Impaired spermatogenesis in testes at risk of torsion

Abstract

The oligospermia observed after unilateral torsion of the spermatic cord could reflect immunological damage to the opposite testis. An alternative explanation, that there may be a pre-existing defect in spermatogenesis, was tested in 20 post-pubertal males with acute torsion. In a prospective study the contralateral testis was biopsied at operation and the histological appearances were related to subsequent testicular function as assessed by seminal analysis 3 months later. Thirteen patients had biopsy evidence of partial maturation arrest in spermatogenesis which was either mild (6), moderate (4) or severe (3), and ten of these were oligospermic (less than 20 X 10(6)/ml). By contrast all seven patients with normal histology had a sperm concentration greater than 25 X 10(6)/ml. Histological grading of spermatogenesis by the Johnsen technique gave a higher score in patients with a normal biopsy (median 9.01, semi-quartile range 8.96-9.21) than in those with abnormal histology (median 8.28, semi-quartile range 7.98-8.45, P less than 0.001) and correlated with the log of the sperm concentration 3 months later (r = 0.79, P less than 0.001). There was minimal anti-sperm and no anti-testis antibody formation following torsion. Serum FSH levels were raised in 6 of 10 oligospermic patients, while all those with a normal sperm count had FSH concentrations within the normal range. Thus many patients who develop testicular torsion have an underlying defect in spermatogenesis, which correlates closely with poor postoperative exocrine function.

Histological Study in Contralateral Testis of Prepubertal Children following Unilateral Testicular Torsion

“…Such damage is pro portional to torsion time. This hypothesis suggests that early orchiectomy would protect the contralateral testis by preventing or decreasing the release of antibodies by the torsed testis [16], On the other hand, other authors have reported the absence of alterations in the contralateral testis [10,11,13]. We think that this lack of coincidence in these results may be explained by different autoimmune responses to testicular antibody in different strains of rats and guinea pigs.…”

“…In 1978, Kramp [1] suggested that infertility in pa tients who have undergone testicular torsion may result from an underlying defect in both testicles which have morphological as well as anatomical alterations; this fact also occurs in the normally descended testis of unilateral cryptorchidism [11,19,20], Based on this fact, Horica et al [21] performed bilateral orchiopexy in 7 patients with acute unilateral testicular torsion, and biopsies were made at the same time for both light-microscopic (semi-thin section method) and electron-microscopic examination. Hadziselimovic et al [20] reported that 53% of the patients showed abnormalities which preceded the tor sion, the Sertoli cell syndrome was observed in 7 of the patients, and 4 of them corresponded to the torsed testi cle.…”

“…Testicular torsion Fertility duction of antibodies which act on the contralateral testis [2,[7][8][9], On the other hand, other authors have found no alterations in the contralateral testis, not regarding that subfertility resulted from testicular torsion [10][11][12][13]. The purpose of our study is to assess the histological parame ters in 8 prepubertal children with history of testicular tor sion and further atrophy.…”

Capsaicin in Albino Rats Prevents Contralateral Testis from the Damaging Effects Posed by Ipsilateral Testis That Underwent Torsion

“…Different theories have been put forward to explain contralateral testicular damage. The proposed theories include reflex decrease in contralateral testicular blood flow [4, 5, 6, 7, 8, 9], autoimmunity [10, 11], associated congenital anomalies [12, 13]and subclinical torsion attacks of the contralateral testis [14]. Since spermatic cord torsion even in the absence of testis and epididymis is shown to cause contralateral testicular injury and contralateral testicular injury has been demonstrated by DNA flow cytometry within 24 h of ipsilateral testicular torsion [15], autoimmunity, associated congenital anomalies and subclinical torsion attacks of the contralateral testis seem unlikely.…”

A fusional anomaly of the epididymis associated with recurrent testicular torsion

“…There was minimal anti-sperm and no anti-testis antibody. They concluded that impaired spermatogenesis in acute testicular torsion could be due to an underlying defect [8]. …”