Testicular torsion and subsequent testicular function in young men from the general population.

STUDY QUESTION: Is prior testicular torsion associated with testicular function (semen quality and reproductive hormones) in young men from the general population? SUMMARY ANSWER: In young men from the general population, no differences in semen parameters were observed in those who had experienced testicular torsion compared to controls and observations of higher FSH and lower inhibin B were subtle. WHAT IS KNOWN ALREADY: Testicular function may be impaired after testicular torsion, but knowledge is sparse and based on studies with small sample sizes and no control group or a less than ideal control group. STUDY DESIGN, SIZE, DURATION: A cross-sectional population-based study was carried out including 7876 young Danish men with unknown fertility potential, examined from 1996 to 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS: All men (median age 19.0 years) had a physical examination, provided a blood and semen sample, and filled in a questionnaire including information about prior testicular torsion, birth, lifestyle and current and previous diseases. Markers of testicular function, including testis volume, semen parameters and reproductive hormones, were compared between men operated for testicular torsion and controls, using multiple linear regression analyses. MAIN RESULTS AND THE ROLE OF CHANCE: The average participation rate was 24% for the entire study period. In total, 57 men (0.72%) were previously operated for testicular torsion (median age at surgery 13.4 years) of which five had only one remaining testicle. Men with prior testicular torsion were more often born preterm (25% versus 9.5% among controls), and they had significantly higher FSH and lower inhibin B levels, and a lower inhibin B/FSH ratio than controls in crude and adjusted models. The association was mainly driven by the subgroup of men who had undergone unilateral orchiectomy. No differences in semen parameters were observed. LIMITATIONS, REASONS FOR CAUTION: A limitation is the retrospective self-reported information on testicular torsion. Also, results should be interpreted with caution owing to the high uncertainty of the observed differences. WIDER IMPLICATIONS OF THE FINDINGS: Overall, the results of our study are reassuring for men who have experienced testicular torsion, especially when treated with orchiopexy, for whom reproductive hormone alterations were subtle and without obvious clinical relevance. Our study found no differences in semen parameters, but follow-up studies are needed to assess any long-term consequences for fertility. STUDY FUNDING/COMPETING INTEREST(S): Financial support was received from the Danish Ministry of Health; the Danish Environmental Protection Agency; the Research fund of Rigshospitalet, Copenhagen University Hospital; the European Union (Contract numbers BMH4-CT96-0314, QLK4-CT-1999-01422, QLK4-CT-2002-00603, FP7/2007-2013, DEER Grant agreement no. 212844); A.P. Møller and wife Chastine Mckinney Møllers Foundation; Svend Andersens Foundation; the Research Fund of the Capital Region of Denmark; and ReproUnion (EU/Interreg). The authors have nothing to declare. TRIAL REGISTRATION NUMBER: N/A.

Multiple needle-pass percutaneous testicular sperm aspiration as first-line treatment in azoospermic men.

Percutaneous testicular sperm aspiration (TESA) has been known for decades as a simple, minimally invasive approach to sperm retrieval in azoospermic men. Because of lower reported sperm retrieval rates (SRR) when compared with microdissection testicular sperm extraction (mTESE), many centers now use mTESE as the first choice for retrieving spermatozoa in nonobstructive azoospermia (NOA). Objectives of this study were to evaluate the outcome and safety of TESA and mTESE in the treatment of azoospermia and to investigate the usefulness of a prognostic TESA to individualize protocols for couples and limit the use of invasive testicular procedures. IRB approval was obtained to retrospectively evaluate 208 patients undergoing multiple needle-pass TESA between 1999 and 2014. Prognostic TESA was performed on 125 men with NOA and 82 with obstructive azoospermia (OA). Nine NOA men and 31 OA men with previously demonstrated spermatozoa had a subsequent therapeutic TESA while nine NOA men with a failed TESA proceeded to mTESE. Main outcome measures were complication rates and SRR. SRR of the prognostic TESA was 30% (38/125) for NOA men and 100% (82/82) for OA men. Eight/nine NOA men and 31/31 OA men had spermatozoa found for intracytoplasmic sperm injection in a subsequent therapeutic TESA. In nine NOA men in whom a TESA produced no spermatozoa, only one had spermatozoa found with mTESE. Overall complication rates of TESA and mTESE were 3% (7/267) and 21% (3/14), respectively. TESA provides reasonable SRR and is a safe procedure. Successful prognostic TESA indicates future success with therapeutic TESA. Men with a failed TESA have a limited chance of sperm retrieval using mTESE. Approaching azoospermic men with an initial prognostic TESA followed by either therapeutic TESA and/or mTESE is an efficient algorithm in the management of azoospermia and limits the use of more invasive procedures.