Unilateral testicular torsion with necrotic outcome: dilemmas of surgical timing

To investigate the possible presence of infection in necrotic nonsalvageable testes of patients presenting with testicular torsion and to question the rationale for deferring orchiopexy in such situations to a later date.

Between 2003 and 2011, 16 consecutive patients underwent same-time contralateral orchiopexy and ipsilateral orchiectomy for testicular torsion with necrosis. In all cases, peritesticular fluid or aspirate directly from the necrotic testes was investigated with Gram staining and culturing. The patients were followed at 1 and 3 months after operation for infection of the scrotal incision, or of the remaining testis.

The median age of the patients was 17 years (range 13-32) and the duration of illness ranged from 3-17 days. Both Gram staining and culturing of the peritesticular fluid or testicular aspirate failed to reveal the presence of pathogenic organisms. On follow-up at 1 and 3 months, there was no clinically evident infection of the scrotal incision, or of the remaining testis.

In cases where testicular torsion with necrosis dictates that unilateral orchiectomy must be done, there is no evidence to suspect the presence of bacterial infection in the necrotic testis or surrounding fluid. There is no evidence that one-stage surgery--ipsilateral orchiectomy and contralateral orchiopexy--carries a risk of clinically evident infection related to the necrotic testis and as such patients should be offered one-stage surgery. Continuous and sustained effort should be made toward assuring that testicular torsion receives timely assessment and referral to qualified medical personnel.