Table 1. Studies investigating testicular function after TT.
| Study (year) | Study characteristics | Main findings and major limitations |
|---|---|---|
| Bartsch et al (1980) [11] | - Retrospective case series | - Semen samples were pathological (sperm counts: <20 millon/mL, motility: <40%, volume: <1.5 mL) in 12/30. |
| - 42 TT patients | - Patients with abnormal semen analyses had elevated FSH (13.6±6.7 mU/mL) and LH (16.3±13.7 mU/mL). | |
| - Blood samples and semen samples (30 sampels were delivered) | ||
| Danner et al (1982) [14] | - Retrospective case series | - T and LH were normal in all patients. 50% of patients had FSH in the upper normal range or slightly elevated, which correlated with abnormal semen samples. |
| - 20 TT patients, evaluated a mean of 22 months (5–60 months) after torsion | - Semen analyses (12 TT patients) found decreased motility (<50%) in 8 samples. | |
| - Testis biopsies, semen samples and blood samples | - Histology was abnormal (spermatogenic arrest, lack of spermatozoa, infiltration of red blood cells and leucocytes) in all patients with a torsion of more than 6 | |
| Mastrogiacomo et al (1982) [15] | - Retrospective case-control study | - The presences of ASA in TT patients showed a significant association with low sperm count (<30 million/mL) (p>0.001). |
| - 25 TT patients (6 months–7 years after TT) and a control group | - ASA were present in 20% of the TT patients. | |
| - Semen samples | - Control group were healthy sperm donors. | |
| Thomas et al (1984) [9] | - Retrospective case series | - LH, FSH, and testosterone were within normal range for all patients. |
| - 67 TT patients, evaluated a mean of 4 years (3 months–12 years) after TT | - 39% had sperm counts <20 millon/mL. Low sperm counts correlated with the duration of torsion (p<0.001). | |
| - Blood samples and semen samples | ||
| Goldwasser et al (1984) [16] | - Retrospective case series | - 11/16 were operated within 12 hours of first pain symptoms and 4/11 (36.4%) had normal semen analysis (sperm count between 32–164 millon/mL, sperm motility between 39%–78% and sperm morphology between 45%–81%). 1/5 operated after 12 hours of pain symptoms had a normal semen analysis. |
| - 16 TT patients, evaluated 4 months–5 years after torsion | - T, FSH, and LH were normal in 14/16 of TT patients. | |
| - Semen samples and blood samples | ||
| Fraser et al (1985) [17] | - Retrospective case series | - 13/32 semen samples (40.6%) had low sperm density (21 millon/mL, p<0.005) and motility (25%, p<0.005). |
| - 47 TT patients, evaluated 2–10 years after TT | - 8 had fathered children. | |
| - Blood samples (44 samples was obtained) and semen samples (32 patients delivered semen samples) | - Teststerone was normal for all patients. | |
| - Mean FSH was elevated (8.9±4 u/L, p<0.005) in 19/44 patients (43.2%). | ||
| - ASA was not found in any of the patients. | ||
| Puri et al (1985) [18] | - Retrospective case series | - 10 semen samples were normal. 2 had low sperm concentration (mean 10 million/mL) and 1 had abnormal semen volume (0.7 mL), sperm concentration (10 million/mL), and motility (15%). |
| - 18 TT patients, evaluated 7–23 years after TT | - MAR test didn't show ASA in any patient. | |
| - Interview and semen samples (13 patients delivered semen samples) | ||
| Anderson and Williamson (1986) [19] | - Retrospective case series | - 20/35 biopsies showed histological evidence of pre-existing partial maturation arrest. 19 of the patients with partial maturation arrest attended postoperative review 3–6 months after TT. 15/19 with this abnormality had oligozoospermia (p<0.002). |
| - 56 TT patients, evaluated 3–6 months after TT | - Preoperatively no patients' serum showed ASA, postoperatively ASA was found in 3/35. | |
| - Testis biopsies contralateral testis biopsies taken at the time of surgery, blood samples and semen samples (from 35 patients) | ||
| Fisch et al (1988) [20] | - Retrospective case series | - TT patients had a greater FSH response than control group, the response was greatest in patients treated with orchioctomy (as was the LH response). |
| - 14 TT patients, evaluated a mean of 33 months after TT. 5 normal men was used as controls. | - Small population | |
| - IV bolus GRH test | ||
| Laor et al (1990) [21] | - Retrospective case series | - 12/20 contralateral biopsies showed abnormalites (maturation arrest, germ cell degeneration, tubular hyalinisation, immature tubules, focal thickening of the basement membrane). |
| - 20 TT patients | ||
| - Contralateral testis biopsies taken at the time of surgery | ||
| Jones (1991) [22] | - Retrospective case series | - FSH, LH, and T was normal in all patients. |
| - 43 patients with recurrent subacute torsion, evaluated preoperative and 3 months postoperative | - 3 patients had abnormal semen analyses (sperm counts: 22 millon/mL, 43% abnormal forms, motility: 35%) the same 3 had abnormal testicular biopsies (Johnson scores: mean 5.7 [4.9–6.8]). | |
| - Bilateral testis biopsies taken at the time of surgery, blood samples and semen samples | ||
| Hagen et al (1992) [23] | - Retrospective case series | - 7 with normal semen analyses 2–8 years after torsion, 19 had OAT syndrome, 10 had asthenozoospermia, and 19 had teratozoospermia |
| - 55 TT patients, evaluated 2–8 years after TT | - Testis biospies were abnormal (desquamination of the germinative epithelium, atrophy of leydig cells, and malformation of spermatids) in 30/34. | |
| - Contralateral testis biopsies taken at the time of surgery, semen samples and blood samples (at the time of surgery, and at follow-up) | - ASA was preoperatively found in 2/36, and at follow-up in 2/36. | |
| Anderson et al (1992) [24] | - Retrospective case control study | - Orchiectomy patients (n=7) had a significant decrease in semen quality (sperm density was average 29 million/mL) compared with controls (p=0.001). |
| - 16 TT patients and 10 controls | - Semen quality was not significantly different in patients treated with orchiopexy compared to control (p=0.25). | |
| - Blood samples, semen samples and GRH stimulation test, presence/ absence of ASA | - Control group: fertile sperm donors | |
| - Small population | ||
| Brasso et al (1993) [25] | - Retrospective case series | - Duration of torsion correlated with orchioctomy. |
| - 35 TT patients, evaluated 6–11 years after torsion | - Duration of torsion correlated with reduced sperm counts. | |
| - Blood samples and semen samples | - FSH and LH were normal. | |
| Tryfonas et al (1994) [26] | - Retrospective case series | - Duration and degree of torsion with orchioctomy. |
| - 25 TT patient, evaluted after 1–12 years after TT | - 4/4 semen samples were abnormal. | |
| - Ultrasound of testis, semen samples (only in 4 patients) | ||
| Daehlin et al (1996) [27] | - Retrospective case series | - Oligoazoospermia was found in 2/13 semen samples. |
| - 52 TT patients, evaluted 4–10 years after TT | - Testosterone level was normal. | |
| - Blood samples and semen samples (n=13) | ||
| Hadziselimovic et al (1998) [28] | - Retrospective case control study | - All TT patients' contralateral testis biopsies showed atrophic Leydig cells, malformed late spermatids, often binuclear spermatids, apoptosis of spermatocytes and pathological changes in the cytoplasm of Sertoli cells. |
| - 17 TT patients and 3 controls | ||
| - Bilateral testis biopsies | ||
| Arap et al (2007) [29] | - Retrospective case control study | - Median FSH was statistically higher in patients treated with orchiectomy (n=15) compared with orchiopexy (n=9): median 7.6 UI/L vs. 5,6 UI/L. |
| - 24 TT patients, evaluated a mean of 6 years (5–7 years) and 10 years (5–12 years) after torsion for patients treated with orchiopexy and orchioctomy, repsectively | - Median T were significantly higher in TT patients compared with controls: 701 ng/ dL (p<0.001) and 641 ng/dL (p=0.017) for patients treated with orchiectomy and orchiopexy, respectively vs. 440 ng/dL in controls. | |
| - 20 voluntary men requesting vasectomy as the control group | - Sperm motility was better in patients treated with orchiectomy compared with orchiopexy: 77% vs. 54% (p=0.028). | |
| - Blood samples and semen samples | - ASA was abnormal for TT patients (21% and 20%) compared with control group (14.5%), but had no siginificant correlation with sperm concentration (p=0.51), sperm motility (p=0.87), or testosteron level (p=0.75). | |
| - Control group was proven fertile men. | ||
| Romeo et al (2010) [5] | - Retrospective case control study | - FSH, LH, and T were within normal range. Mean inhibin B was significantly reduced in TT patients compared with controls: 34.5±5.2 vs. 63.9±12.8 pg/mL, p=0.02. This significantly correlated with T levels (p=0.02) and testis volume (p=0.03). |
| - 20 TT patient and 15 age-matched controls, evaluated a mean of 5 years after TT | - Subfertility (negative WHO fertility index) was found in 6/7 semen samples. | |
| - Blood samples, semen samples (7 samples were delivered), testes ultrasound | ||
| Yang et al (2011) [3] | - Retrospective case control study | - Duration and degree of torsion correlates with testicular salvageability (p=0.008 and p=0.011, respectively.) |
| - 86 TT patients, evaluated a mean of 7 years after surgery (3 months–16.5 years) and 60 controls | - FSH, LH, and T were within normal range when compared to age matched controls regardless of surcigal management. | |
| - Ultrasound of the testis, urine samples and blood samples | ||
| Gielchinsky et al (2016) [30] | - Retrospective case series | - Pregnancy rates in TT patients were 90.2% and 90.9% for orchiectomy and orchioepexy patients, respectively, vs. the accepted pregnancy rate in the general population of 82% to 92%. |
| - 63 TT patients, married more than 1 year, with proven female fertility | - 6/63 of the TT patients (9.5%) had been diagnosed infertile. | |
| - Questionnaire |
TT: testicular torsion, FSH: follicle-stimulating hormone, LH: luteinizing hormone, T: testosterone, ASA: anti-sperm antibodies, MAR: mixed antiglobulin reaction, IV: intravenous, GRH: gonadotropin realizing hormone, OAT: oligoasthenoteratozoospermia, WHO: World Health Organization.