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.     

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.     

Germ cell degeneration in the contralateral testis of the guinea pig with unilateral torsion of the spermatic cord. Quantitative and ultrastructural studies

This study evaluated the long term effects of unilateral torsion of the spermatic cord on the contralateral testis of guinea pigs, employing both fine structural and quantitative studies. Young, adult Hartley strain guinea pigs were divided into six experimental groups (12 animals per group). The first three groups consisted of 36 animals in which unilateral torsion was surgically induced. In group I (torsion maintained), unilateral torsion of the spermatic cord was maintained until the day of sacrifice; in group II (torsion and untwist), torsion of the spermatic cord was maintained for 8 to 12 hours, then the spermatic cord was untwisted and the testis was retained until the day of sacrifice. In group III (torsion and orchiectomy), testes were removed after 8 to 12 hours of spermatic cord torsion. The second three groups consisted of 36 animals: group IV (unilateral orchiectomy), group V (unilateral sham operation), and group VI (pentobarbital injection alone), which served as controls. One half of the animals from each group were killed after 4 months and the other half were killed after 8 months. The most frequently observed histologic changes in the contralateral testes of the experimental animals were focal disorganization and exfoliation of immature germ cells into the lumen. Severe damage, with almost complete absence of germ cells, was noted only in an occasional tubule. Quantitative evaluation of the germ cells of the contralateral testis revealed significant loss of germ cells in groups I, II, and III after 4 months, and in groups I and II after 8 months.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

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.     

Effect of insulin-like growth factor-1 on apoptosis of rat testicular germ cells induced by testicular torsion

OBJECTIVE: To investigate the possible protective role of insulin-like growth factor-1 (IGF-1, reported to have a protective effect in experimental models of hypoxic ischaemia), and the involvement of apoptotic cell death in a model of torsion/detorsion of the rat testis. MATERIALS AND METHODS: Adult male Wistar rats were divided into five groups of five rats each. Group 1 underwent a sham operation as a control; in group 2 the testis was twisted and in group 3 then untwisted; in group 4 IGF-1 was injected subcutaneously just before bilateral torsion, and then the right testis removed after 4 h and the left after 24 h; in group 5, IGF-1 was injected immediately after bilateral detorsion and then the testes removed as in group 4. Both testicles were examined histologically, with apoptosis detected using the in situ DNA fragmentation (TUNEL) system, with combined enzymology and immunohistochemistry techniques. RESULTS: In groups 2 (torsion) and 3 (detorsion), light microscopy of the testis showed some degenerative changes in the germ cells. Compared to group 1, apoptosis was more significant in group 3 than in the other groups. Group 4 (torsion/IGF-1) had a similar number of apoptotic germ cells as in group 2 (torsion) after 24 h, but fewer than the same group after 4 h. In group 5 (detorsion/IGF-1), apoptosis was reduced by IGF-1 significantly more than in group 3 (P < 0.05). Apoptosis was significantly less in spermatids in group 5 than in group 3 (P < 0.05). CONCLUSIONS: IGF-1 seems to lower the levels of germ cell apoptosis, which may be important for protecting the testes from torsion/detorsion injury. Further clinical studies are needed to evaluate this protective effect in testicular torsion/detorsion.     

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     

Morphological responses of the rabbit testis to ischemic/reperfusion injury due to torsion

OBJECTIVE: To investigate the morphological effects of free radical injury on spermatogenic cells in both testes of the rabbit experimental model of testicular torsion. MATERIALS AND METHODS: The left testes of 8 peripubertal NZW rabbits (3-6 months) were subjected to 0, 15, 30, 60, 90, 120, and 180 min of ischemia by applying a clamp to the spermatic cord, followed by reperfusion. Another set of 8 rabbits was subjected to 60 min of ischemia and administered antioxidants (acetylsalicylic acid, ascorbic acid, allopurinol, quercetin, superoxide dismutase) before reperfusion. Both testes of 4 animals per group were harvested at 24 h and the remaining 4 at 3 months. Johnsen scores for spermatogenic activity and other changes were assessed histologically and these were compared with testicular malondialdehyde (MDA), a measure of free radical damage, assayed on testicular homogenates using the thiobarbiturate method. RESULTS: In the 24-hour reperfusion group, apoptotic bodies and giant cells were more prominent in the seminiferous tubules of the left testes compared to the right, and were maximal after 90 min. In the 3-month reperfusion group, giant cells were absent, and apoptotic bodies were reduced in both testes. Testicular MDA showed an increase only in the left testes in the 24-hour reperfusion group, while the 3-month group showed increased MDA levels in both testes, but more on the left. The Johnsen score fell only to 8.0 in the left testes in the 24-hour reperfusion group, but dropped to 2.3 in the 3-month reperfusion group. Only in the 3-month reperfusion group, did antioxidant-treated animals show a fall in Johnsen scores in the left testes, regardless of the type of antioxidant. CONCLUSION: These findings confirm a role for reactive oxygen species (ROS) in damage to spermatogenic cells in both the ipsilateral and contralateral testes following torsion, with longer term effects in the torted testis. Currently available antioxidants do not provide any significant long-term protection against morphological damage to the testis by ROS generated in testicular torsion.     

Unilateral testicular disease: effect on the contralateral testis (morphometric study)

Unilateral testicular disease has been reported to damage the contralateral testis. In order to find out whether this detrimental influence is permanent in nature or can be avoided by therapeutic measures, and furthermore to quantify the damage, the following experiments were performed. Seventy-five rats were classified into the following five groups: I) testicular torsion persisting for eight hours; II) ipsilateral semicastration after torsion persisting for eight hours; III) semicastration; IV) sham operation as control; V) immunosuppression with azathioprine after torsion persisting for eight hours. The contralateral testes were removed two months later and perfused with fixative via the testicular artery. Stereologic techniques were employed to obtain quantitative morphologic data. Serum hormone levels were determined. The volume density of the contralateral germinal epithelium was not decreased two months after torsion for eight hours, torsion following by semicastration or torsion followed by immunosuppression. The same was true of the total volume of germinal epithelium per rat testis. The hormone levels remained essentially unchanged.     

Histological changes occurring in the contralateral testes of prepubertal rats subjected to various durations of unilateral spermatic cord torsion

Prepubertal rats were exposed to unilateral spermatic cord torsion for 0, 1, 3, 5, 9 or 12 hours duration. At the end of this time the damaged testes were either removed or untwisted and pexed into place. The animals were then allowed to mature to 77 days of age at which time the contralateral testes were examined for 12 histological parameters and scored according to the degree of pathology noted in each. Pathological changes in the contralateral testes were found to be dependent on the duration of spermatic cord torsion but were less severe in the orchiectomized group. Thus, removal of the damaged organ minimized the long-term damage to the contralateral testes. We also noted that specific histological parameters of the contralateral testes correlated well with fertility and that specific changes in the ipsilateral testes predicted contralateral pathology.     

Ethyl pyruvate reduces germ cell-specific apoptosis and oxidative stress in rat model of testicular torsion/detorsion

Purpose

Testicular torsion/detorsion (T/D) results in enhanced formation of free radical metabolites, which contributes to the pathophysiology of tissue damage. We investigated the protective effects of ethyl pyruvate (EP) against testis tissue damage in an experimental model of testicular torsion.

Methods

Sprague-Dawley rats were divided into 5 groups. In those animals that underwent T/D, right testes were rotated 720° for 1 hour. Group 1 control rats underwent sham operation. In group 2, the rats underwent T/D. The EP was prepared and injected in the form of Ringer's ethyl pyruvate solution. The rats in group 3, 4, and 5 received 2 doses of 20, 50, and 100 mg/kg EP (30 minutes before and after detorsion), respectively. The right testes of 6 animals from each group were excised 4 hours after detorsion for the measurement of lipid peroxidation, myeloperoxidase (MPO), and antioxidant enzymes activities. Germ cell apoptosis was determined in right testes of 8 animals per group 24 hours after detorsion. The epididymal sperm concentration and motility were evaluated 1 month after treatments.

Results

Germ cell apoptosis indices were significantly higher in group 2 compared with control group. The level of lipid peroxidation and MPO activity increased, whereas antioxidant enzymes activities decreased after T/D. Sperm count and motility were also reduced 1 month after T/D in group 2 rats. However, EP treatment at doses of 50 and 100 mg/kg significantly decreased the early apoptotic damage and improved long-term sperm count and motility. In the same dosing groups, we observed normalization of oxidant/antioxidant balance and decrement of MPO activity. However, administration of 20 mg/kg of EP conferred no protective effect.

Conclusions

Administration of Ringer's ethyl pyruvate solution (in appropriate doses) is protective against apoptotic tissue damage following testicular torsion and improves long-term testicular function. The antioxidant and anti-inflammatory properties of EP seem responsible for the protective effects. Our findings suggest this resuscitation solution as a possible substitute for fluid and electrolyte maintenance during surgical detorsion.     

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.     

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.     

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.     

Evaluation of contralateral testicular damage after unilateral testicular torsion by serum inhibin B levels.

BACKGROUND/PURPOSE: It is still controversial whether unilateral testicular torsion (TT) affects contralateral testis. The authors wanted to evaluate contralateral testicular damage in a rat model by the serum inhibin B levels, which is suggested as a marker of Sertoli cell function and spermatogenesis. METHODS: Fifty peripubertal male Wistar Albino rats were divided into 5 groups each containing 10 rats. Surgery was conducted under intraperitoneal 1-shot ketamine (50 mg/kg) anesthesia. Torsion-detorsion, torsion-detorsion-orchiectomies, orchiectomies, and sham operations were performed on the right testicle through a midline incision. Torsions were created by rotating the right testes 720 degrees in a clockwise direction and maintained by fixing the testes to the scrotum with a silk suture. Torsion duration was 4 hours. After each surgical intervention the incisions were closed. In group 1, 3-mL blood samples were taken to determine basal values of inhibin B in serum, and bilateral orchiectomies were performed. In group 2, 4 hours of torsion and detorsion was created and 1 month later, 3-mL blood samples were taken, and bilateral orchiectomies were performed. In group 3, 4 hours of torsion-4 hours of detorsion was created, and right orchiectomies were performed and 1 month later, 3-mL blood samples were taken and contralateral orchiectomies were added. In group 4, unilateral orchiectomies were performed, and 1 month later, 3-mL blood samples were taken, and contralateral orchiectomies were added. After the measurement of the serum inhibin B levels and histopathologic examinations, results are expressed as mean +/- SD. RESULTS: Serum inhibin B levels expressed as mean +/- SD were 108.233 +/- 21.296 pg/mL for group 1, 54.065 +/- 16.910 pg/mL for group 2, 74.195 +/- 2.779 pg/mL for group 3, 108.335 +/- 26.078 pg/mL for group 4, and 107.645 +/- 4.705 pg/mL for group 5. Inhibin B levels in group 2 and group 3 were different from group 1, group 4, and group 5 (P <.05). In histologic examination, Johnsen's scores expressed as mean +/- SD of right testes were 9.74 +/- 0.08 for group 1, 3.64 +/- 3.36 for group 2, and 9.86 +/- 0.05 for group 5. Histologic findings in group 2 were different from group 1 and group 5 (P <.05). Johnsen's scores expressed as mean +/- SD of left testes were 9.78 +/- 0.09 for group 1, 9.75 +/- 0.14 for group 2, 9.76 +/- 0.15 for group 3, 9.79 +/- 0.07 for group 4, and 9.82 +/- 0.08 for group 5, and there was no difference between groups (P >.05). CONCLUSIONS: The serum inhibin B levels decrease after unilateral TT reflecting contralateral testicular damage. Orchiectomy to prevent contralateral testicular damage after TT may not be effective after critical period. Measurement of inhibin B levels to evaluate contralateral testicular damage after unilateral TT is more effective than histopathologic examination.     

Artificial intra-abdominal cryptorchidism in young adult rats leads to irreversible azoospermia

To study reversibility of artificial intra-abdominal cryptorchidism, in four groups of 5 rats at 3 months of age vasocystostomies (a microsurgical operation anastomosing both sperm ducts into the urine bladder) were carried out. This procedure enables sperm output measurements, which was performed by putting the animals for 24 h in metabolic cages. Four weeks later 15 of the remaining animals were operated again to induce artificial cryptorchidism. In a fourth group, 3 animals were sham-operated only, leaving the testes in place. Two weeks later in the animals of group I cryptorchidism was reversed by an orchiopexy operation; in group II orchiopexy was carried out after 4 weeks, in group III after 8 weeks. In group IV the animals were sham-operated again. Evaluation of sperm output took place for 3 months after orchiopexy. In the 1st week after vasocystostomy the animals showed a large variation in sperm output, but 2 weeks later, all animals had sperm output between 30-60 x 10(6) of spermatoza/24 h. Immediately after cryptorchidism sperm output decreased dramatically, and 2 weeks later all animals were azoospermic, except for sham-operated controls. After orchiopexy not one of the experimental animals showed any return of spermatozoa. We concluded that intra-abdominal cryptorchidism soon leads to irreversible damage to the testes resulting in azoospermia.     

The role of nitric oxide in testicular ischemia-reperfusion injury

PURPOSE: This study was designed to determine the role of nitric oxide (NO) in the ischemia-reperfusion (I/R) injury process in testes. METHODS: Fifty prepubertal male rats were divided into 5 groups each containing 10 rats. After 4-hour torsion and 4-hour detorsion, bilateral orchiectomies were performed for measurement of tissue malondialdehyde (MDA) level and histopathologic examination. The results were compared statistically. The groups were labeled as group 1, basal values of biochemical parameters in testes; group 2 (control group), torsion plus detorsion; group 3, torsion plus N-monomethyl-L-arginine (L-NMMA) plus detorsion; group 4, torsion plus L-arginine plus detorsion; group 5, sham operation. RESULTS: The highest MDA values were determined in the L-arginin group in ipsilateral testes. Group 3 and group 4 were statistically different from control group. Histological examination showed that specimens from group 4 had a significantly (P < .05) greater histological injury than group 3, and contralateral testes showed normal testicular architecture in all groups. CONCLUSIONS: These results suggest that NO plays an important role in damaging the testis with I/R. Although inhibition of NO synthesis with L-NMMA significantly improves I/R injury in testes, enhancing NO production by providing excess of L-arginine increases such damage. In the early periods of detorsion, there is no damage to contralateral testes after unilateral testicular torsion.     

Histopathology of prepubertal rat testes subjected to various durations of spermatic cord torsion

Sixty prepubertal rats were subjected to unilateral spermatic cord torsion for a duration of 0, 1, 3, 5, 9 or 12 hours. At the end of this period, the ipsilateral testes either were removed for immediate processing or subjected to detorsion and orchiopexy, followed by a six-week recovery period prior to histologic study. Twelve histologic parameters were each scored according to the degree of pathologic findings, thus allowing for a quantitative assessment of testicular damage. The sequence of specific histologic degeneration that occurred with spermatic cord torsion is described. These changes were found to be dependent on the duration of torsion, with the greatest damage occurring after three hours or more. In the animals undergoing detorsion followed by a six-week recovery period, severe degeneration was noted for all durations of torsion studied. The extent of this degeneration was significantly correlated with a reduction in fertility.     

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.