The protective effects of grape seed extract on MDA, AOPP, apoptosis and eNOS expression in testicular torsion: an experimental study

Objectives

Grape seed proanthocyanidin extract (GSPE) is a potent antioxidant and a free radical scavenger. This study was designed to determine whether GSPE could protect against dysfunction and oxidative stress induced by torsion–detorsion injury in rat testis.

Methods

A total of 45 male Wistar albino rats were divided into five groups: control group, sham group, torsion–detorsion (T/D) group, T/D + GSPE group, GSPE group. GSPE was administrated 100 mg/kg/day with oral gavage over seven days before torsion. Testicular torsion was performed for 2 h, and afterward, detorsion was performed for 2 h. The rats were decapitated under ketamine anesthesia, and their testes tissues were removed. Tissue malondialdehyde, advanced oxidation protein products levels, eNOS expression, apoptosis and histopathological damage scores were then compared.

Results

Testicular torsion–detorsion caused significant increases in malondialdehyde level, apoptosis and eNOS expression level and caused a significant decrease in advanced oxidation protein product levels and testicular spermatogenesis in ipsilateral testes. GSPE prevented the rise in malondialdehyde, apoptosis and eNOS expression and improved testicular morphology and Johnsen’s score.

Conclusions

As a result, testicular torsion gives rise to serious damage in testes and GSPE is a potent antioxidant agent in preventing testicular injury.     

Traumatic testicular dislocation

Introduction

Traumatic testicular dislocation is a rare entity. It occurs after a direct blunt scrotal trauma causing the testicle to migrate outside the scrotum, most frequently to the superficial inguinal region.

Materials and methods

A review of the diagnostic database of our two institutions was performed searching for complex genital trauma between 1990 and 2012.

Results

Seven cases of traumatic testicular dislocation were identified (four on the left side; one on the right side and two bilateral) for a total of nine testicles. Six were motorcycle accidents, and the other case suffered a pelvic crush injury. All victims had significant associated injuries, one case had an open dislocation and two were killed by the accident. The testicle was located at the inguinal region in four cases at the suprapubic area in four, and the other was an open dislocation. Diagnosis was suspected with the physical examination and confirmed by Doppler ultrasound; however, in one case, the diagnosis was missed during several weeks. In one case, the testicle was reduced into the scrotum immediately at the emergency department. Two cases were operated shortly after admission, performing testicular reduction into the scrotum and standard orchidopexy. Two other cases underwent delayed intervention, and both needed release of peri-testicular adhesions. Two cases (both bilateral) died at the accident site and were diagnosed by autopsy. In all surviving cases, it was possible to obtain a satisfactory orchidopexy with gonadal preservation.

Conclusions

Traumatic testicular dislocation is rare and diagnosis can be elusive. It should be suspected in motorcycle and high-energy accidents around the groin area and depends on a careful physical examination. With proper management, prognosis is excellent.     

Neonatal testicular torsion: a survey of current practice amongst paediatric surgeons and urologists in the United Kingdom and Ireland

Purpose

Management of neonatal testicular torsion (NTT) is controversial, with varied opinion regarding the merit(s) and role of “emergent” testicular exploration and/or contralateral orchidopexy of the healthy testis.

Methods

A survey of consultant paediatric surgeons and urologists working in the United Kingdom and Ireland was conducted to ascertain views to guide best practice.

Results

A total of 148 questionnaires were mailed, of which 110 were returned (74% response rate). Of these, 60 (54.5%) surgeons considered NTT secondary to torsion of the spermatic cord and 8 (7.2%) thought primary vascular infarction of the testis responsible. Twelve (10.9%) use Doppler ultrasound to guide management and exclude tumour. Eighty-two surgeons (74.5%) explore the scrotum, and 59 (71.9%) perform ipsilateral orchidectomy and contralateral orchidopexy of the “healthy” testis. Few surgeons undertake emergent exploration. Only 11 (10%) surgeons have ever found a viable testis. Seven (6.4%) cases of synchronous NTT were reported. Twenty-four (21.8%) surgeons do not perform contralateral orchidopexy with concerns of damaging a healthy testis. Orchidopexy is favoured by 89 surgeons, with 46 (52%) using nonabsorbable suture fixation and 28 (31.4%) creating a sutureless extradartos pouch. In boys later found to have a “solitary scrotal testis” and a contralateral testicular remnant, 38 (36.5%) of 104 would always “pex” the testis to avert anorchia.

Conclusions

Surgeons' opinions with NTT in the United Kingdom and Ireland remain diverse. Strong argument can be made for scrotal exploration with/without contralateral orchidopexy. Parents should be counselled on the merits of varied strategies to gain better understanding of the long-term outcomes for their male child.     

Comparison of erythropoietin and sildenafil protective role against ischemia/reperfusion injury of the testis in adult rats

Purpose

Tissue damage in testicular torsion/detorsion is caused not only by the ischemia, but also by the ischemia/reperfusion injury after detorsion. Erythropoietin and sildenafil are considered to protect against ischemia/reperfusion injury. Here, we studied and compared their actions in testicular torsion/detorsion in adult rats.

Methods

Twenty-two adult male Wistar Albino rats were divided into four groups. Rats in group A (n = 5) were sham operated. Rats in group B (n = 5), group C (n = 6) and group D (n = 6) underwent torsion of the right testis and detorsion after 90 min. No pharmaceutical intervention was performed in group B. Erythropoietin (1,000 IU/kg) and sildenafil (0.7 mg/kg) were injected intraperitoneally in groups C and D, respectively, after 60 min of torsion. All animals were killed 24 h after detorsion, and their right testis was extracted, placed into 10 % formalin solution and sent for histopathological examination. The histological changes in the testes were scored according to the four-point grading system proposed by Cosentino et al.

Results

All rats in group A had normal testicular architecture (grade 1). The untreated group B had a mean grade of 3.81 (range 3.65–4). The treated groups C (mean grade 3.24; range 3.05–3.45) and D (2.69, range 2.4–2.9) presented statistically significant better results (lower grades) compared with the untreated group B. Group D had significantly better results (lower grades) than group C.

Conclusions

The intraperitoneal injection of erythropoietin and sildenafil protects against ischemia/reperfusion injury after testicular torsion and detorsion. Sildenafil may have a stronger action than erythropoietin at the doses used in this study.     

Intrauterine testicular torsion: a surgical emergency

Background

Intrauterine torsion of testes (IUTT) is a very rare condition that is being recognized with increasing frequency. The exact cause of IUTT is not known, and controversies still continue regarding the need for urgent exploration as well as the necessity of contralateral orchidopexy. This is a review of our experience with 11 cases of IUTT, highlighting aspects of diagnosis and management.

Patients and Methods

From 1990 to 2005, we treated 11 newborns with IUTT. Their mean birth weight was 3.50 kg (range, 2.6-4.12 kg). Their age at presentation ranged from 2 hours to 10 days (mean, 45 hours). All underwent emergency exploration. There were 6 left-sided, 4 right-sided, and 1 bilateral torsion.

Results

In all, the affected testis was enlarged, tender, firm in consistency, and higher in position, and the overlying skin was dark red in color. Exploration revealed extravaginal torsion in all. In 1, there was partial torsion and the testis was enlarged, congested, but not gangrenous. Another child had complete torsion, but the testis was found enlarged, congested with hemorrhage, but not gangrenous. Both were treated with detorsion and preservation of testes and bilateral orchidopexy. On follow-up, both testes were viable, of good size, and in normal position. The patient with bilateral torsion had frankly necrotic left testis that was removed, but the right testis was smaller in size and ischemic but not frankly necrotic, so it was preserved, but on follow-up, it was found atrophic. One of our patients was evaluated few hours after delivery and found to have normal testes. On the second day, he was found to have enlarged, tender left testis. Emergency exploration revealed extravaginal torsion with slightly enlarged left testis that was ischemic but not frankly necrotic. This was preserved and bilateral orchidopexy was done. On follow-up, both testes were viable, of good size, and normal position. In the remaining 7 patients, the testes were frankly necrotic. They were treated with orchidectomy and contralateral orchidopexy. Histology of the removed testes was variable. In 6, the testes were totally necrotic without any viable testicular tissue, whereas in the remaining 2, there was preservation of some semineferous tubules and hemorrhage with ischemic infarction.

Conclusion

Intrauterine torsion of testes should be treated as an emergency. To obviate the risk of anorchia, we advocate early recognition of IUTT, expeditious exploration and simultaneous contralateral orchidopexy.     

Radioprotective reverse orchidopexy

Background/Purpose: With the improvement in long-term outcome from childhood malignancy, the expected quality of life is important. This study was to assess the value of reverse orchidopexy in patients requiring radiotherapy to the groin or pelvic area. Methods: The details of 6 boys (age 2 to 13 years) who had malignancy necessitating groin or pelvic radiotherapy were reviewed. Each had reverse orchidopexy of the contralateral testis for the course of the radiotherapy treatment. Brief case summaries are presented. The testis was replaced in the scrotum 4 to 12 months after the reverse orchidopexy. Results: The protected testis continued to grow and was considered normal at 1 to 7 years later. One individual had fathered a child. Conclusion: Reverse orchidopexy is a promising method of preserving testicular function in boys who require radiotherapy to the groin or pelvis area.     

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.     

Polyorchidism with presumed contralateral intrauterine testicular torsion

INTRODUCTION

Polyorchidism was first described by Blasius in 1670¹ during a routine autopsy. We report a child with unilateral polyorchidism and a contralateral absent testis, a combination not reported previously.

PRESENTATION OF CASE

A 2-year-old boy was referred to the outpatient clinic with an impalpable left testis. At laparoscopy, the left vas deferens and testicular vessels ended blindly proximal to a closed internal ring. No gonadal tissue was identified. On the right side, a single vas deferens and testicular vessels were seen entering the internal ring as normal. The right side of the scrotum was explored and two testes were identified within a single tunica vaginalis.

DISCUSSION

Polyorchidism is rare with a literature search identifying approximately 230 reported cases. Whilst prenatal testicular torsion is increasing being recognized and treated as a surgical emergency,⁹ prenatal testicular torsion in association with polyorchidism has not been previously reported.

CONCLUSION

We describe a unique case of a 2-year-old boy with right-sided polyorchidism and an absent left testis associated with a blind ending vas deferens and testicular vessels, presumed secondary to intrauterine testicular torsion.     

Testikuläre Ischämie

Background

Ischemia and reperfusion (I/R) lead to cellular damage. A disturbance of testicular perfusion occurs during the therapy of cryptorchidism and in cases of testicular torsion. This results in the activation of mediator cells with an increasing synthesis of mediators of infection like TNF-α and the expression of cell adhesion molecules like ICAM (intercellular adhesion molecule) and VCAM (vascular cell adhesion molecule) at the cellular surface.

Methods

The expression of the cytokines IL-10 and TNF-α and the adhesion molecules ICAM and VCAM after defined testicular I/R injury in nine male transsexuals was evaluated with rt-PCR. Furthermore we examined lactate and the diameter of the testicular tubulus under ischemic conditions.

Results

During ischemia ICAM, IL-10, and VCAM do not show significant changes on the side of testicular ischemia and the contralateral side; the same was seen for the tubulus diameter. TNF-α and the testicular lactate values showed a significant change of the expression pattern.

Discussion

The statistical changes of TNF-α and testicular lactate are the expression of leukocyte migration, infectious reaction, and immune response. To what extent the TNF-α expression represents a severe immunological reaction remains undefined. This human study shows primary results for the immunological understanding of and cellular response to testicular ischemia.     

Urologische Behandlungsfehler bei chirurgischen Eingriffen

Background

In the examinations of the appraisal commission of Northern Rhine the third most frequent urologic errors are ascertained after surgical procedures. In order to prevent them, it is adequate to evaluate their causes.

Material and Methods

Urologic claims were examined that came before the appraisal commission for treatment errors of the Northern Rhine Physicians’ Authority between 1975 and 2005. The results of the first 23 years were compared with those of the last 7 years. The judgment criteria were professional standards and required care.

Results

Ninety-five treatment errors were registered in 1975–2005. From 1975 to 1998 there were 60 such errors (2.6 per year) and from 1999 to 2005 there were 35 (5.0 per year). These errors concerned diagnosis in 14.7% of cases (mainly testicular torsion), indication in 7.5%, and explanations of the surgery in 2.1%. About half the cases (46.3%) applied to surgical technique, especially for injuries to the spermatic cord, urinary bladder, ureter, or urethra. In nearly one third of cases (29.4%), errors were found in postoperative care, concerning especially lesions of the spermatic cord and ureter.

Conclusions

There is considerable risk of misjudging or even causing urologic disorders in abdominal and vascular surgery. This applies most strongly to diagnosis, above all for testicular torsion. Hernia surgery and colon resection are the treatments leading to the highest number of injuries to testicular vessels, ureter, bladder, and/or urethra. Such occurrences cannot be tolerated if they can be avoided or, if unavoidable, not recognized promptly and adequately managed.     

Protective effect of urapidil on testicular torsion–detorsion injury in rats

Purpose

The aim of this study was to investigate the effect of urapidil and low-molecular weight heparin (LMWH) on testicular torsion–detorsion injury in rats.

Methods

Thirty-two male Sprague–Dawley rats were used. In the torsion–detorsion (T/D) group, the left testis was twisted at 720° for 3 h. After 3 h of reperfusion, the testis was removed. Urapidil or LMWH was administered intraperitoneally 30 min before detorsion in the treatment groups.

Results

Unilateral testicular torsion–detorsion caused significant increases in the malondialdehyde level and apoptosis and significant decreases in the superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities in ipsilateral testes (p < 0.001). The rats treated with urapidil had a significant decrease in the malondialdehyde level and apoptosis and significant increases in the SOD and GPx activities in ipsilateral testes compared to the T/D group (p < 0.001). Animals treated with LMWH showed non-significant reductions in malondialdehyde levels and apoptosis compared to the T/D group. In addition, no significant difference in the SOD activities (p = 0.52) between the groups was found. The increase in the GPx activities was significant in the LMWH group compared to the T/D group (p < 0.001).

Conclusion

The administration of urapidil before detorsion prevents ischemia/reperfusion cellular damage in testicular tissue. LMWH was not found to have a beneficial effect on testicular T/D injury in rats.

     

Testicular atrophy after attempted pediatric orchidopexy for true undescended testis

Background/Purpose

A normal testis in the scrotum is the most important outcome of the attempted pediatric orchidopexy for a true undescended testis. The reports of post-orchidopexy testicular atrophy in the literature have ranged from non-existent to unclear. Our purpose in this study was to estimate the incidence of and associated risk factors for post-orchidopexy testicular atrophy.

Methods

We performed a retrospective review of data from children who had an attempted orchidopexy for a true undescended testis from 1969 to 2003 inclusive. REB approval 1000011987.

Results

There were 1400 attempted orchidopexies involving common (low) type (n = 1135), ectopic type (n = 174), and high type testes (n = 91). There were a total of 111/1400 (8%) atrophic testes, mostly right-sided. 66/111 (59%) were MADE atrophic, and 45 (41%) were FOUND atrophic. Of the 1135 common type, 56 (5%) were MADE atrophic. In the ectopic and high types, the incidence of post-operative testicular atrophy was 1% and 9%, respectively.The most significant risk factors associated with testes MADE atrophic were high testicle, vas problems, and pre-operative torsion.

Conclusions

In this series, the incidence of post-operative testicular atrophy that was MADE was 5% in the common (low) type and 9% in the high type. These numbers and the above risk factors should be quoted to the caregiver during pre-operative informed consent.     

d-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial

Purpose

To test whether d-mannose powder is effective for recurrent urinary tract infection (UTI) prevention.

Materials and methods

After initial antibiotic treatment of acute cystitis, 308 women with history of recurrent UTI and no other significant comorbidities were randomly allocated to three groups. The first group (n = 103) received prophylaxis with 2 g of d-mannose powder in 200 ml of water daily for 6 months, the second (n = 103) received 50 mg Nitrofurantoin daily, and the third (n = 102) did not receive prophylaxis.

Results

Overall 98 patients (31.8 %) had recurrent UTI: 15 (14.6) in the d-mannose group, 21 (20.4) in Nitrofurantoin group, and 62 (60.8) in no prophylaxis group, with the rate significantly higher in no prophylaxis group compared to active groups (P < 0.001). Patients in d-mannose group and Nitrofurantoin group had a significantly lower risk of recurrent UTI episode during prophylactic therapy compared to patients in no prophylaxis group (RR 0.239 and 0.335, P < 0.0001). In active groups, 17.9 % of patients reported side effects but they were mild and did not require stopping the prophylaxis. Patients in d-mannose group had a significantly lower risk of side effects compared to patients in Nitrofurantoin group (RR 0.276, P < 0.0001), but the clinical importance of this finding is low because Nitrofurantoin was well tolerated.

Conclusions

In our study, d-mannose powder had significantly reduced the risk of recurrent UTI which was no different than in Nitrofurantoin group. More studies will be needed to validate the results of this study, but initial findings show that d-mannose may be useful for UTI prevention.     

Organerhaltende Hodentumortherapie

Background

The therapy of malignant testicular neoplasms has always been characterized by a high degree of radicality. Thanks to a number of medical achievements the cure rate of testicular cancer has notably increased through the last decades. In the meanwhile the main focus is on reducing therapy load, scrutinizing radical orchiectomy as the only adequate therapy for the primary tumour.

Objectives

This article discusses the question, if and under which conditions an organ-sparing approach can be used appropriately in clinical practice.

Materials and methods

A selective literature search was performed in PubMed.

Results

A set of data suggest that endocrine and exocrine function of the testis can be preserved using an organ-sparing approach and many patients could benefit regarding their quality of life, e.g., preserving the ability to father a child at least temporarily and avoiding the need for hormone substitution. Different from kidney tumors, precancerous lesions (testicular intraepithelia neoplasia, TIN) can almost inevitably be found in the surrounding tissue of testicular tumors. This has to be considered when making a decision in favor of an organ-sparing approach, because radiation therapy on the affected testis has to be performed after tumor resection. Despite the absence of prospective data, organ-sparing surgical tumor resection can be recommended in carefully selected patients.

Conclusion

After careful selection of patients, particularly young men can profit from an organ-sparing therapy regimen. Therefore, organ preservation should always be considered in the surgical treatment of testicular masses.     

Les traumatismes des bourses

Objective|To evaluate the epidemiological, clinical, laboratory and therapeutic features of scrotal trauma seen in the Department of Urology and Andrology of Brazzaville University Hospital, and to compare these results to the literature

Patients and Methods

This study included 18 patients hospitalized for scrotal trauma between January 1990 and December 2006. The parameters studied were: frequency, age, etiology, presenting symptoms, the time elapsed since the accident, the findings on clinical examination and ultrasonography, treatment and outcome.

Results

Scrotal trauma represented 0,4% of all hospital admissions to Brazzaville University Hospital. The mean age of the patients was 34.6 (range 9–64) years. The trauma was mainly due to traffic accidents (8 cases) and to work accidents (5 cases). The mean time elapsed between the accident and consultation was 3 days for blunt trauma and 1 hour for open trauma. The main presenting symptom was scrotal pain (n=10). Ultrasonography done in 8 patients revealed rupture of the tunica albuginea in 4, intra-testicular hematoma in 2 and hematocele in another 2 cases. Medical treatment was applied in 6 cases, while 12 patients were treated surgically by resection of the extruded testicular pulp and suturing of the tunica albuginea in 4, orchidopexy in 1, orchidectomy in 3, evacuation of the hematocele in 2 and drainage of the testicular hematoma in 2 cases. On longterm follow-up residual scrotal pain was observed in 3, oligoasthenozoo-spermia in 3, testicular atrophy in 2 and erectile dysfunction in 1 patient.

Conclusion

If hematocele is present, surgical exploration is mandatory. Ultrasonography can help to diagnose a rupture of the tunica albuginea, however this examination should not delay surgical treatment.     

Ultrasonic predictors of improved seminal parameters after bilateral laparoscopic varicocelectomy

Objective

The effect of varicocelectomy on semen parameters of varicocele with low-grade reflux and low testicular vein diameter is poorly documented. Our study aimed at determining whether preoperative venous diameter and grade of reflux predict semen parameters improvement after varicocelectomy.

Patients and methods

We studied 85 patients undergoing bilateral laparoscopic varicocelectomy (BLV). Follow-up was performed at 3 and 6?months after surgery. We surveyed the correlation between semen parameters improvement and testicular vein diameter at the inferior pole of the testis, and the degree of reflux measured by color Doppler ultrasound (CDU).

Results

BLV resulted in a statistically significant increase in semen analysis parameters (p?=?0.00). There was a correlation between testicular vein diameter and the improvement index in sperm motility (r?=?0.31, p?=?0.006). There was a significant correlation between the degree of reflux detected by CDU and improvement index in sperm concentration (r?=?0.37, p?=?0.001).

Conclusion

Patients with testicular vein diameter >2.5?mm and higher grades of reflux detected at the veins at the lower pole of the testis had higher improvement index after BLV. Therefore, we can select the patients with these criteria for BLV.     

Organ-sparing surgery is the treatment of choice in benign testicular tumors

Purpose

Ablation of the testis has been the reference standard for malignant and benign testicular tumors in the past. Nowadays, an organ-sparing surgery (OSS) can be attempted in special cases. Removal of a testis for a benign lesion should be avoided. In this retrospective survey, we analyze the results and long-term follow-up of OSS in benign testicular tumors.

Methods

Charts of all patients that underwent OSS because of a benign testicular tumor between 1999 and 2011 at our department were searched and the data from patients were collected. Before surgery, all patients underwent ultrasound (US) and complete staging. Surgery was performed under US or palpation guidance. Frozen-section examination of the tumor and tumor bed biopsies was obtained. All patients underwent postoperative follow-up. We retrospectively reviewed surgical technique, histology, epidemiology, and outcome in all patients.

Results

In the study period, 40 benign testicular tumors were surgically removed in 37 consecutive patients. Definitive histology did not report of any malignant histopathologic features in all patients. All patients are free of disease after a mean follow-up of 63 months (range 10–120). During this period, two patients developed a second leydig cell tumor (LCT) on the contralateral side; another patient had a second LCT within the same testicle, but on the opposite pole. All patients underwent a subsequent organ-sparing tumor resection.

Conclusions

An overtreatment for benign testicular tumors should be avoided. Our initial results indicate that OSS in benign tumors is a safe, feasible treatment for patients.     

Perinatal testicular torsion: a unique strategy

Background/Purpose

Perinatal testicular torsion (PTT) is defined as testicular torsion occurring prenatally or within the first 30 days of life. The aim of this study was to evaluate the data obtained from patients with PTT and propose principles of management based on clinical, surgical, and histologic findings.

Methods

A retrospective analysis of 27 boys seen between 1990 and 2005 with surgically documented PTT was conducted. Patients were divided into 2 groups: A, prenatal testicular torsion; B, postnatal testicular torsion. The presence of acute scrotal inflammatory signs defined the urgency to operate.

Results

There were 4 clinical pictures in group A: A1, patients with a nubbin testis (n = 3); A2, patients with a small and hard testis (n = 12); A3, patients with a normal-sized and hard testis (n = 8); and A4, patients with an acute scrotum (n = 2). Group B (n = 2) presented no sign after birth and later developed an acute scrotum. Surgical exploration and histologic examination showed clear signs of a long-standing testicular torsion in groups A1, A2, and A3 or a recent-onset testicular torsion in groups A4 and B. Only one testis could be salvaged (group B).

Conclusions

Clinical signs correlated very well with surgical and histologic findings and can define the need and the urgency to operate. Although testicular salvage rate is very low, the affected side always should be explored to confirm the diagnosis and to fix or remove the affected testicle. The contralateral scrotum also should be explored because of the risk of asynchronous contralateral 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     

Les torsions du cordon spermatique chez l’enfant

Objectives

To evaluate the frequency of testicular torsion, to describe its clinical presentation and treatment and to evaluate the treatment results at Tokoin University Hospital, Lomé, Togo.

Patients and Methods

This is a retrospective study of the files of 17 patients seen in the pediatric surgery department in the period 1 January 2002 to 31 December 2006 with testicular torsion diagnosed at surgery. The following parameters were studied: patient age, delay prior to presentation, symptoms, diagnostic investigations, treatment and post-operative results.

Results

During the study period, 57 patients with acute scrotum were treated in the department of pediatric surgery. Testicular torsion was found in 17 (29.8%) with 11 patients being aged between 6 and 15 years, showing a clear preponderance of boys in puberty. The mean age of our patients was 9 years (range 7 days to 15 years). The average duration of symptoms prior to presentation was 30 hours (range 10 to 72 hours). Pain was the main symptom in infants and older children. Eleven of 17 patients underwent colour Doppler sonography. Surgical interventions consisted of surgical exploration followed by detorsion of the cord and bilateral fixation of the testes. All 17 testes were preserved. With an average follow-up of 12 months (range: 4 months to 5 years) the post-operative period was uneventful.

Conclusion

Testicular torsion mainly occurs in the neonatal period and during puberty. However, it may also occur between these two periods. Surgical exploration is mandatory in every suspected case of spermatic cord torsion.