. Management of perinatal torsion: today, tomorrow or never? J Urol. 2005;174(4 Pt 2):1579-1583. doi:10.1097/01.ju.0000179542.05953.11 ↩
  7. John CM, Kooner G, Mathew DE, Ahmed S, Kenny SE. Neonatal testicular torsion – a lost cause? Acta Paediatr. 2008;97(4):502-504. doi:10.1111/j.1651-2227.2008.00701.x ↩
  8. Kaye JD, Levitt SB, Friedman SC, Franco I, Gitlin J, Palmer LS. Neonatal torsion: a 14-year experience and proposed algorithm for management. J Urol. 2008;179(6):2377-2383. doi:10.1016/j.juro.2008.01.148 ↩
  9. Ahmed SJ, Kaplan GW, DeCambre ME. Perinatal testicular torsion: preoperative radiological findings and the argument for urgent surgical exploration. J Pediatr Surg. 2008;43(8):1563-1565. doi:10.1016/j.jpedsurg.2008.03.056 ↩
  10. Broderick KM, Martin BG, Herndon CDA, Joseph DB, Kitchens DM. The current state of surgical practice for neonatal torsion: a survey of pediatric urologists. J Pediatr Urol. 2013;9(5):542-545. doi:10.1016/j.jpurol.2012.12.010 ↩
  11. Monteilh C, Calixte R, Burjonrappa S. Controversies in the management of neonatal testicular torsion: a meta-analysis. J Pediatr Surg. 2019;54(4):815-819. doi:10.1016/j.jpedsurg.2018.07.006 ↩
  12. O'Kelly F, Chua M, Erlich T, Patterson K, DeCotiis K, Koyle MA. Delaying urgent exploration in neonatal testicular torsion may have significant consequences for the contralateral testis: a critical literature review. Urology. 2021;153:277-284. doi:10.1016/j.urology.2020.10.064 ↩
  13. Erlich T, Ghazzaoui AE, Pokarowski M, et al. Perinatal testicular torsion: the clear cut, the controversial, and the "quiet" scenarios. J Pediatr Surg. 2022;57(10):288-297. doi:10.1016/j.jpedsurg.2021.10.003 ↩
  14. Melcer Y, Mendlovic S, Klin B, et al. Fetal diagnosis of testicular torsion: what shall we tell the parents? Prenat Diagn. 2015;35(2):167-173. doi:10.1002/pd.4512 ↩