The most common testicular and scrotal anomalies are
Congenital hydrocele
Undescended testes (cryptorchidism)
Neonatal testicular torsion
Testicular torsion in neonates is rare, but testicular torsion in adults is a common urologic emergency. Rare congenital anomalies include scrotal agenesis, hypoplasia, ectopia, or hemangioma; penoscrotal transposition; and bifid scrotum.
Congenital Hydrocele
A congenital hydrocele is a collection of fluid in the scrotum between layers of the tunica vaginalis. It may be isolated (noncommunicating) or may communicate with the abdominal cavity through a patent processus vaginalis (a potential hernia space). Hydrocele manifests as a painless, enlarged scrotum.
The condition may resolve spontaneously but usually requires repair if it persists after 12 months or if it enlarges.
Congenital Hydrocele
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Neonatal Testicular Torsion
Neonatal torsion is the twisting of a testis that occurs from the prenatal period to 30 days postnatal. Incidence is estimated at approximately 6/100,000 live births (1).
The torsion leads to ischemia and ultimately testicular necrosis. Most cases of neonatal torsion are extravaginal (external to the tunica vaginalis) and frequently occur in the perinatal period.
Diagnosis is with a physical examination where a hard testis is palpated; scrotal skin may be erythematous.
The testis is rarely salvageable unless the torsion is witnessed (ie, acute torsion). Although bilateral asynchronous torsion can occur, it is rare. Timing of intervention is controversial. However, some experts advocate immediate surgical intervention for contralateral fixation because the loss of both testes is devastating.
Neonatal testicular torsion reference
1. Kylat RI, Ahmed MN. Neonatal testicular torsion. Afr J Paediatr Surg. 2022;19(1):1-4. doi:10.4103/ajps.AJPS_153_20
