Complications
Number of rotations, which can range from 180° to 1080°, and duration of ischaemia both determine the degree of tissue viability.[16][17][18] If treatment is started within 4 to 6 hours after the onset of symptoms then the testis will most likely remain viable. If the testis remains twisted for more than 10 to 12 hours, ischaemia and irreversible testicle damage are likely.[19] After 12 hours, necrosis has most likely occurred.
If the testis remains twisted for more than 10 to 12 hours, ischaemia and irreversible testicle damage is likely.[19] After 12 hours, necrosis has most likely occurred. Spermatogenesis is significantly impaired in most patients who experience torsion, with nearly 36% of patients having sperm counts of <20 million/mL.[3]
The traumatic experience of losing a testicle can be mitigated by offering a prosthetic device, usually a saline-filled silicone implant, which can improve cosmetic appearance and perhaps the patient's psychological well-being. Testosterone-releasing prosthetic devices have shown some success in animal models.[55][56]
Cosmetic appearance after orchiectomy can be improved by considering saline-filled silicone implants. If implants are placed before puberty they will need to be changed after puberty to an age appropriate size.
Recurrent torsion may develop in patients with a past history of testicular fixation many years later, regardless of whether absorbable or non-absorbable sutures were used.[57] A heightened level of suspicion for these patients is important to prevent testicular damage.
For patients with significant or bilateral testicular loss, hormone replacement therapy may be needed to improve the likelihood of appropriate pubertal development of secondary sex characteristics.
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