Unilateral testicular trauma: optimal management and potential impact on seminal and endocrinal parameters

Moatamed, Ahmed; Ahmed, EI-Shahat Farag; S.A-Aga, Ahmed Abdel-Khabieand

doi:10.21608/ejsur.2002.403113

Unilateral testicular trauma: optimal management and potential impact on seminal and endocrinal parameters

Document Type : Original Article

Authors

¹ General Surgery, Faculty of Medicine, Mansoura University, Egypt

² Dermatology & Andrology, Faculty of Medicine, Mansoura University, Egypt

³ Clinical Pathology Departments, Faculty of Medicine, Mansoura University, Egypt

10.21608/ejsur.2002.403113

Abstract

From 1995 to 2000, Fifty three patients were identified to have unilateral testicular trauma according to the records of Emergency Hospital, Mansoura Faculty of Medicine. Of these, 32 patients were contacted for prospective follow up and evaluation. Injuries included blunt trauma in 26 patients and penetrating wounds in 6 patients. Treatment consisted of orchiectomy (9 patients), exploration and repair (12 patients) and conservative measures (11 patients). The study protocol comprised reproductive history, physical examination, routine semen analysis, semen antisperm antibodies estimation and determination of serum FSH, LH and testosterone. Results were compared with a group of semen donors with proved fertility. In orchiectomy group, mean sperm count was normal but significantly decreased compared to controls. Sperm motility and abnormal forms were not significantly affected. Serum FSH was significantly higher compared to control group but serum testosterone and LH were not significantly altered. In the repair group, all semen and endocrine! parameters did not differ significantly from controls. Seminal antisperm antibodies were elevated in 2 patients with grade 3 injury and unilateral testicular atrophy in another 2 patients with the same grade of injury. In conservative group, sperm count and motility were significantly lower than controls and 3 patients had significantly elevated antisperm antibodies. Hormonal pattern in this group revealed significant elevation of serum FSH with no significant changes in serum LH and testosterone levels. Testicular atrophy was reported in 5 patients 45%) in this group. Pregnancy rate was significantly higher in repair group (83%) compared to orcheictomy (57%) and conservative (50%) groups. In conclusion immediate exploration and repair of unilateral testicular injuries is the most protective to testicular function and fertility especially in grade I and 2 injuries. In grade 3 and 4 injuries, orchiectomy is preferred but it is associated with significant decrease in sperm count and pregnancy rate. Conservative treatment is the least protective to testicular function and fertility with the highest incidence of atrophy and abnormal semen parameters and lowest pregnancy rate.

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