Perinatal Testicular Torsion – Seeking the Timeline and Finding Unexpected Pathologic Evidence

To determine the time of onset of perinatal torsion based on the clinical, sonographic, and histologic characteristics and shed light on the pathogenesis.
The data of 21 neonates (22 testes) who underwent orchiectomy for perinatal testicular torsion between 2008 and 2022 were retrospectively collected from two medical centers.
Median age at surgery was 13 h, and median interval between ultrasound and surgery was 2.9 h. All patients presented with rigid, painless testes, 15 on the left side and 5 on the right; one patient had bilateral torsion. Torsion was extravaginal in 17 cases and intravaginal in one; in 3 cases, no torsion was found intraoperatively. On ultrasound study, available for 16 torsed testes (15 patients), there was no blood flow in 13 and scant flow in 1; in 2, perfusion was found at the rim. Histologic examination after surgical removal revealed grade 3 tissue damage in 20 testes. In all of them, viable tissue was present along with the necrosis and calcifications.
All testes had been damaged at least one week before surgery. There was no association of the sonographic with the histologic findings. The unexpected finding of viable tissue coexistent with necrosis and dystrophic calcifications supports an etiology of ischemia-reperfusion injury resulting from intermittent torsion.