Prepubertal testicular torsion: subsequent fertility

Area of Science:

• Urology
• Andrology
• Pediatric Surgery

Background:

• Prolonged unilateral testicular torsion can lead to testis loss or severe atrophy.
• Surgical detorsion and scrotal replacement are performed in the prepubertal period.
• Long-term outcomes regarding fertility and contralateral testis development are important.

Purpose of the Study:

• To evaluate the long-term reproductive outcomes in men treated for prepubertal unilateral testicular torsion.
• To assess the development of the contralateral testis after torsion.
• To investigate the presence of sperm autoantibodies.

Main Methods:

• Retrospective review of 18 patients 7-23 years post-surgery for unilateral testicular torsion.
• Assessment of testicular status (presence, atrophy, volume) on both sides.
• Seminal analysis in unmarried patients.
• Mixed agglutination reaction (MAR) test for sperm autoantibodies (IgG and IgA).

Main Results:

• 14/18 patients had absence of the affected testis; 4 had severe atrophy (<1 mL).
• Contralateral testis showed normal volume or compensatory hypertrophy (>25 mL).
• 10/13 unmarried men had normal seminal analysis; 2 had low sperm density.
• No sperm autoantibodies detected via MAR test.

Conclusions:

• Prepubertal unilateral testicular torsion does not negatively impact contralateral testis development.
• Torsion in prepubertal males does not lead to autosensitization or diminished fertility in adulthood.
• Surgical untwisting and replacement in prepuberty can preserve reproductive potential.