The effect of unilateral testicular torsion on the contralateral testicle in prepubertal Chinese hamsters

Recent studies of experimental testicular torsion in rats, rabbits, and guinea pigs have demonstrated conflicting evidence regarding contralateral testicular damage. Those studies in which cellular damage has been found are postulated to result from an immunological mechanism whereby the blood-testis barrier is disrupted with subsequent autoantibody formation. In this study, the histologic and immunologic effects of testicular torsion on the contralateral testicle were investigated in prepubertal Chinese hamsters. Four study groups were established; (1) Left orchiectomy only, (2) sham surgery (scrotal incision), (3) 720 degrees left testicular torsion with left orchiectomy 24 hours later, (4) 720 degrees torsion of left testicle with detorsion after 24 hours. The initial procedure was performed at 1 month of age with subsequent biopsies of the contralateral testicle at 1 week, 1 month, and 6 months after the initial procedure. Testicular tissue was examined for immunofluorescent activity using fluorescent labeled goat anti-hamster IgG. Positive controls were established by rabbit immunization (rabbit anti-hamster immunoglobulin) which was subsequently combined with fluorescent labeled goat antirabbit IgG. There was no appreciable difference in immunologic activity between control and experimental animals. Representative sections were examined histologically and no tubular damage was demonstrated and active spermatogenesis was noted at 6 months in all groups. We believe that our results support the premise that testicular torsion in the prepubertal period has no effect on the contralateral testicle.     

The effects of human chorionic gonadotropin treatment on the contralateral side in unilateral testicular torsion

BACKGROUND/PURPOSE: Unilateral testicular torsion can cause histologic damage, consisting of aspermatogenesis and tubular atrophy, in the contralateral testis human chorionic gonadotropin (HCG) treatment is widely used in undescended testis, and has been shown to improve histomorphometric alterations beside the testicular descent. However, the role of HCG in testicular torsion has not been investigated before. Therefore, this experimental study was conducted to evaluate the effects of HCG treatment on contralateral testicular histology and function in unilateral testicular torsion. METHODS: Forty adult male Wistar rats were randomized into 4 groups: SHAM, SHAM+HCG, TORSION, and TORSION+HCG. Torsion was created by twisting the righ testis 720 degrees and maintained by fixing it to the scrotum. HCG treatment started 24 hours after the torsion at a dose of 100 IU/kg, twice weekly for three weeks. Left orchiectomy was performed one month after the torsion and removed testes were immersed in Bouin's fixative for histopathological evaluation. Mean seminiferous tubule diameter (MSTD) was measured and Johnsen's score was calculated. Blood samples were taken for assaying serum testosteron level. RESULTS: Unilateral testicular torsion resulted in a significant decrease in spermatogenesis and MSTD on the contralateral side. Serum testosteron level was also reduced. HCG treatment improved these parameters in the contralateral 'untwisted' testis beside the serum testosteron. CONCLUSIONS: Our data demonstrates that unilateral testicular torsion adversely effects its counterpart. HCG treatment improves contralateral histomorphometric alterations and serum testosteron in unilateral torsion.     

单侧睾丸扭转引发对侧睾丸生精损伤免疫机制的实验研究

目的探讨单侧睾丸扭转对侧睾丸生精功能损伤的机理。方法雄性SD大鼠24只,随机分为3组,建立睾丸扭转动物模型。第1组为假手术组,第2、3组扭转左侧睾丸720°并固定维持,分别于12 h和24 h后复位固定。术后1个月留取对侧睾丸称重。应用流式细胞术(FCM)检测各组生精细胞凋亡和各级生精细胞计数,免疫组化SABC法检测抗精子抗体免疫复合物(IgG)在睾丸组织中的沉积。结果第1、2、3组对侧睾丸重量分别为(1555.73±72.34)、(1184.20±101.02)、(783.60±117.93)mg,凋亡细胞数依次为53.25±8.61、1622.00±129.31、3401.25±179.75,抗精子抗体阳性染色率为0、0.55±0.02、0.69±0.03,组间两两比较差异均有统计学意义(P<0.01)。与第1组相比,第2、3组对侧睾丸单倍体、二倍体和四倍体细胞群计数明显减少,同时可见抗精子抗体免疫复合物在睾丸组织中明显沉积,其差异均有统计学意义(P<0.01)。第2、3组间(除四倍体细胞群计数外)差异亦有统计学意义(P<0.01)。结论单侧睾丸扭转导致对侧睾丸生精细胞广泛凋亡,自体免疫反应可能在对侧睾丸生精功能损伤中起重要作用。     

Experimental testicular torsion: Effect on endocrine and exocrine function and contralateral testicular histology

Summary In order to investigate whether unilateral testicular torsion exerts a negative influence on the previously undisturbed contralateral side, exocrine and endocrine testicular function were evaluated before and two months after torsion. A rat model with 6 hours', 12 hours' or permanent extravaginal 540° torsion of the right testis was used; a sham operated group of animals served as controls. Ejaculates were collected by electrostimulation; LH, FSH and testosterone serum levels were determined by radioimmunoassays. Eight weeks after torsion sperm output had decreased by half in the experimental groups, and LH levels increased significantly, whereas the other hormone levels, as well as the controls, remained unchanged. Morphometry of the contralateral testis revealed no alterations except a significant increase of the Leydig cells and interstitial cells in some subgroups. All observed changes correlate with the functional loss of one testis; definite evidence for contralateral damage was not observed.     

Flow cytometric DNA analysis demonstrates contralateral testicular deterioration in experimental unilateral testicular torsion of prepubertal rats

Summary. It has been postulated that unilateral testicular torsion causes damage to the contralateral testis and reduces fertility. However, in animal studies such an effect has not been fully proven by histopathologic examination or other conventional assays of spermatogenesis. We investigated the effect of unilateral testicular torsion on contralateral spermatogenesis in prepubertal rats using quantitative flow cytometric DNA analysis. Male rats were divided into three groups which underwent sham-operation, simple hemiorchiectomy or unilateral testicular torsion. Five weeks after these operations, fertility and spermatogenesis by flow cytometry were evaluated. No significant differences were observed in body weight, contralateral testicular weight or serum testosterone concentration among the three experimental groups. In the torsion group, mean seminiferous tubular diameter, number of foetuses, fertility rate and percentage of haploid cells were all significantly decreased compared to the other two groups. These results suggest that unilateral testicular torsion causes damage to the contralateral testis and consequently can reduce the future fertility of prepubertal rats.     

一侧睾丸扭转对对侧睾丸组织发育的影响

目的:研究一侧睾丸扭转以后对对侧睾丸组织的影响。方法:以大鼠为研究对象,按扭转时间及药物应用情况进行分组。在一侧睾丸扭转以后2个月,观察对侧睾丸曲细精管的变化。结果:一侧睾丸扭转2h以内,对侧睾丸曲细精管管腔和生精上皮增生;扭转6 h以后,曲细精管管腔和生精上皮萎缩;扭转6h以内应用别嘌呤醇能缓解对侧病变。结论:一侧睾丸扭转可以使对侧睾丸组织发育发生病理改变。     

Blood perfusion of the contralateral testis evaluated with contrast-enhanced ultrasound in rabbits with unilateral testicular torsion

The changes of blood perfusion of contralateral testis after unilateral testicular torsion remain controversial. In this study, 28 New Zealand white male rabbits were randomly divided into five groups. Group A (n = 8), the control group, underwent a sham operation on the unilateral testis without inducing testicular torsion. In groups B, C, and D (n = 5 each), unilateral testicular torsion was induced, and, after 3, 6 or 24 h, respectively, detorsion was performed. In group E (n = 5), permanent unilateral testicular torsion was applied. Contrast-enhanced ultrasound was used to observe the blood perfusion of the contralateral testis at the following stages: pre-torsion (preopration), immediately post-torsion (postopration), pre-detorsion, immediately post-detorsion, and late-stage post-detorsion (6–12 h post-detorsion in groups B–D) or at a similar time point (15–21 h post-torsion in group E). Time-intensity curves were generated, and the following parameters were derived and analyzed: arrival time, time to peak intensity, peak intensity, and half-time of the descending peak intensity. The analysis revealed that blood perfusion of the contralateral testis increased immediately after testicular torsion on the opposite side (P < 0.05), which increased with prolonged testicular torsion of the other testis. This research demonstrated that contrast-enhanced ultrasound was valuable in evaluating blood perfusion of the contralateral testis after unilateral testicular torsion.     

The effects of unilateral testicular ischemia and hemicastration on contralateral testicular IGF-1 level,histology and lipid peroxidation

Hemicastration is followed by compansatory hypertrophy whereas unilateral testicular torsion is followed by atrophy in contralateral testicle in rats. Insulin-like growth factor (IGF-1) has important roles in testicular paracrine and autocrine functions. In this study it was aimed to compare ischemic parameters and IGF-1 levels in the contralateral testicle in unilateral spermatic cord ligation, testicular torsion, and hemicastratron. 32 wistar rats were equally altocated into sham, ligation, torsion, and hemicastration groups. In ligation group, right spermatic cord was ligated with 3/0 silk suture. In the torsion group, right testis was tcrsed for 720 degrees. In hemicastration group, right orchiectomy was done. 48 hours later left orchiectomy was done in all groups. Malondialdehyde (MDA) and IGF-1 levels were determined in the testicle. Average values of the groups were compared with Anova followed by Dunnett T3 multiple comparison tests. MDA levels were significantly reduced in ligation and torsion groups (p < 0.05). This reduction was more prominent in hemicastration group (p < 0.05). Contralateral testicular IGF-1 levels in ligation and torsion groups were not different compared with the sham group. Left testicular IGF-1 level in the hemicastration group was decreased significantly compared with other groups (p < 0.05). Histological. changes evaluated. Contralateral Johnsen's testicular biopsy scores were significantly decreased in all experimental groups but mean tubular diameter was not changed in all groups.     

环孢素对大鼠睾丸缺血-再灌注损伤后生精细胞凋亡的影响

目的探讨环孢素对大鼠单侧睾丸缺血-再灌注损伤后生精细胞凋亡的影响,研究其保护性作用。方法雄性SD大鼠24只,随机分成假手术组、扭转组和环孢素组,每组8只,建立720°2h单侧睾丸扭转动物模型。扭转组和环孢素组于复位前15min分别腹腔注射生理盐水和环孢素,术后24h留取手术侧睾丸。应用流式细胞术检测各组患侧睾丸组织生精细胞凋亡;Quantitative Real-time PCR技术对Fas、FasL和Bax mRNA进行定量分析;Western-blot技术检测细胞色素C含量。结果与假手术组相比,扭转组患侧睾丸组织早期凋亡生精细胞百分比明显增多,Fas、FasL和Bax mRNA表达上调,同时胞质中细胞色素C含量显著升高,其差异均有显著性(P均<0.05)。环孢素干预能显著减轻上述变化,患侧睾丸组织正常细胞群百分比升高,Fas、FasL和Bax mRNA表达下调,同时胞质中细胞色素C含量显著降低,其差异均有显著性(P均<0.05)。结论环孢素可能参与调控生精细胞凋亡的分子途径,对睾丸扭转术后的生精功能具有明显的保护性效果。     

一氧化氮在一侧睾丸扭转对侧睾丸损伤中的作用

目的 研究总抗氧化能力(T-AOC)和一氧化氮(NO)在一侧睾丸扭转对侧睾丸损伤中的作用。方法 SD雄性大白鼠建立左侧睾丸扭转模型，于扭转后6h再分为扭转睾丸复位及切除组，分别于术后1h、1d、1周、2周和4周处死4—5只，取出睾丸用于一氧化氮合酶(NOS)活性、NO、T-AOC及细胞凋亡的检查。结果 UTT复位后对侧睾丸组织NOS活性、NO含量明显升高，T—AOC显著降低。结论 NO过量产生及T-AOC的下降是UTT对侧睾丸损伤的重要原因。     

大鼠单侧睾丸扭转复位后对对侧睾丸的影响

目的研究大鼠单侧睾丸扭转复位后对对侧睾丸的影响。方法16只成年健康SD雄性大鼠随机分为实验组(n=8)和对照组(n=8)；建立单侧睾丸扭转复位模型。术后30d取扭转对侧睾丸,采用原位缺口末端标记法(TUNEL)检测生殖细胞凋亡,光镜下计数精子数。结果与对照组相比,实验组对侧的睾丸重量和日产精子量都有显著性差异(P＜0.05),实验组生殖细胞凋亡显著增多(P＜0.01)。结论大鼠单侧睾丸扭转后,对侧睾丸生殖细胞凋亡增多可能是导致不育的原因之一。     

Irreducible inguinal hernia,bowel obstruction,and torsion of testis in a patient with testicular feminization syndrome

Testicular feminization syndrome, irreducible inguinal hernia, bowel obstruction, and testicular torsion were diagnosed and treated in a 13-year-old girl. Diagnosis of this case in such a complex form in an emergency room is a rare occurrence. Through this case, we want to emphasize the coincidence of inguinal hernia and testicular feminization and the X-linked recessive transmission character of the disease.     

Histological and immunohistochemical studies on the damage of contralateral testis following the unilateral testicular torsion in Wistar rats

The effect of experimental unilateral torsion of the testis on the contralateral intrascrotal testis in Wistar rats was evaluated histologically and immunohistochemically. The results were summarized as follows. 1) Histological damage of the seminiferous tubules in the contralateral testis was present only in adult rats. 2) The histological change 3-5 weeks after the experimental torsion consisted of marked decrease of spermatocytes, loss of spermatids and spermatozoa and numerous Sertoli-cell only tubules. Hyperplasia of the interstitial cells was demonstrated without thickness of the basement membrane and infiltration of the inflammatory cells. The tubular diameter and the ratio of contralateral testicular weight to rat body weight were significantly decreased (p less than 0.05) in torsion group. 3) Using an indirect immunofluorescent method, the positive immunohistochemical staining on spermatid and spermatozoa of normal testicular tissue was demonstrated using only the serum of rat with histological damage on the contralateral testis. Therefore, the phenomenon may be ascribable to the presence of antisperm antibody. It is concluded that the mechanism of the damage in seminiferous tubules of the contralateral testis with experimental torsion in adult Wistar rats is related to the humoral immunity producing antisperm antibody.     

Protective effects of immunophilin ligands on testicular torsion/detorsion damage in rats

Objectives  The purpose was to investigate the role of immunophilin ligands in ischemia/reperfusion (I/R)-induced germ cell apoptosis in the rat. Materials and methods  Sprague–Dawley rats were divided into five groups with ten animals in each. In animals undergoing torsion/detorsion, right testes were rotated 720o for 1 h. A baseline group was for basal normal values. The sham-operated group served as a control group. The TD group underwent torsion/detorsion surgery alone; the cyclosporine-A group (TD-CsA) received intravenous cyclosporine injection (5 mg/kg) at the time of detorsion, and the FK-506 group (TD-FK) received intravenous FK-506 (3.5 mg/kg) at the time of detorsion. For measurement of lipid peroxidation and antioxidant enzyme activities, the right testes of five animals in each group were excised after 4-h reperfusion. Germ cell apoptosis indices were determined 24 h following detorsion in the right testes of the remaining five animals in each group. Results  Malondialdehyde (MDA) levels in the TD group were significantly higher compared to control and baseline groups. Moreover, testicular MDA values in TD-CsA and TD-FK groups were significantly lower than in TD. There were also significant decreases in catalase and superxide dismutase activities in the TD group compared to control and baseline groups. These values in TD-CsA and TD-FK groups were significantly higher than in TD. The mean germ cell apoptosis scores were significantly higher in TD animals compared to control and baseline groups; however, CsA and FK-506 treatment significantly reduced the apoptosis compared with the TD group. Conclusion  We have shown that administration of immunophilin ligands in testicular torsion decreases ischemia/reperfusion (I/R) cellular damage. The results of biochemical studies suggest that reduction of oxidative stress along with attenuated neutrophil accumulation by immunophilin ligands may have a major role in their cytoprotective effects.     

Effect of testicular torsion on contralateral testis and fertility in mature rats

The effect of unilateral testicular torsion on the contralateral testis and the fertility rate was studied in Charles River adult rats. Animals were divided into groups that underwent a sham operation or torsion and ligation of the left testicular vessels followed by orchiectomy after 24 h, orchiectomy after 48 h, release of the ligature after 24 h, release of the ligature after 48 h, and no further treatment following ligation. Another group of animals underwent unilateral orchiectomy. After 8 weeks animals were allowed to mate and were sacrificed 2 weeks later. The results did not point to either histological alterations in the contralateral testis or impairment of fertility in any group of treatment compared with the control.     

婴幼儿睾丸扭转的早期诊断和治疗方法选择

目的：探讨提高婴幼儿睾丸扭转疗效的方法。方法：对12例睾丸扭转患儿均行阴囊彩超检查,10例提示睾丸扭转。根据病情选择手法复位、睾丸复位 双侧睾丸固定术和切除扭转的睾丸同时固定对侧睾丸。结果：1例行手法复位成功,随访4个月～3年,3例保留睾丸者彩超显示双睾丸血流一致;9例切除睾丸者显示对侧睾丸血流正常。结论：阴囊彩超检查对婴幼儿睾丸扭转的诊断有较大的帮助;婴幼儿睾丸扭转后发生睾丸坏死的比率高,早期诊断、及时治疗是救活睾丸的关键,一旦明确或高度怀疑睾丸扭转,应立即行手术探查。     

Ethyl pyruvate reduces germ cell-specific apoptosis and oxidative stress in rat model of testicular torsion/detorsion

Purpose

Testicular torsion/detorsion (T/D) results in enhanced formation of free radical metabolites, which contributes to the pathophysiology of tissue damage. We investigated the protective effects of ethyl pyruvate (EP) against testis tissue damage in an experimental model of testicular torsion.

Methods

Sprague-Dawley rats were divided into 5 groups. In those animals that underwent T/D, right testes were rotated 720° for 1 hour. Group 1 control rats underwent sham operation. In group 2, the rats underwent T/D. The EP was prepared and injected in the form of Ringer's ethyl pyruvate solution. The rats in group 3, 4, and 5 received 2 doses of 20, 50, and 100 mg/kg EP (30 minutes before and after detorsion), respectively. The right testes of 6 animals from each group were excised 4 hours after detorsion for the measurement of lipid peroxidation, myeloperoxidase (MPO), and antioxidant enzymes activities. Germ cell apoptosis was determined in right testes of 8 animals per group 24 hours after detorsion. The epididymal sperm concentration and motility were evaluated 1 month after treatments.

Results

Germ cell apoptosis indices were significantly higher in group 2 compared with control group. The level of lipid peroxidation and MPO activity increased, whereas antioxidant enzymes activities decreased after T/D. Sperm count and motility were also reduced 1 month after T/D in group 2 rats. However, EP treatment at doses of 50 and 100 mg/kg significantly decreased the early apoptotic damage and improved long-term sperm count and motility. In the same dosing groups, we observed normalization of oxidant/antioxidant balance and decrement of MPO activity. However, administration of 20 mg/kg of EP conferred no protective effect.

Conclusions

Administration of Ringer's ethyl pyruvate solution (in appropriate doses) is protective against apoptotic tissue damage following testicular torsion and improves long-term testicular function. The antioxidant and anti-inflammatory properties of EP seem responsible for the protective effects. Our findings suggest this resuscitation solution as a possible substitute for fluid and electrolyte maintenance during surgical detorsion.     

Effects of melatonin on spermatogenesis and testicular ischemia-reperfusion injury after unilateral testicular torsion-detorsion

Purpose

This study aimed to determine the effect of melatonin in preventing ischemia-reperfusion (I-R) injury-induced tissue damage and on spermatogenesis after experimental testicular torsion (TT).

Methods

Forty peripubertal rats were divided into 4 groups each containing 10 rats: control (C), sham (S), torsion plus detorsion (TD), and torsion plus melatonin (M). The left testes were rotated 720° for 6 hours and detorsed for 6 hours thereafter. Serum inhibin B (IB) levels were measured in blood samples taken from all groups. Left orchiectomies were performed to determine the tissue levels of Johnsen's scores (JS) and malondialdehyde (MDA).

Results

Serum IB levels in the S and TD groups were significantly lower compared with that in the C group, whereas they were higher in the M group compared with the TD group. The MDA levels were significantly lower in the C, S, and, M groups compared with the TD group. Johnsen's scores were significantly higher in the C, S, and M groups compared with the TD group.

Conclusions

Our results suggested that melatonin is a potent antioxidant agent in preventing testicular I-R injury, as shown by increased IB levels and JS.     

The protective effects of nitric oxide on the contralateral testis in prepubertal rats with unilateral testicular torsion

OBJECTIVE: To investigate histological changes in the contralateral testis of rats with unilateral testicular torsion and the protective effects of nitric oxide (NO) on possible damage. MATERIAL AND METHODS: Twenty-eight prepubertal male Sprague-Dawley rats were divided into four equal groups. Group 1 underwent a sham operation of the right testis under general anaesthesia. Group 2 underwent a similar operation but the right testis was rotated 720 degrees clockwise for 6 h, maintained by fixing the testis to the scrotum, and saline infused during the procedure. Group 3 underwent similar torsion but L-arginine methyl ester (a precursor of NO) was infused during the procedure. In Group 4, NG-nitro-L-arginine-methyl ester, a NO synthase inhibitor, was infused separately during the administration of L-arginine methyl ester and torsion. All the left (untwisted) testes were removed from rats 21 days after surgery and evaluated histologically, assessing seminiferous tubule diameter, loss of sperm and spermatids, loss of germ cell layers, disarray of germ cell layers, rupture of tubules, Leydig cell proliferation and reaction in the ruptured tubules, and oedema. RESULTS: There was a significant difference in the indicators of histological damage between groups 2 and 4 and groups 1 and 3, except for the Leydig cell reaction in the ruptured tubules and oedema. The damage was significantly less in group 3 than in groups 2 and 4. CONCLUSION: These results suggest that long-term histopathological changes in the contralateral testes are important after unilateral testicular torsion and that NO has a protective effect on the contralateral testis.     

Ginkgo biloba (EGB 761) affects apoptosis and nitric-oxide synthases in testicular torsion: an experimental study

Introduction  We investigated the effect of ginkgo biloba on germ cell apoptosis and also on expressions of endothelial (eNOS) and inducible (iNOS) nitric oxide synthases after testicular torsion. Materials and methods  Thirty-two Wistar albino rats were randomly assigned into four groups. Torsion/detorsion (T/D) was performed on the rats in group 1, group 2 received ginkgo biloba for a month before T/D, group 3 received only gingko biloba for a month, and group 4 was the sham group. Left testicular torsion was created in group 1 and group 2, and the testes were untwisted and replaced in the scrotum for reperfusion. No procedure was applied to group 3, and after 1 month, testes were removed in all groups. Results  Mean apoptotic cell, eNOS, and iNOS were increased in group 1. Group 2 showed significantly decreased apoptotic cells, eNOS, and iNOS in testes compared to group 1 (P < 0.05). The rats in group 3 had significantly decreased apoptotic cell, eNOS, and iNOS values, like the sham group (P < 0.05), and this group provided basal values. Conclusions  Ginkgo biloba, as a free radical scavenger, seems to have a protective role against apoptosis in testicular ischemia reperfusion injury.