Successful Testis Replantation After Bilateral Traumatic Testis Amputation With a 15-Year Follow-Up of Functional Testis: A Case Report

Bilateral traumatic amputation of the testis is a very rare condition. It is important to preserve the reproductive and endocrine functions of the testis after replantation. In this paper, we report on an 18-year-old male patient with a history of a tractor accident who had a crush avulsion-amputation injury of both testes and lacerations on both sides of the scrotum. The left testicle could not be replanted due to severe damage to the vascular structures, but the right testicle was found to be suitable for replantation. After dissection of the recipient vessels in both inguinal canals under the appropriate magnification of the operating microscope, the testicular artery in the right spermatic cord and the internal spermatic vein of the pampiniform plexus were prepared as recipient vessels; at the same time, after dissection of the right vas deferens, microanastomosis of the artery, vein, and vas deferens was performed using the end-to-end microsurgical technique, and the right testis was successfully replanted orthotopically. No postoperative complications were observed; early (1–3 months) and late (1–15 years) follow-up were uneventful, and functional (endocrine and reproductive) recovery was confirmed based on clinical, laboratory, radiologic, and histopathologic evaluations. Although partial endocrine recovery after testicular replantation in traumatic testicular amputation has been reported in the literature, no case with preserved reproductive function has been reported. In this article, we review the literature and discuss that unilateral and bilateral as well as traumatic and self-mutilating (psychotic) conditions should be considered when deciding the indication for testicular replantation, and the critical ischemia period should not be exceeded. Our case of bilateral traumatic testicular amputation in which only one testicle could be replanted is a good example to show that both endocrine and reproductive testicular function can be fully preserved if the critical ischemia period is not exceeded.