单侧睾丸扭转对大鼠两侧睾丸生精功能的损害

目的 研究单侧睾丸扭转对大鼠两侧睾丸精子发生的影响。方法 制作单侧睾丸扭转不同时间的大鼠模型，以乳酸脱氢酶X(LDH—X)为观测指标，分析附睾内的精子数量和活力，从而反映睾丸生成精子的能力。部分组别的动物在扭转复位前注射别嘌呤醇，观察药物对组织的保护作用。结果 单侧睾丸扭转后，患侧附睾管腔内的精子数量及活力明显降低；对侧改变出现于扭转6h以后；应用别嘌呤醇能改善扭转2h以内患侧的精子发生。结论 单侧睾丸扭转造成两侧睾丸生精功能下降，下降程度与先前扭转时间有关；早期手术复位加以别嘌呤醇的应用能对受损组织提供有限保护。     

西地那非对大鼠单侧睾丸扭转后对侧睾丸的影响及作用研究

目的 探讨大鼠单侧睾丸扭转后对侧睾丸的损伤以及西地那非（万艾可）的保护机理.方法 将72只健康雄性SD大鼠,随机分为假手术组、安慰剂组、西地那非组.3组分别在假手术/左侧睾丸扭转复位术后4 h、24 h、2周时,各组各处死8只大鼠.分别观察右侧睾丸组织病理学变化、测定右侧睾丸组织中MDA、NO/NOS含量.结果 术后4 h,各组间组织病理学变化、MDA、NOS含量无明显差异,睾丸组织未见损伤,但NO在两地那非组较假手术组、安慰剂组明显增加（P〈0.05）.术后24 h,假手术组右侧睾丸组织损伤最小,西地那非组较严重,安慰剂组最为严重;与假手术组比,其余两组MDA、NO/NOS含量明显升高（P〈0.05）;西地那非组NO/NOS含量与安慰剂组相比明显下降（P〈0.05）;术后2周时,睾丸组织损伤有不同程度恢复,但仍以安慰剂组最为严重;与假手术组比,其余两组MDA、NO/NOS含量仍然升高（P〈0.05）;西地那非组NO/NOS含量与安慰剂组相比明显下降（P〈0.05）.结论 大鼠单侧睾丸扭转复位后,对侧睾丸组织术后4 h时.睾丸组织未见损伤.12 h后睾丸组织明显损伤,并且持续至2周后.早期应用适量西地那非（万艾可）可促局部NO增加,扩血管作用加强,拮抗交感神经缩血管作用,进而保护对侧睾丸.     

儿童睾丸附件扭转的保守治疗指征

目的探讨儿童睾丸附件扭转保守治疗的指征。方法回顾性总结分析1993～1997年底的25例急性阴囊疼痛患儿的诊疗情况,结合文献提出鉴别诊断及选择疗法的依据,将其应用于1998年以后收治的26例患儿中,进一步探讨诊断和治疗指征。结果回顾性总结表明睾丸扭转症状重,就诊早,就诊时间多在发病24h之内。附件扭转疼痛轻,就诊晚,多有48h以上的病史,两者比较,差异有显著性意义(P＜0.05)。1998年后治疗的26例中,5例就诊时疼痛时间短于48h,1例在睾丸上极摸到疼痛性结节,诊断睾丸附件扭转,行保守治疗;4例行急症手术,证实1例睾丸扭转、3例附件扭转。21例就诊时疼痛已48h以上,19例症状轻,彩色多普勒检查,睾丸血流正常,行保守治疗,治疗过程中均可摸到大小不等的触痛性结节,诊断睾丸附件扭转。2例睾丸扭转坏死而行睾丸切除。结论睾丸附件扭转是一种自限性疾病。扪到其特有体征,即阴囊内触疼性结节者;阴囊痛持续48h以上,彩色多普勒检查,睾丸血流正常者,可行保守治疗。睾丸扭转是外科急症,应急症手术。彩色多普勒超声检查对鉴别诊断有重要意义。     

大鼠睾丸扭转复位及减压治疗对睾丸的影响

目的 研究睾丸扭转复位及减压治疗对睾丸的影响,为睾丸扭转的预后判断、治疗方法的选择等提供新的理论依据.方法 将30只SD雄性大鼠随机分成5组,制成睾丸扭转复位及复位+减压治疗的模型.分别设立空白对照组及实验A～D组,睾丸扭转/复位组(A组)、睾丸扭转/复位+减压治疗组(B组)喂养至术后1 d处死;睾丸扭转/复化组(C组)、睾丸扭转/复位+减压治疗组(D组)喂养至术后1个月处死.应用化学检测和组织学分析方法,观察睾丸大体标本的变化、睾丸组织内丙二醛(MDA)含量的变化及睾丸组织Johnsen's评分.结果 五组睾丸MDA分别为3.18±0.22(空白对照组)、9.54±2.05(A组)、7.92±1.38(B组)、6.67±0.61(C组)、4.30±1.81(D组),实验组术侧睾丸的MDA含量显著高于自身对侧(P<0.05).D组MDA含量比C组明显下降(P<0.05).单纯复位组的术后睾丸标本比自身对侧和减压治疗组有明显萎缩;五组Johnsen's评分分别为10±0、7.2±0.18、8.2±0.19、2.2±0.19、9.2±0.18.D组比C组明显提高(P<0.05).结论 睾丸扭转复位+减压治疗能明显减少扭转侧睾丸生殖细胞凋亡,减轻脂质过氧化程度,可能有利于睾丸组织结构与功能的恢复.     

硫氧还蛋白对大鼠睾丸缺血再灌注损伤保护作用的研究

目的 探讨硫氧还蛋白对大鼠睾丸缺血再灌注损伤的保护作用.方法 选取雄性SD大鼠60只,随机分为4组:假手术对照组(A组);睾丸扭转/复位组(B组);睾丸扭转/复位+腹腔内注射生理盐水组(C组);睾丸扭转/复位+腹腔内注射硫氧还蛋白组(D组).无菌条件下制作左侧睾丸扭转模型,扭转持续4h,复位4h后取睾丸标本(D组在复位前15 min腹腔内注射硫氧还蛋白).对标本进行病理组织学检查;检测睾丸组织中超氧化物歧化酶(SOD)和丙二醛(MDA)的含量.结果 睾丸扭转/复位后可见生精小管退变,间质出现水肿及出血,腹腔注射硫氧还蛋白使睾丸扭转/复位诱发的组织学改变明显改善.B组及C组睾丸损伤评分(8.3±0.96;8±0.87)明显高于A组(0.78±0.36)(P＜0.01),而腹腔注射硫氧还蛋白可以使睾丸损伤分值(3.1±0.42)显著降低(P＜0.05).B组及C组MDA含量(4.39±0.21;4.42±0.17)升高,SOD活性(269±27.1;271±21.3)降低,与对照组(MDA:1.61±0.18;SOD:317±22.3)相比,差别具有显著性意义(P＜0.01).而腹腔注射硫氧还蛋白能有效降低MDA含量(2.03±0.03)并升高SOD活性(315±24.2)(P＜0.01).结论 本实验为硫氧还蛋白作为治疗睾丸扭转继发损害的有效物质提供了组织学及生化依据.为临床预防和治疗睾丸缺血再灌注损伤提供了理论依据.     

兔睾丸扭转复位后睾丸细胞凋亡的观察

目的　观察兔睾丸扭转复位后睾丸细胞凋亡情况及药物减轻睾丸凋亡的效果。方法　选用青春期雄性日本大耳白兔 2 0只 ,体重 90 0～ 110 0g ,月龄 2～ 3个月 ,随机分为 4组 ,每组 5只。手术制作幼兔睾丸扭转模型 (72 0° ,2h) ,对部分扭转组应用抗氧化剂 (抗坏血酸 )或钙离子通道拮抗剂 (维拉帕米 )。 2d后取出睾丸 ,TUNEL法观查各组动物睾丸组织细胞凋亡情况 ,HE染色检查睾丸病理组织学改变。结果　幼兔睾丸扭转复位后 ,精原细胞发生凋亡 ,而睾丸支持细胞及间质细胞未见凋亡现象。单纯扭转组精原细胞平均凋亡指数 (AI) (7.92± 1.2 9)‰ ,较对照组 (2 .6 0± 1.0 1)‰显著升高 ;睾丸扭转前后应用抗坏血酸及维拉帕米组的睾丸细胞平均AI ,分别为 (4.12± 0 .73)‰ ,(4.0 8± 0 .88)‰ ,较单纯扭转组 (7.92± 1.2 9)‰显著下降。HE染色的组织学改变与TUNEL法类似。结论　睾丸扭转损伤后可致使生精细胞凋亡。应用抗氧化剂及钙离子通道拮抗剂可以减轻扭转睾丸的精原细胞凋亡     

小儿睾丸扭转的诊治体会

目的 探讨小儿睾丸扭转的诊断和治疗。方法 回顾性分析获随访的8例小儿睾丸扭转病例。结果 发病24h内就诊并及时手术治疗者睾丸发育正常。超过24h后诊治者4例中有3例睾丸轻微萎缩。结论 小儿睾丸扭转须早诊断，及时治疗，才能提高睾丸的生存质量。     

新生儿睾丸扭转临床回顾与分析

目的 探讨新生儿睾丸扭转的治疗措施选择.方法 回顾性分析11例新生儿睾丸扭转的诊治资料.分析评估内容包括临床表现、体格检查、辅助检查、治疗方法的选择以及术后随访情况等.结果 11例新生儿睾丸扭转,左侧6例,右侧5例;顺产8例,剖宫产3例;足月产10例,早产1例.产前睾丸扭转5例;产后睾丸扭转6例.产前睾丸扭转5例均行患侧睾丸切除,1例行对侧睾丸预防性固定术.所有产后睾丸扭转均行患侧睾丸切除+对侧睾丸预防性固定术.术后病理检查提示睾丸组织大部分出血伴坏死,其中5例产前睾丸扭转病例中4例病理检查提示睾丸组织有钙化灶.术后随访对侧睾丸未见明显异常.结论 对产前睾丸扭转,需切除患侧睾丸并同时行对侧睾丸固定.对双侧产前睾丸扭转,建议手术探查行睾丸扭转矫正术后保留睾丸.对产后睾丸扭转则需尽早安排手术探查并行预防性睾丸固定.     

56例小儿睾丸扭转的诊断与治疗

目的提高对小儿睾丸扭转的临床诊断和治疗水平。方法回顾性分析56例睾丸扭转患儿的临床资料,左侧扭转32例,右侧扭转24例。初诊时间<6h20例,6～24h28例,>24h8例。初诊确诊为睾丸扭转34例,延误诊断22例(本院8例,外院14例)。结果12例发病后<6h就诊者手法复位成功,其余44例手术探查,16例手术探查发现睾丸已坏死而行睾丸切除,其中>24h者7例。结论提高首诊诊断正确率将有助于扭转睾丸的救治。彩色多普勒超声是首选的辅助检查方法。主张尽早手术及预防性对侧睾丸固定。     

小儿睾丸扭转的诊断与治疗

目的提高对小儿睾丸扭转的临床诊断和治疗水平。方法回顾性分析42例睾丸扭转的临床资料,年龄4～15岁,平均8.5岁。左睾丸27个,右睾丸15个。初诊时间<6h10例,6～24h26例,6例超过24h。初诊确诊为睾丸扭转24例,延误诊断18例(本院7例,外院11例)。结果8例发病后6h就诊者,给予手法复位成功;34例发病时间>6h者手术探查,18例手术探查睾丸已坏死,而行睾丸切除。结论彩色多普勒超声是首选辅助检查方法。提高首诊诊断正确率将有助于扭转睾丸的获救。主张尽早手术及预防性对侧睾丸固定。     

The effect of ATP-MgCl(2) on prevention of reperfusion injury after unilateral testicular torsion.

This study was designed to investigate the effect of ATP-MgCl(2) administered before and after detorsion on the prevention of reperfusion injury after unilateral testicular torsion. The rats were divided into six groups, each containing six rats. Torsion was created by rotating the left testes 720 degrees in a clockwise direction. Group 1 functioned as a control group. Torsion only was carried out in Group 2. Detorsion was carried out in Group 3. ATP-MgCl(2) (100 micromol/kg) was injected intravenously immediately before detorsion in Group 4. ATP-MgCl(2) (100 micromol/kg) was injected intravenously immediately after detorsion in Group 5. Saline was injected intravenously immediately after detorsion in Group 6. The effect of ATP-MgCl(2) on reperfusion injury was investigated by determining the levels of thiobarbituric acid-reactive substances (TBAR) and resulting lipid peroxidation in the bilateral testicular tissue. Testicular torsion and detorsion caused a significant increase in the TBAR levels in the bilateral testicular tissue. TBAR levels decreased to approximately normal levels in Groups 4 and 5. It is concluded that if reperfusion injury has occurred in both testes after unilateral testicular torsion, ATP-MgCl(2) administered before or after detorsion may prevent reperfusion injury in testicular torsion.     

The testes after unilateral incarcerated inguinal hernia in prepubertal rats

The ipsilateral and contralateral testes after unilateral incarcerated inguinal hernia were evaluated, and compared to the contralateral testis after unilateral testicular torsion in 30 prepubertal rats. Control, torsion and detorsion at 24 hours, and incarcerated inguinal hernia and reduction in the 24 hour groups, each consisting of ten rats were established. The testes were harvested after 15 days. Mean seminiferous tubular diameters (MSTD) and mean testicular biopsy scores (MTBS) were determined and compared. A decrease in MSTD and depression in MTBS, which was more prominent in the ipsilateral testes, were found in both ipsilateral and contralateral testes following unilateral incarcerated inguinal hernia. The testicular damage encountered after unilateral incarcerated inguinal hernia was similar to the contralateral testicular damage following unilateral testicular torsion with the utilized parameters.     

Division of the genitofemoral nerve and late orchiectomy: effects on the contralateral testis in ipsilateral testicular torsion

Unilateral torsion of the spermatic cord has been demonstrated to damage the contralateral testis; however, the pathogenesis has not yet been examined in detail. The purpose of this study was to evaluate the influence of unilateral torsion on the contralateral testis in rats by performing ipsilateral division of the genitofemoral nerve (GFN) and/or late orchiectomy. Male 25-day-old, prepubertal Wistar albino rats were divided into five groups: (1) sham operation; (2) unilateral testicular torsion; (3) simultaneous unilateral testicular torsion and ipsilateral GFN division; (4) unilateral testicular torsion and orchiectomy on the 4th day after torsion; and (5) simultaneous unilateral testicular torsion and GFN ipsilateral division, and orchiectomy on the 4th day after torsion. Torsions performed were 720°, all on the right testes. On day 55 after torsion, which represents the early postpubertal period of the rat, the contralateral testes were removed. Tubular biopsy score (TBS) was calculated, and seminiferous tubular diameters (STD) were measured. Student's t-test was used for statistical analysis. There was no contralateral testicular damage in the control group, but in all of the study groups destructive changes were found in the left gonad after torsion of the right testicle. The mean TBS of the study groups was higher than that of the control group. STD values were lower in the study groups, but the differences were not statistically significant between groups. In prepubertal rats, unilateral torsion causes histologically measurable changes in the contralateral testis. Ipsilateral division of the GFN and late orchiectomy did not cause any significant alterations in terms of contralateral damage. Further investigations are needed to determine the role of the GFN in testicular torsion.     

A study of warm testicular ischaemia and paternity in rats

The effect of testicular ischaemia on fertility as assessed by paternity rate was studied in seven groups of male Sprague-Dawley pubertal rats. Transient unilateral occlusion of the testicular artery and venous outflow was performed for 30, 60, 90, and 120 min using non-crushing microvascular clamps in groups 1–4 (n = 6). Group 5 (n = 12, Fowler-Stephens) had division of both the testicular artery and vein, whereas group 6 (n = 12, Refluo) had division of the testicular artery only. Group 7 (n = 6) consisted of controls upon whom a sham operation was performed. Testicular biopsy 6 weeks after transient testicular ischaemia of 30, 60, and 90 min showed tubular atrophy in 20%–33% of the testes. Ischaemia of 120 min led to tubular atrophy in 84% of testes. Division of only the testicular artery caused tubular atrophy in 58% of testes. Division of both testicular artery and venous outflow was associated with total tubular destruction and necrosis in 78% of testes and 22% had variable tubular atrophy. A paternity rate of 50%–80% was noted in groups 1–4 following transient unilateral testicular ischaemia and contralateral vasectomy. This compared well with the expected 75% paternity rate for a control rat population. Chronic ischaemia (group 5) together with testicular venous interruption was associated with observably lower fertility and a paternity rate of 18%. However, when venous outflow was preserved (group 6), chronic ischaemia after testicular artery division did not affect the paternity rate (50%) significantly. Offprint requests to: A. Bianchi     

The protective effect of selenium on ipsilateral and contralateral testes in testicular reperfusion injury

This study was designed to investigate the effect of selenium on ipsilateral and contralateral testicular damage after unilateral testicular torsion/detorsion (T/D). Thirty-two male rats were divided into four groups, each containing eight rats. Torsion was created by rotating the right testis 720° in a clockwise direction. Group 1 underwent sham operation to determine basal values for biochemical and histopathological evaluation. Sham operation was performed in group 2, and sodium selenate (0.2 mg/kg) was given intraperitoneally. Group 3 served as a T/D group, receiving 4-h torsion and 4-h detorsion. Similarly, in group 4 sodium selenate (0.2 mg/kg) was injected intraperitoneally 20 min before detorsion. Bilateral orchiectomies were performed for measurement of tissue malondialdehyde (MDA) levels and superoxide dismutase (SOD) activities and histopathologic examination. The results were compared statistically. The highest MDA and the lowest SOD values were determined in both testes in group 3. There were statistically significant differences in MDA levels and SOD activities in group 3 compared with group 4. Specimens from group 3 had a significantly greater histologic injury than other groups. These results suggest that ischemia-reperfusion injury occurred in both testes after unilateral testicular T/D and that selenium administration before detorsion prevents reperfusion injury in testicular torsion.     

Effect of Lomodex–MgSO4 in the prevention of reperfusion injury following unilateral testicular torsion: an experimental study in rats

Fertility in patients treated for unilateral testicular torsion has been shown to be significantly reduced in all the reported series to date, implying that the present-day treatment requires further refinement in the form of adjunct pharmacotherapeutic intervention (Lomodex and MgSO₄) in addition to scrotal exploration. Prepubertal Holtzman strain rats (35 days old) were used for our study. Two sets were formed with six groups of rats in each set. Rats were treated as follows: group 1, sham-operated group; group 2, torsion (4 h); group 3, torsion + detorsion (1 h); group 4, torsion + ATP–MgCl₂ + detorsion; group 5, torsion + Lomodex–MgSO₄ + detorsion; group 6, torsion + normal saline + detorsion. Whereas the first set of animals was sacrificed immediately at the end of experiment, animals in set 2 were sacrificed 8 weeks after the end of the experiment to look for the development of antisperm antibodies. Parameters studied were thiobarbituric acid reductase (TBAR) assay, histology of testicular tissue, and sperm agglutination test. Students t-test was used for significance. With detorsion (149.95±30.68) there was a significant rise in the TBAR values (P<0.05) compared with torsion (57.39±14.47). Treatment with both Lomodex–MgSO₄ (40.74±6.39) and ATP–MgCl₂ (48.30±18.35) yielded TBAR levels comparable to those in the sham group (31.35±11.96). Similar injury was also seen on the contralateral testis, with detorsion (114.28±10.68) much more detrimental than torsion (40.59±15.02) and rescue seen following treatment with Lomodex–MgSO₄ (27.55±8.64) as well as ATP–MgCl₂ (38.61±12.23). Regarding th histology, with detorsion there was evidence of severe distortion of tubules, with almost all the tubules showing maturation arrest and a few tubules completely devoid of any germinal cells. Treatment with Lomodex–MgSO₄ as well as ATP–MgCl₂ showed preservation of tubular morphology. Our study failed to document the presence of agglutinating antibodies (antisperm antibodies) in any of the groups. Unilateral testicular torsion has bilateral effects and is a form of ischemia–reperfusion injury. Treatment of torsion by detorsion alone does not prevent testicular damage. The results of the present study show that administration of Lomodex + MgSO₄ prior to detorsion results in prolonged testicular salvage with a potential of subsequent improvement in semen quality and fertility and reduction in long-term morbidity. The presence of agglutinating antibodies could not be detected in the present study.     

Testicular infarction in the newborn: Ultrasound findings

Three patients with neonatal testicular torsion and infarction (two bilateral, one unilateral) are presented with a distinctive sonographic appearance. All five testes appeared inhomogeneously hypoechoic and each was surrounded by a brightly echogenic rim. Whereas surgical exploration was required in the past to establish the diagnosis of testicular infarction in the neonate, sonographic demonstration of the abnormality in the appearance of the testicular parenchyma permits nonoperative diagnosis. Because surgical salvage of the testis in the setting of neonatal extravaginal torsion is thought to be quite rare, the necessity of removing the testis is less clear when the diagnosis is established preoperatively.     

Perinatal testicular torsion in siblings

The management of perinatal torsion remains a controversial topic in pediatric urology. We present two cases of brothers diagnosed with perinatal torsion during the postnatal period. The first brother experienced bilateral torsion, with both testes found to be unsalvageable during emergent surgery on day 4 of life. Two years later the second brother was found on his newborn exam to have findings consistent with unilateral left testicular torsion. Emergent exploration was undertaken that confirmed the left testis to be necrotic. The contralateral testis was found to be normal and a fixation procedure was undertaken.     

Neonatal testicular torsion--a lost cause?

Twenty-four neonates presented with signs of testicular ischaemia over a 13-year period. They had a mean birth weight of 3.706 kg. The right testicle was affected in 13, the left in 9 and there was bilateral torsion in 2 babies. Two babies had no twist in the cord, but the testicles were nonviable macroscopically and microscopically. Twenty-one babies had primary exploration revealing necrotic testes in all patients and they underwent orchidectomies. The other three babies had conservative management and the affected testes had atrophied on follow-up. Sixteen babies had contralateral orchidopexy. Doppler ultrasound scans were reported as normal in 2 of 13 babies who had scans. No testes were salvaged following surgery. CONCLUSION: The incidence of testicular torsion in the neonatal period was calculated as 6.1 per 100,000 live births. No testis was salvaged following surgery in our series of 24 patients. This dismal outcome underlines that immediate surgical exploration, although commonly performed, rarely saves torted testes.