Effectiveness of long-acting gonadotrophin-releasing hormone agonist (GnRH-A) treatment in combination with conventional therapy on testicular outcome in human orchitis/epididymo-orchitis.

A group of 24 patients suffering from acute post-pubertal orchitis/epididymo-orchitis were prospectively randomized to treatment over a total period of 3 months with a combined conventional plus long-acting gonadotrophin-releasing hormone analogue (GnRHa) (leuprolide, 3.75 mg every 27 days) therapy (n = 13, group A) or conventional therapy alone (n = 11, group B) respectively, in order to verify any differences in clinical and sperm outcome during treatment and follow-up. Seven patients affected by uncomplicated mumps (group C), receiving GnRHa for 3 months, served as an additional control group. Combined leuprolide plus conventional therapy provided better outcomes than conventional therapy alone in terms of scrotal ultrasound scans and serum antisperm antibodies (ASA) at time of presentation and monthly thereafter throughout the study: the most solid data relate to testicular atrophy in three out of 11 patients from group B and their sAb positivity persisting, as opposed to zero out of 13 in group A. Moreover, semen analyses performed at 3-6 months after therapy withdrawal revealed in groups A and C mean total sperm counts and percentages of oval forms significantly higher than those observed in group B. It is concluded that GnRHa treatment is a promising pharmacological tool with no side-effects, effective in reducing testicular vascular leakages in male orchitis.