Testicular Viability Research Articles

A Case with Torsion Testis: Restore Testicular Viability after 18 Hours!

A Case with Torsion Testis: Restore Testicular Viability after 18 Hours!

A Case with Torsion Testis: Restore Testicular Viability after 18 Hours!

A Case with Torsion Testis: Restore Testicular Viability after 18 Hours!

611 - Other than duration of symptoms, is there a predictive factor for testicular viability following testicular torsion in children?

611 - Other than duration of symptoms, is there a predictive factor for testicular viability following testicular torsion in children?

Ultrasonographic Assessment of Testicular Viability Using Heterogeneity Levels in Torsed Testicles

Gross testicular heterogeneity on ultrasound has been associated with testis loss following testicular torsion in children. We aimed to quantify the extent of temporal heterogeneity associated with testis loss in testicular torsion cases using a noninvasive technique to determine a HI (heterogeneity index) on ultrasound images. We retrospectively studied the records of patients who presented with acute scrotal pain to the Pediatric Emergency Department over a 6-year period. Ultrasound images of the affected testis and the unaffected contralateral testis were examined using a proprietary program to determine the extent of heterogeneity of each image. The difference between the HI of the torsed testis and that of the contralateral normal testis was termed ΔHI. Receiver operating characteristics curve analysis was performed to determine the ΔHI threshold for nonviability. Among 529 patients who presented with acute scrotal pain 147 had testicular torsion based on surgical findings. Of these 147 patients 110 (74.8%) were found to have a viable testis while 37 (25.2%) had a nonviable testis. Using the ΔHI cutoff of 0.394 or greater for nonviability, sensitivity and specificity were 100% and 94.5%, respectively. Positive and negative predictive values were 86% and 100%, respectively. Our results demonstrate that a quantifiable temporal gradation of heterogeneity exists and the heterogeneity index can be used as an objective parameter to determine the viability of a torsed testicle. By developing the technology to measure the heterogeneity index in real time, we could potentially identify which patients with testicular torsion have a nonviable testicle and, thus, would not require immediate surgical exploration.

The effects of melatonin and colchicine on ischemia–reperfusion injury in experimental rat testicular torsion model

PurposeThe aim of the present study is to investigate the efficiency of colchicine and melatonın in an experimental rat testicular torsion model in the light of histological and biochemical data. MethodsA total of 34 Wistar albino male rats were randomly divided into 5 groups as: Group C (control, n=6), Group S (sham; underwent only left scrotal exploration, n=7), Group TD (torsion and detorsion; 6h of ischemia and 7days of reperfusion, n=7), Group TD/M (TD+Melatonin; 6h of ischemia and 7days of reperfusion and 7days of 17mg/kg intraperitoneal melatonin per day, n=7), group TD/Col (TD+Colchicine; 6h of ischemia and 7days of reperfusion and 7days of 1mg/kg oral colchicine per day, n=7). Histopathologic evaluation of seminiferous tubule deterioration was performed by Johnsen's scoring system. Total antioxidant status (TAS), total oxidant status (TOS), IL-6, TNF alpha levels were analyzed in each group. ResultsThe histopathologic scores, total antioxidant status (TAS), total oxidant status (TOS), IL-6, TNF alpha levels in groups C and TD/Col were significantly lower than groups TD and TD/M (P<.001). ConclusionOur study results revealed that colchicine reduced testicular ischemia–reperfusion injury in experimental rat testis torsion model. Although detorsion of testis is crucial for the preserving the testicular viability, antioxidant and anti-inflammatory treatment modalities like colchicine might help to reduce ischemia–reperfusion injury in detorsed testis.

Explorative surgery for acute scrotal pain: The importance of patient age, side affected, time to surgery and surgeon.

Testicular torsion must be diagnosed quickly and accurately. The delay of the diagnosis and the subsequent delay of surgery may lead to loss testicular viability and orchidectomy. Aim of our retrospective evaluation was to define which element should be considered as major support to the clinician in distinguishing spermatic cord torsion from the other diseases mimicking this clinical emergency requiring surgical exploration. We retrospectively reviewed all clinical and instrumental data of emergency scrotal exploration performed for acute scrotal pain at two different Urological Department in a 10 year period. Results of surgical exploration represented the four diagnostic categories in which patients were divided for statistical evaluation. We evaluated the relationship between diagnosis performed by testicular surgical exploration and the all clinical data available including surgeon involved in the procedures. A total of 220 explorative scrotal surgery were considered. We divided the cases in 4 categories according to the diagnostic results of each surgical procedure. Of all, spermatic cord torsion was diagnosed in 45% (99/220). The total testis salvage rate was of 78.8%. The patients with a diagnosis of spermatic cord torsion were older than patients with appendix torsion (15 vs 11 years in mean). When the affected side was the left, the probability to have a diagnosis of spermatic cord torsion was higher than the right side [χ2 (2, N = 218) = 11.77, p &lt; 0.01]. Time elapsing between onset of symptoms and testicular salvagewas significantly lower even than in case of appendix torsion/necrosis (p &lt; .0001), and of others pathologies diagnosed (p = .0383). In case of spermatic cord torsion, in addition to the clinical data, patient age and left side affected may represent an independent diagnostic predicting factor. The time elapsing between onset of symptoms and explorative surgery remain the only still prognostic factor for testicular viability.

Presentation of Testicular Torsion in the Emergency Department.

Testicular torsion is a urological emergency affecting 3.8 per 100,000 males younger than 18 years. Differential diagnosis of the acutely painful scrotum is crucial for the advance practice nurse to understand. Advanced practice nurses should consider the differential diagnosis of testicular torsion for any patient with testicular pain despite the patient's age, history, or physical examination findings. The standard of care for a patient with testicular pain to rule out testicular torsion is a Doppler ultrasound scan and an emergent urology consult. Immediate attention to this urological emergency will decrease risks to testicular viability.

Editorial comment for Protective effect of tunica albuginea incision with tunica vaginalis flap coverage on tissue damage and oxidative stress following testicular torsion: Role of duration of ischemia

The authors presented their experimental study investigating the effects of testicular torsion in a rat model. Not surprisingly they found that there is a linear increase in parameters of testicular distress with increasing duration of torsion (1, 5 and 9 h). A tunica vaginalis flap (TVF) placed in the incised tunica albuginea of an experimentally torsed testes reduced testicular histologic damage and reduced a serum marker of injury (MDA) only in testes torsed for 9 h. The authors found no measurable benefit in those testes torsed for lesser time intervals (1 and 5 h); indeed, there was worse injury in those animals subjected to the TVF intervention. While the authors stated in the Introduction that testicular torsion must be differentiated from other causes of scrotal pain so as to prevent the loss of the testicle in those with torsion, the real issue at hand is what to do with the ischemiclooking testes at the time of surgery. Few would want to leave necrotic testes, but how clinically are irrevocable changes discerned? Which testes can be helped with TVF? The duration of scrotal pain, as indicated by the patient’s history, is a poor indicator of testicular viability given the vagaries of adolescent male perceptions, the occasional but real occurrence of intermittent torsion and the anatomic variability (i.e. the number of twists) of spermatic cord torsion. There is literature [1] directly relating necrosis to duration of symptoms, but experience demonstrates many outliers to the general rules governing the relationship between testicular viability and duration of symptoms. Indeed, Sessions et al. [2] found that 40% of patients presenting with symptoms of >20 h duration had testicular salvage with standard detorsion and fixation. Would these patients be harmed with the TVF techniques, as were those rats

Modulation of Thrombosis Significantly Reduces Testicular Damage after Testicular Torsion in Rats: Anti-Thrombotic Treatment and Testicular Torsion

To evaluate the effects of thrombolysis and/or anticoagulation on testicular viability after testicular tortion (TT) was the aim of this study. It has been suggested that alterations of circulation during TT result in thrombus formation that might prevent sufficient perfusion after detorsion. Due to the narrow safety margin of testicular perfusion, even moderate disturbances in blood supply can cause major testicular damage. In 112 rats, the right testicle was torsed for 3 or 6 hours. After detorsion and randomization, they received either enoxaparin, alteplase, both, or placebo, according to their subgroup. Thrombus formation was accessed via D-dimers, pDNA, oxidative testicular damage was evaluated via glutathione peroxidase and malondialdehyde, and cellular damage via inhibin B, testosterone, histological analysis (Johnsen score, Cosetino grading), and TUNEL assay. One hundred and twelve rats were included in the study. The treatment with alteplase or enoxaparin showed significantly less testicular damage and significantly improved Sertoli cell function. Enoxaparin significantly reduced oxidative impairment. The results of the study indicate that TT induces thrombus formation and demonstrate that modulation of thrombosis significantly ameliorates testicular damage in rats. Hence, this treatment option after TT ought to be evaluated in humans.

Factors Predicting Testicular Atrophy after Testicular Salvage following Torsion.

Testicular atrophy (TA) is a significant complication in patients who undergo salvage procedures for testicular torsion. Studies on outcome focus on factors predicting testicular viability during scrotal exploration but few assess factors predicting TA in patients who undergo salvage procedures. We assess the incidence of TA after salvage and identify associated factors. With ethical approval, we reviewed patients who underwent salvage for testicular torsion in our institution from 2001 to 2013. Data was collected on patient demographics, duration of pain, sonographic findings, postoperative complications, and follow-up assessment of TA (defined as difference in testicular volume > 50% compared with the contralateral testis, based on measurement by Prader orchidometer or by ultrasound). We excluded patients with torted undescended testis, those under 1 month, and those with follow-up < 6 months. Chi-square or Mann-Whitney U tests were used as appropriate with significance level < 0.05. Of 85 patients who had scrotal exploration for testicular torsion, 53 had testicular salvage. Overall, 16 patients defaulted or had < 6 months follow-up, leaving 37 patients who were studied, median age 12 years (range, 0.5-16.0 years) at presentation. Median follow-up was 12.5 months (range, 6-88 months). A total of 20 patients (54%) developed TA. Median duration to TA was 12.5 months (range, 2-88 months). All had clinical evidence of atrophy by 14 months, except two who initially defaulted follow-up, but were diagnosed with TA at 35 and 88 months postoperatively when presenting with unrelated complaints. Factors associated with TA were duration of pain > 1 day (p = 0.004) and heterogeneous echogenicity on ultrasound (p = 0.001). Sonographic evidence of reduced vascularity was not predictive. Of 11 that had pain > 1 day, 10 (91%) had TA. No testes survived when pain ≥ 3 days. Half of patients with testicular torsion undergoing salvage surgery will develop testicular atrophy, even when intraoperatively assessed as viable, and should be counseled accordingly. Duration of pain > 1 day and sonographic heterogeneous echogenicity are predictive. Salvage rates are dismal when duration of symptoms exceeds 1 day.

Testicular hypertrophy as a predictor for contralateral monorchism: Retrospective review of prospectively recorded data

Testicular hypertrophy has previously been evaluated as a predictor of monorchism. However, its implication in clinical practice is not well evaluated. The aim of the present study was to examine its value in planning the operative time. Medical charts of prospectively recorded data of 76 consecutive patients with unilateral impalpable testis from 2011 to 2014 were reviewed at the present institute. Inclusion criteria included prepubertal patients with non-palpable testes by examination under anesthesia. Contralateral testes were prospectively measured using a Takihara orchidometer. Orchiectomy or orchiopexy was performed according to the viability of the undescended testis (UDT). Collected data included age of surgery, contralateral testicular size, surgical time and laparoscopic findings. A ROC curve was used to define the best cut-off volume of the contralateral testis that can predict ipsilateral testicular viability. The Student's t-test was used to examine if this cut-off volume would be useful in allocating the operative time. Of 76 patients, four palpable testes by examination under anesthesia were excluded. The remaining 72 patients were included in the study. Ipsilateral normal viable testes were found in 26 (36.1%) patients, while 46 (63.9%) had non-viable testes (testicular nubbins or vanishing testes) (Figure). A contralateral testicular volume > 2 ml was significantly predictive for monorchism with 71.7% sensitivity and 100% specificity (P < 0.001). The mean operative time for management of UDT with a contralateral size >2 ml was 50 min, which was significantly shorter than that for UDT with a contralateral size ≤ 2 ml, which was 88 min (P < 0.001). In previously published reports, the cut-off value for testicular hypertrophy that predicts monorchism greatly varied. This is likely due to the different methods used for testicular measurements that make it impractical to make a direct comparison. The usefulness of predicting monorchism before surgery has not previously been used as a guide for allocating operative time in the management of a unilateral non-palpable testicle. This study had some limitations, including a relatively small sample size and involvement of different surgeons, which may have affected the operative time. Using the cut-off volume of a contralateral testis >2 ml as a predictor for monorchism can reduce the allocated operative time by approximately one third.

Predictive role of hematologic parameters in testicular torsion.

PurposeTo evaluate the predictive role of the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV), and platelet count (PLT) in the diagnosis of testicular torsion (TT) and testicular viability following TT.Materials and MethodsWe analyzed two study groups in this retrospective study: 75 patients with a diagnosis of TT (group 1) and 56 age-matched healthy subjects (group 2). We performed a complete blood count as a part of the diagnostic procedure, and NLR, PLR, MPV, and PLT values were recorded. We compared the patient and control groups in terms of these parameters. Then, TT patients were divided into two subgroups according to the time elapsed since the onset of symptoms. Subsequently, we evaluated the relationship between the duration of symptoms and these parameters.ResultsThere were significant differences between groups 1 and 2 in NLR, PLR, and PLT (p<0.001 for all). There was no predictive role of MPV in the diagnosis of TT (p=0.328). We determined significantly high sensitivity and specificity levels for NLR in the prediction of TT diagnosis (84% and 92%, respectively). Furthermore, NLR was significantly related to the duration of symptoms in TT patients (p=0.01).ConclusionsNLR may be a useful parameter in the diagnosis of TT. Furthermore, NLR may be used as a predictive factor for testicular viability following TT.

Traumatic Testicular Dislocation after Minor Trauma in a Pediatric Patient

BackgroundTraumatic dislocation of the testicle is a rare injury that may result from blunt abdominopelvic trauma. The majority of cases reportedly occur in young adults secondary to severe scrotal trauma during high-speed motorcycle crashes. Our review of the available English medical literature revealed only one pediatric case. ObjectiveWe present a case of pediatric testicular dislocation and torsion resulting from minor abdominopelvic trauma. The case report is followed by a brief review of the available literature. Case ReportA 10-year-old boy presented to the Pediatric Emergency Department with abdominal pain. He had suffered a strike to the abdomen and groin during an attempt at flipping over a “monkey bar” at school. A tender mass was found in his right inguinal canal and the genital examination revealed an empty right hemiscrotum. Bedside ultrasonography was used to locate the testicle and it was noted by color-flow Doppler to lack demonstrable blood flow. The patient was taken emergently to the operating room, where he underwent orchiopexy and hernia repair after a viable testicle was found. He had a subsequently uneventful recovery. ConclusionAlthough rare, testicular dislocation may be a serious result of abdominopelvic trauma. Emergency providers who care for trauma patients must include this condition in their differential diagnosis; to do otherwise risks a delay in diagnosis that may affect testicular viability. In this case, testicular dislocation may have resulted from the combination of trauma and a previously undiagnosed indirect inguinal hernia.

Two-Step Fowler-Stephens Orchiopexy for Intra-Abdominal Testes: A 28-Year Single Institution Experience

Two-Step Fowler-Stephens orchiopexy for high undescended testes allows for mobilization of the testicle to the scrotal position while preserving perfusion by collateral circulation after gonadal vessel ligation. Although used for decades, the long-term efficacy of this procedure has not been reported. We present our 28-year clinical experience with this technique. We retrospectively studied a cohort of patients who underwent 2-step Fowler-Stephens orchiopexy at our institution between 1982 and 2009. Patients were excluded if either step was performed elsewhere or if followup was less than 6 months. Bivariate and multivariate analyses were performed to determine associations between clinical, surgical and anatomical factors and testicular viability at last followup. A total of 62 patients (79 testes) met inclusion criteria. Median followup was 3.1 years (range 0.6 to 20). Based on the most recent examination/ultrasound, 70.9% of testicles were considered to be normal, with the remainder exhibiting relative (15.2%) or complete (14.9%) atrophy. Of the 10 testes assessed at or after puberty 6 were normal and 4 showed relative atrophy. On bivariate and multivariate analyses only an open second stage approach was associated with normal testicular viability, with 69.9% of normal vs 18.9% of completely atrophic testes being managed by an open approach (p = 0.0084). Thought to be highly effective in short-term followup, our data suggest that 2-step Fowler-Stephens orchiopexy leads to complete testicular viability in 70.9% of cases. This viability is strongly associated with an open second step.

Laparoscopic Management for Non-Palpable Testis

Purpose: To present our experience with laparoscopic management of the non-palpable undescended testis. Patients and Methods: Between Nov. 2010 and Oct. 2012, 47 non-palpable testes in 41 patients were evaluated prospectively by laparoscopy. The age of the patients at the time of surgery varied from 1 to 9 years with a mean age of 2.85 years. Testicular viability and location were evaluated by physical examination and Doppler ultrasonography after 1 and 3 months. Results: Out of 49 testicular units, 47 (95.9%) were successfully treated by laparoscopic orchiopexy. 45 testicular units (91.8%) were treated by one-stage laparoscopic orchiopexy, 2 (4.1%) were treated by two-stage laparoscopic orchiopexy and 2 (4.1%) diagnosed as vanishing testis with detection of blind end spermatic vessels and vas deferens during laparoscopy. Physical examination and Doppler study demonstrated that 46 of 47 testes (97.9%) were viable and 45 of 47 (95.7%) were located in the lower scrotum and 2 of 47 (4.3%) in the upper scrotum at the end of follow-up. Conclusion: The laparoscopy is a reliable technique for diagnosis and treatment of the non-palpable intra-abdominal testis with high success and survival rates of the testes.

Prediction of testicular viability after unilateral testicular torsion by ultrasonography

Objective To investigate the value of predicting testicular viability following unilateral testicular torsion by color-Doppler ultrasound (CDU). Methods The clinical manifestations, intraoperative findings and scrotol CDU appearances before and after operation of 42 cases with testicular torsion were compared. According to a bleeding test intraoperatively, testicular viability was divided into A-D level. Testis of level A-C would be saved .while the level D removed. Testicular viability assessed by follow-up CDU was then classed into Ⅰ-Ⅲ level. In Ⅰ-Ⅱ level, the salvaged testis were recovery ultimatelybut atrophy in level Ⅲ. Results Seventeen cases of the 42 underwent orchidopexy and the remaining 25 cases underwent orchidectomy. As followed up, however, testis in only 7 cases were recovered, including 2 cases in level A,3 cases in level B and 2 cases in level C. respectively. The preoperative scrotal CDU appearances of the recovered testis were mainly as follows: ① Homogeneous parenchyma with decreased or disappeared blood perfusion. ②Sheet or radial hypoechoic in the local testis but with preserved blood perfusion in most area else. Testis in the remaining 10 patients, including 8 cases in level C and 2 cases in level D, respectively, were atrophy finally. And large radial hypoechoic or diffuse inhomogeneous echo with none or a small amount of blood supply on the edge parenchyma were found during their preoperative CDU (similar CDU performance was present in the orchidectomy group. The CDU appearances of contralateral testes both in orchidopexy and orchidectomy group were not obviously abnormal during follow-up. Conclusions The scrotal CDU examination is competent to predict testicular viability after detorsion. In addition, timely operation would be a key to CDU evaluation. Key words: Ultrasonography; Spermatic cord torsion

Is Staging Beneficial for Fowler-Stephens Orchiopexy? A Systematic Review

Fowler and Stephens showed that by dividing the spermatic vessels a high intra-abdominal testis could be placed in the scrotum. Testicular atrophy is a potential complication of this technique. We conducted a systematic review to determine whether single or 2-stage Fowler-Stephens orchiopexy results in better testicular viability. We searched electronic databases, clinical trial registries and gray literature. We included reports describing boys younger than 18 years with a primary outcome of "testicular viability and position." We performed a meta-analysis using random effects models. Heterogeneity was assessed using forest plot and I(2) statistic. We identified 1,807 citations and included 61 articles. Single stage Fowler-Stephens orchiopexy was discussed in 9 articles, a 2-stage procedure in 36 and both approaches in 16. There were no randomized controlled trials, and most studies were cohort or case series. The pooled estimate of success rates was 80% for single stage Fowler-Stephens orchiopexy (95% CI 75 to 86) and 85% for 2-stage Fowler-Stephens orchiopexy (95% CI 81 to 90). The pooled odds ratio of single stage vs 2-stage Fowler-Stephens orchiopexy was 2.0 (95% CI 1.1 to 3.9) favoring the 2-stage procedure. There was no difference in the success rate between laparoscopic and open techniques in either single or 2-stage Fowler-Stephens orchiopexy. There was no evidence of asymmetry on the funnel plot. There were no complications reported with single stage, while ileus, hematoma and infection were the most common complications with 2-stage Fowler-Stephens orchiopexy. Both techniques have a fairly high success rate but 2-stage Fowler-Stephens orchiopexy appears to carry a higher rate of success than the single stage approach (85% vs 80%, OR 2 in favor of 2-stage). Laparoscopic and open techniques had the same success rate. However, the level of evidence of the studies was low, and a study of a more robust design, such as a randomized controlled trial, should be performed.

Laparoscopic Orchiopexy for a Nonpalpable Testis

PurposeWe evaluated the efficacy and the availability of laparoscopic orchiopexy to manage a nonpalpable intra-abdominal testis and studied outcomes including the testicular survival rate and associated complications.Materials and MethodsWe retrospectively reviewed the medical records of 67 children (86 testicular units) who underwent laparoscopic orchiopexy for a nonpalpable intra-abdominal testis between 1996 and 2008. The mean patient age was 2.4 years (median, 1 year; range, 0.5-9 years), and the mean follow-up period was 21.8 months (range, 0.3-138.4 months). Testicular viability and orchiopexed positioning were evaluated within 1 month and beyond 3 months.ResultsOf 86 testes, 69 testes were treated with primary laparoscopic orchiopexy (PLO) sparing the internal spermatic vessel, 14 testes were treated with one-stage Fowler-Stephens laparoscopic orchiopexy 1, and 3 testes were treated with two-stage Fowler-Stephens laparoscopic orchiopexy 2. The testicular survival rates were 97.7% (84/86) within 1 month and 93.7% (59/63) beyond 3 months. Of 59 viable testes followed up beyond 3 months, 48 (81.4%) testes were positioned in the lower scrotum and 11 (18.6%) testes in the mid to high scrotum.ConclusionsLaparoscopic orchiopexy was successful for a nonpalpable intra-abdominal testis with a high testicular survival rate irrespective of the location from the internal ring. However, atrophy of the testis or upward migration of the testis can occur during follow-up, so we suggest watchful, periodic follow-up evaluating the viability and location of orchiopexed testes that are located in the lower scrotum in the immediate postoperative period or during short-term follow-up.

Testicular torsion: sonomorphological appearance as a predictor for testicular viability and outcome in neonates and children

Testicular torsion in children is found both in neonates [perinatal testicular torsion (PTT), <30th day of life] and in older children [testicular torsion (TT)]. Prediction of testicular viability is essential for deciding whether to perform emergency exploration surgery. The aim of the present study, therefore, was to investigate the sonomorphological parameters as predictors for testicular viability. All our cases of sonographically diagnosed and surgically confirmed testicular torsion (n = 25) in a 7.5-year period were reviewed. We evaluated the overall group and two subgroups, PTT (n = 9) and TT (n = 16), and assessed the following sonomorphological parameters: normal echogenicity (homogeneous), diffuse hyper-/hypoechogenicity (homogeneous) and focal hyper-/hypoechogenicity (heterogeneous). These findings were correlated with the testicular recovery rate. In both groups, we found the highest recovery rates in testes with normal, homogeneous echogenicity and a zero recovery rate in testes with heterogeneous echogenicity (p = 0.0117). By using the sonomorpohological criteria presented here, testicular viability can be appraised in all age groups to help determine the prognosis for testicular outcome. In PTT, a nonperfused, homogeneously appearing testis represents the initial phase of torsion. Only for this type is there hope for salvage. In addition to the intraoperative appearance, a testis that is preoperatively heterogeneous in appearance can support the decision for orchiectomy.

Testicular Infarction Becoming Apparent After Hernia Reduction

Testicular infarction from an incarcerated inguinal hernia is a rare event in children, often not considered in the initial evaluation. To report a case that describes the presentation, diagnosis, and management of testicular infarction in the setting of an incarcerated inguinal hernia. A 2-month old boy was brought to the Emergency Department (ED) by his parents for vomiting, crying, and a left-sided scrotal swelling. An inguinal hernia was manually reduced successfully in the ED. Subsequently, scrotal ultrasound with color Doppler was obtained, demonstrating no blood flow to the left testis. The patient underwent a left orchiectomy and right orchiopexy with hernia repair. Testicular injury can occur from torsion due to the effect of an incarcerated hernia or due to ischemia from cord compression. Delay in diagnosis and surgery risks testicular viability, therefore, surgery should not be delayed for imaging in the presence of strong suspicion of torsion. The diagnosis of testicular torsion is not always straightforward because many conditions may have a similar clinical presentation or may compromise testicular blood supply. This case is an unusual presentation of testicular infarction in the setting of an incarcerated inguinal hernia.