Disruptions of spermatogenic function after testicle torsion in childhood and adolescence

Aim of research. To assess the state of spermatogenesis in men after an experience of testicle torsion in childhood and adolescence. 

Materials and methods. A semen analysis was performed involving 76 men, ages 18 to 29 years, who had testicle torsion in childhood and adolescence. Inclusion criteria in this study were an age of 18 years and an active sexual life. Analysis of the ejaculate was performed in accordance with the World Health Organization Guidelines for the study of human ejaculate. Macroscopic and microscopic evaluation of ejaculate, as well as assessment of motility, viability, number, and morphology of sperm was performed. The control group included 49 men who lacked potential risk factors for male infertility. 

Results and discussion. Changes in the ejaculate depended on the patient's age, as well as the duration and degree of testicular ischemia. When the gonad was preserved after critical ischemia occurred, the spermogram indices were significantly worse than when performing primary orchiectomy, which indicates functional failure of the gonad following its atrophy and suggests that it is inadvisable to maintain the gonad with the expectation of improved long-term results. 

Conclusions: 1. Changes in the spermogram after ischemia were observed in terms of sperm morphology and mobility. 2. The most pronounced changes in the spermogram were noted in patients who had experienced third-degree inversion of the testicle with preservation of gonads; the least pronounced changes were noted in patients who had experience inversion with spontaneous generation and incomplete inversion, which involved minimal ischemic damage. 3. The worst ischemia in puberty occurred in the context of mature sex glands. 4. There was a direct dependence of spermogram changes on the duration of acute ischemia. 5. The most unfavorable combination occurred in puberty, with disease lasting for more than 1 day, comprising complete inversion with “critical” ischemia. 6. After critical ischemia with preservation of the gonad, the semen is less favorable than after completion of orchiectomy, due to the failure of atrophied gonads; this finding casts doubt on the practice of gonad preservation.