Prognosis
The most important prognostic factor in testicular torsion is time. There are about four to six hours left after the occurrence of the event. Already after only four hours, irreversible tissue damage occurs as a result of oxygen deficiency.
After six hours, the entire tissue is usually dead and cannot be saved. This is why quick action, an immediate stay in hospital and emergency surgery at any time of day or night are absolutely necessary. The repetition rate of torsion is very high, since the cause is the hypermobility of the testis.
For this reason, the restoration of the blood supply to the testicle is always followed by a fixation of the organ. After successful fixation of the testicle, the repetition of the event is almost impossible. An increased risk of torsion for the second side remains of course.The most drastic consequence of testicular torsion is necrosis of the tissue in the case of a long-standing interruption of the blood supply.
This means that the tissue of the testis dies and cannot recover. If this happens, the testicle must be removed completely. In a second operation, a testicular prosthesis can be inserted if the patient so desires.
Visually, this can achieve quite appealing aesthetic results. However, one of the two sperm production sites is missing, which means that this man’s fertility will be and remain limited. In most cases, the quantity and quality of the sperm produced on the other side is still sufficient so that children can still be conceived. However, especially in these cases, the second side should be treated prophylactically in order to exclude any risk to the remaining testicles.
Prophylaxis
After emergency surgery for testicular torsion on one side, surgical fixation of the other side is always useful. It is then suspected that the other testis is also increasingly mobile and it is only a matter of time until torsion is expected there as well. Especially if a patient has had a testicle removed due to a late diagnosis or too slow treatment or for other reasons, the other side is operated prophylactically in order to avoid any risk.
If a patient lost both testicles due to unfortunate circumstances, the entire sperm production site would be missing; he would be infertile. Since this should be avoided if possible, a decision is made relatively quickly in favour of prophylactic treatment. If the tissue conditions allow, it is possible to operate on the second side as part of the emergency treatment.
The patient saves one for further anesthesia and one more operation. If the tissue is still inflamed or swollen, one waits until the tissue is stabilized and after about six weeks a so-called elective surgery is performed. The aim is to fix the second testicle as soon as possible, but since there is no acute danger until the time of surgery, the date can be scheduled by arrangement.
Without previous testicular torsion there is no reason for a prophylactic fixation of the testicles, even if the father or brothers were affected. The normal case is a normal growth of the testicles and the spermatic cord and the resulting stable fixation of the testicles in the scrotum. As long as no torsion was detectable, one assumes inconspicuous anatomical conditions.
