睾丸扭转的诊治分析(附20例报告)

目的 提高睾丸扭转的诊断和治疗水平.方法 回顾性分析本院2004年10月～2010年7月诊治的20例睾丸扭转患者的临床资料.平均年龄22.1(15～30)岁,发病至确诊的时间4h～3个月,平均7.4天.9例发病于睡眠中,18例以突发睾丸剧烈疼痛起病,15例提睾反射消失,10例阴囊抬高试验(Prehn征)阳性,7例睾丸横...     

Sertoli cell tumor in a prepubertal boy mimicking testicular torsion

A 9-year-old boy presented with left, intermittent testicular pain that was present for 3 days. On physical examination, left testis was grossly enlarged and firm but mildly tender. Serum alpha-fetoprotein and beta-human chorionic gonadotropin levels were within normal range. Color doppler ultrasonography which was performed to rule out testicular torsion revealed an intratesticular mass located at the upper pole of left testis and left radical orchiectomy was performed. The histopathological diagnosis was Sertoli cell tumor.     

Infarctus testiculaire. A propos d'un cas et revue de la littérature

Testicular infarction is a rare pathology whose etiology has not yet been identified. The main presenting symptom, is severe testicular pain in the absence of trauma or torsion, often simulating a tumor, but tumor markers are normal and urine is sterile. Ultrasonography shows a hypoechogenic area, which on Doppler is avascular. Magnetic resonance imaging (MRI) remains the diagnostic tool of choice. Treatment usually consists of orchidectomy. In case of segmental testicular infarction a resection of the segment in question can be done instead. The authors report on a case of segmental testicular infarction for which they propose a policy of watchful waiting.     

The Early Histopathologic Effects of Intratesticular Injection with Hyperosmolar Glycerol, Glucose or NaCI Solutions

A total of 50 Sprague-Dawley adult male rats were used to compare the effects of intratesticular injection of 0.2 ml of hyperosmolar solutions of glycerol, glucose and NaCl with or without simultaneous treatment with indomethacin or dexamethasone. The hyperosmolar solutions caused a characteristic focal lesion with destruction of central testicular tissue as early as 12 hr after injection, and an inflammatory leukocytic halo present throughout the first week after injection. Neither anti-inflammatory drug altered this lesion. We concluded that intratesticular sterilization by hyperosmolar solutions in not a viable means of male contraception.     

Color-coded duplex sonography for diagnosis of testicular torsion

By color-coded duplex sonography moving structures are visualized as red or blue colors within a normal gray-scale B-mode ultrasound image. Thus, blood flow even within small vessels can be visualized clearly. Color-coded duplex sonographic examination was performed in 11 patients who presented with scrotal pain. This method proved to be reliable to differentiate between testicular torsion and testicular inflammation. By clearly demonstrating a lack of intratesticular blood flow in testicular torsion, while avoiding flow in scrotal skin vessels being misinterpreted as intratesticular blood flow, this method significantly decreases the number of patients in whom surgical evaluation is necessary to exclude testicular torsion.     

Segmental infarction of the testis: an exceptional complication of diabetes microangiopathy

We report a case of segmental infarction of the testis in a 55-year-old man. Past medical history included 12 years of type II diabetes and hypertension. The patient presented with a 2-month history of testicular pain and was found clinically and sonographically to have a testicular tumour. The pathological examination of the partial orchiectomy specimen revealed segmental infarction of the testicle secondary to diabetes microangiopathy. We propose diabetes microangiopathy as a localization and aetiology of segmental testicular infarction. A possible testicular sparing procedure through an inguinal approach may be considered in cases of testicular masses for which the clinical and imaging findings are suggestive of focal testicular infarction.     

Effect of Simultaneous Local Injection of 6-Hydroxydopamine and Naloxone on the Testis of Neonatal Rats/Der Einfluß einer gleichzeitigen lokalen Injektion von 6-Hydroxydopamin und Naloxon auf den Hoden neugeborener Ratten

The effect of simultaneous intratesticular injection of the opiate receptor antagonist naloxone and the neurotoxic drug 6-hydroxydopamine (6-OHDA) on testicular growth, compensatory testicular hypertrophy, serum testosterone level and basal testosterone secretion in vitro was studied in neonatal rats. In animals with two testes unilateral intratesticular administration of naloxone alone enhanced, while 6-OHDA alone decreased the weight of the treated gonad. In animals treated simultaneously with these two agents the decrease in testicular weight induced by 6-OHDA was partially prevented by naloxone. In hemicastrated animals intratesticular treatment with naloxone enhanced the extent of compensatory testicular hypertrophy. Treatment of the remaining testis with 6-OHDA + naloxone did not interfere with the diminished compensatory testicular hypertrophy observed following 6-OHDA treatment. Data indicate that naloxone can counteract the degenerative effect of 6-OHDA in animals with two testes but not in hemicastrates.     

Simple cysts of the testis in children: preoperative diagnosis by ultrasound and excision with testicular preservation

We report on 2 children with simple cysts of the testis who were treated with excision and testicular preservation. To our knowledge both cases represent the first report of conservative surgery for these lesions in children. In 1 case the diagnosis of a simple intratesticular cyst was made by ultrasound. This patient was followed conservatively until enlargement resulted in excision of the cyst with preservation of the gonad. In the other case the diagnosis was made intraoperatively and simple excision of the lesion with testicular sparing was performed. High resolution real-time ultrasound should be performed routinely for all suspected testicular masses in children. Benign testicular tumors are more common than in adults and ultrasound may permit identification of lesions that can be excised locally with testicular preservation. Should the diagnosis of a simple, small intratesticular cyst be made by ultrasound regular followup may be appropriate. Should enlargement occur surgical excision can be done with the possibility of gonadal preservation.     

The classification, diagnosis and treatment of closed injuries to the scrotum and testis

Clinical and intraoperative evidences of closed scrotal and testicular injuries were correlated in 119 out of 171 treated patients. On the basis of clinical and anatomical signs the authors developed the classification of the aforementioned injuries distinguishing between the isolated scrotal and testicular ones. In 80.9 per cent of the patients operated on for the testicular injuries the patterns of the trauma were identified as the ruptures, contusions, or intratesticular hematomas. With regard to the clinical signs the classification permitted one to diagnose isolated injuries of the scrotum, the ruptures of the testis or intratesticular hematomas. Regardless of the extent of the trauma (testicular ruptures or intratesticular hematomas) histological studies revealed hemorrhagic infiltrations, vascular thromboses and dystrophic changes of the tubular epithelium only in the hours immediately after the accident. The authors documented the early development of suppuration and sclerosis of the compromised organ. The conservative treatment was found to be advisable only for the patients with isolated scrotal injuries and small hematomas in tunica dartos. Large hematomas in tunica dartos, testicular ruptures or intratesticular hematomas necessitated the performance of emergency organ-sparing surgeries with the use of anticoagulants, antibiotics and anti-inflammatory drugs. The above treatment policy was a success in 65 per cent of these treated.     

Two cases of testicular infarction: the usefulness of enhanced MRI for preoperative diagnosis]

The differential diagnosis in acute scrotum, particularly torsion of spermatic cord and epididymitis, is sometimes difficult. An erroneous diagnosis may result in unnecessary and improper treatment. We report two cases of testicular infarction including torsion of spermatic cord, preoperatively diagnosed by enhanced magnetic resonance imaging (MRI). Case 1: A 16-year-old boy presented with a 3-day history of left scrotal swelling and left lower abdominal pain. He had fever and leukocytosis. Antibiotics for 2 days failed to relieve the symptoms. Enhanced MRI showed absence of blood flow in the left testis. Scrotal exploration revealed hemorrhage and necrosis in the left testis. Left orchiectomy and right orchiopexy were performed. Case 2: A 12-year-old boy visited with scrotal swelling and fever 30 hours after an acute onset of left scrotal pain. Enhanced MRI showed absence of blood flow in the left testis. Exploration revealed left necrotic testis with torsion of spermatic cord. Left orchiectomy and right orchiopexy were performed. Our two cases suggested that enhanced MRI, by which the intratesticular blood flow can be evaluated, may be useful for the diagnosis of testicular infarction.     

Influence of human menopausal gonadotrophin treatment on testicular blood flow and on seminal plasma nitric oxide levels in infertile males

Gonadotrophin treatment is capable of increasing intratesticular blood flow and improving sperm fertilization potential. A nitric oxide (NO)-mediated mechanism may play a role. This study aimed at evaluating whether the increase in intratesticular blood flow, in response to human menopausal gonadotrophin (hMG) treatment, is accompanied by an increase in seminal plasma NO levels in 20 normogonadotropic males affected by severe oligoasthenoteratozoospermia. Patients received 150 IU of hMG, three times a week for 3 months. Before starting treatment and at month 3 of therapy, levels of NO in the seminal plasma were determined, followed by ultrasound scanning of testis, Doppler evaluation of intratesticular vascular resistance, serum hormone and conventional semen evaluation. Statistical analysis was performed by using Wilcoxon test; the limit of statistical significance was p<0.05. At the end of treatment, seminal plasma concentration of NO, conventional semen parameters and testicular volume did not increase significantly. Follicle-stimulating hormone serum level significantly increased (p=0.014) after treatment, whereas luteinizing hormone, testosterone and oestradiol values did not change. The resistance index of both intratesticular arteries significantly decreased (p=0.012 and 0.005 for right and left testes respectively). The results of this study confirmed the positive effect of exogenous hMG on testicular blood flow, but failed to demonstrate any effect of hMG treatment on NO levels in the seminal plasma in infertile males.     

Does testicular mass always require orchiectomy?

Surgical exploration of a testicular mass should follow the basic principles of cancer surgery, including an inguinal approach, occlusion of the spermatic vessels, opening of the tunica vaginalis, and careful exploration of the testicle, epididymis, paratesticular structures, and spermatic cord. In a very few patients, when intratesticular lesion is small and moveable and can be seen through the tunica albuginea, and if there is a long history of scrotal mass, then the tunica albuginea should be opened and intratesticular exploration performed. The opening of the tunica albuginea does not violate the principles of cancer surgery, and for a few selected cases can prevent unnecessary orchiectomy. The incision of the tunica albuginea should no longer represent a surgical taboo to the urologist. Six cases of rare, benign intratesticular tumors are presented along with a rare indication for intratesticular exploration and testicle-preserving surgery.     

Assessment of the intratesticular resistive index by colour Doppler ultrasonography measurements as a predictor of spermatogenesis

OBJECTIVE

To investigate the value of the resistive index (RI) of intratesticular arteries, and to establish diagnostic criteria for normal and pathological sperm counts on the basis of quantitative colour Doppler ultrasonography (CDUS), as the assessment of the testicular RI is widely used to measure intratesticular blood flow.

PATIENTS AND METHODS

In all, 160 men (aged 22–43 years, 320 testicles) were prospectively investigated; 80 had a normal and 80 a pathological sperm count, the latter having mild oligoasthenozoospermia. The RI was measured using a high‐frequency Doppler ultrasound probe (14 MHz), three times on each testicle at an intratesticular artery in the upper, middle and lower testicular pole. The testicular volume was also measured by US. The RI values were compared between patients with normal and pathological sperm counts, and were compared statistically with testicular volumes. In addition, blood samples were obtained for DNA extraction, chromosome analysis and hormonal evaluations.

RESULTS

Patients with normal sperm counts had a mean (sd ) RI of 0.54 (0.05) and a mean testicular volume of 18.7 (5.2) mL, the respective values in those with pathological sperm counts were 0.68 (0.06) and 16.8 (6.0) mL, with a significantly greater RI in the latter (P < 0.001), but with no statistically significant difference in testicular volume between the groups (P > 0.05).

CONCLUSION

These preliminary data suggest that an RI of >0.6 might be suggestive of a pathological sperm count in andrological patients. The intratesticular RI as measured by CDUS seems to be a reliable indicator for routine clinical use to identify subfertile men.     

Testicular fine-needle aspiration for the assessment of intratesticular hormone concentrations

Measurement of intratesticular sex steroid concentrations in men informs both the development of male hormonal contraceptives and the understanding of male infertility. Given the challenges of using invasive techniques to measure testicular hormone physiology, our group has used a minimally-invasive fine-needle aspiration technique to measure intratesticular hormones in normal healthy men. Herein, we present a post-hoc analysis of the safety and efficacy of testicular fine-needle aspiration (FNA) completed as part of six clinical trials. From 2001 through 2011, a total of 404 procedures were conducted among 163 research volunteers, 85.9% of which were successful in obtaining sufficient fluid for the measurement of intratesticular steroid concentrations. Pain was the most common side effect, with 36.8% of procedures associated with moderate procedural pain and 4.7% with severe procedural pain. Postprocedural pain was uncommon and abated within a few days. Mild local bruising occurred with 14.9% of procedures. Two serious adverse events (0.5%) required surgical intervention. The risk of an adverse event was not associated with age, body mass index, testicular size, or the volume of fluid aspirated. Testicular FNA to obtain fluid for measurement of intratesticular steroid concentrations frequently causes mild to moderate procedural pain, but serious adverse events occur rarely. Testicular FNA has been instrumental for defining human intratesticular hormone physiology and is a minimally-invasive, safe, effective method for obtaining fluid for research on testicular physiology and pathology.     

Metastatic intratesticular alveolar rhabdomyosarcoma discovered after induction of systemic chemotherapy

Alveolar rhabdomyosarcoma is an aggressive cancer that can metastasize to a variety of organs. We present what we believe to be the first reported case of metastatic intratesticular rhabdomyosarcoma in a patient presenting with testicular pain shortly after the induction of systemic chemotherapy. The published data regarding this unusual condition are reviewed.     

节段性睾丸梗死二例报告

节段性睾丸梗死发病率极低,通常表现为睾丸急性疼痛,需与睾丸肿瘤、睾丸扭转等鉴别,只有少数病例报告。本文报道2例,例1患者13岁,因右睾丸肿大、疼痛3 d,伴呕吐1次于2017年5月5日入院,行右侧阴囊探查+睾丸固定术,术后诊断为右侧睾丸局部梗死。术后第5日睾丸疼痛症状消失出院。术后1年查彩色多普勒超声未见明显异常。例2患者26岁,2018年3月15日因左睾丸肿痛6 d入院,彩色多普勒超声检查提示左睾丸局部梗死可能。入院诊断为左侧睾丸局部梗死,予血塞通、那曲肝素钙、迈之灵片治疗,治疗7 d后患者疼痛症状好转出院。出院后1个月患者无疼痛不适,复查彩色多普勒超声示左睾丸下极团样低-等回声,周边少量星点状血流信号。     

A rare cause of infertility: intratesticular varicocele associated with ipsilateral extratesticular varicocele

Intratesticular varicocele is an uncommon condition with variable sonographic appearence and identified as dilated intratesticular veins lying from the mediastinum through testicular parenchyma. We present a case of a 20‐year‐old male, married and unable to conceive for 2 years. Routine scrotal sonography disclosed extratesticular varicocele which was associated with ipsilateral intratesticular varicocele. Colour Doppler ultrasonography should be the first choice modality of imaging to confirm the diagnosis. Detection of intratesticular varicocele is essential because it is one of the most common recoverable reasons of male infertility.     

HCG treatment increases intratesticular pressure in the abdominal testis of unilaterally cryptorchid rats

Adult, unilaterally cryptorchid rats were given a single subcutaneous injection of hCG. HCG treatment of 100 I.U. (but not 10 I.U.) resulted in a marked increase in intratesticular pressure (approximately 40 mm Hg) in the abdominal testis that was maximal 24 hours after treatment. This increase in pressure is caused by increased vascular permeability coupled with insufficient lymph drainage. In the scrotal testis, hCG treatment resulted in increased vascular permeability and lymph flow, but this did not result in a marked increase in testicular pressure. No morphologic signs of hCG-induced damage were observed in either the abdominal or scrotal testis 10 days after hCG treatment. Testicular microcirculation, as studied by laser doppler flowmetry, was abnormal in the abdominal testis, but hCG treatment inhibited vasomotion in both the abdominal and scrotal testis.     

Testicular focal atrophy – tubular blockade as partial degeneration of the tubule

This study investigated whether focal atrophy is a degenerative process of a whole tubule or tubular blockade as partial intratesticular degeneration. Serial section analyses of testicular tissue from 19 men with different andrologic diseases were examined. From every fifth section of any series, defined areas were viewed under a light microscope, and tubule sections were drawn. Three-dimensional reconstructions were made from these materials. Reconstructions of the seminiferous tubules showed tubular blockade as partial degeneration of the tubules. Transition from an intact portion to a blockade was accompanied by an increase in the thickness of the lamina propria. The blockade was a cell cord that contained Sertoli cells and, at most, spermatogonia, or it was a completely atrophied tubule, a so-called tubular scar. In a given tubule, defined areas of atrophy and areas of spermatogenic activity were both found. Occurrence of tubular blockade increased with age. Serial section analyses of testicular tissue showed tubular blockade as the partial degeneration of seminiferous tubules. In focal atrophy, a given tubule can have defined areas of atrophy and areas of spermatogenic activity. Received: 25 August 1999 / Accepted: 21 April 2000     

精索形态观察在睾丸扭转早期诊治中的意义

目的:提高睾丸扭转早期的诊断和治疗水平。方法:回顾性分析49例睾丸扭转的临床资料及睾丸内血流声像图和精索超声特征。结果:49例睾丸扭转患者,彩色多普勒血流显像出现睾丸血流改变42例,其中血流增加3例,睾丸血流无明显改变7例;二维超声检查发现精索形态异常47例。手术复位固定21例,睾丸存活12例。结论:彩色多普勒超声扫描精索形态与睾丸血流变化对睾丸扭转的早期诊断有重要价值,尽早手术探查有助于挽救存活睾丸。