SARS-CoV-2-Associated Obliterative Arteritis Causing Massive Testicular Infarction

Seminal fluid changes in the COVID-19 era: During infection and Post-vaccination

Coronavirus disease 2019 (COVID-19) predilection for angiotensin-converting enzyme 2 (ACE2) receptors allows its entrance and replication; however, they are not biochemically required for viral fusion into the cell membrane. Testicular tissue has abundant ACE2 receptors, making it a target for the COVID-19 virus. Seminal fluid parameters are measures of male fertility. Changes in semen parameters have been caused by coronavirus disease and vaccines. Some attribute that effect to direct hematogenic spread to the testis; others propose that the excessive immunological response triggered by the infection causes a deleterious effect. An unsubstantiated claim questioned whether the SARS-CoV-2 vaccine could trigger an unintentional immunological response that would impair male fertility once receiving the vaccine. Extensive research confirms the transient nature of those changes that affect sperm motility and count with full recovery post-COVID-19 infection and after vaccination. The vaccine's safety was reaffirmed; however, there are currently no recommendations for screening sperm donors. Research is warranted to guarantee the safety of couples undergoing assisted reproduction.

Acute testicular infarction in the setting of SARS-CoV-2 infection and diabetic vasculopathy

Acute testicular pain with no arterial flow on Doppler ultrasonography is highly consistent with testicular torsion. In adults, there are rare etiologies of testicular infarction other than torsion, including infection, vasculitis, and trauma. We describe a 41-year-old man with type 2 diabetes complicated by severe vasculopathy and positive SARS-CoV-2 status presenting with acute right testicular pain. Surgical exploration and pathology were concerning for arteriosclerosis and vasculitis. These observations suggest that medically complex patients presenting with acute testicular pain in the setting of COVID-19 infection could be at risk for ischemia; causes of testicular pain beyond torsion should be considered.

Comparison of the outcomes of testicular torsion among children presenting during the Coronavirus Disease 2019 (COVID-19) pandemic versus the pre-pandemic period: A systematic review and meta-analysis

OBJECTIVE

To evaluate whether the Coronavirus Disease 2019 (COVID-19) pandemic resulted in a prolonged duration of symptoms, a delayed presentation to the medical facility, and consequently more orchiectomy procedures among children with testicular torsion compared to the pre-COVID-19 period.

METHODS

Systematic search of four scientific databases was performed. The search terms used were (coronavirus OR novel coronavirus OR SARS-CoV-2 OR COVID-19) AND (testicular torsion OR orchidectomy OR orchiectomy OR orchidopexy OR orchiopexy). The inclusion criteria were all boys presenting with testicular torsion during the COVID-19 and pre-COVID-19 periods. A comparison of the average duration of symptoms, the proportion of children with delayed presentation (>24 h), and the proportion of children requiring orchiectomy was made among the two groups. The Downs and Black scale was used for methodological quality assessment.

RESULTS

The present meta-analysis included six comparative studies (five retrospective studies). A total of 711 patients (473 during the COVID-19 period) were included. No significant differences in the average duration of symptoms (WMD: 2.6, 95% CI -6.78 to 11.99, P = 0.59), the proportion of children with delayed presentation (RR = 1.03, 95% CI 0.52-2.02, p = 0.94), and orchiectomy rate (RR = 1.23, 95% CI 0.82-1.84, p = 0.31) were observed among the two patient groups. All studies had a moderate risk of bias.

CONCLUSION

The duration of symptoms, the proportion of children with delayed presentation, and orchiectomy rate did not significantly differ among the children with testicular torsion presenting during the COVID-19 and pre-COVID-19 periods. However, due to the moderate risk of bias, the level of evidence of the available comparative studies is limited.