A new grading system for testicular trauma and one-year follow-up results on male testicular function: Gülhane Grading System

This study reports our seven-year experience of one-year follow-up results after scrotal and testicular trauma, classified according to the Gülhane Grading System (GGS). We provide detailed hormonal analyses, ultrasound (US) evaluations, and spermiogram results. There are no previous studies that focus on all these detailed topics in relation to a grading system. Between October 2016 and October 2022, a total of 41 patients with testicular trauma were classified according to GGS. Patients with Grade 1 (G1) trauma were followed up without surgical intervention. Patients with Grade 2 (G2) trauma underwent surgical repair, while patients with Grade 3 (G3) trauma underwent orchiectomy. After the resolution of the emergency period, we recorded the following parameters at the one-year follow-up: follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone, free testosterone; testicular size, other testicular size, testicular parenchyma appearance in ultrasound; total sperm count, sperm concentration, total motility, progressive motility, and morphology in the spermiogram. A total of 41 patients with a mean age of 25.56±6 years (range: 16-39) had testicular trauma. The trauma was bilateral in 10 patients (25%), right-sided in 14 patients (34%), and left-sided in 17 patients (41%). At the one-year follow-up, patients with unilateral G1 trauma had normal FSH, LH, total testosterone, and spermiogram levels. Patients with unilateral G2 or G3 trauma had slightly elevated FSH and LH levels, but normal testosterone and sperm parameters. Patients with combined G3 and G1 trauma had significantly elevated FSH and LH levels to maintain normal testosterone levels, though their morphology was lower than in the normal population. Patients with G3 + G2 trauma had significantly elevated FSH and LH levels to maintain normal testosterone levels, but all sperm counts were lower than the normal population. Patients with G3 + G3 trauma had significantly elevated FSH and LH levels, but all other hormonal and sperm parameters were zero. Our new grading system provides a practical and usable grading scale for evaluating scrotal and testicular trauma. Patients with unilateral trauma experienced good recovery, regardless of trauma grade. Bilaterally affected patients, however, were more likely to experience testosterone deficiency and poor spermiogram parameters.