The preventive effects of thiopental and propofol on testicular ischemia-reperfusion injury

BACKGROUND: Testicular torsion is a urological emergency that requires immediate surgical intervention to prevent testicular damage. The aim of the study was to investigate the preventive effects of thiopental and propofol as anesthetics on testicular ischemia-reperfusion injury. METHODS: Forty male Wistar Albino rats were randomly assigned to four groups of 10 rats each. During 5 h, anesthesia was induced and maintained with thiopental in groups 1 and 2 and with propofol in groups 3 and 4. Groups 2 and 4 received left testicular ischemia (torsion) during 1 h and reperfusion (detorsion) during 4 h. Groups 1 and 3 (control groups) had no testicular torsion and detorsion. At the end of 5 h, animals were killed and both ipsilateral and contralateral testes were removed for histopathologic examination and measurement of tissue MDA (malondialdehyde) and NO (nitric oxide) levels. RESULTS: In the contralateral testes of all the groups, MDA and NO measurements were not different from ipsilateral testes of the control groups. Between the groups 1 and 3, there were no differences in MDA and NO levels. Although torsion/detorsion of testes in group 4 caused significantly increased levels of tissue MDA and NO values compared with group 3, ischemia-reperfusion in group 2 caused a further increase in these levels compared with group 4. The ipsilateral testes in the control groups did not show any morphological changes. Testicular torsion/detorsion in rats with thiopental anesthesia (group 2) caused significantly greater histopathologic injury levels than rats with propofol anesthesia (group 4). CONCLUSION: Our results suggest that propofol as an anesthetic agent may prevent testicular damage by scavenging reactive oxygen and nitrogen species and inhibiting lipid peroxidation in an animal model of testicular torsion and detorsion.     

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.     

The role of nitric oxide in testicular ischemia-reperfusion injury

PURPOSE: This study was designed to determine the role of nitric oxide (NO) in the ischemia-reperfusion (I/R) injury process in testes. METHODS: Fifty prepubertal male rats were divided into 5 groups each containing 10 rats. After 4-hour torsion and 4-hour detorsion, bilateral orchiectomies were performed for measurement of tissue malondialdehyde (MDA) level and histopathologic examination. The results were compared statistically. The groups were labeled as group 1, basal values of biochemical parameters in testes; group 2 (control group), torsion plus detorsion; group 3, torsion plus N-monomethyl-L-arginine (L-NMMA) plus detorsion; group 4, torsion plus L-arginine plus detorsion; group 5, sham operation. RESULTS: The highest MDA values were determined in the L-arginin group in ipsilateral testes. Group 3 and group 4 were statistically different from control group. Histological examination showed that specimens from group 4 had a significantly (P < .05) greater histological injury than group 3, and contralateral testes showed normal testicular architecture in all groups. CONCLUSIONS: These results suggest that NO plays an important role in damaging the testis with I/R. Although inhibition of NO synthesis with L-NMMA significantly improves I/R injury in testes, enhancing NO production by providing excess of L-arginine increases such damage. In the early periods of detorsion, there is no damage to contralateral testes after unilateral testicular torsion.     

Beneficial effects of rolipram,a phosphodiesterase 4 specific inhibitor,on testicular torsion-detorsion injury in rats

IntroductionThe aim of the study is to investigate the effect of Rolipram, a selective phosphodiesterase 4 inhibitor, on testicular torsion – detorsion injury.MethodsSixty young male rats were divided into five groups. In each group, the right testes of six rats were removed four hours after detorsion for biochemical analysis, and the right testes of the remaining six rats were removed 24 h after detorsion for pathological analysis. In group 1 (sham-operated) right orchiectomy was performed without torsion, and right testes were sent to the laboratory for biochemical and pathologic analyses. In group 2 (control) torsion was applied to the right testes for 60 min, and detorsion was performed without the administration of Rolipram. In group 3 torsion was applied to the right testes for 60 min. 1 mg/kg Rolipram was administered 30 min before detorsion. In group 4 torsion was applied to the right testes for 60 min, and 1 mg/kg Rolipram was administered during detorsion. In group 5 torsion was applied to the right testes for 60 min. 1 mg/kg Rolipram was administered 30 min after detorsion. The malondialdehyde and nitric oxide levels were determined. The rates of necrosis and apoptosis were evaluated by histopathological examination.ResultsThe level of malondialdehyde was higher in the torsioned groups (Group 2, 3, 4, 5) than that in group 1 (p = 0.004). There was no statistically significant difference between the groups regarding the level of nitric oxide (p = 0.182). Apoptosis was higher in groups 2, 3 and 4 than in group 1; however, apoptosis was similar in group 1 and group 5 (p = 0.122). The level of necrosis in group 1 was similar to that in groups 4 and 5 (p = 0.194 and p = 0.847, respectively).ConclusionWe suggest that the administration of Rolipram can decrease the rate of necrosis and apoptosis in testicular ischaemia-reperfusion injury.     

Protective role of erythropoietin during testicular torsion of the rats

Testicular torsion is an important clinical urgency. Similar mechanisms occurred after detorsion of the affected testis as in the ischemia reperfusion (I/R) damage. This study was designed to investigate the effects of erythropoietin (EPO) treatment after unilateral testicular torsion. Fifty male Sprague-Dawley rats were divided into five groups. Group 1 underwent a sham operation of the right testis under general anesthesia. Group 2 was same as sham, and EPO (3,000 IU/kg) infused i.p., group 3 underwent a similar operation but the right testis was rotated 720° clockwise for 1 h, maintained by fixing the testis to the scrotum, and saline infused during the procedure. Group 4 underwent similar torsion but EPO was infused half an hour before the detorsion procedure, and in group 5, EPO was infused after detorsion procedure. Four hours after detorsion, ipsilateral and contralateral testes were taken out for evaluation. Treatment with EPO improved testicular structures in the ipsilateral testis but improvement was less in the contralateral testis histologically, but EPO treatment decreased germ cell apoptosis in both testes following testicular IR. TNF-α, IL-1β, IL-6 and nitrite levels decreased after EPO treatment especially in the ipsilateral testis. We conclude that testicular I/R causes an increase in germ cell apoptosis both in the ipsilateral and contralateral testes. Eryhropoietin has antiapoptotic and anti-inflammatory effects following testicular torsion.     

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.     

An enigma: Contralateral effects of experimental unilateral testicular torsion

To investigate the effects of unilateral testicular torsion on both testes, we studied 4 groups of adult male New Zealand rabbits using sham operation, torsion and detorsion after one or eight hours and permanent torsion. Bilateral orchiectomy was performed 9 weeks after the operation, and testicular weights, Johnsen scores, quantitative analyses, tubular diameters were calculated and histopathologic diagnosis was determined. Testicular weights, Johnsen scores, spermatid counts and tubular diameters were all decreased in torsioned testes depending on the duration of torsion. The contralateral testes showed no significant change in any of the study groups when compared with the control group.     

大鼠一侧睾丸扭转对侧睾丸改变的实验研究

目的 :研究一侧睾丸扭转 (UTT)后对侧睾丸组织学及生精细胞凋亡的改变 ,以明确UTT后对侧睾丸是否存在损伤。　方法 :SD雄性大鼠 6 0只 ,随机分为实验组 (n =4 8)及对照组 (n =12 )。实验组采用Turner方法建立左侧睾丸扭转模型 ,于扭转后 6h处死 4只 ,其余 4 4只再分为扭转睾丸复位及切除组 ,分别于术后 1d、1周、4周处死7～ 8只 ,取睾丸组织进行组织学及生精细胞凋亡的检测。　结果 :UTT复位后对侧睾丸组织学发生明显改变 ,生精细胞凋亡指数明显高于对照组 (P <0 .0 5 )。扭转睾丸切除后对侧睾丸变化不明显。　结论 :UTT可引起对侧睾丸损伤 ,其机制可能与再灌注有关 ,扭转睾丸切除可防止或减轻对侧睾丸的损伤     

生脉注射液对不同周龄大鼠睾丸扭转复位后睾丸损伤影响的研究

目的:探讨生脉注射液对不同周龄大鼠睾丸扭转复位后睾丸损伤影响的差异。方法:3、6、12周龄健康雄性SD大鼠各16只,随机分成睾丸扭转复位+注射生脉注射液组(实验组)和睾丸扭转复位+注射生理盐水组(对照组),每组8只,建立睾丸扭转动物模型(左侧阴囊切开,绕精索顺时针扭转睾丸720°2h),并于手术后24h处死,测定各组大鼠睾丸组织内总抗氧化能力(T-AOC)、超氧化物歧化酶(SOD)活性与丙二醛(MDA)含量。结果:与各自对照组比较,3、6周实验组大鼠左侧睾丸组织中T-AOC、SOD活性和MDA含量均无显著性改变(P>0.05);12周实验组大鼠左侧睾丸组织中SOD、T-AOC明显升高,而MDA含量显著降低,差异均具有显著性(P<0.05)。结论:生脉注射液对睾丸扭转复位后的缺血再灌注急性损伤有保护作用,但对不同周龄大鼠的再灌注损伤保护作用不同,存在年龄相关性差异,对较大周龄大鼠的急性保护作用较为明显。     

Effect of unilateral testicular torsion on blood flow and histology of contralateral testes.

BACKGROUND/PURPOSE: Infertility occurs in 25% of patients after unilateral testicular torsion; hence, the authors examined hemodynamic and histological changes in both testes after acute testicular torsion in neonatal piglets. METHODS: The animals were anesthetized, intubated, ventilated, catheterized, and assigned randomly to a sham group or one of three experimental groups undergoing 720 degrees torsion of the left testis for 8 hours after which it was untwisted in group I and removed in group II. In group III, both testes were removed. Data were collected at baseline (T = 0), 4 hours (T = 4), and 8 hours of torsion (T = 8) and at the ninth hour of the experiment (T = 9). Testicular blood flow was determined by using radiolabeled microspheres. The testes also were examined blindly with routine and electron microscopy. RESULTS: In group I, testicular blood flow decreased in the affected testis during torsion and increased significantly after detorsion, whereas blood flow to the contralateral testis increased significantly after detorsion. Sham-operated animals showed no histological abnormality in either testis. In all torsion groups, the affected testis showed extensive changes caused by hemorrhagic necrosis. The contralateral testis only showed changes in group I. CONCLUSION: Unilateral testicular torsion resulted in ipsilateral damage caused by a decrease and subsequent increase in blood flow while in the contralateral testis; damage was the result of a significant increase in blood flow after detorsion.     

Protective effects of quercetin on testicular torsion/detorsion-induced ischaemia-reperfusion injury in rats

The aim of this study was to investigate the protective effect of quercetin (QE) on testicular torsion/detorsion-induced ischaemia-reperfusion (I/R) injury. A total of 24 male Wistar albino rats were divided into three groups: control, I/R and I/R treated with QE; each group contain eight animals. Testicular torsion was created by rotating the left testis 720° in a clockwise direction. The ischaemia period was 5 h and orchiectomy was performed after 5 h of detorsion. QE (15 mg kg(-1) , i.p.) was administered only once, 40 min prior to detorsion. Left orchiectomy was performed in all I/R groups. To date, no histopathological changes on testicular torsion/detorsion-induced I/R injury in rats by QE treatment have been reported. Spermatogenesis and mean seminiferous tubule diameter were significantly decreased in I/R groups were compared with the control group. Furthermore, QE treated animals showed an improved histological appearance in I/R group. Our data indicate a significant reduction in the activity of TUNEL, endothelial nitric oxide synthase and a rise in the expression of testosterone in testes tissue of I/R treated with QE therapy. We believe that further preclinical research into the utility of QE may indicate its usefulness as a potential treatment on testes injury after I/R in rats.     

Effect of testicular torsion on the contralateral testis and prevention of this effect by prednisolone

This study was instituted to evaluate the effect of unilateral testicular torsion on contralateral testicular histology and the prevention of this effect by prednisolone. Fifty Swiss albino rats were equally divided into 5 groups. In group 1, it was observed that, due to torsion, the mean seminiferous tubular diameter and percentage of spermatogenetic activity of the contralateral testes were reduced and an inflammatory reaction was also noted. In group 2, detorsion increased the above-mentioned damage, and in group 3, orchiectomy failed to prevent it. In group 4, it was seen that prednisolone slightly increased the mean percentage of spermatogenetic activity and produced proliferation of the Leydig cells in the intact testicle. In group 5, when prednisolone was injected just after torsion, no damage to the contralateral testes appeared. It has been thought that damage to the contralateral testes may arise from an autoimmune mechanism and prednisolone appeared to be very helpful in preventing damage by immunologic suppression.     

Protective effect of trapidil on long-term histologic damage in a rat model of testicular ischemia-reperfusion injury

Objectives  Trapidil is an antianginal compound with a broad spectrum of pharmacological activities. In recent years, it has been used successfully to decrease ischemia-reperfusion injury in several organ systems. We evaluated the effect of trapidil on the long-term histologic damage in testicular ischemia-reperfusion injury. Methods  Adult male Wistar rats were divided into three groups of six rats each. One group underwent 2 h of testicular torsion; one received pretreatment with trapidil before detorsion; and one group underwent sham operation. All rats underwent bilateral orchiectomy 60 days after the experiment. The mean seminiferous tubular diameter, germinal epithelial cell thickness, and mean testicular biopsy score were determined by histological examination of each testis. Results  Testicular torsion–detorsion caused a significant decrease in the mean seminiferous tubular diameter, germinal epithelial cell thickness, and mean testicular biopsy score in the ipsilateral testes, but not in the contralateral testes. The animals treated with trapidil had a significant increase in these histological parameters as compared to the torsion–detorsion group. Conclusion  Trapidil administration before reperfusion may have the potential to decrease the long-term histologic damage that occurs after experimental testicular torsion. Trapidil is used as an antianginal drug and additional clinical studies are required to elucidate the protective role of trapidil in patients with testicular torsion.     

Effect of insulin-like growth factor-1 on apoptosis of rat testicular germ cells induced by testicular torsion

OBJECTIVE: To investigate the possible protective role of insulin-like growth factor-1 (IGF-1, reported to have a protective effect in experimental models of hypoxic ischaemia), and the involvement of apoptotic cell death in a model of torsion/detorsion of the rat testis. MATERIALS AND METHODS: Adult male Wistar rats were divided into five groups of five rats each. Group 1 underwent a sham operation as a control; in group 2 the testis was twisted and in group 3 then untwisted; in group 4 IGF-1 was injected subcutaneously just before bilateral torsion, and then the right testis removed after 4 h and the left after 24 h; in group 5, IGF-1 was injected immediately after bilateral detorsion and then the testes removed as in group 4. Both testicles were examined histologically, with apoptosis detected using the in situ DNA fragmentation (TUNEL) system, with combined enzymology and immunohistochemistry techniques. RESULTS: In groups 2 (torsion) and 3 (detorsion), light microscopy of the testis showed some degenerative changes in the germ cells. Compared to group 1, apoptosis was more significant in group 3 than in the other groups. Group 4 (torsion/IGF-1) had a similar number of apoptotic germ cells as in group 2 (torsion) after 24 h, but fewer than the same group after 4 h. In group 5 (detorsion/IGF-1), apoptosis was reduced by IGF-1 significantly more than in group 3 (P < 0.05). Apoptosis was significantly less in spermatids in group 5 than in group 3 (P < 0.05). CONCLUSIONS: IGF-1 seems to lower the levels of germ cell apoptosis, which may be important for protecting the testes from torsion/detorsion injury. Further clinical studies are needed to evaluate this protective effect in testicular torsion/detorsion.     

Predictive value of ischaemia-modified albumin in spermatogenesis in an experimental testicular torsion model

Our aim was to measure the ability of ischaemia-modified albumin (IMA) to predict testicular histopathological damage in the testes of rats with short- and long-term ischaemia using experimental testicular torsion and subsequent reperfusion via detorsion.21 Wistar Albino rats were randomized into three groups. The sham group was subjected to a mid-scrotal incision only. The 4- and 8-hr T/D (Torsion/Detorsion) groups were subjected to left testicular torsion by twisting the testes by 720 degrees counterclockwise. 2 cc venous blood samples were taken from the sham group after the mid-scrotal incision, and from the 4- and 8-hr T/D groups after 4 and 8 hr respectively. After that, the 4- and 8-hr T/D groups were subjected to detorsion. Two days later, orchiectomy was performed. Ischaemia-modified albumin levels were significantly different among the groups at 48 hr prior to orchiectomy (reperfusion; p = .003). Based on the results of the paired comparisons, it was found that IMA levels of the sham group were significantly higher than those of the 4- and 8-hr T/D groups (p = .002 and .009 respectively). Our study has showed that IMA may be used to predict ischaemia/reperfusion injury, which is another complication that may occur following detorsion in testicular torsion.     

Unilateral testicular torsion: evaluation of bcl-2, p-53 and PCNA expression in contralateral testes

OBJECTIVES AND METHODS: The present study aims to evaluate the histologic as well as apoptotic changes indicated by PCNA, p-53 and bcl-2 expression in the contralateral testes after a period of unilateral testicular torsion of 4 h. RESULTS: Regarding the histologic changes, while some significant alterations such as complete or incomplete spermatocytic arrest as well as sertoli cell only formation have to some extent been noted after the detorsion procedure, reasonably better preserved histology could be demonstrated following the orchiectomy procedure both in the early and late follow-up. Thus, the orchiectomy procedure was found to be limiting enough on the severity of the histologic changes in the contralateral testes after a certain period of time following the torsion procedure. On the other hand, however, in relation to the apoptotic events indicated by the three markers, while PCNA activity was found to be significantly different depending on the procedure performed (detorsion or orchiectomy), p-53 and bcl-2 positivity did not exhibit any difference in this aspect. Increased PCNA activity (especially after the detorsion procedure) together with marked positivity of p-53 both in the early and late follow-up indicated the increased cell turnover in the contralateral testes, which in turn may be accepted as a sign of increased apoptosis in these testes. In addition to these findings, bcl-2 expression has been found to be consistently negative in all specimens evaluated both in the early and late follow-up. CONCLUSION: Taking into account the strong inhibitory effect of bcl-2 during apoptotic events, these findings again support the likelihood of increased apoptosis in the contralateral testes.     

Protective role of methylprednisolone and heparin in ischaemic‐reperfusion injury of the rat testicle

This study evaluated the therapeutic efficacy of heparin and methylprednisolone in the treatment of ischaemic reperfusion (IR) injury of the testis. Twenty‐four male Sprague‐Dawley rats were allocated equally into three groups of eight animals each. The left testes were rotated 720° for 2 h in the rats in the torsion–detorsion group. Rats in the treatment groups underwent the same surgical procedure as the torsion–detorsion group but were also given methylprednisolone (group II) or heparin (group III) by an intraperitoneal route 30 min prior to detorsion. Left orchiectomy was performed in all rats from each experimental animal at 2 h after detorsion, and the tissue was harvested for the measurement of malondialdehyde (MDA), protein carbonyl (PC) and nitric oxide (NO) and the endogenous antioxidant enzymes, superoxide dismutase (SOD), glutathione peroxidase (GSH‐Px) and catalase. Additional tissue was evaluated using histopathological and immunohistochemical changes. PC and MDA levels were significantly reduced in the treated groups compared to the control group. There was no statistically significant difference in NO level or SOD, GSH‐Px and catalase activity among the treatment groups. Histopathological and immunohistochemical findings supported biochemical changes. It is concluded that pre‐treatment with methylprednisolone or heparin protects the testis in ischaemic reperfusion injury caused by testicular torsion–detorsion.     

Gradual detorsion of torsioned rat testis attenuates ischemia reperfusion injury

Aim

This study was designed to investigate effect of gradual detorsion on testicular ischemia reperfusion injury.

Materials and Methods

A total of 21 male rats were divided into 3 groups, each containing 7 rats. Torsion was created by rotating the left testis 720° in a clockwise direction. Group 1 underwent sham operation. Group 2 (sudden detorsion) served as a torsion/detorsion group, receiving 2 hours torsion and 2 hours detorsion. In group 3, 360° detorsion was done for 20 minutes after 720° torsion for 2 hours. Then, testis was done full detorsion for 100 minutes. At the end of the experiments (fourth hour), left orchiectomy was performed to measure the tissue levels of malondialdehyde (MDA), superoxide dismutase, and glutathione peroxidase and to perform histologic examination in testes.

Results

The MDA levels of testis tissues were significantly increased in the sudden detorsion group as compared with the sham group. We found decrease of the MDA level in gradual detorsion group, but it was not a statistically significant amount. Significant decrease was found in the superoxide dismutase and glutathione peroxidase activities in the sudden detorsion group as compared with the sham and gradual detorsion groups. Histologic examinations were in accordance with the testicular tissue MDA levels.

Conclusion

In the light of our biochemical and histopathologic findings, we can say that gradual detorsion has a trend to decrease the degree of testicular reperfusion injury in the rat torsion/detorsion model.     

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.     

Semen quality and endocrine parameters after acute testicular torsion.

Of 16 postpubertal patients evaluated following testicular torsion 9 were treated with detorsion and bilateral orchiopexy (detorsion group), and 7 were treated with ipsilateral orchiectomy and contralateral orchiopexy (orchiectomy group). Each patient was evaluated with regard to semen quality, endocrine parameters (follicle-stimulating hormone, luteinizing hormone and testosterone) and the presence or absence of semen antisperm antibodies. These data were compared to similar data from a group of proved fertile semen donors. The semen quality in the detorsion group did not differ significantly from that of controls (p = 0.25) but follicle-stimulating hormone was significantly elevated compared with that of controls before and after stimulation with gonadotropin-releasing hormone. The orchiectomy group, which had been subjected to prolonged torsion (mean 69 hours), demonstrated a significant decrease in semen quality compared with semen quality in controls (p = 0.001), with average sperm density of only 29.0 million per ml. Baseline and post-stimulation levels of follicle-stimulating hormone in the orchiectomy group were also significantly abnormal when compared with those in controls and in the detorsion group. Our study demonstrates that testicular damage (changes in semen quality and/or endocrine parameters) occurs in the ipsilateral and contralateral testis following torsion, regardless of treatment modality. However, with early intervention by detorsion and testicular salvage, subsequent semen quality is likely to remain within normal limits. Late surgical intervention, even with removal of the nonviable testes, may result in significant impairment of semen quality.