Table 3.

Available literature investigating SARS-CoV-2 infection on testicular histology and/or ultrasonography

Reference	Study design	Cohort (n)	Control (n)	Histology	Other findings
31	Cross-sectional case-controlled study	COVID-19 patients (6)	Uninfected controls with similar comorbidities and age distribution (3)	Impaired spermatogenesis in 3 COVID-19-positive cases; viral spike protein particles observed in testis of one COVID-19-positive autopsy case, associated with infiltration of macrophages and leucocytes; reduced expression of ACE2 receptors in testes of COVID-19 patients with normal spermatogenesis compared to COVID-19 patients with impaired spermatogenesis.	–
42	Cross-sectional case-controlled study	Autopsies of males who died of COVID-19 (10)	Uninfected controls with similar comorbidities and age distribution (7)	Acute testicular injury reported that is related to oxidative stress (spermatocytes elongation and sloughing with Sertoli cell swelling) compared to chronic damage in controls (decreased spermatogenesis and Leydig cells)	No SARS-CoV-2 RNA detected in testes on autopsy
45	Cross-sectional case-controlled study	COVID-19 patients (5)	Uninfected controls (3)	Morphological disruptions of testes reported. GCs degeneration and sloughing in seminiferous tubule lumen in the COVID-19 patients.	–
46	Cross-sectional case-controlled study	Autopsy of testes of COVID-19 cases (11)	Uninfected controls (5)	Sertoli cell swelling, vacuolisation and detachment from basement membranes; significantly reduced Leydig cells compared to control; interstitial oedema and mild inflammatory infiltrates; no microscopy detection of viral particles	SARS-Cov-2 RNA detected in testes of 1 COVID-19 sample; spermatogenesis was not altered.
47	Retrospective cohort study	COVID-19 patients (142)	–	Orchitis, epididymitis, or epididymo‐orchitis in 22.5% of patients with COVID-19, associated with thickened tunica albuginea and increased vascular flow as common findings	–