Testicular torsion is an emergency and can lead to primary hypogonadism.Testicular torsion begins suddenly, and patients experience intractable pain due to decreased blood supply to the testicles. Testicular torsion also causes germ cell injury, depending on the ischemia and severity of the cord twisting.

In cases of testicular torsion, ischemia is usually followed by reperfusion, which in turn leads to impaired spermatogenesis and the release of toxic substances such as free radicals from damaged tissue into the circulation. During reperfusion, endothelial damage and microcirculatory disturbances lead to impaired testicular function.

Testicular torsion can lead to permanent testicular dysfunction; however, reducing and immobilizing the spermatic cord within 6 hours can significantly reduce the likelihood of recurrence. In cases with a higher degree of torsion, cellular necrosis occurs within 4 hours, and a 360-degree twisted cord can lead to complete or severe testicular atrophy within 24 hours. The recommended therapeutic approach is to improve ischemic conditions, enhance spermatogenesis, and regulate the immune response. Based on their immunomodulatory effects, differentiation potential, and endocrine support, studies have also shown that stem cells successfully treat torsion-induced infertility. Stem cells injected into mice with testicular torsion restored fertility due to upregulation of pre- and post-meiotic genes, leading to improved testicular structure and function.