Testicular torsion is an urgent medical condition characterized by the twisting of the spermatic cord, which can severely compromise blood flow to the testicle. A common concern for individuals and families facing this condition is its potential impact on future fertility. Understanding the damage mechanisms and the importance of prompt medical intervention is key.
Understanding Testicular Torsion
Testicular torsion occurs when the spermatic cord, a structure containing blood vessels, nerves, and ducts, twists around itself, cutting off the blood supply to the testicle it serves. This sudden loss of blood flow (ischemia) can lead to rapid tissue damage.
The condition typically manifests with sudden, severe pain in the scrotum, often accompanied by swelling, nausea, vomiting, and abdominal discomfort. Sometimes, the affected testicle may appear higher or at an unusual angle within the scrotum. This condition is a medical emergency that requires immediate attention to prevent permanent damage to the testicle.
While it can occur at any age, it is most common in adolescents between 12 and 18 years old, affecting approximately 1 in 4,000 males under the age of 25. Many cases are linked to an anatomical variation called “bell clapper” deformity, where the testicle is not securely anchored and can swing freely, making it prone to twisting.
How Testicular Torsion Can Affect Fertility
Testicular torsion impacts fertility by damaging sperm-producing cells due to reduced blood flow (ischemia). This cellular damage can lead to a reduction in sperm count, impaired sperm motility, and abnormal sperm morphology, all of which compromise fertility.
Damage can also arise upon the restoration of blood flow, a phenomenon known as reperfusion injury, which involves oxidative stress to the testicular tissue. The disruption of the blood-testis barrier during torsion can expose sperm antigens to the immune system. This exposure may trigger the formation of anti-sperm antibodies, which are immune system proteins that can attack and impair sperm, potentially affecting both the torsed and the unaffected testicle.
The unaffected testicle can also experience a reflectory sympathetic-mediated vasoconstriction, leading to reduced blood flow and potential hypoxia. While sperm quality is frequently affected, some research indicates minor changes in testosterone levels, which also play a role in sperm production.
The Critical Role of Timely Treatment
Prompt surgical intervention is essential for preserving testicle viability and sperm production. The likelihood of saving the testicle is considerably higher, around 90%, if surgery is performed within six hours of symptom onset.
After 12 hours, the probability of saving the testicle drops to approximately 50%, and after 24 hours, it can be as low as 10%. Delayed treatment increases the risk of irreversible damage, often requiring orchiectomy (surgical removal of the testicle). During surgery, the spermatic cord is untwisted, and the testicle is typically stitched to the inside of the scrotum to prevent future episodes.
Factors Influencing Long-Term Fertility
The duration of torsion, or how long the testicle was deprived of blood flow, determines the extent of damage and impact on fertility. The degree of twisting also plays a role, as a greater twist can lead to more complete blood flow obstruction.
The age of the patient at the time of torsion is another significant factor. Studies suggest that torsion experienced during childhood may have a less pronounced effect on adult fertility compared to cases occurring in adolescence or adulthood. This difference may be due to the compensatory capacity of the unaffected testicle, which can maintain overall fertility.
The health and function of the contralateral, or unaffected, testicle are important for maintaining reproductive potential. While a healthy single testicle can often produce enough sperm for fertility, the preservation of the injured testicle, when feasible, generally leads to better fertility outcomes compared to its removal, especially for individuals over 18 years of age. Even with successful treatment, some individuals may still experience reduced sperm quality, including issues with motility and morphology.