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.     

New animal model to evaluate testicular blood flow during testicular torsion.

BACKGROUND/PURPOSE: Unilateral testicular torsion is known to cause infertility because of damage to the contralateral testis. Testicular damage has been attributed to many different mechanisms, one of which is altered contralateral blood flow. In our experiment, in an effort to identify the reason for contralateral testicular injury, the authors developed an accurate method of measuring blood flow in both testes before, during, and after unilateral torsion. METHODS: Four- to 6-week-old piglets weighing 4 to 6 kg were studied. The animals were anesthetized, intubated, ventilated, and catheterized for vascular access. Piglets were assigned randomly to a sham group or a group undergoing 360 degrees or 720 degrees torsion of the left testis (n = 5 per group) for 8 hours, after which it was untwisted. Data were collected at baseline (T = 0), 8 hours of torsion (T = 8), and 1 hour after detorsion (T = 9). Mean arterial blood pressure and heart rate were monitored continuously. Testicular blood flow was determined using radiolabeled microspheres. Blood flow data were evaluated by analysis of variance. RESULTS: In the 360 degrees torsion group, blood flow changes were insignificant during torsion and after detorsion. In the 720 degrees torsion group, blood flow to the twisted testis was reduced significantly, whereas the contralateral testis was unaffected. One hour after detorsion, blood flow to both testes was increased significantly. CONCLUSIONS: The authors describe a new animal model to evaluate testicular blood flow during and after testicular torsion. Increased blood flow after detorsion may be the cause of testicular damage in patients with unilateral testicular torsion.     

Testicular salvage following spermatic cord torsion

There have been several reports indicating that men who have suffered from spermatic cord torsion are likely to have abnormal seminal analyses. It is now well recognized that unilateral spermatic cord torsion can result in contralateral testicular damage. This study was instituted to evaluate possible methods of preventing post-torsion contralateral testicular damage. Experimental torsion was produced in 250 g Wistar rats. The duration of torsion was either 3, 6, or 24 hours. The rats were then treated by one of three methods, namely, detorsion, immediate ipsilateral orchidectomy, or detorsion and adjuvant immunotherapy. Contralateral testicular damage was prevented by immediate ipsilateral orchidectomy and by detorsion with adjuvant immunotherapy. The immunotherapeutic agents administered were either hydrocortisone, azathioprine, or cyclosporin A. The results strongly support the premise that detorsion with adjuvant immunotherapy results in salvage of the ipsilateral testis while preventing contralateral testicular damage. Hydrocortisone is the immunotherapeutic agent of choice because its administration was associated with the fewest complications.     

单侧睾丸扭转对生殖细胞凋亡及黄芪保护作用的实验研究

目的观察大鼠单侧睾丸扭转／复位后患侧和对侧睾丸生精细胞凋亡情况,探讨单侧睾丸扭转／复位后生殖能力下降的机制以及黄芪注射液对其再灌注损伤的保护作用。方法将40只健康雄性Wistar大鼠分为4组,分别为假手术对照组（A组）,睾丸扭转／复位组（B组）,睾丸扭转／复位＋单次腹腔内注射黄芪注射液组（C组）及扭转／复位十连续腹腔内注射黄芪注射液组（D组）,每组10只。按Turner法建立睾丸扭转／复位模型,所有大鼠均在同等条件下喂养至术后7d处死,切取双侧睾丸后检测凋亡指数。结果扭转侧睾丸生殖细胞凋亡指数（AI）A组（5．82±1．21）与B组（36．18±8．40）、C组（20．39±3．57）、D组（11．61±5．12）相比差异有显著性（P〈0．05）,B组明显高于C组及D组（P〈0．05）,C组与D组相比差异有显著性（P〈0．05）;B组对侧睾丸（12．95±3．06）与C组（9．45±1．71）、D组（7．56±1．06）两组对侧睾丸AI相比差异有显著性（P〈0．05）,C、D两组对侧睾丸AI差异有显著性（P〈0．05）。结论单侧睾丸扭转可致患侧和对侧睾丸生精细胞凋亡明显增加,黄芪注射液可明显减少双侧睾丸生殖细胞凋亡,连续应用黄芪注射液优于单次应用。     

Unpredictability of capsulotomy in testicular torsion

Testicular torsion results in irreversible histologic changes in the ipsilateral testis, which may induce alterations in contralateral testicular histology and in fertility. It was hypothesized that these ipsilateral changes could be minimized by splitting the tunica albuginea at the time of detorsion, thus decompressing the testicular "closed compartment syndrome." Unilateral spermatic cord torsion was induced in prepubertal, male Sprague Dawley rats for a period of 0, 4, 8, or 12 hours. At the time of detorsion, capsulotomy was performed on half the animals. The mature rats were killed 35 days after detorsion and the testes examined histologically. Testicular capsulotomy did not alter the significant histologic changes observed in the affected testis following spermatic cord torsion.     

Spermatic cord torsion: effects of cyclosporine and prednisone on fertility and the contralateral testis in the rat

Unilateral spermatic cord torsion results in contralateral degeneration and reduced fertility in the prepubertal male rat. This study was conducted to investigate the use of immunosuppression with cyclosporine and prednisone to prevent these untoward effects. Thirty-five-day-old male rats were subjected to 720 degrees unilateral spermatic cord torsion of 9 hours duration. At the time of detorsion, animals were given a subcutaneous injection of i) cyclosporine, ii) prednisone, or iii) cyclosporine combined with prednisone. Control groups included: i) animals undergoing orchiectomy of the ipsilateral testis following the torsion period, ii) hemicastration in the absence of torsion and iii) sham surgery. Orchiectomy at the end of the torsion period prevented the torsion induced reduction of fertility, contralateral seminiferous tubule diameter and testis weight. Treatment with cyclosporine combined with prednisone significantly increased these parameters above detorsion alone. These data indicate that short term immunosuppression with cyclosporine alone or in combination with prednisone limits the adverse effects of unilateral spermatic cord torsion as does removal of the damaged organ at the end of the torsion period.     

The effect of testicular torsion on the contralateral testis and the value of various types of treatment

In an attempt to investigate the effect of testicular torsion and various forms of treatment on the contralateral testis, an experimental study on rats was undertaken. The first group comprised control animals. In the second group the left testes were twisted 720 degrees and the right testes were removed 4 weeks later for histopathological examination. In the third group the rats were subjected to a left detorsion procedure 24 h after torsion, while in the fourth group cortisone treatment was added to the above procedure. The fifth group consisted of rats which had undergone left orchiectomy 24 h after torsion and the sixth group had cortisone treatment plus orchiectomy after torsion. Cortisone treatment was started 24 h after testicular torsion and continued for 4 weeks. Histopathological examination of the contralateral testes which were removed 4 weeks later showed that either orchiectomy plus cortisone or detorsion plus cortisone was more successful than other forms of treatment.     

Experimental testicular torsion and its effects on the contralateral testicle

Objective Following experimental unilateral torsion of the testis the histologic effects of unilateral testicular torsion on the contralateral testis were investigated. Materials and methods Utilizing detorsion or orchiectomy at 4 hours and 8 hours after torsion, the effects of early and late treatment modalities on the contralateral testicle were observed. Results Morphometry of the contralateral testis revealed some alterations including focal sclerosis, decrease in mean seminiferous tubular diameter and a marked increase of the Leydig cells in some subgroups. Conclusion In spite of some changes, definite evidence for contralateral damage due to ipsilateral torsion contributing to male infertility was hardly observed.     

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.     

Exocrine and endocrine functions in unilateral testicular disease

Summary Exocrine testicular function was determined in 30 prepubertal and pubertal patients who had undergone detorsion and fixation for unilateral torsion of the testis, in 46 men who had undergone unilateral orchidopexy, and in 16 patients with unilateral absence of the testis. In 42 patients with seminomas and non-seminomatous testicular tumors, sperm analyses were performed before orchiectomy. The semen analyses in patients with unilateral cryptorchidism were normal in 13, doubtful in 23 and pathological in 10. The semen quality in patients with torsion was normal in 15, doubtful in 3 and pathological in 12. Of the 16 patients with monorchidism, 14 had normal sperm analyses. Of the 42 patients with seminomas and non-seminomatous testicular tumors, only two patients with HCG-negative seminomas had normal sperm analyses before orchiectomy. In patients with doubtful and pathological sperm analyses after testicular torsion and unilateral orchidopexy, elevated follicle-stimulating-hormone levels were observed. HCG-positive testicular tumors showed decreased FSH levels but elevated 17--estradiol and prolactin levels.Supported by the Fonds zur Förderung der wissenschaftlichen Forschung, Austria, P 4030     

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.     

The significance of measuring the time course of serum malondialdehyde concentration in patients with torsion of the testis

PURPOSE: We determined the time course of malondialdehyde, a measure of free radical damage, in patients undergoing standard surgical treatment for testicular torsion. MATERIALS AND METHODS: Patients presenting with testicular torsion were studied prospectively. Blood samples were obtained after administering general anesthesia but before surgical incision, and 10 minutes, 30 minutes and 24 hours after detorsion. Orchiopexy was performed in patients with viable testes (group 1) and orchiectomy was performed in those with nonviable testes (group 2). Further blood samples were obtained 1 and 3 months after surgery. Similar blood samples were taken from controls, including patients younger than 40 years undergoing other operations involving manipulation of the testis, such as hydrocelectomy or orchiopexy (group 3). The level of malondialdehyde in each serum sample was determined by the thiobarbituric acid reaction. RESULTS: A total of 65 patients were studied, including 56 with testicular torsion and 9 controls (group 3). Of the 56 patients 11 (19.6%) with testicular torsion underwent ipsilateral orchiectomy and contralateral orchiopexy (group 2). The remaining 45 patients (80.4%) underwent bilateral orchiopexy (group 1). However serum malondialdehyde was estimated in only 34 of the 56 patients with torsion. Mean malondialdehyde at 0, 10 and 30 minutes, 24 hours, and 3 and 6 months was 3.3, 3.69, 3.69, 2.9, 2.65 and 2.39 nmol./ml. on the 24 group 1 patients, 3.53, 4.56, 3.87, 2.87, 2.82 and 2.64 nmol./ml. in the 10 group 2 patients, and 3.6, 3.08, 3.18, 2.95, 2.88 and 2.65 nmol./ml. in the 9 group 3 controls, respectively. The highest serum malondialdehyde was at 10 minutes after detorsion in groups 1 and 2. There was a statistically significant difference in malondialdehyde between groups 1 and 2 compared with group 3 at 10 minutes (p <0.04). Serum malondialdehyde returned to baseline at 24 hours in all patients. CONCLUSIONS: The results of this study indicate that testicular torsion and its treatment with detorsion is an example of ischemia-reperfusion injury, producing measurable changes in malondialdehyde in humans. Thus, serum malondialdehyde could be used to determine the extent of injury.     

Prepubertal testicular torsion: subsequent fertility

Eighteen patients were reviewed 7 to 23 years after prolonged unilateral testicular torsion. They had all undergone surgical untwisting with replacement of the nonviable testis in the scrotum during prepubertal period. Five patients were now married and had fathered one or more children. Thirteen patients were unmarried. There was absence of testis on the affected side in 14 of 18 patients. Four patients had severe testicular atrophy on the affected side (testicular volume less than 1 mL). The contralateral side showed either a normal testicular volume or a compensatory hypertrophy (testicular volume greater than 25 mL). Seminal analysis was done in 13 unmarried men and it was completely normal in 10 patients. Two patients had low sperm density but normal semen volume and motility. One patient had pathologic semen analysis. IgG and IgA specific mixed agglutination reaction (MAR) test did not show evidence of sperm autoantibodies in any patient. Our clinical experience shows that, after prepubertal torsion, the contralateral testis undergoes normal development. Furthermore, torsion in the prepubertal male does not cause autosensitization and diminished fertility in adult life.     

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.     

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.     

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.     

睾丸扭转的研究进展

睾丸扭转是泌尿外科最常见的阴囊急症之一,常需要急诊手术以争取保留患侧睾丸。有不少学者认为扭转复位后的睾丸仍存在缺血再灌注损伤并且会对患者性激素水平、生育能力等造成威胁。本文通过综述睾丸扭转的研究进展,以期提高临床医生对睾丸扭转的认识。     

Flow cytometric DNA analysis demonstrates contralateral testicular deterioration in experimental unilateral testicular torsion of prepubertal rats

Summary. It has been postulated that unilateral testicular torsion causes damage to the contralateral testis and reduces fertility. However, in animal studies such an effect has not been fully proven by histopathologic examination or other conventional assays of spermatogenesis. We investigated the effect of unilateral testicular torsion on contralateral spermatogenesis in prepubertal rats using quantitative flow cytometric DNA analysis. Male rats were divided into three groups which underwent sham-operation, simple hemiorchiectomy or unilateral testicular torsion. Five weeks after these operations, fertility and spermatogenesis by flow cytometry were evaluated. No significant differences were observed in body weight, contralateral testicular weight or serum testosterone concentration among the three experimental groups. In the torsion group, mean seminiferous tubular diameter, number of foetuses, fertility rate and percentage of haploid cells were all significantly decreased compared to the other two groups. These results suggest that unilateral testicular torsion causes damage to the contralateral testis and consequently can reduce the future fertility of prepubertal rats.     

Pentoxifylline improves blood flow to both testes in testicular torsion

Objectives: Electromagnetic and radioisotopic studies have shown thatunilateral testicular torsion causes a decrease in contralateral testicularblood flow. Pentoxifylline improves microvascular blood flow in conditionsof vascular insufficiency. An experimental study was designed to evaluatethe effects of pentoxifylline (Ptx) on blood flow to both testes duringunilateral testicular torsion and detorsion.Materials and methods: Thirty-six adult male albino Wistar rats wererandomly divided into six groups where each consisted of six rats: group1: sham operation, group 2: sham operation with Ptx, group 3: torsion,group 4: torsion with Ptx, group 5: detorsion, group 6: detorsion with Ptx.After intraperitoneal administration of Ptx at a dose of 50 mg/kg 15minutes before torsion; right testes of the rats underwent 30 minutes oftorsion and 30 minutes of detorsion. Blood flows of both testes weremeasured during torsion and detorsion simultaneously by using ¹³³Xeclearance technique.Results: Unilateral testicular torsion caused decrease in bilateraltesticular blood flow. Pentoxifylline had no effect on testicular blood flowduring torsion. Detorsion caused a partially increase in blood flow toipsilateral (detorted) testis, but had no effect on contralateral (nontorted)testicular blood flow. Pentoxifylline administration during detorsionsignificantly increased blood flow to both testes.Conclusions: Testicular torsion is a pathological process that causesdecreased blood flow to both testes. Pentoxifylline improves blood flow toboth testes during detorsion in a rat model of testicular torsion. Furtherstudies are needed to evaluate the effects of pentoxifylline on testiculartorsion.     

Testicular dysplasia causing disturbance of spermiogenesis in patients with unilateral torsion of the testis.

Fifty-five patients were followed up for their state of fertility at a time varying in length after testicular torsion. In addition to the spermiogram they were screened for sperm antibodies. Biopsy samples were collected from the contralateral (not contorted) testis in 34 patients at the time of torsion or immediately afterwards. Two to 8 years after torsion only 7 out of 55 patients had a normal spermiogram. Nineteen had an OAT syndrome, 10 had asthenospermia and 19 had teratospermia. Sperm antibodies occurred very rarely at the time of torsion (2/36) or at the time of a further checkup (2/36). Immunological damage to the noncontorted testis by the contorted one seems therefore rather unlikely. Histology of the contralateral testis, the samples of which were taken at the time of torsion (30) or up to 4 months later (4), showed pathological conditions in 30/34 cases (desquamation of the germinative epithelium, atrophy of the Leydig cells, malformation of spermatoblasts) and normal spermiogenesis in 4 cases only. Hence, a preexistent congenital testicular dysplasia must be assumed to be the cause of the observed disturbance of spermiogenesis and reduced fertility.