Missed testicular torsion presenting with male infertility and erectile dysfunction

Testicular torsion has been estimated to affect 1 in every 4 000 males younger than the age of 25 years and has peaks of incidence occurring in the neonate and the adolescent entering puberty. The incidence of missed testicular torsion was about was 4%. The incidence of missed non-simultaneous bilateral torsion was unknown. We presented a case of missed bilateral testicular torsion with resulting primary testicular failure and hypogonadism with erectile dysfunction. The patient was seen for infertility and erectile dysfunction 10 years after the testicular torsion. Semen analysis revealed azoospermia. Serum total testosterone was at the castration level (0.14 nmol/L). His infertility was irreversible. His erectile dysfunction was managed successfully with testosterone replacement and use of sildenafil.