Metachronous Testicular Loss Following Testicular Torsion; A Pathology requiring a time dependent intervention: A Case Report and Review of the Literature.

Bilateral metachronous testicular torsion is rare, few cases are reported in the literature. A high clinical index of suspicion is required to avoid a delay in diagnosis and intervention on the part of the managing physician and if necessary avoid delayed referral. It is also important to educate patients on the possibility of this condition and the need for timeous presentation at the hospital to avoid testicular loss. We present a case of a 24-year-old who presented 48 hours after sudden onset of left testicular pains after an initial delay of 24 hours at a private hospital, where he had analgesics and antibiotics. He previously had right orchidectomy 10 years ago for right testicular torsion and left orchidopexy, after an initial delay in presentation. Examination findings revealed an oedematous left hemiscrotum, tender with hard, indurated knotted mass and absent testis in right hemiscrotum. He immediately had scrotal exploration with findings of a gangrenous left testis with 540 degrees anticlockwise twist, he subsequently had orchidectomy. Post-operative recovery was uneventful. Hormonal parameters revealed hypergonadotrpic hypogonadism, 2weeks after surgery, he was placed on testosterone replacement therapy and counselled for immediate sperm banking. Bilateral testicular torsion is rare, it is important to emphasize to the patients that it can occur, despite orchidopexy, therefore the need to present early to avoid testicular loss and the challenges of hypogonadism and infertility. In the literature it is documented that use of non-absorbable sutures and more than two-point fixation may reduce risk of recurrent testicular torsion.