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Gonadal function and fertility outcomes after orchiopexy versus orchiectomy for testicular torsion: A systematic review and meta-analysis.

Aya M Nasr·Ali Zamlout·Hamzah M Alghzawi·Youssef Ali Youssef·Aseel Nassar Altell·Ibrahim Abdullah
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Abstract

PURPOSE: To review the early and late changes in hormonal profiles, semen parameters, and clinical outcomes in patients treated with orchiopexy versus orchiectomy for testicular torsion. METHODS: A systematic search was conducted across MEDLINE, Scopus, Web of Science, Cochrane Library, and other databases, following PRISMA guidelines. PRIMARY OUTCOMES: FSH, LH, testosterone, inhibin-B, and semen parameters. Quality was assessed using the Newcastle-Ottawa Scale. Certainty of evidence was evaluated using the GRADE framework. Statistical analysis was performed using the random-effects model. RESULTS: Eleven studies involving 538 participants (197 orchiectomy, 341 orchiopexy) were included. Orchiectomy was associated with a significant increase in FSH (SMD: 1.63, P < 0.0001) and LH (SMD: 1.31, P < 0.0001) compared to orchiopexy. However, testosterone (MD: 0.31 ng/mL; P = 0.4) and inhibin-B (SMD: -0.14; P = 0.87) levels were comparable between groups. Regarding semen parameters, orchiectomy resulted in a significant reduction in sperm concentration (MD: -18 million/mL, P = 0.01). No significant differences were found in sperm count (MD: 13.9 million; P = 0.43), normal morphology (MD: 4.97%; P = 0.12), or total motility (MD: 4.05%; P = 0.49). The pooled rate for ipsilateral atrophy following orchiopexy was 38%, which likely depends on ischemia duration. CONCLUSION: Surgical choice in testicular torsion does not significantly affect the overall hormonal balance or most semen parameters due to compensatory mechanisms of the hypothalamic-pituitary-gonadal axis. Clinical decisions should consider individual case factors, as we lack reliable data on subsequent paternity rates.

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MaleHumansSpermatic Cord TorsionOrchiopexyOrchiectomyTestosteroneInhibinsTreatment OutcomeFollicle Stimulating HormoneLuteinizing HormoneFertilitySemen AnalysisTestisMeta-analysisSystematic reviewTesticular detorsionTesticular fixationTesticular salvageTesticular torsionJournal ArticleSystematic ReviewMeta-AnalysisComparative StudyReview

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Aya M Nasr, Ali Zamlout, Hamzah M Alghzawi, Youssef Ali Youssef, Aseel Nassar Altell, Ibrahim Abdullah. 2026-08-04. Gonadal function and fertility outcomes after orchiopexy versus orchiectomy for testicular torsion: A systematic review and meta-analysis.. https://doi.org/10.1016/j.jpedsurg.2026.163348

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