Testicular torsion

SmilingBluEyes · Dec 12, 2006

The good news, is, fertility can and is usually preserved in a child with the rare and unfortunate condition. Here is an abstract of information I found at the following site:

UrologyHealth.org - Pediatric Conditions - Abnormalities - Neonatal Testicular Torsion

How is testicular torsion in children treated?

Because the problem usually is not detected until scrotal reaction calls attention to a dead testicle, for most babies diagnosed with testicular torsion at birth, the testicle cannot be salvaged. However, in cases where the testicle twists shortly after birth, it may be saved if it is untwisted within a few hours. For this reason, a newly recognized firm and enlarged scrotum following an initial physical examination is an emergency and should be evaluated by a surgeon as quickly as possible. Although the testicle may not be saved if the blood supply has been cut off for too long, there is some evidence that surgery to prevent twisting of the other testicle may be useful. However, not all pediatric urologists agree with the need to operate on the normal opposite testis for fixation. There are multiple considerations, including the likelihood of testicular torsion occurring in the opposite testicle as well as risks associated with anesthesia.

What can be expected after treatment for testicular torsion?

Many newborns will need to stay in the hospital overnight after their surgery because of post-anesthesia monitoring of breathing and pulse. The incisions are often painless for several hours because of local anesthetic and afterwards patients need only acetaminophen or ibuprofen for pain.

Frequently asked questions:

How will my son's future fertility be affected after the loss of a testicle?

Only one functioning testicle is necessary for normal fertility potential and full masculinization. A single testicle will produce normal amounts of sperm and testosterone.

Can this condition be prevented?

No.

There is much more there, for your information. I do hope this helps?

cardiacRN2006, ADN, RN · Dec 12, 2006

He could expect some degree of infertility depending on a lot of factors. People who have this condition will develop anti-sperm antibodies (ASAs) to some degree depending on their immune system-regardless of what treatment is performed. This is due to a break in the blood-testes barrier.

He won't find out if it's a problem until later on. However, just as we only need one ovary, they only need on testicle. Usually the other will compensate.

Joni's Mom · Dec 12, 2006

Thanks for your replies,

My little infant has both of the testes that are rock hard and strangled. When I left the unit the family was going to take him to a pediatric specialist. I wont know the outcome, because my clinicals are over, but I am worried about him.

Thanks

58flyer · Dec 18, 2006

He could expect some degree of infertility depending on a lot of factors. People who have this condition will develop anti-sperm antibodies (ASAs) to some degree depending on their immune system-regardless of what treatment is performed. This is due to a break in the blood-testes barrier.
He won't find out if it's a problem until later on. However, just as we only need one ovary, they only need on testicle. Usually the other will compensate.

First let me say that I am no expert on this subject which is to say that I might not know what I'm talking about. I'm just going to pass along what my doctor told me as I understood it since I have a related condition.

Two different urologists were of the opinion that I have a torsed appendix of the testicle, caused most likely by an injury. The result is that the affected testicle cannot allow sperm to pass out through the epididymis into the vas deferens. The affected testicle thinks it has had a vasectomy and the sperm is reabsorbed into the body. Anti-sperm antibodies are the result which attach to the normal sperm produced by the normal testicle. The antibodies will impair the ability of the sperm to fertilize the egg, meaning, at least in my case, no father's day for me.

The unaffected testicle in my case was able to produce good volume and good swimmers, but under a microscope are covered in antibody material. They just can't penetrate the egg. Sperm wash and direct insemination has not been successful. Neither has 3 rounds of IVF (at $15K a pop).

My thinking is that the anti-sperm antibodies are the result of a torsion that precludes the passage of sperm out of the body and that assumes that only one side is affected and to the degree that sperm passage is impaired. If the torsion blocks blood flow and the testicle dies, or both testicles are torsed to the point that both die, I don't think that antibodies are an issue anyway.

Joni's Mom · Dec 18, 2006

Thanks for the reply and giving information first hand with your personal history,

What I'm understanding is that this infant as an adult will still be able to have a relationship with a significant other even though he doesn't have testicles, is this right?

The Doctor told the mother that at about age 9 the child will go on testosterone, and at about age 18 he will go through a sort of cosmetic surgery to replace the hard testes (or are the dead testes removed earlier)for fake testes that feel and look like the real thing.

This little infant has both of his testes that are strangled and dead.

cardiacRN2006, ADN, RN · Dec 19, 2006

The antibodies will impair the ability of the sperm to fertilize the egg, meaning, at least in my case, no father's day for me.
The unaffected testicle in my case was able to produce good volume and good swimmers, but under a microscope are covered in antibody material. They just can't penetrate the egg. Sperm wash and direct insemination has not been successful. Neither has 3 rounds of IVF (at $15K a pop).
.

I'm sorry to hear this. Especially the IVF part. Did they try IVF with ICSI? It's necessary if ASA's are on the head piece of the sperm...

Ok, so I know a little too much on the subject!

RN BSN 2009 · Dec 19, 2006

All I've learned so far is that it is a VERY EMERGENCY Situation that needs to be seen by a surgeon. I've learned a lot here :)

58flyer · Dec 19, 2006

I'm sorry to hear this. Especially the IVF part. Did they try IVF with ICSI? It's necessary if ASA's are on the head piece of the sperm...
Ok, so I know a little too much on the subject!

If they did they didn't tell me all the facts. One of the IVF attempts was at UF Shands, supposedly with the latest IVF technology available at the time. This was around 1999-2000.

cardiacRN2006, ADN, RN · Dec 19, 2006

Well, ICSI (Intracytoplasmic sperm injection ) costs more. At my fertility clinic (where IVF will run only 8k) it costs around $1500 more than just plain IVF where they just throw the sperm into a dish with the egg and cross their fingers for fertilization. But if ASAs are on the headpiece, then they just can't fertilize-no matter how close to the egg they are!

ASAs can bind anywhere they want on the sperm itself-if they bind anywhere else a wash can bust them loose. BUT, and I stress BUT, I would never get a wash and IUI at a fertility clinic (which performs IVF)because their ultimate goal is $$$. Where IVF costs 8-25K and a wash and IUI costs around $400. Many clinics use the wrong wash so that it won't be effective.

BTW, I'm not saying that all places are that way!

I'm really active on a fertility board. And I could do an SA at home (I do). What I have found is that the less a pt knows about what their fertility problem is the more money and time they end up losing.

michigooseBSN · Dec 19, 2006

Two of my three sons were diagnosed with "Bell clapper syndrome" which is a condition where the normal attatchments are missing and the testis can twist on its ligament. This can, but doesn't always, result in compromised bloodflow and resultant gangrene of the testicle. The first son developed sudden severe testicular pain and swelling which he didn't tell us about because he was 14 and embarrassed. By the time we discovered why he was vomitting, the testicle was dead. He had an emergency orchiectomy and surgery to "anchor" the other testicle so torsion couldn't occur on that side. He is now a healthy 36 year old father of a son. We told both of our other boys about it, they were 15 and 11 at that time. About a year later the younger one came to me with testicular discomfort. He had immediate surgery to anchor both testes and is fine. My understanding is that this isn't too rare a condition but isn't ever diagnosed unless torsion occurs causing symptoms. It certainly is a shame, though, for bilateral torsion to happen to a newborn. There was apparently never a chance to repair the condition before permanent damage was done. My experience shows how important it is to tell our sons to come to their parents with an unexplained pain or swelling in the scrotum no matter how embarrassing.

58flyer · Dec 19, 2006

Well, ICSI (Intracytoplasmic sperm injection ) costs more. At my fertility clinic (where IVF will run only 8k) it costs around $1500 more than just plain IVF where they just throw the sperm into a dish with the egg and cross their fingers for fertilization. But if ASAs are on the headpiece, then they just can't fertilize-no matter how close to the egg they are!
ASAs can bind anywhere they want on the sperm itself-if they bind anywhere else a wash can bust them loose. BUT, and I stress BUT, I would never get a wash and IUI at a fertility clinic (which performs IVF)because their ultimate goal is $$$. Where IVF costs 8-25K and a wash and IUI costs around $400. Many clinics use the wrong wash so that it won't be effective.
BTW, I'm not saying that all places are that way!
I'm really active on a fertility board. And I could do an SA at home (I do). What I have found is that the less a pt knows about what their fertility problem is the more money and time they end up losing.

OK, you are starting to jar my memory cells into action. I don't remember the term ICSI, but I do recall them saying icksie. That Doc always seemed to be in a hurry, no time to explain anything. During the Shands evolution, there was a Doc trained especially to do the injection of the sperm cell into the egg. I know it did "take" and the egg started to divide, but after it was placed into my wife's uterus her system rejected it. It was a donor egg since by that time we were starting to get concerned about the viability of my wife's eggs at age 40.

I don't doubt that the fertility clinic we used for the first 2 rounds of IVF got more $$ out of us than they should have. You are right, it was the same clinic that did both the sperm wash and IVF.

I wish I could have met you sooner!!!!

Our emotions clouded our decisions about all this. My wife was getting desperate to have a kid, me too for that matter, as we weren't getting any younger.