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.     

Effect of unilateral testicular torsion on contralateral testis in a rat model

The aim of this study was to investigate the function of the contralateral testis after unilateral testicular torsion (UTT) and its possible mechanism. 56 rats were randomly divided into four groups: Group A: Sham operation, Group B: Testicular torsion (TT)+normal saline (NS), Group C: Testicular torsion (TT)+cyclosporine, Group D: Testicular torsion (TT)+NG-Monomethyl-l-arginine (l-NMMA). The right testes were removed 1 week and 8 weeks after surgery, respectively. Biochemistry and histopathologic evaluations were used to evaluate the germ cell damage. Compared with Group A, the levels of malondialchehyche (MDA) and nitric oxide (NO)/nitricoxide synthase (NOS) were increased remarkably in Group B. Significant differences were shown between histopathological damages and density and motility of sperm in two groups. Compared with Group B, the levels of MDA and NO/NOS in Group D decreased significantly while mean seminiferous tubule diameter (MSTD) and mean testicular biopsy scoring (MTBS) maintained in a better condition. The levels of major histocompatibility complex (MHC) peptide-tetramer complex in Group C and Group D decreased significantly than Group B, while sperm density and motility were significantly higher than Group B. It was also known that the histopathological damages in Group C and Group D were less than those in Group B in the 8 weeks after operation. UTT can cause impairment of contralateral testicular function and decrease of spermatogenic function. The mechanism may be related to ischemia–reperfusion (IR) in early stage and autoimmune response in late stage.     

Effect of diclofenac on germ cell apoptosis following testicular ischemia-reperfusion injury in a rat

Recent evidence suggests that enhanced cell apoptosis is responsible for germ cell loss following testicular ischemia-reperfusion (IR) injury. A nonsteroidal anti-inflammatory drug diclofenac sodium (Voltaren) is a prostaglandin-synthesis inhibitor, which is widely used in many testicular disorders. The purpose of the present study was to examine the effect of diclofenac (DIC) on germ cell apoptosis in the ischemic and contralateral testes following testicular IR in a rat. Forty rats were divided randomly into four experimental groups of ten rats each: group A (Sham)—Sham operated animals; group B (Sham-DIC)—Sham operated rats that were treated with DIC given subcutaneously at a dose of 10 mg/kg, once daily, 24, 48 and 72 h following operation; group C (IR) underwent 90 min of unilateral testicular IR; group D (IR-DIC)—rats underwent 90 min of unilateral testicular IR and were treated with DIC similarly to group B. Ninety-six hours following operation, the rats were sacrificed and testes were harvested. Johnsen’s criteria and the number of germinal cell layers were used to categorize the spermatogenesis. TUNEL assay was used to determine germ cell apoptosis in both the ischemic and contralateral testes. Statistical analysis was performed using the non-parametric Kruskal–Wallis ANOVA test, with P less than 0.05 considered statistically significant. Testicular ischemia in rats led to histological damage in the ipsilateral testis. In the contralateral testis, minimal damage was observed. Germ cell apoptosis in both the ischemic and the contralateral testes increased significantly after IR. Treatment with DIC did not change histologic parameters of spermatogenesis in both the ischemic and contralateral testes, but decreased germ cell apoptosis in both testes following testicular IR. We conclude that testicular ischemia causes an increase in germ cell apoptosis in the contralateral testis. Diclofenac may be beneficial for spermatogenesis following testicular IR by decreasing germ cell apoptosis.     

别嘌呤醇对睾丸扭转的治疗作用

目的 研究睾丸扭转以后组织的受损情况，观察别嘌呤醇药物对睾丸扭转的治疗意义。方法 以大鼠为研究对象，测定一侧睾丸扭转后两侧睾丸组织的脂质过氧化物含量。按扭转时间分组，分析睾丸扭转、复位、药物应用以后局部的损伤变化情况。结果 单侧睾丸扭转以后，两侧组织的脂质过氧化物含量都明显上升。脂质过氧化物的含量与扭转时间有关。别嘌呤醇应用后，能降低扭转2h以内的两侧睾丸脂质过氧化物产量，以及扭转6h以内的对侧睾丸脂质过氧化物含量。结论 别嘌呤醇对改善睾丸扭转损伤有治疗意义，临床上应提倡早期用药。     

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.     

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.     

Effect of phospodiesterase 5 inhibitors on apoptosis and nitric oxide synthases in testis torsion: an experimental study

To investigate the effects of phosphodiesterase (PDE) 5 inhibitors, sildenafil citrate and vardenafil HCl, on testicular germ cell apoptosis and also on the expressions of eNOS and iNOS within the bilateral testis after a unilateral torsion in a rat model. Forty-eight Wistar Albino rats, weighing between 210 and 262 g, were housed in individual cages. The rats were randomly assigned into four main groups and each group received drugs. Saline, sildenafil citrate and vardenafil HCl were given to each for 1 month and the last received no drug. After 1 month, testicular torsion was created for 1 h of ischemia and the left testis was untwisted and replaced to the scrotum for 2 h of reperfusion. At the end of 3 h, contralateral and ipsilateral testes were removed for histopathologic and biochemical examinations. Under light microscopy; the histopathological patterns of the contralateral testes in all groups were not affected. Mean apoptotic cell, eNOS and iNOS levels were increased in saline study group. The rats treated with vardenafil and sildenafil (groups 2s and 3s) showed significantly increased apoptotic cell, eNOS and iNOS values in ipsilateral testis (P < 0.05). Sildenafil citrate and vardenafil HCl caused an exaggerated testicular apoptosis after IR injury in rats. Additionally these drugs increased the NOSs levels in the testicular tissue.     

The protective effect of dexpanthenol on testicular atrophy at 60th day following experimental testicular torsion

Despite the prompt diagnosis and treatment of testicular torsion (TT), there are problems with fertility and atrophy after testicular salvage. Dexpanthenol (Dxp) is the biologically active alcohol of pantothenic acid (PA). Dxp is converted to PA in tissues. PA increases the content of reduced glutathione (GSH), Coenzyme A and ATP synthesis in cells. GSH and glutathione-dependent peroxidases (GPX) are the major defense systems against oxidative stress. GPX-4 is the major antioxidant in testicular tissue. However, the activity of GPX-4 appeared and increased only after puberty. We investigated the effect of Dxp on testicular atrophy after TT at the 60th day. Rats were separated randomly into four groups. Group C: control group, group Td: torsion + detorsion, group Sal: torsion + saline + detorsion, group Dxp: torsion + Dxp + detorsion. The left testis was rotated 720° for 2 h. In group Sal, normal saline and in group Dxp, Dexpanthenol were injected intraperitonally, 30 min before detorsion. After 60 days, the testicular weights and volumes were measured. Histopathology of the left testis was evaluated with mean seminiferous tubular diameter (MSTD) and mean testicular biopsy score (MTBS). The left (torsed) testicular weight and volume of groups Td and Sal were significantly lower compared to group Dxp. The MSTD and MTBS of group Td and Sal were significantly lower than group Dxp. Contralateral testicular weight and volume of groups Td, Sal and Dxp had no significant difference compared to the control group. Dxp significantly prevented testicular atrophy after 60 days of TT. Dxp has FDA approval, is safe, cost effective and readily available. Its relevance for clinical trials may especially be for the problem of testicular atrophy catastrophe, seen very frequently following testicular salvage.     

Effect of allopurinol on germ cell apoptosis following testicular ischemia–reperfusion injury in a rat

Recent evidence suggests that apoptosis is involved in germ cell loss following testicular ischemia-reperfusion (IR) injury. Allopurinol (Allo) is as a free radical scavenger which prevents tissue damage caused by reperfusion and oxygenation after ischemia; however, its effect on apoptosis in this type of injury has not been studied. To examine the effect of allopurinol on germ cell apoptosis following testicular IR in a rat. Forty rats were divided randomly into 4 experimental groups of 10 rats each: group A (Sham)-Sham operated animals; group B (Sham-Allo)-Sham operated rats treated with allopurinol given PO (by gavage) at a dose of 200 mg/kg, once daily, immediately before and 24 h following operation; group C (IR)-rats underwent 90 min of unilateral testicular ischemia and 48 h of reperfusion; group D (IR-Allo)-rats underwent IR and were treated with allopurinol similar to group B. The ipsilateral and contralateral testes were harvested 48 h following operation. Johnsen's criteria and the number of germinal cell layers were used to categorize spermatogenesis. TUNEL assay was used to determine germ cell apoptosis. Statistical analysis was performed using one-way ANOVA test, with P < 0.05 considered statistically significant. Testicular ischemia in rats led to histological damage in the ipsilateral testis. In the contralateral testis minimal damage was observed. Treatment with allopurinol increased significantly Johnsen's score in both the ischemic (7.3 +/- 0.5 vs 5.6 +/- 0.5, P < 0.05) and contralateral (8.9 +/- 0.1 vs 8.3 +/- 0.2, P < 0.05) testis, compared to IR-animals. Germ cell apoptosis in both the ischemic and the contralateral testis increased significantly after IR. Treatment with allopurinol resulted in a significant decrease in germ cell apoptosis in the ipsilateral testis, expressed as the number of positive tubules per 100 tubules (AI-1, (apoptotic index) threefold decrease, P < 0.005) and the number of apoptotic cells per 100 tubules (AI-2, fivefold decrease, P < 0.005) as well as a significant decrease in germ cell apoptosis in the contralateral testis (AI-1, 3.5-fold decrease, P < 0.05, AI-2- sixfold decrease, P < 0.005) compared to IR animals. In a rat model of testicular IR, treatment with allopurinol decreases germ cell apoptosis in both ischemic and contralateral testes and improves spermatogenesis.     

Use of laparoscopy as the initial surgical approach of impalpable testes:10-year experience

AIM: To review the experience in the management of impalpable testes using laparoscopy as the initial approach and the need for inguinal exploration.METHODS: From January 2004 to June 2014, 339 patients with undescended testes underwent operation in our institute. Fifty patients(15%) had impalpable testes. All children with impalpable testes underwent initial laparoscopy. A retrospective review was conducted on this group of patients and the outcome was analyzed.RESULTS: Forty children had unilateral impalpable testis. Ten children had bilateral impalpable testes. Thirty-one children(78%) in the unilateral group underwent subsequent inguinal exploration while 4 children(40%) in the bilateral group underwent inguinal exploration(P 0.05). Orchidopexy was performed in 16 children(40%) in the unilateral group and 9 children(90%) in the bilateral group(P 0.05). Regarding the 24 children with unilateral impalpable testis and underwent orchidectomy for testicular nubbin(n = 19) or atrophic testes(n = 2) or has vanishing testes(n = 3); contralateral testicular hypertrophy was noticed in 10(41%). No intra-operative complication was encountered. Two children after staged Fowler-Stephensprocedure and 1 child after inguinal orchidopexy had atrophic testes.CONCLUSION: The use of laparoscopy in children with impalpable testes is a safe procedure and can guide the need for subsequent inguinal exploration. Children with unilateral impalpable testis were associated with an increased need for inguinal exploration after laparoscopy. Orchidopexies could be performed successfully in 90% of children with bilateral impalpable testes.     

The time relationship between ipsilateral testicular ischemia and germ cell apoptosis in the contralateral testis in rat

Unilateral testicular ischemia-reperfusion (IR) in the rat is followed by histologic damage in the contralateral testis, which has been previously explained on immunologic grounds. There is evidence to suggest that apoptosis in the contralateral testis is involved in germ cell loss following IR injury to the testis. We examined the time-dependent effect of testicular ischemia on germ cell apoptosis in the contralateral testis in a rat. Adult Sprague–Dawley rats weighing 250–280 g, were subjected to testicular ischemia for 1, 2, 3 or 24 h. Twenty-four hours following onset of the ischemic insult, testes were harvested for immunohistochemical studies. Apoptosis was detected using TUNEL immunohistochemical assay. Testicular ischemia in rats led to histological damage, which was related to the duration of the ischemia. In the contralateral testis, the minimal damage included a decrease in number of germ cell layers, mild disorganization, and single cell apoptosis. Apoptosis in the contralateral testes increased significantly after 2, 3, and 24 h of ischemia and showed direct, time-related correlation with the duration of ischemia. We conclude that testicular ischemia causes an increase in germ cell apoptosis in the contralateral testis. The extent of apoptosis increases with the duration of the ischemia.     

两种手术方法治疗婴幼儿腹股沟嵌顿疝肠坏死的临床分析

目的探讨腹腔镜手术治疗婴幼儿腹股沟嵌顿疝肠坏死的临床应用价值。方法自2011年1月至2014年7月我们收治婴幼儿腹股沟嵌顿疝肠坏死患儿71例,其中采取腹腔镜手术治疗32例,为腹腔镜手术组,同期采取常规手术治疗腹股沟嵌顿疝肠坏死39例,为常规手术组,比较两组患儿手术时间、住院时间、术后并发症、家属满意度等临床资料,评价两种手术治疗方式在该病治疗中的优劣。结果腹腔镜手术组术后随访1~15个月,平均6.3个月,平均手术时间(61±21)min,早期出现阴囊红肿(术后3 d以内)30例,患侧复发1例;常规手术治疗组术后随访1~12个月,平均6.1个月,平均手术时间(58±25)min,早期阴囊红肿(术后3 d以内)38例,患侧复发3例,两组手术时间、早期阴囊红肿及复发情况比较,差异均无统计学意义(P值均0.05)。腹腔镜手术组平均住院时间(6.1±1.2)d,后期阴囊红肿(3 d)8例,患侧复发1例,睾丸下降不全1例,无肠粘连梗阻病例;常规手术组平均住院时间(6.9±1.1)d,后期阴囊红肿(3 d)35例,睾丸下降不全8例,肠粘连梗阻6例。腹腔镜手术较常规手术在住院时间,后期红肿、睾丸下降不全、肠粘连梗阻等术后并发症比较具有优势,差异均有统计学意义(P值均0.05)。结论腹腔镜手术治疗婴幼儿腹股沟嵌顿疝肠坏死与常规手术相比,创伤小,减少了术后并发症及住院时间,可一并处理隐匿疝,能取得良好的手术效果,有一定的临床应用价值。     

Resveratrol may reduce apoptosis of rat testicular germ cells after experimental testicular torsion.

The aim of the study is to evaluate the effects of resveratrol on apoptosis of testicular germ cells after experimental testicular torsion. Thirty Wistar albino rats were divided into 3 groups. Torsions were created by rotating the right testis 720 degrees in a clockwise direction for 4 h in all groups except the control group (group 1). They were then repaired by counter-rotation and replaced into the scrotum. In group 2, saline was infused 30 min before detorsion. In group 3, 30 mg/kg resveratrol was infused 30 min before detorsion. In groups 2 and 3, the bilateral testes were removed to determine germ cell apoptosis after 20 h of detorsion. The number of apoptotic cells was evaluated using the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling (TUNEL) technique and caspase 3. Mean apoptotic score of ipsilateral testes in group 3 was lower than that of group 2 (p < 0.05). Mean apoptotic score of the contralateral testes in group 3 was not different from that of group 2 (p > 0.05). The present study demonstrates that intraperitoneal administration of resveratrol in rats may decrease germ cell apoptosis in the ipsilateral testes.     

Desferrioxamine effectively attenuates testicular tissue at the end of 3 h of ischemia but not in an equal period of reperfusion

ObjectiveTo investigate the effect of desferrioxamine (DFX) on ipsilateral and contralateral testis damage caused by experimental testis torsion and detorsion.Materials and methodsForty rats were divided into five groups (n = 8): control, torsion (T), torsion + desferrioxamine (T + DFX), torsion/detorsion (T/D), and torsion/detorsion + desferrioxamine (T/D + DFX). The right testes of the rats were subjected to torsion and detorsion for 3 h each. Thirty minutes before the application of torsion and detorsion, DFX (100 mg/kg) was administered intramuscularly. Blood samples and testicular tissues were examined using specific biochemical and histopathological methods.ResultsIpsilateral and contralateral testis tissue glutathione levels in the T group decreased compared with the control and T + DFX groups. Plasma glutathione peroxidase activity in the T, T/D, and T/D + DFX groups was lower than in the control group. Plasma catalase activity in the T and T/D groups decreased compared with the control group. Ipsilateral mean seminiferous tubule diameter of the T group was lower than that of the T + DFX group. The ipsilateral mean testis biopsy scores in the T and T/D groups were lower than in the control group.ConclusionThe administration of DFX prior to torsion may be useful only for preventing ischemic damage in ipsilateral and contralateral testes.     

The incidence of complications following primary inguinal herniotomy in babies weighing 5 kg or less

The aim of this study was to quantify the incidence of complications following inguinal herniotomy in small babies weighing 5 kg or less. This was a retrospective review of inguinal herniotomies performed in our unit between December 1997 and March 2002 on babies weighing 5 kg or less. A total of 154 patients underwent hernia repair, of which 125 patients (221 hernias) were available for review (81%). The median weight at surgery was 3.6 kg (range 1.7–5 kg) and 84 patients (67%) were classified as premature (< 36 weeks gestation). Thirty-three patients presented with an irreducible hernia, in whom all but one were successfully reduced prior to surgery. Patients were reassessed at a clinic following surgery and follow-up data was obtained from the clinic notes after a median follow-up of 3 months (range 1–60 months). Five cases of hernia recurrence occurred in four patients (2.3%) and the incidence of testicular atrophy was 2.7% (six patients). In the testicular atrophy group, four of the six patients presented with an incarcerated hernia and of these, three were noted to have evidence of ischaemia at operation. There were six cases of high testes requiring subsequent orchidopexy (2.7%). Although neonatal inguinal herniotomy is a technically demanding procedure, this series has demonstrated a low complication rate. Testicular atrophy was associated with a history of preoperative incarceration in the majority of cases.     

Division of the genitofemoral nerve in normal scrotal testicular rats

The role of the genitofemoral nerve (GFN) on testicular descent has been clearly shown. It has also been suggested that in unilateral cryptorchid rats, after division of the ipsilateral GFN fertility rates are higher, i.e., transection of the GFN prevents contralateral testicular damage, but the mechanism is unclear. The purpose of this study was to investigate the effect of dividing the GFN on the normal scrotal testes. Thirty male Wistar albino rats were divided into three groups: group A, transection of right GFN; group B, bilateral transection of the GFN; and group C, sham operations, all at the age of 30 days. The animals were killed at 90 days of age and the testes were removed. Each excised testis was weighed and fixed for histological studies. Mean seminiferous tubular diameter was measured and germinal epithelium maturity was determined using the modified Johnsen testicular-biopsy score. In all groups, all three parameters were similar, suggesting that division of the GFN had no effect on normal testes. Accepted: 12 January 2000     

Ischemic damage of the testis as a complication of incarcerated hernia in the infant

The possibility of atrophy of testicular tissue after torsion of testis is well known. To a lesser extent it is known that an incarcerated inguinal hernia carries the risk of ischemia of the testis by pressure on the testicular vessels. Incarceration of an inguinal hernia is most common in premature and young babies. When it occurs a reposition should be tried, but, if unsuccessful an urgent operation is indicated. Between 1979 and 1983 we operated on 36 boys under the age of one with an unreducible inguinal hernia. As sign of partial or total tissue destruction the follow-ups showed a smaller testis on the operated side in five cases and a total atrophy in four cases. Early operation of inguinal hernias in babies seems to be the best prophylaxis of this above mentioned complication of an otherwise rather harmless anomaly.     

The effects of orchidopexy and orchidectomy on testes of rats subjected to ipsilateral abdominal testis with vas deferens obstruction

An experimental study was planned to evaluate and compare the effects of orchidopexy and orchidectomy on the testes of rats subjected to unilateral abdominal testis with vas deferens obstruction. Four groups were established. Rats in the control group underwent a sham procedure. While the testis was maintained in the abdomen with the vas deferens ligated for 8 weeks in group 2, rats in groups 3 and 4 underwent orchidopexy or orchidectomy after 4 weeks. Remaining testes were harvested at the end of the 8-week period. Testis and body weights were obtained during harvest. Samples were evaluated through DNA flow cytometry, and percentages of haploid cells were determined. Groups were compared through unpaired t-test, and p-values less than 0.05 were considered significant. All three treatments had decreased testis weight over body weight values of ipsilateral testes. Ipsilateral orchidectomy increased the value among contralateral testes. However, none of the groups had a contralateral testicular value less than the sham-operated group. All three treatments decreased the percentage of haploid cells among ipsilateral testes, but only an abdominal testis was associated with a decrease in the percentage of haploid cells among contralateral testes. Maintaining a testis with an obstructed vas deferens in the abdomen for 8 weeks damages both ipsilateral and contralateral testes. Orchidopexy, while showing amelioration of the ipsilateral testis, spares the contralateral testis as well as orchidectomy. Orchidopexy for an undescended testis with vas deferens obstruction is a rational approach.     

Preoperative sonography of the inguinal canal prevents unnecessary contralateral exploration

The need for contralateral inguinal exploration in children during unilateral inguinal hernia repair remains controversial. We questioned whether an elective preoperative sonographic examination of the contralateral inguinal canal was accurate enough to prevent unnecessary exploration of the asymptotic side. Sonography (US) of the groins was performed randomly in 200 out of 600 patients awaiting unilateral hernia repair over a 1.5-year period during 1990–1991. The patients and their medical records were reviewed in 1994, 3–4 years following surgery. Four hundred infants and children underwent unilateral inguinal hernia repair without preoperative US, based on the clinical diagnosis (group I). Of the remaining 200, 160 (group II)_ had the clinical diagnosis confirmed by US. Forty patients with US evidence of a contralateral hernia or hydrocele (group III) were excluded from the study. At follow-up after 3–4 years, 26 patients in group I presented with a hernia in the opposite groin 2 weeks to 2 years following surgery. The incidence of a subsequent contralateral hernia in patients under 1 year, 1–2 years, and older than 2 years was 7.3%, 9.6%, and 4.5%, respectively. None of the patients in group II presented with a clinically evident hernia during the follow-up period. These findings suggest that US is a readily available, non-invasive, and accurate method of preoperative evaluation of the groins. Our policy of contralateral exploration based on the US findings was shown to be reliable in preventing unnecessary surgical exploration of the unaffected inguinal canal.     

新生儿睾丸扭转临床特点探讨

目的 探讨新生儿睾丸扭转发生的特点及治疗时机选择.方法 回顾性分析近10年新生儿睾丸扭转患儿可能的致病危险因素、临床特点、超声检查结果、治疗策略、病理结果及术后随访情况.结果 新生儿睾丸扭转共17例,左侧7例,右侧10例;其中剖腹产11例(65%),第二产程延长5例(29%),羊水过少2例(12%);术前体检均发现睾丸增大,多伴有阴囊色泽改变(94%).超声检查均发现患睾体积增大、回声不均或增强、血流信号减小或消失.术中探查打开肉膜组织后均发现精索睾丸扭转并已坏死而行患睾切除,其中14例行对侧睾丸固定术.所有患睾病理活检均提示睾丸坏死,7例(41%)可见钙化灶.所有随诊病例超声检查未发现对侧睾丸异常.结论 新生儿睾丸扭转失睾率极高;当发现阴囊色泽改变、睾丸增大等改变,即应考虑睾丸扭转可能;超声检查敏感性高,可作为首选检查方法;患儿出生过程出现异常可能是新生儿睾丸扭转的诱因.

Abstract：

Objective To investigate the clinical characteristics and management of neonatal testicular torsion. Methods Neonatal testicular torsion were reviewed focusing on the possible risk factors, clinical features, ultrasonic characteristics, management, pathological outcome and follow-up results. Results A total of 17 neonatal testicular torsion (left side 7, right side 10) was diagnosed. 11cases of them were cesarean delivery (65 %). 5 cases were found a prolonged second stage of labor (29%), and 2 cases with oligohydramnios (12%) before birth. All patients presented an enlarged testes. Most of them presented with scrotal discoloration (94%). Ultrasound examination showed enlargment of testicular volum, heterogeneity and lacked of blood flow. The twisted testes and spermatic cord showed necrosis intra-operatively. Orchiectomy was carried out. Orchidopexy on contralateral testis was performed in 14 cases. Pathology of ipsilateral testes showed necrosis, and calcification occurred in 7 cases(41 %). All contralateral testes presented normal Ultrasound image during the followup. Conclusions The rate of testicular necreosis was high in neonatal testicular torsion. Testicular torsion should be suspected when neonatal testis presents scrotal discoloration and enlarged testicular mass. Ultrasound inspection is a sensitive method in diagnosing neonatal testis torsion, and should be recommended. Abnormal labor may lead to the neonatal testis torsion.