Can testicular failure occur suddenly?

Testicular Failure Can Occur Suddenly Due to Acute Conditions

Yes, testicular failure can occur suddenly, particularly in cases of testicular torsion which is a surgical emergency requiring intervention within 6-8 hours to prevent permanent testicular damage or loss. 1, 2

Causes of Sudden Testicular Failure

• Testicular torsion: Defined as twisting of the spermatic cord that compromises blood flow to and from the testes, presenting with abrupt scrotal pain developing within minutes 1
• Vascular occlusion: Acute testicular ischemia may occur without torsion of the cord, due to sudden vascular occlusion, though this is less common 3
• Bilateral torsion: Though rare, simultaneous bilateral testicular torsion can cause sudden and complete testicular failure 4
• Orchitis: Severe inflammation of the testes can lead to rapid testicular damage in some cases 1

Clinical Presentation of Sudden Testicular Failure

• Acute onset of severe unilateral scrotal pain, often accompanied by nausea and vomiting 2, 5
• Scrotal swelling and redness developing rapidly (within minutes to 1-2 days) 1, 6
• High-riding testicle with absent cremasteric reflex in cases of torsion 2
• Pain is typically not relieved when the testes are elevated (negative Prehn sign), unlike in epididymitis 1

Diagnostic Approach

• Testicular torsion is primarily a clinical diagnosis requiring immediate surgical exploration if suspected 2
• Ultrasound with Doppler is the first-line imaging modality if diagnosis is uncertain, showing:
  • Decreased or absent blood flow to the affected testicle 6
  • Enlarged, heterogeneous testis 6
  • Possible "whirlpool sign" (twisted spermatic cord) 6
• Early manifestations on ultrasound may include diminished arterial velocity and decreased diastolic flow 6

Time-Sensitive Management

• Immediate surgical exploration is indicated if history and physical examination suggest torsion 2
• There is typically a 4-8 hour window before permanent ischemic damage occurs 2
• Delay in diagnosis beyond 6-8 hours significantly increases risk of testicular loss 1, 6
• Manual detorsion may be attempted while arranging for surgery but should not delay definitive treatment 5

Long-Term Consequences

• Untreated sudden testicular failure can lead to:
  • Need for orchiectomy (removal of the affected testicle) 2
  • Decreased fertility 2, 7
  • Need for testosterone replacement therapy if bilateral damage occurs 4, 8

Important Considerations

• Testicular torsion has a bimodal distribution, occurring more frequently in neonates and postpubertal boys, but can occur at any age 1
• False-negative Doppler evaluations can occur in partial torsion or spontaneous detorsion 6
• Early presentation may not show all classic symptoms, potentially leading to missed diagnosis 6
• The Testicular Workup for Ischemia and Suspected Torsion (TWIST) score can help identify high-risk patients who need immediate surgical intervention without imaging 1