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     

大鼠单侧精索扭转后保留同侧坏死睾丸对对侧睾丸和附睾的组织学影响

目的:将大鼠单侧精索持续扭转96 h,研究保留扭转侧坏死睾丸对对侧睾丸和附睾的影响,以说明延迟性的睾丸切除是否对对侧睾丸功能有保护作用。方法:将33只青春前期(21～42日龄)正常雄性SD大鼠,随机分为假手术对照组(n=11)、扭转保留组(n=12)和扭转切除组(n=10)。假手术对照组只对左侧睾丸行睾丸肉膜囊固定术,后两组扭转实验组用睾丸肉膜囊固定术固定维持扭转720°的睾丸、附睾,在扭转96 h后将扭转保留组扭转侧睾丸、附睾行复位及固定,而同时扭转切除组则将扭转侧睾丸、附睾切除。术后3个月抽取血液标本,ELISA测定大鼠血清睾酮、抗精子抗体浓度。同时取睾丸、附睾标本,石蜡包埋切片后作组织学观察,并利用体视学方法定量研究睾丸、附睾结构的体积以及生精小管直径。结果:3组大鼠血清睾酮值无统计学差异;仅扭转保留组造模后1例大鼠血清抗精子抗体阳性。光镜下定性观察发现精索扭转组睾丸间质细胞核较假手术对照组间质细胞核增大,假手术对照组、扭转保留组和扭转切除组睾丸结构有明显形态改变的数量分别为1、3、0只。扭转保留组对侧睾丸相对假手术对照组睾丸体积增加19%,相应附睾体积增加11%,扭转切除组对侧睾丸体积增加21%,附睾体积增加7%,且睾丸代偿性肥大具有统计学意义(P<0.05)。假手术对照组、扭转保留组和扭转切除组对侧睾丸生精小管体积分别为(1.15±0.07)、(1.30±0.04)、(1.35±0.05)cm3,3组间无显著性差异。3组大鼠对侧睾丸内间质体积分别为(0.25±0.02)、(0.36±0.02)、(0.34±0.03)cm3,精索扭转组和假手术对照组相比显著增加(P<0.05)。3组大鼠对侧睾丸内生精小管直径分别为(226.00±7.00)、(223.00±6.00)、(221.00±3.00)μm,无显著性差异(P>0.05)。结论:单侧精索长期扭转后对侧睾丸、附睾主要改变是单侧去势后的对侧代偿性肥大表现,是否切除对对侧睾丸和附睾组织学上无明显影响。     

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。     

一侧睾丸扭转对侧睾丸预防性固定必要性的研究

目的探讨睾丸扭转对侧睾丸预防性固定必要性。方法分析31例睾丸扭转病人做预防性固定及末做预防性固定后盲发生睾丸扭转的机率。结果仅1例未做预防性固定后再发生睾丸扭转。结论 一侧睾丸扭转对侧睾丸的预防性固定有手术的必要性，但并非绝对必须。     

新生儿睾丸扭转

新生儿睾丸扭转是睾丸扭转的特殊形式。一旦明确诊断或高度怀疑时应急诊探查 ,但睾丸功能的保留十分困难。对侧睾丸的固定问题仍然存在较大争议 ,但从急诊的观点出发 ,应行对侧睾丸固定术。单侧睾丸扭转后的长期后遗症像精子发生、生育和第二性征的发育及相关药物的治疗仍需进一步研究     

睾丸扭转的研究进展

睾丸扭转是阴囊内常见急症,主要由于睾丸扭转后睾丸缺血可致睾丸坏死.睾丸扭转可发生于从新生儿到78岁的任何年龄,这其中又有两个年龄高峰:新生儿期和青春期.并且青春期睾丸扭转发病率占所有睾丸扭转中比例最高,因此睾丸扭转导致的生育能力下降将严重影响患者的家庭和生活质量.为了提高患者生育率,最近越来越多的人研究睾丸扭转后及睾丸扭转复位后睾丸及附睾损伤的机制,以使睾丸及附睾能够减轻因缺血和再灌注导致的细胞损伤,延长扭转后睾丸坏死的时间 ,为保留睾丸争取时间,减少了睾丸切除的机率.     

睾丸扭转的研究进展

睾丸扭转是阴囊内常见急症,主要由于睾丸扭转后睾丸缺血可致睾丸坏死。睾丸扭转可发生于从新生儿到78岁的任何年龄,这其中又有两个年龄高峰：新生儿期和青春期。并且青春期睾丸扭转发病率占所有睾丸扭转中比例最高,因此睾丸扭转导致的生育能力下降将严重影响患者的家庭和生活质量。为了提高患者生育率,最近越来越多的人研究睾丸扭转后及睾丸扭转复位后睾丸及附睾损伤的机制,以使睾丸及附睾能够减轻因缺血和再灌注导致的细胞损伤,延长扭转后睾丸坏死的时间,为保留睾丸争取时间,减少了睾丸切除的机率。     

睾丸扭转与睾丸干细胞凋亡

睾丸扭转，即使没有睾丸组织梗死出现，但由于扭转所致的睾丸缺血后再灌注损伤，产生活性氧族诱发广泛睾丸干细胞凋亡，睾丸生精作用受损，可能导致男性不育     

On unilateral testicular and epididymal torsion: no effect on the contralateral testis

It is often stated that unilateral testicular torsion results in damage to the contralateral testis; however, there are a growing number of experimental and clinical papers which suggest this is not so. Conflicting results from experimental studies confuse the issue and may be due, among other things, to some specifics of the experimental model. In the present paper, we have examined bilateral rat testes 30 and 60 days after 720 degrees torsion to determine 1) the effect of unilateral testicular torsion with and without the inclusion of epididymal torsion, 2) the effect of relatively chronic torsion (24 hr., 10 day) versus relatively acute torsion (two hr., four hr.), and 3) the effect of establishing the model using scrotal surgery versus using an abdominal approach. Bilateral testicular histology, testis wt. (gm.), cauda epididymal sperm concentrations (sp./ml.), and cauda sperm motility scores (0-4) were examined. Ipsilateral testicular torsion or testicular plus epididymal torsion of two hr. or four hr. duration significantly reduced (p less than .05) ipsilateral testis weights, sperm concentrations, and motility scores, and disrupted normal tissue histology. Contralateral testicles were not altered. Epididymal ischemia alone produced no significant ipsilateral or contralateral effects. Chronic torsion (one day, 10 days) also destroyed ipsilateral testis function without altering the contralateral testicles. The occult cryptorchidism associated with the scrotal approach to establishing the torsion model had no effect on contralateral testicles. In no group, using either Lewis rats or Sprague-Dawley rats, were contralateral testicles altered by unilateral testicular torsion. These results plus recent clinical reports indicate that contralateral testicular damage due to ipsilateral torsion is hardly a proven phenomenon, let alone a significant factor contributing to male infertility.     

Effect of testicular torsion on the contralateral testis

It has been previously shown that unilateral testicular torsion can cause disruptive anatomic changes in the contralateral testis in rats [1]. In this experimental study plasma and urine prostaglandin E2 levels were studied correlatively with testicular histopathology in acute testicular torsion cases. As a result of this study, necrobiotic morphologic alterations causing testis necrosis and significant increase in plasma prostaglandin E2 levels were observed. Contralateral testicular histology was analyzed in all dogs. None of them showed abnormal tubular architecture.     

Late hormonal function after testicular torsion

Introduction

Testicular torsion may be an important cause of male infertility. We aimed to investigate the late hormonal function in patients with testicular ischemia/reperfusion injury of the testis after orchidectomy or detorsion.

Methods

Twenty patients (mean age, 13.6 years) were prospectively evaluated at a mean of 5 years after testicular torsion. The serum follicle-stimulating hormone, luteinizing hormone (before and after gonadotropin-releasing hormone stimulation), testosterone, and inhibin B were measured. Fifteen age-matched adolescents without evidence of endocrine disease were used as controls for inhibin B values. Data are quoted as mean ± SEM.

Results

Twelve patients were treated with detorsion and orchidopexy, and 8 underwent orchidectomy. Serum follicle-stimulating hormone, luteinizing hormone, and testosterone were all within the reference range. Inhibin B levels were significantly reduced in the 2 groups compared with the controls (34.5 ± 5.2 vs 63.9 ± 12.8 pg/mL, P = .02), but were not significantly different between the orchidectomy group and the group that underwent detorsion (41.3 ± 9.7 vs 30.4 ± 5.9 pg/mL, P = .41).

Conclusion

Hormonal testicular function can be compromised after testicular torsion, although the type of surgery (orchidectomy or orchidopexy) does not seem to change the effect of this ischemia/reperfusion injury.     

Reperfusion injury after detorsion of unilateral testicular torsion

Summary Reperfusion injury has been well documented in organs other than testis. An experimental study was conducted to investigate reperfusion injury in testes via the biochemical changes after unilateral testicular torsion and detorsion. As unilateral testicular torsion and varicocele have been shown to affect contralateral testicular blood flow, reperfusion injury was studied in both testes. Given that testicular blood flow does not return after 720° testicular torsion lasting more than 3 h, the present study was conducted after 1 and 2 h of 720° torsion. Adult male albino rats were divided into seven groups each containing ten rats. One group served to determine the basal values of biochemical parameters, two groups were subjected to 1 and 2 h of unilateral testicular torsion respectively, two groups were subjected to detorsion following 1 and 2 h of torison respectively, and two groups underwent sham operations as a control. Levels of lactic acid, hypoxanthine and lipid peroxidation products were determined in testicular tissues. Values of these three parameters obtained from the sham operation control groups did not differ significantly from basal values (P>0.05). All three parameters were increased significantly in both ipsilateral and contralateral testes after unilateral testicular torsion when compared with basal values (P<0.01 and P<0.05, respectively). Detorsion caused significant changes in lipid peroxidation products levels in ipsilateral but not in contralateral testes when compared with values obtained after torsion (P<0.01 and P>0.05, respectively). It is concluded that ipsilateral testicular torsion causes a decrease in perfusion not only in the ipsilateral but also in the contralateral testis. Additionally, detorsion following up to 2 h of 720° torsion causes reperfusion injury in ipsilateral but not in contralateral testis.     

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.     

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.     

Activation of endothelial nitric oxide synthase in contralateral testis during unilateral testicular torsion in rats

There are controversies about the injury of the contralateral testis during unilateral testicular torsion (UTT). An autonomic reflex arc between bilateral testes has been proposed. The authors focused on the involvement of nitric oxide (NO) in the contralateral testis during UTT. Eight-week-old male Wistar rats underwent unilateral torsion (1 h)-detorsion (up to 24 h). NO synthase (NOS) activity was detected as NADPH-diaphorase activity after fixation by paraformaldehyde. N-nitro-L-Arginine methyl ester (L-NAME, 20 mg/kg) was injected intravenously to the other group of rats. To evaluate the testicular injury, proteolysis of alpha-fodrin production was detected by Western blotting. Apoptosis of the germ cells was evaluated by TUNEL. Long-term effect on spermatogenesis was evaluated by flow cytometry at 60 days after UTT. Transient activation of NOS was detected following the proteolysis of alpha-fodrin in the contralateral testis. L-NAME inhibited these alterations. NADPH-diaphorase activity and eNOS immunoreactivity were co-localized in the endothelial cells. These reactions were not observed in other organs. There was neither enhanced apoptosis nor deteriorated spermatogenesis in the contralateral testis during and 60 days after UTT. In the contralateral testis, eNOS-derived NO regulates the vasomotor function against unilateral testicular torsion, whereas it acts slightly cytotoxic. These results suggest the possible involvement of a testis-specific neurovasomotor reflex between the bilateral testes.     

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.     

Acute experimental testicular torsion. No effect on the contralateral testis

Other investigators have shown that chronic unilateral testicular torsion produces negative effects on the contralateral testis in experimental animals. In the present study, bilateral testicular weight and histology, and concentrations and motility of spermatozoa from the cauda epididymidis were studied after 0 to 4 hours of acute unilateral testicular torsion in the rat. The obstruction of blood flow by torsion was documented, as well as the presence or absence of return blood flow after the relief of torsion. The above mentioned parameters of testicular function were studied at 7, 30, and 60 days after relief of torsion. Ipsilateral testis weights and epididymal sperm concentrations and motility were significantly reduced by 1, 2, and 4 hours of torsion. The histology of torsioned testes was also severely altered, and no seminiferous epithelial repair was evident 60 days after torsion. Contralateral testicles were not affected by ipsilateral torsion of 1, 2, or 4 hours duration, despite the fact that the ipsilateral testis function was completely compromised by 2 and 4 hours of torsion. These results indicate that there would be no clinical benefit in removing the acutely torsioned testis of Sprague-Dawley rats since it poses no threat to the contralateral testis.     

Valoration of the FAS in the contralateral testis after unilateral testicular torsion. Experimental study in rats

The role the FAS and BCL-2 in the apoptosis of testicular cells in the contralateral testis after unilateral testicular torsion, was investigated. We compared with control group. These experiments were performed in male Wistar rats prepuberal old. FAS and BCL-2 determination is realized in cells cultures of contralateral testis. Flow cytometry and immunohistochemistry studies, using a FAS and BCL-2 specific monoclonal antibody, were utilized to value FAS y BCL-2 expression on testiculaires cells following unilateral testicular torsion. We observed an increase of expression of FAS and decrease of BCL-2 in the contralateral testis in comparison with control group. The present results may indicate that the expression of this molecules is implicated in cellular apoptosis.