📃 Paper Title: Testicular function after torsion of the spermatic cord
🧍 Author: Visser
🕒 Year: 2003
📚 Journal: BJU International
🌎 Country: South Africa
ㅤContext to the study:
Can you tell me about the factors influencing salvage after torsion?
ㅤ✅ Take-home message of study:
The two most important factors determining testicular salvage after torsion are the duration and the degree of testicular rotation.
To salvage the testis three factors are needed: prompt presentation, prompt diagnosis and referral, and immediate surgery.
Saving the ipsilateral testis requires prompt presentation by the patient, prompt diagnosis, and immediate surgery.
Subfertility found in 36-39% patients after torsion
ㅤ Literature review / meta-analysis
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Study participants:
Literature review - focus on the prognosis for testicular function after torsion, and the possible mechanisms responsible for testicular damage
Meta-analysis - the authors performed two meta-analyses of 1140 patients in 22 series and 535 patients in eight series to calculate early salvage rate and late atrophy rate respectively
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Key study outcomes:
The two most important factors determining testicular salvage after torsion are the duration and the degree of testicular rotation.
Subfertility (sperm count < 20 million/mL) found in 36-39% patients after torsion
Sperm count and degree of atrophy both closely correlate with duration of torsion
Hormonal function relatively well preserved - only increased FSH/LH if >8hr duration or testicular atrophy
Contralateral testicular biopsies are abnormal in 57-88% of cases at the time of torsion. Contralateral testicular injury after unilateral torsion is most probably caused by pre-existing damage combined with hypoxia resulting from sympathetic reflex-mediated vasospasm.
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Study Limitations:
Methodology is not clear and undocumented - uncertain how authors conducted this review
Mixture of animal and human studies commented on
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