Torsion of spermatic cord and testicular appendages

Forty-seven cases of torsion of the spermatic cord and testicular appendages have been reviewed. Twenty-eight patients with acute spermatic cord torsions underwent surgical correction. Only 10 were treated in time to preserve viability. The other cases were either gangrenous and required orchidectomy or were questionably viable. Acute, painful scrotal swelling with negative findings on urinalysis is a surgical emergency. Ten patients had warning attacks, but because of delay in diagnosis and treatment, 4 required orchidectomy. Those patients with spermatic cord torsion who were detorsed before twelve hours had elapsed had viable testes. Patients with complaints of intermittent scrotal swelling and pain, with negative urinalysis, may be suffering from intermittent spermatic cord torsion and should be evaluated for prophylactic orchidopexy; 7 patients were treated in this manner. Six of these had a transverse lie of both testes, which suggested the underlying anatomic defect leading to torsion of the spermatic cord. The diagnosis of epididymitis or epididymo-orchitis is untenable with a negative finding on urinalysis and results in delay in correct diagnosis and treatment.     

精索扭转的诊断及治疗(附26例报告)

目的总结精索扭转的诊治经验。方法回顾性总结了1995年6月-2004年6月期间26例精索扭转患者的诊治资料,结合文献进行分析。结果本组26例患者经彩超检查（CDu）确诊为精索扭转23例,25例患者经手术证实为精索扭转。1例手法复位治愈,18例行坏死睾丸切除术。7例手术复位者随访0．5—3年,6例复位睾丸血流正常,1例睾丸萎缩。结论在诊断精索扭转中,CDU与核素显像相比,CDU具有准确率高,方便快捷。早期诊断、及时手术探查行扭转精索复位和睾丸固定是提高睾丸存活率的关键。     

Is ipsilateral testis mandatory for contralateral testicular deterioration encountered following spermatic cord torsion?

Although deteriorating effects of unilateral spermatic cord torsion are generally accepted, the mechanism remains controversial. An experimental study was performed to evaluate the necessity of testicular and spermatogenetic material for contralateral testicular deterioration following unilateral spermatic cord torsion in rats. The animals were allocated to four groups: control, spermatic cord torsion, subepididymal orchiectomy, and spermatic cord torsion 14 days after subepididymal orchiectomy. The testes were removed on the 14th days and mean seminiferous tubular diameters and mean testicular biopsy scores were determined. Although contralateral testicular deterioration was more pronounced in the presence of testicular tissue, the absence of testicular tissue and/or spermatogenetic material did not prevent its occurrence. This is highly suggestive that autoimmune mechanism does not play a role in contralateral testicular damage following unilateral spermatic cord torsion.     

睾丸扭转和精索扭转的诊断与治疗(附68例报告)

目的:探讨睾丸和精索扭转的诊断与治疗方法,提高睾丸和精索扭转的治疗水平。方法:对68例睾丸和精索扭转的临床资料进行总结,68例平均年龄21岁,<20岁者占84%,左侧55例占80.8%.发病至确诊时间6h～30天,12h以上者占90.2%。结果:53例术前彩色多普勒血流动态显象(CDFI)应作为诊断疾病的常见与首选检查方法。诊断并经手术证实,符合率100%,经手术探查;41例行手术复位、固定,睾丸获救。27例行患侧睾丸切除术,所有病例均行对侧探察,固定。结论:阴囊X核素显象,B超对睾丸精索扭转早期诊断有帮助。早期诊断,及时治疗是提高疗效的关键。彩色多普勒血流动态显象应作为诊断该疾病的常见及首选检查方法,对睾丸精索一旦确诊或疑有精索扭转的患者应及早行紧急复位,以期挽救睾丸,同时行睾丸固定术也十分必要。对于确诊毫无保留价值的睾丸需行切除术。     

睾丸扭转的早期诊断和治疗

目的 提高睾丸扭转的早期诊治水平.方法 回顾性分析本院2001年4月至2011年5月得到早期诊断和治疗的12例睾丸扭转患者的临床资料.平均年龄21(14～28)岁.发病至确诊时间2～6h,平均4.5h..12例发病时均有睾丸剧烈疼痛症状.12例均表现患侧精索异常.12例均行彩超检查,11例显示血流消失或减少.结果 12例均在发病后10小时内手术复位.结论 早期睾丸扭转诊断应重视精索的检查,精索异常是最主要的特征,彩超是最重要的辅助检查且有诊断价值.     

彩色多普勒超声在精索扭转诊断和鉴别诊断中的价值

目的 :应用彩色多普勒超声鉴别精索扭转和急性睾丸炎。　方法 :回顾性分析 13例急性睾丸疼痛病人的彩色多普勒血流显像 (CDFI)表现和治疗情况。　结果 :8例显示睾丸内血流信号稀疏或消失 ,诊断为精索扭转 ,其中 1例手法复位成功 ,7例手术探查并得以证实。其余 5例显示患侧睾丸血流信号丰富 ,诊断为急性睾丸炎或睾丸附睾炎 ,经抗生素治疗后症状好转 ,超声复查显示血流减少。　结论 :CDFI在精索扭转诊断和鉴别诊断中具有重要意义 ,可作为急性睾丸疼痛病人的首选检查方法     

睾丸扭转处理与探讨

目的 :提高睾丸扭转的诊断和治疗水平。　方法 :回顾性分析 9例睾丸扭转疑诊病例 ,并结合文献进行分析。　结果 :9例患者年龄为 12～ 2 7岁 ,平均 15岁 ,1例经过镇痛治疗后自行复位 ,8例行手术治疗 ,其中 7例手术证实为睾丸扭转 ,1例术中探查为急性附睾炎。睾丸扭转患者中有 6例绕精索旋转 180°～ 72 0° ,1例绕着与精索垂直的轴线旋转 180°。彩色多普勒超声检查准确率为 87.5 % ,所有病例均有阴囊皮肤红肿 ,Prehn征 ( + )。　结论 :对突发睾丸疼痛应常规行彩色多普勒超声检查 ,睾丸扭转方向不全是绕精索轴旋转 ,手法复位不可靠 ,若怀疑为睾丸扭转 ,应急诊手术探查     

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。     

Multicenter assessment of ultrasound of the spermatic cord in children with acute scrotum

PURPOSE: Intravaginal or extravaginal spermatic cord torsion is a diagnostic challenge for the surgeon and radiologist. Color Doppler sonography can be inaccurate, leading to dangerous false-negative results. To date, no single reliable test has been able to provide 100% diagnostic accuracy. The direct visualization of the twisted cord during emergency high resolution ultrasonography has been proposed to avoid systematic and abusive surgical exploration. The aim of this multicenter study was to assess the validity and reproducibility of high resolution ultrasonography based management of acute scrotum in children. MATERIALS AND METHODS: A total of 919 patients from 11 European university hospitals underwent color Doppler sonography and high resolution ultrasonography for acute scrotum between 1992 and 2005. The spermatic cord was studied along its complete length to detect a spiral twist. The surgical findings were correlated with the preoperative results. RESULTS: A total of 208 patients had spermatic cord torsion proved at surgery. Intratesticular vascularization was absent in the affected testis in only 158 cases (76%). In contrast, high resolution ultrasonography detected the twist as a snail shell-shaped mass, measuring 7 to 33 mm, in 199 patients (96%). High resolution ultrasonography revealed a linear cord for all other causes of acute scrotum (711 patients) with a specificity of 99%. The radiologist training level was the best predictive factor of high resolution ultrasonography reliability (p <0.05). CONCLUSIONS: High resolution ultrasonography based management of acute scrotum is reliable and reproducible. Thanks to its high sensitivity and specificity for the diagnosis of spermatic cord torsion, high resolution ultrasonography can significantly improve the management of acute scrotum in children.     

睾丸扭转诊治体会(附39例报告)

目的 提高睾丸扭转的诊治水平。方法 对39例睾丸扭转患者的临床资料进行总结。39例均有睾丸绞痛症状，Prehn征阳性20例。8例行阴囊核素显像检查，均有放射性分布缺损。B超显示睾丸、附睾在阴囊内位置改变，睾丸内血流减少或消失。结果 5例12h以内手术者，睾丸均存活；5例12～24h手术者，3例睾丸存活；27例超过24h手术者，仅6例睾丸存活。2例未手术。结论 阴囊核素显像、B超对睾丸扭转早期诊断很有帮助。早期诊断、及时治疗是提高疗效的关键。     

精索形态声像图在睾丸扭转诊断中的价值

目的分析睾丸扭转精索及睾丸内血流声像图表现，旨在强调精索二维图像在睾丸扭转中的价值。方法回顾性分析经手术证实的睾丸扭转患者精索超声和睾丸内血流CDFI检查的声像图特征。结果35例睾丸扭转患者，34例二维出现精索形态异常，31例CDFI出现睾丸内血流改变异常，敏感性分别为97．14％、80．00％；特异性分别为100％、96．70％。结论精索形态声像图改变在睾丸扭转诊断中具重要价值。     

Prenatal testicular torsion: principles of management.

To assess our experience with in utero testicular torsion, we retrospectively studied all newborns presenting in the newborn nursery with a diagnosis of neonatal testicular torsion. A total of 25 consecutive cases of torsion of the spermatic cord in 23 patients was identified and explored on an emergency basis. To our knowledge this represents the largest single institution series and 40% of all of the confirmed cases reported in the literature. No viable testicles were found. We strongly believe that torsion of the testis presenting at birth represents an irreversible intrauterine event best treated in an early elective setting. We suggest an inguinal approach with contralateral orchiopexy in all patients who present with signs and symptoms of prenatal (in utero) testicular torsion.     

睾丸钟摆畸形与睾丸扭转22例报告

目的 提高对睾丸钟摆畸形（bell-clapper deformity，BCD）的认识，探讨鞘膜内睾丸扭转的解剖和发病特点。方法 回顾性分析22例间歇性睾丸疼痛病例，年龄7～23岁，平均17岁。左侧18例、右侧4例。其中睾丸扭转坏死16例、睾丸大小正常4例、左侧睾丸萎缩2例。结果 22例解剖上均有钟摆畸形即睾丸缺乏正常鞘膜的包裹，睾丸引带缺如，缺乏与壁层鞘膜的粘连，鞘膜腔大，鞘膜在精索上的止点较高，精索活动度较大。16例睾丸坏死或萎缩者行病侧睾丸切除，对侧睾丸固定；6例间歇性睾丸疼痛患者作双侧睾丸探查及固定。22例随访6个月～10年，平均4年9个月，均无睾丸疼痛症状。结论 应高度重视间歇性睾丸疼痛患者，提高间歇期或扭转早期的诊断率，在睾丸未发生扭转坏死之前及时行双侧睾丸探查及固定术，减少睾丸坏死率。     

Pathogenesis of testicular atrophy in spermatic cord torsion in childhood

Results of experiments (in 123 immature male rats) and clinical investigations (in 22 children) have shown that changes in a testicle resulting from torsions of the spermatic cord are dependent not only on the time from the moment of torsion and its degree, but also on a disturbance of the hemato-testicular barrier and a developing auto-immune process in the operated testicle.     

睾丸扭转误诊113例分析

目的 :提高睾丸扭转 (精索扭转 )诊治水平。　方法 :回顾分析 1994～ 2 0 0 4年总计 113例睾丸扭转误诊的临床资料。　结果 :首诊误诊率 84 .3%。误诊为急性附睾、睾丸炎 81例 (71.7% ) ;鞘膜积液 10例 (8.8% ) ;急性肠炎 7例 (6 .2 % ) ;泌尿系结石 5例 (4.4 % ) ;腹股沟疝 5例 (4.4 % ) ;睾丸肿瘤 3例 (2 .7% ) ;附睾结核 2例 (1.8% )。发病至误诊时间 2h～ 2个月 ,平均 6 .3d。手法复位成功 3例 ;92例行手术探查 ,睾丸、附睾切除 6 4例 ,睾丸萎缩 2 6例 ,总计睾丸毁损率 79.6 %。　结论 :提高首诊医生对睾丸扭转的诊治水平是减少误诊的关键 ,诊断流程采用病史、体征、彩超 3者结合 ,治疗的最佳方法是积极开展阴囊急诊的手术探查。     

Paracolic recurrence: the importance of wide excision of the spermatic cord at retroperitoneal lymph node dissection.

PURPOSE: Four patients who underwent retroperitoneal lymph node dissection elsewhere and subsequently had radiographic evidence of expanding ipsilateral paracolic recurrence were referred to our institution for treatment. We evaluated ipsilateral spermatic cord metastatic involvement at retroperitoneal lymph node dissection and identified the possible etiology of these unusual recurrences. MATERIALS AND METHODS: Between January 1988 and February 1998, 34 of 685 patients who underwent a total of 702 retroperitoneal lymph node dissections had metastatic disease in the spermatic cord specimen. Variables examined in this group of patients included other disease sites, lymphovascular invasion in the primary tumor, histopathological findings of the primary tumor and retroperitoneal disease, clinical and pathological stage, disease side and the specific site of anatomical involvement of metastatic disease within the spermatic cord specimen, that is spermatic vessels and/or surrounding lymphatic tissue. RESULTS: Of these 34 positive spermatic cord specimens 18 were in primary retroperitoneal lymph node dissections and 16 were in post-chemotherapy specimens. Histopathological evaluation in 25 (74%) and 9 (26%) of the 34 primary tumors showed a mixed germ cell pattern and pure embryonal carcinoma, respectively. Similarly 9 of the 34 retroperitoneal lymph node specimens (26%) showed pure embryonal cell carcinoma and the remainder showed mixed histopathological findings. Disease was clinical stage I in 13 cases (38%) and lymphovascular invasion was absent in the primary tumor in 11 (32%). Despite disease in the spermatic cord specimen there was none at the primary landing zone in 2 patients (6%), including 1 in whom the spermatic cord was the only disease site. In 12 positive spermatic cord specimens (35%) disease was identified in the surrounding perivascular and lymphatic tissue without gonadal vessel involvement. CONCLUSIONS: Metastatic disease in the spermatic vessels and/or surrounding lymphatic tissue represents a possible site of recurrence when incompletely excised. The lack of lymphovascular invasion in the primary tumor does not preclude metastatic disease in the spermatic cord specimen. Complete and wide excision of the spermatic cord and surrounding lymphatic tissues at retroperitoneal lymph node dissection is necessary and may prevent paracolic recurrence.     

Can haematologic parameters be used to predict testicular viability in testicular torsion?

The purpose of this study was to evaluate the predictive value of haematologic parameters for testicular survival in torsion. Children with testicular torsion (TT) treated in Beijing Children's Hospital from January 2006 to December 2018 were enrolled in this study. Patient data collected in this study included age, symptom duration, preoperative preparation time, cryptorchidism testicular torsion or not, spermatic cord torsion degree, orchiectomy/orchiopexy, testicular volume 3 months after operation by ultrasound in orchiopexy patients and haematologic parameters. The orchiopexy group comprised of 54 patients with a mean age of 135.6 ± 43.73 months, and the orchiectomy group included 58 patients with a mean age of 119.36 ± 60.82 months. The multivariate analysis showed that symptom duration (Odds Ratio = 1.11, p < 0.001), spermatic cord torsion degree (Odds Ratio = 1.006, p = 0.002) and mean platelet volume (MPV; Odds Ratio = 3.697, p = 0.044) were significant predictors of orchiectomy. The cut‐off value for MPV during window time for orchiectomy was 10.55 fl (10^?9 L) and provided a sensitivity of 47.8% and a specificity of 92.6%. This study found that symptom duration, spermatic cord torsion degree and MPV could be indicators of testicular viability in testicular torsion. MPV can provide valuable information before operation which can guide doctors and family members of the patients to select the appropriate treatment.     

Two cases of liposarcoma of spermatic cord

Liposarcomas are most commonly found in the extremities, in the retroperitoneum and, less often, in the head and neck area. The spermatic cord is a rare site of origin, accounting for about 3-7% of all liposarcomas. We report two cases of liposarcoma of spermatic cord. Case 1. A 69-year-old male presented with complaints of a painless left inguinal mass. MRI showed a huge fatty mass in the left inguinal region. The mass was removed with left testis and spermatic cord. Histopathological examination revealed a well-differentiated and dedifferentiated liposarcoma. The surgical margin was positive, so re-resection was performed. Complete excision was achieved after re-resection. Case 2. A 63-year-old male with the difficulty urinating had a left scrotal mass. Left radical orchiectomy was performed. Histopathological examination revealed a well-differentiated liposarcoma. These are the 84th and 85th cases of liposarcoma of the spermatic cord reported in Japan.     

精索旁侵袭性血管黏液瘤的临床特征(附2例报告及复习文献)

目的探讨精索旁侵袭性血管黏液瘤的临床特征。方法报告2例精索旁侵袭性血管黏液瘤患者的临床资料,结合文献复习进行讨论。结果2例患者的精索旁侵袭性血管黏液瘤均手术完整切除,经随访6~8个月,无肿瘤复发。病理诊断为精索旁侵袭性血管黏液瘤。结论侵袭性血管黏液瘤临床罕见,在男性好发于精索旁,确诊依赖病理学检查,治疗需手术完整切除肿瘤,术后应长期严密随访。     

Malignant fibrous histiocytoma of the spermatic cord

We present 3 cases of malignant fibrous histiocytoma arising from the spermatic cord. This tumor occurs rarely in genitourinary organs and only 2 cases involving the spermatic cord have been reported previously. Recurrence rates of approximately 44 per cent of malignant fibrous histiocytoma in other sites are not improved by radiation or chemotherapy as adjuvants or primary means of treatment. Radical inguinal orchiectomy along with wide en bloc local resection is the therapy of choice.