Allopurinol provides long-term protection for experimentally induced testicular torsion in a rabbit model

Urate-lowering agents do not have clinically relevant negative effects on sperm quality and reproductive hormones in men with gout: a prospective open-label cohort study

OBJECTIVE

The objective of this study was to analyze and compare the effects of different urate-lowering agents on testicular functions in men with gout in a clinical setting.

METHODS

In this prospective cohort study (Clinical Trial Registration Number: NCT04213534), a total of 49 male patients aged 18-45 years with gout were enrolled. They were divided into three groups and received treatment with either allopurinol, febuxostat or benzbromarone for a duration of 3 months. Semen parameters, reproductive hormones and biochemical assessments were evaluated at baseline, month 1, and month 3.

RESULTS

Overall, 40 individuals (81.6%) completed the follow-up visits. In allopurinol group, there were no significant differences in semen parameters from baseline to month 3. Most of sperm parameters in febuxostat group did not show notable changes, except for a decrease in sperm motility at month 3(33.6%, [22.9-54.3] vs 48.4%, [27.4-67.6], p = 0.033). However, the total motile sperm count did not differ significantly after febuxostat treatment. Surprisingly, administration of benzbromarone resulted in improved sperm concentration (37.19 M/mL, [29.6-69.92] vs 58.5 M/mL, [49.8-116.6], p = 0.001). There were no significant changes observed in sperm DNA integrity and reproductive hormones in the three groups from baseline to month 3. The incidence of adverse events did not differ significantly among the three groups as well.

CONCLUSION

This study is the first to demonstrate that urate-lowering agents, allopurinol and febuxostat, do not have clinically relevant negative effects on sperm quality and reproductive hormones in men with gout, and benzbromarone presents improving sperm concentration. Results provide important preliminary guidance for the development of reproductive health management guidelines for patients RCID with gout.

Testicular torsion: a race against time

Torsion of the testis is a medical emergency that is most commonly encountered in adolescents. Patients usually present with sudden onset scrotal pain associated with nausea and vomiting. On physical examination the involved testis is tender, high riding and usually horizontal. The cremasteric reflex is usually absent. If left untreated irreversible ischaemia starts appearing in 6 h. Doppler ultrasound is the diagnostic imaging of choice. The ideal treatment is surgical exploration and orchidectomy with contralateral orchidopexy or bilateral orchidopexy depending on the condition of the affected testis. If surgical options are delayed then manual detorsion should be attempted.