Fertility preservation following torsion and severe ischemic injury of a solitary testis.

Objective: To present a case of solitary testicular torsion and an adolescent faced with future hypogonadism and infertility.

Design: Case report.

Setting: University-affiliated teaching hospital.

Patient(s): A 16-year-old male with solitary testicular torsion of >8 hours' duration.

Intervention(s): Immediate scrotal exploration, orchiopexy, and sperm cryopreservation.

Main Outcome Measure(s): Maintenance of testosterone production and determination of preservation after detorsion of an ischemic testis.

Result(s): Color flow Doppler ultrasound showed markedly decreased flow to solitary testis. A subjectively dead testis was seen upon scrotal exploration, with the decision to proceed with orchiopexy. Semen analysis of cryopreserved specimen 50 hours after onset of symptoms showed 1.4 mL, normal sperm concentration (89 million/mL), 67% motility, and 28% World Health Organization morphology. Normal levels of testosterone were found at 4 and 12 weeks after surgery. Testicular salvage with normal intratesticular blood flow was seen by ultrasound at 4 and 12 weeks after surgery.

Conclusion(s): To our knowledge, this is the first reported case of testicular salvage after torsion of a solitary testicle with subsequent normal semen analysis and cryopreservation. This demonstrates the need to attempt salvage even in cases of subjectively dead testicle and the importance of offering expedient sperm cryopreservation in such cases.