Immunohistopathology of the contralateral testis of rats undergoing experimental torsion of the spermatic cord

Aim： To evaluate the immunohistopathological changes in the contralateral testis of rats after an experimental spermatic cord torsion. Methods： Male Sprague-Dawley rats of 45-50 days old were subjected to a 720° unilateral spermatic cord torsion for 10, 30 and 80 days （experimental group, E）, respectively or sham operation （control group, C）. Histopathology of the contralateral testis as well as germ cell apoptosis were studied using the Terminal Deoxynucleotidyl Transferase Biotin-dUTP Nick End Labeling （TUNEL） technique. The number of testicular lymphocytes, mast cells and macrophages, and the expression of tumor necrosis factor-α （TNF-α） and its receptor （TNFR1） in testicular cells of the contralateral testis were quantified by histochemistry and immunohistochemistry. TNF-α concentration in testicular fluid was determined by ELISA. Results： In the contralateral testis of rats from the E group, the maximal degree of damage of the germinal epithelium was seen 30 days after torsion. At this time we observed in the E group vs. the C group increases： （i） the number of testicular T-lymphocytes; （ii） the number of testicular mast cells and macrophages; （iii） the percentage of macrophages expressing TNF-α; （iv） TNF-α concentration in testicular fluid; （v） the number of apoptotic germ cells; and （vi） the number of TNFR1^＋ germ cells. Conclusion： Experimental spermatic cord torsion induces, in the contralateral testis, a focal damage of seminiferous tubules characterized by apoptosis and sloughing of germ cells. Results suggest humoral and cellular immune mediated testicular cell damage in which macrophages and mast cells seem to be involved in the induction of germ cell apoptosis through the TNF-α/TNFR1 system and in the modulation of the inflammatory process.

Predictors of Spermatic Cord Torsion—Clinical Presentation and Intraoperative Findings

Background: To evaluate aetiology of acute scrotum after surgical exploration suspicious for spermatic cord torsion, to compare surgical with clinical findings and to support the clinician distinguishing spermatic cord torsion from other diseases mimicking this emergency requiring surgical exploration. Methods: All men with the diagnosis of an acute scrotum who underwent emergency scrotal exploration between January 1995 and October 2009 were retrospectively evaluated. Results: 230 patients were analyzed. Torsion of the spermatic cord (53%) was the most common cause followed by torsion of the testis appendages (25%). Patients with spermatic cord torsion were significantly older (15.5 y) and haunted hospital faster than others (p Conclusions: Our data demonstrate that spermatic cord torsion is more common in adolescent. Short pain duration and high intrascrotal position of the testicle are associated with higher probability of spermatic cord torsion. Duplex sonography plays an important role in the diagnostic workup but history and physical examination are the crucial parameters. In nebulous clinical cases emergency surgical exploration has to be recommended.

Torsion of the Spermatic Cord: Clinical and Therapeutic Aspects in the Region of Thies (Senegal)

Introduction: The purpose of this work is to evaluate the epidemiological, clinical and therapeutic aspects of spermatic cord in our context. Patients and Methods: This is a retrospective study over a period of 4 years from January 1, 2014 to June 30, 2018. Results: We collected 55 cases divided into 26 cases, 44.27% for the Thies Regional Hospital, 21% or 38.18% for the Mbour EPS and 8 cases representing 14.55% for the Saint Jean de Dieu Hospital. We found an average age of 20.03 years with extremes of 4 years and 56 years. In 28 patients or 50% of cases, we found no particular pathological history, while in 4 patients or 7.14%, we found a notion of recurrent ipsilateral testicular pain. We recorded 67.27% (n = 37) of the cases received for testicular pain;15 patients or 27.27% presented a large painful pouch. Two patients (3.64%) were received for inguinal swelling and 1 patient (1.82%) presented testicular atrophy. The average consultation time is 16.9 hours with extremes of 2 hours and 96 hours. The torsion was in 59.61% of cases (n = 32) located on the right versus 40.38% (n = 22) on the left. There was no bilateral form. The pick-up time was 3 hours with extremes of 1 h to 24 h. All patients benefited from an exploratory scrotomy. We found a total of 22 patients or 40% of cases with ischemic testis, 8 cases or 14.55% of patients with necrotic testis and 2 cases or 3.64% where the testis was normal. Orchidopexy was performed in 46 patients or 83.63% and orchiectomy in 9 patients. Conclusion: Care is urgent. There is a need for better awareness of the population and the medical staff for the early diagnosis.

Management of the Torsion of Spermatic Cord in the Urology-Andrology Department of the Ignace Deen National Hospital in Conakry

Introduction: Torsion of the spermatic cord is an emergency whose delay in treatment conditions the functional prognosis of the testicle. The aim of this study was to analyze the management of spermatic cord torsion in the Urology Andrology Department of the Ignace Deen National Hospital in Conakry. Material and methods: This was a ten-year retrospective descriptive study from January 1, 2012 to December 31, 2021. It involved all patients admitted for torsion of the spermatic cord, confirmed at surgical exploration. Results: We identified 21 cases of torsion of the spermatic cord. The mean age of the patients was 17.9 ± 4.4 years. The average consultation time was 19.2 ± 21.4 hours with extremes of [2 h and 98 h]. Only 6 patients (28.6%) consulted before the sixth hour. All patients presented with scrotal swelling. At scrototomy, all torsions were intravaginal with two turns of spiral in 13 cases and three turns in 8 cases. Orchiectomy followed by contralateral orchidopexy was performed in 6 cases. In the other cases, bilateral orchidopexy was performed after detorsion. The average hospital stay was 4.5 days. We recorded 4 cases of testicular atrophy after orchidopexy. Conclusion: Spermatic cord torsion is an infrequent emergency in our department. The delay in consultation remains the main predictive factor of testicular necrosis. Emergency exploratory scrotomy should be the rule.

Torsion of the spermatic cord in adults:a multicenter experience in adults with surgical exploration for acute scrotal pain with suspected testicular torsion

Acute scrotal pain(AsP)requiring surgical exploration is common in the pediatric population,but little has been reported on this subject with regard to the adult population.The aim of this study was to investigate the demographic and clinical characteristics and outcomes of scrotal explorations performed on adult patients.Patients over 21 years of age who underwent surgical exploration for ASP with suspected testicular torsion(TT)at 14 French hospitals between January 2005 and December 2019 were included in this study.The main outcome measures were demographic characteristics,pathology found during scrotal exploration,and perioperative outcomes.Logistic regression was used to perform univariate and multivariate analyses to identify predictors of TT.Data for 1329 men were analyzed.The median age was 30(interquartile range[IQR]:25-35;range:21-89)years.Regarding the clinical examination,867(65.2%)patients presented with an elevation of the testicle,613(46.1%)patients with scrotal edema or erythema,and 211(15.9%)patients with nausea or vomiting.Operative findings identified TT in only 684(51.5%)patients,epididymo-orchitis in 112(8.4%)patients,a tumor in 16(1.2%)patients,and no causes in 475(35.7%)patients.Orchiectomy for nonviable testes was required in 101(7.6%)patients.In multivariate analysis,an elevation of the testicle,erythema/swelling,and the presence of nausea/vomiting were found to be associated with the occurrence of TT.Testicular torsion is not exclusive to children and adolescents,so must be considered in males of any age with acute scrotal findings.However,one-third of scrotal explorations in adults did not lead to a diagnosis.

Large Painful Bursae at Abeche Hospital: Epidemiological, Clinical, Therapeutic and Evolutionary Aspects

Introduction: Acute large bursae (ALB) are a frequent reason for emergency consultations. The aim of this study was to investigate the prevalence, clinical course, treatment and evolution of ALB at Abeche University Hospital. Patients and Method: This was a 45-month cross-sectional study from January 2020 to September 2023. Male patients of any age who had been admitted to and treated for acute large bursae at the Abeche University Hospital were included. Sociodemographic, clinical and therapeutic variables were studied. Results: Acute large bursae accounted for 7.92% of emergency admissions. The average age was 39.40 years. 60.27% of patients came from rural areas. The average consultation time was 4 days, ranging from a few hours to 18 days. The main reason for consultation was pain. Strangulated inguino-scrotal hernia was the most common, followed by acute orchi-epididymitis, accounting for 41.8% and 26% of cases respectively. Traditional treatment prior to consultation was attempted in 13.7% of cases. All patients were treated as emergencies, 41 of whom had received medical treatment. Of the patients treated surgically, orchidopexy was performed in all. Parietal suppuration and anaemia occurred in 6.2% and 4.8% of cases respectively. Conclusion: A accounts for a significant proportion of our emergency care activity. However, patients are seen with a delay, which jeopardises the functional prognosis of the testicle and intestine.

睾丸扭转误诊113例分析

目的 :提高睾丸扭转 (精索扭转 )诊治水平。 方法 :回顾分析 1994～ 2 0 0 4年总计 113例睾丸扭转误诊的临床资料。 结果 :首诊误诊率 84 .3%。误诊为急性附睾、睾丸炎 81例 (71.7% ) ;鞘膜积液 10例 (8.8% ) ;急性肠炎 7例 (6 .2 % ) ;泌尿系结石 5例 (4.4 % ) ;腹股沟疝 5例 (4.4 % ) ;睾丸肿瘤 3例 (2 .7% ) ;附睾结核 2例 (1.8% )。发病至误诊时间 2h～ 2个月 ,平均 6 .3d。手法复位成功 3例 ;92例行手术探查 ,睾丸、附睾切除 6 4例 ,睾丸萎缩 2 6例 ,总计睾丸毁损率 79.6 %。 结论 :提高首诊医生对睾丸扭转的诊治水平是减少误诊的关键 ,诊断流程采用病史、体征、彩超 3者结合 ,治疗的最佳方法是积极开展阴囊急诊的手术探查。

阴囊镜在睾丸附睾疾病诊断与治疗中的应用

目的:评估阴囊镜在睾丸扭转和附睾肿块诊断和治疗中的安全性和有效性。方法:对中南大学湘雅二医院泌尿外科2010年9月至2012年3月,行阴囊镜检或阴囊镜下附睾肿块等离子电切术的75例患者进行回顾性分析,评估阴囊镜术后并发症、病变复发和附睾痛缓解情况,以病理检查结果为标准对比研究超声和阴囊镜诊断的准确率。结果:74例患者成功实施阴囊镜检,1例患者因鞘膜腔炎性粘连改开放手术,手术平均时间为(34.3±5.8)min,术后无严重阴囊水肿、血肿、睾丸鞘膜积液和伤口感染等并发症。阴囊镜和B超对睾丸扭转的诊断准确率分别为100%和66.7%,阴囊镜附睾肿块诊断与病理诊断符合率为76.2%,而B超与病理诊断符合率为58.7%。63例有症状附睾肿块患者接受阴囊镜附睾肿块等离子电切,患者术前阴囊疼痛视觉模拟评分为(7.1±0.8)分,术后6个月为(2.4±0.6)分。结论:阴囊镜是安全的,阴囊镜对附睾肿块和睾丸扭转的诊断准确率高于B超检查,阴囊镜下等离子电切对附睾肿块(特别是附睾囊肿)引起的附睾疼痛治疗效果良好,术后肿块未见复发。

精索形态声像图在睾丸扭转诊断中的价值

目的分析睾丸扭转精索及睾丸内血流声像图表现,旨在强调精索二维图像在睾丸扭转中的价值。方法回顾性分析经手术证实的睾丸扭转患者精索超声和睾丸内血流CDFI检查的声像图特征。结果35例睾丸扭转患者,34例二维出现精索形态异常,31例CDFI出现睾丸内血流改变异常,敏感性分别为97.14%、80.00%;特异性分别为100%、96.70%。结论精索形态声像图改变在睾丸扭转诊断中具重要价值。

彩色多普勒超声在精索扭转诊断和鉴别诊断中的价值

目的 :应用彩色多普勒超声鉴别精索扭转和急性睾丸炎。 方法 :回顾性分析 13例急性睾丸疼痛病人的彩色多普勒血流显像 (CDFI)表现和治疗情况。 结果 :8例显示睾丸内血流信号稀疏或消失 ,诊断为精索扭转 ,其中 1例手法复位成功 ,7例手术探查并得以证实。其余 5例显示患侧睾丸血流信号丰富 ,诊断为急性睾丸炎或睾丸附睾炎 ,经抗生素治疗后症状好转 ,超声复查显示血流减少。 结论 :CDFI在精索扭转诊断和鉴别诊断中具有重要意义 。

彩色多普勒超声诊断和鉴别诊断小儿睾丸扭转

目的评估彩色多普勒超声诊断及鉴别诊断小儿睾丸扭转的价值。方法回顾分析因急性阴囊肿痛而接受彩色多普勒超声检查的125例患儿的声像图特征,并与手术病理、临床最终诊断相比较。结果 125例中,急性睾丸扭转14例,超声诊断符合率92.86%(13/14),均接受手术治疗,其中11例睾丸完全坏死切除,CDFI显示睾丸内无明显血流信号,3例手术复位后睾丸存活,CDFI示睾丸内有少量血流信号;急性睾丸附件扭转68例,睾丸上极或与附睾间见回声不均质结节,内无血流信号,超声诊断符合率97.06%(66/68);急性附睾炎43例,附睾内血流信号明显增多,超声诊断符合率100%(43/43)。结论彩色多普勒超声对小儿睾丸扭转具有较高的诊断及鉴别诊断价值,是临床首选的影像检查方法。

精索形态观察在睾丸扭转早期诊治中的意义

目的:提高睾丸扭转早期的诊断和治疗水平。方法:回顾性分析49例睾丸扭转的临床资料及睾丸内血流声像图和精索超声特征。结果:49例睾丸扭转患者,彩色多普勒血流显像出现睾丸血流改变42例,其中血流增加3例,睾丸血流无明显改变7例;二维超声检查发现精索形态异常47例。手术复位固定21例,睾丸存活12例。结论:彩色多普勒超声扫描精索形态与睾丸血流变化对睾丸扭转的早期诊断有重要价值,尽早手术探查有助于挽救存活睾丸。

彩色多普勒超声和超声造影检测睾丸扭转的诊断价值

目的探讨彩色多普勒超声(CDU)和超声造影(CEUS)对睾丸扭转的诊断价值。方法对17例睾丸扭转患者首先用二维超声显示双侧睾丸附睾形态、结构及内部回声,再用彩色多普勒观察血供状况,其中11例再用SonoVue肘静脉团注法进行超声造影。所有病例均经手术病理证实。结果彩色多普勒显示16例患者睾丸内血流信号明显减少或消失,超声诊断睾丸扭转结果正确;1例患者睾丸内血流较丰富,超声误诊为急性睾丸附睾炎。超声诊断符合率为94.1%。11例超声造影均显示睾丸实质内造影剂充填缺损,诊断符合率为100%。结论彩色多普勒超声和超声造影诊断睾丸扭转有较高的敏感性和特异性,应作为诊断睾丸扭转的首选方法。

小儿睾丸附件扭转的彩色多普勒超声诊断意义

目的探讨彩色多普勒超声检查在诊断小儿睾丸附件扭转中的意义。方法回顾性分析我院1999年2月～2005年11月收治的小儿睾丸附件扭转病例的临床资料及超声检查结果。结果在所有病人中,发现蓝斑征9例(8.6%),痛性结节23例(21.9%),74例超声检查资料完整的病例中,超声检查在睾丸上极发现无血流回声结节67例,均经手术证实。结论彩色多普勒超声检查若发现睾丸上极附近无血流回声团,则提示睾丸附件扭转。超声检查在小儿睾丸附件扭转的诊断中具有重要的意义。

大鼠单侧精索扭转后保留同侧坏死睾丸对对侧睾丸和附睾的组织学影响

目的:将大鼠单侧精索持续扭转96 h,研究保留扭转侧坏死睾丸对对侧睾丸和附睾的影响,以说明延迟性的睾丸切除是否对对侧睾丸功能有保护作用。方法:将33只青春前期(21～42日龄)正常雄性SD大鼠,随机分为假手术对照组(n=11)、扭转保留组(n=12)和扭转切除组(n=10)。假手术对照组只对左侧睾丸行睾丸肉膜囊固定术,后两组扭转实验组用睾丸肉膜囊固定术固定维持扭转720°的睾丸、附睾,在扭转96 h后将扭转保留组扭转侧睾丸、附睾行复位及固定,而同时扭转切除组则将扭转侧睾丸、附睾切除。术后3个月抽取血液标本,ELISA测定大鼠血清睾酮、抗精子抗体浓度。同时取睾丸、附睾标本,石蜡包埋切片后作组织学观察,并利用体视学方法定量研究睾丸、附睾结构的体积以及生精小管直径。结果:3组大鼠血清睾酮值无统计学差异;仅扭转保留组造模后1例大鼠血清抗精子抗体阳性。光镜下定性观察发现精索扭转组睾丸间质细胞核较假手术对照组间质细胞核增大,假手术对照组、扭转保留组和扭转切除组睾丸结构有明显形态改变的数量分别为1、3、0只。扭转保留组对侧睾丸相对假手术对照组睾丸体积增加19%,相应附睾体积增加11%,扭转切除组对侧睾丸体积增加21%,附睾体积增加7%,且睾丸代偿性肥大具有统计学意义(P<0.05)。假手术对照组、扭转保留组和扭转切除组对侧睾丸生精小管体积分别为(1.15±0.07)、(1.30±0.04)、(1.35±0.05)cm3,3组间无显著性差异。3组大鼠对侧睾丸内间质体积分别为(0.25±0.02)、(0.36±0.02)、(0.34±0.03)cm3,精索扭转组和假手术对照组相比显著增加(P<0.05)。3组大鼠对侧睾丸内生精小管直径分别为(226.00±7.00)、(223.00±6.00)、(221.00±3.00)μm,无显著性差异(P>0.05)。结论:单侧精索长期扭转后对侧睾丸、附睾主要改变是单侧去势后的对侧代偿性肥大表现,是否切除对对侧睾丸和附睾组织学上无明显影响。

小儿隐睾扭转的诊治体会

目的：探讨小儿隐睾合并扭转的临床诊治经验。方法回顾性分析2008年7月至2013年12月我们收治的14例小儿隐睾合并睾丸扭转病例的临床资料，其中左侧9例，右侧5例；左侧9例中，2例为双侧隐睾；右侧5例中，1例术中及术后病理检查证实为隐睾合并睾丸成熟畸胎瘤。14例均为单侧隐睾扭转。患儿年龄4岁至11岁5个月，平均3．1岁。结果14例患儿中，11例行扭转坏死睾丸切除术，3例行扭转睾丸复位＋下降固定术，患儿均同期行健侧睾丸固定术或健侧睾丸下降固定术。术后经2个月至5年随访，11例睾丸切除患儿健侧睾丸发育良好，血清睾酮水平正常；3例睾丸下降固定术患儿中，2例睾丸发育良好，1例合并睾丸畸胎瘤患儿经保睾手术后患侧睾丸发育较小，无肿瘤复发。结论早期诊断和及时手术治疗是提高隐睾并扭转患儿睾丸存活率的关键。

超声造影环状增强模式评估扭转睾丸损伤的实验研究

目的超声造影环状增强现象评估扭转睾丸的损伤程度及其意义。方法实验采用20只家兔,手术制成假手术组对照组(5只),扭转组(5只)及复位组(10只),并按复位后睾丸内有无灌注分为复位成功组及复位失败组,于手术前后各时段行超声造影检查,绘制时间-强度曲线(TICs)分析达峰时间(time to peak intensity,TP)、强度峰值(peak intensity,PI)、伽马曲线尖度(Shapness,β)及曲线下面积(AUC)等参数变化。结果 1)扭转组及复位组均显示环状灌注增强,而对照组无环状增强;2)扭转组随时段延长环状灌注逐渐增强,主要表现为PI升高(P<0.05);3)睾丸复位后仍有环状增强但复位成功组晕环PI值低于扭转组(P<0.01)及复位失败组(P<0.05);4)复位前复位失败组晕环PI较复位成功组高(P<0.05)。结论超声造影时间-强度曲线分析对评估扭转睾丸的损伤程度有重要价值。

急诊阴囊疼痛患者核素阴囊显像的临床研究

目的评价放射性核素阴囊显像用于鉴别急性睾丸蒂扭转和急性睾丸附睾炎的临床应用价值。方法对４９例主诉急性阴囊疼痛患者的核素阴囊显像结果进行临床分析，并与超声检查结果相比较。“弹丸”式静脉注射Ｎａ９９ＴｃｍＯ４后，分别行动态和静态采集，得到睾丸血流灌注像和静态血池像。结果阴囊显像患侧阴囊放射性分布呈扭转表现的３７例患者中，经临床手术证实为睾丸蒂扭转者３５例，余２例为患侧腹股沟斜疝；３５例确诊为扭转者超声检查仅诊断１７例。阴囊显像患侧阴囊放射性分布呈炎症表现的１２例患者中，经保守治疗，临床随访证实全为睾丸附睾炎症，而超声检查仅诊断８例。结论核素阴囊显像诊断急性阴囊疼痛原因明显优于超声检查，具有简单、快速、准确、无创伤性等优点；

睾丸扭转和精索扭转的诊断与治疗(附68例报告)

目的:探讨睾丸和精索扭转的诊断与治疗方法,提高睾丸和精索扭转的治疗水平。方法:对68例睾丸和精索扭转的临床资料进行总结,68例平均年龄21岁,<20岁者占84%,左侧55例占80.8%.发病至确诊时间6h～30天,12h以上者占90.2%。结果:53例术前彩色多普勒血流动态显象(CDFI)应作为诊断疾病的常见与首选检查方法。诊断并经手术证实,符合率100%,经手术探查;41例行手术复位、固定,睾丸获救。27例行患侧睾丸切除术,所有病例均行对侧探察,固定。结论:阴囊X核素显象,B超对睾丸精索扭转早期诊断有帮助。早期诊断,及时治疗是提高疗效的关键。彩色多普勒血流动态显象应作为诊断该疾病的常见及首选检查方法,对睾丸精索一旦确诊或疑有精索扭转的患者应及早行紧急复位,以期挽救睾丸,同时行睾丸固定术也十分必要。对于确诊毫无保留价值的睾丸需行切除术。

精索扭转的早期诊断及处理(附12例报告)

目的:提高精索扭转的早期诊断水平。方法:回顾性分析12例精索扭转的临床资料。结果:11例经手术证实。与术前彩色多普勒血流成像(CDFI)诊断结果一致,其中5例扭转时间短或不全扭转者经手术复位后保留了睾丸,6例因睾丸坏死而予以切除。1例保守治疗。结论:对青少年突发的阴囊疼痛应考虑到本病的可能。CDFI是一种高效、可靠的诊断方法。早期诊断及手术可提高睾丸存活率。主张对对侧睾丸应作预防性固定并随访。