Clinical characteristics of testicular torsion and factors influencing testicular salvage in children:A 12-year study in tertiary center

BACKGROUND Testicular torsion is the most common acute scrotum worldwide and mainly occurs in children and adolescents.Studies have demonstrated that the duration of symptoms and torsion grade lead to different outcomes in children diagnosed with testicular torsion.AIM To predict the possibility of testicular salvage(TS)in patients with testicular torsion in a tertiary center.METHODS We reviewed the charts of 75 pediatric patients with acute testicular torsion during a 12-year period from November 2011 to July 2023 at the Suzhou Hospital of Anhui Medical University.Univariate and multivariate logistic regression analyses were used to determine independent predictors of testicular torsion.The data included clinical findings,physical examinations,laboratory data,color Doppler ultrasound findings,operating results,age,presenting institution status,and follow-up results.RESULTS Our study included 75 patients.TS was possible in 57.3%of all patients;testicular torsion occurred mostly in winter,and teenagers aged 11-15 years old accounted for 60%.Univariate logistic regression analyses revealed that younger age(P=0.09),body mass index(P=0.004),torsion angle(P=0.013),red blood cell count(P=0.03),neutrophil-to-lymphocyte ratio(P=0.009),and initial presenting institution(P<0.001)were associated with orchiectomy.In multivariate analysis,only the initial presenting institution predicted TS(P<0.05).CONCLUSION The initial presenting institution has a predictive value for predicting TS in patients with testicular torsion.Children with scrotal pain should be admitted to a tertiary hospital as soon as possible.

Blood perfusion of the contralateral testis evaluated with contrast-enhanced ultrasound in rabbits with unilateral testicular torsion

The changes of blood perfusion of contralateral testis after unilateral testicular torsion remain controversial.In this study,28 New Zealand white male rabbits were randomly divided into five groups.Group A(n=8),the control group,underwent a sham operation on the unilateral testis without inducing testicular torsion.In groups B,C,and D(n=5 each),unilateral testicular torsion was induced,and,after 3,6 or 24 h,respectively,detorsion was performed.In group E(n=5),permanent unilateral testicular torsion was applied.Contrast-enhanced ultrasound was used to observe the blood perfusion of the contralateral testis at the following stages:pre-torsion(preopration),immediately post-torsion(postopration),pre-detorsion,immediately post-detorsion,and late-stage post-detorsion(6-12 h post-detorsion in groups B-D)or at a similar time point(15-21 h post-torsion in group E).Time-intensity curves were generated,and the following parameters were derived and analyzed:arrival time,time to peak intensity,peak intensity,and half-time of the descending peak intensity.The analysis revealed that blood perfusion of the contralateral testis increased immediately after testicular torsion on the opposite side(P<0.05),which increased with prolonged testicular torsion of the other testis.This research demonstrated that contrast-enhanced ultrasound was valuable in evaluating blood perfusion of the contralateral testis after unilateral testicular torsion.

Single intratesticular injection of blood-serum-derived exosomes can potentially alleviate testopathy following testicular torsion

Background:Testicular torsion(TT)is an acute inflammatory process leading to male infertility.Today,anti-i nflammatory effects of exosomes derived from blood serum are used in various laboratory procedures.In the present study,the anti-i nflammatory effects of blood-serum-derived exosomes in treatment of acute inflammation following TT in mice were evaluated.Materials and Methods:Eighteen male mice were grouped as healthy control,TT,and TT+exosome.TT was induced surgically,and exosomes were extracted from blood serum and administrated by a single intratesticular injection(10 IU).Malondialdehyde(MDA)and Griess assays were used to evaluate the level of oxidative stress.Sperm indices,testosterone(Tes),and apoptotic gene expression(p-53,Bcl2,and Caspase-3)were also assessed.H&E and immunohistochemistry(IHC)stainings were used for histopathological investigations.Data analysis was applied by SPSS(v.19)software.Results:Oxidative stress and apoptotic genes expression were increased significantly(p<0.05)in TT group compared with control.Sperm parameters and Tes were significantly increased,and expression of apoptotic genes was significantly reduced in TT+exosome group(p<0.05).Conclusion:Since the blood-serum-derived exosomes have anti-i nflammatory features,the intratesticular application of blood-serum-derived exosomes can be used clinically in acute phase of orchitis following TT to inhibit testicular inflammation.

Clinical evaluation of testicular torsion presenting with acute abdominal pain in young males

Objective:To evaluate the features of testicular torsion presenting with acute abdominal pain and to raise awareness of testicular torsion with specific symptoms.Methods:From October 2005 to June 2016,nine patients with testicular torsion who presented with isolated acute abdominal pain rather than scrotal pain as their primary symptom were retrospectively reviewed.Data,including the age of patients,season at admission,initial medical history,external genital examination,emergency ultrasound findings,operative findings,duration of abdominal pain,complications,and follow-up results,were collected.Results:The average age of patients was 14 years(range 10-17 years).Seven patients whose genitals were not initially examined externally were misdiagnosed as having ordinary abdominal diseases.Surgical exploration revealed that all the involved testes necrotized,and orchidectomy was performed.In the other two patients,scrotal and testicular abnormalities were detected immediately on admission,and emergency surgical exploration determined that the involved testis remained vital,so orchiopexy was performed.The mean duration from symptom onset to diagnosis was 4 h(3-5 h)in the orchiopexy group and 37 h(18-72 h)in the orchidectomy group.Six patients were psychologically affected during postoperative follow-up.Neither recurrence of testicular torsion nor testicular atrophy was recorded.Conclusion:Acute abdominal pain can be the initial and sole symptom of testicular torsion in young males.Physicians should pay close attention to the specific clinical presentation of testicular torsion.

Ultrasound heterogeneity as an indicator of testicular salvage in testicular torsion: A single center experience

Objective:Testicular torsion is a common urological emergency,mainly in the younger population.Our aim is to evaluate the efficacy and value of testicular echogenicity in predicting testicular viability.Methods:Patients who were older than 13 years of age and were discharged with the diagnosis of testicular torsion were reviewed.Data obtained included demographic data,history,physical examination results,ultrasound findings including size,color Doppler flow,and echotexture,torsion degrees,and surgical procedure.In addition,the histopathological findings of patients who underwent orchiectomy were reviewed.Results:A total of 71 cases were diagnosed with testicular torsion between January 2016 to December 2018.The mean age at presentation was 20.4±7.0 years.The average time from the onset of pain until the presentation was 36.0±55.1 h.Out of the 71 ultrasound scans reviewed,45.1%showed homogenous echotexture and 54.9%showed heterogeneous echotexture of the affected testis.On scrotal exploration,the mean degree of torsion was 475.7±301.8 degrees;66.2%of the patients had a viable testis;and bilateral orchidopexy was done.The remaining 33.8%had a non-viable testis.Homogenous echotexture was after an average of 13.5 h of scrotal pain,while heterogeneous echotexture presented after 53.7 h of scrotal pain.There was a statistically significant difference between the time of presentation and echotexture changes on scrotal ultrasonography(p<0.01).The relationship between echotexture changes and testicular viability was statistically significant as well(p<0.001).Conclusion:A long time since the onset of pain coupled with heterogeneous changes in testicular parenchyma is a good indicator of non-viability.However,we still advocate for surgical exploration as the gold standard in diagnosis and management.

Emergency Treatment of Testicular Torsion and Postoperative Follow-up: A 71 Case Report

This study presented our experience in the treatment of testicular torsion,which may help achieve early diagnosis and improve therapeutic effects.A retrospective analysis was conducted in 71 patients with testicular torsion who were treated in our hospital from October 2007 to April 2011.The age of the patients ranged from 16 days to 34 years.All the patients had unilateral testicular torsion,which took place on the left side in 43 cases and on the right side in 28 cases.The course of the disease varied between three hours to 30 days.Post-operative follow-up was conducted until October 2011.Items examined included signs and symptoms at their first clinical visit,ultrasound findings,treatment in emergency surgery,and post-operative follow-up.In this study,the 71 patients were diagnosed with testicular torsion by color Doppler sonography,7 had testicular fixation,63 patients received orchiectomy,while 1 patient did not undergo surgery due to pressure from family members.Post-operative follow-up showed that the one patient’s testicle,which had been reserved,atrophied,while all the other survived.No recurrence was found during the follow-up visits.It is concluded that an early diagnosis and surgery is important in improving the survival rate of testicular torsion,and the diagnosis and treatment by the first attending clinician is of critical importance.

Improving testicular examinations on paediatric patients in the emergency department:A quality improvement study to improve early diagnosis of testicular torsion

Objective:Male paediatric patients presenting with abdominal and/or testicular pain are common in the emergency department.As a time-sensitive diagnosis,the importance of early recognition,referral,and definitive management is critical.Missed or delayed diagnoses and management of testicular torsion can result in significant long-term sequelae including impaired fertility and psychological burden.In this quality improvement study,we utilised educational posters aiming to improve awareness of testicular torsion as a differential for abdominal pain and therefore,improve the quality of testicular examinations performed in the emergency department.Methods:Observational pre-and post-intervention study was conducted at a tertiary hospital emergency department.A pre-interventional retrospective review of the electronic medical records was conducted.All male patients under 16-years-old presenting with“abdominal pain”or“testicular problem”were included.We assessed the rate of testicular examination and the quality of the examination based on four domains:Cremasteric reflex,lie,swelling,and hardness.Educational posters targeting both patients and clinicians were placed around the emergency department.Subsequent review of the electronic medical records post-intervention was performed assessing the same domains.Results:A total of 235 presentations were analysed with 124 in the pre-intervention group and 111 in the post-intervention group.Overall rate of documented testicular examinations increased by 14%(p=0.032).The quality of testicular examinations also improved from an average of 0.85 domains documented to 2.29 post-intervention(p<0.001).Subgroup analysis found doctors in training had a greater improvement in both rate and quality of documented testicular examination.Conclusion:Our study demonstrated the value of continuing education in promoting awareness of testicular torsion in the emergency department.We found a clear improvement in the quality of clinical documentation of a time-sensitive condition which may infer a decreased risk of missed and delayed diagnosis of testicular torsion.

Evaluation of the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and monocyte lymphocyte ratio for diagnosis of testicular torsion

Objective:To explore the value of complete blood count(CBC),including neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),and monocyte lymphocyte ratio(MLR)in diagnosis of testicular torsion(TT)and differential diagnosis from epididymo-orchitis.Methods:The study was conducted at the Antalya Training and Research Hospital Emergency Department in Turkey with acute scrotal pain patients from January 1st,2016 to January 1st,2018.The patients were categorized into 3 groups:the TT group who underwent an operation for TT(n=70),the epididymo-orchitis group who received epididymo-orchitis treatment(n=120),and the healthy control group(n=100).NLR,PLR,and MLR of the three groups were analysed and compared.The optimum cut-off values of NLR,MLR,and PLR were analyzed.Results:Mean NLR and MLR values were significantly higher in the epididymo-orchitis group and the TT group compared to the control group(P<0.001).Receiver operating characteristic analysis revealed a sensitivity of 77.1%and a specificity of 80%for NLR(77.1)and a sensitivity of 68.2%and a specificity of 78%for PLR(124.80).Moreover,when MLR was used to differentiate the two treatment groups,the optimal cut-off value had a sensitivity of 67.1%and a specificity of 75%(AUC:0.677-0.826,P<0.001).Conclusions:NLR,PLR,and MLR might be associated with the diagnosis of TT.These parameters provide a useful and economical method to help diagnose TT in the emergency department.

Perinatal testicular torsion—An emergency with grave consequences

Introduction: Perinatal testicular torsion is not a frequent, but a grave finding finding. As only immediate surgical retorsion may save the viability of the testicle, time is of essence. We report the case of a newborn where delayed diagnosis led to an unnecessary loss of one testicle. Presentation of Case: The newborn was presented one day after delivery with a swollen left blue scrotal pouch. The left testicle was little tender, higher in position and enlarged. Ultrasound revealed a globular, enlarged testicle left, showing hypodense necrotic areas within. Doppler sound could not detect any perfusion of the spermatic vessels. Scrotal fluid was present bilaterally. At operation, the testicle was considered unsalvageable, and left orchiectomy and right orchidopexy were performed. Discussion: In the new-born, it is more than convenient to perfom ultrasound of both testicles at the same time, which allows to compare texture and perfusion easily. Immediate surgical exploration should be performed at any time, even if in diagnostic doubt. The very most important step though is to professionally recognise and to react to this pediatric emergency, as time is of paramount essence. Conclusion: A case of a male newborn with unilateral perinatal testicular torsion is presented, where typical clinical signs and ultrasound features can be seen. Early exploration with orchiectomy of the necrotic testicle and orchidopexy of the healthy side may save the endocrine function and fertility.

Clinical Findings of Patients Undergone Surgery for Testicular Torsion: A 12-Year Single Center Experience in Northern Iran

Introduction: Testicular torsion is a surgical emergency which requires early diagnosis and prompt surgical management to avoid testicular damage. The aim of this study is to survey the clinical findings and outcome of the patients treated for testicular torsion in a university hospital in Babol, northern Iran. Methods: In this cross sectional study, a retrospective survey of all cases presenting with acute scrotum and primarily diagnosed as testicular torsion was conducted during 2001 and 2012 in Babol, northern Iran. All 103 cases were reviewed and several clinical data, including duration of symptoms and operative findings were collected. Findings: Of 103 patients who presented to the emergency department with acute scrotum, the median age of the cases was 16.0 years. Thirty four percent of the patients presented emergency unit less than 6 hours from symptom exposure. Pain (95.1%) was the major symptom in all patients. Surgery revealed that 72 (70.9%) cases were diagnosed firmly as testicular torsion that 23 patients underwent orchidectomy for a necrotic torsed testis. There were significant differences between orchiectomized versus non-orchiectomized torsion cases in affected side, symptom presentation to operation time. Conclusion: According to our results more than half of the cases presented more than in the golden time. Late presentation to hospital was the major cause of delay leading to orchidectomy in patients with testicular torsion. Greater effort in health education and direct or selfreferal to hospital may reduce this delay.

Comparison of quercetin and resveratrol in the prevention of injury due to testicular torsion/ detorsion in rats

Quercetin （QE） and resveratrol （RSV） are powerful antioxidants with the potential to protect the testes against ischemia/reperfusion （I/R） injury. We compared their effects in testicular torsion/detorsion （T/D） in adult rats. Twenty-four male Wistar rats were divided into four groups： sham （group A）, T/D （group B）, T/D treated with QE （group C）, and T/D treated with RSV （group D）. QE （20 mg kg-1） and RSV （20 mg kg-1） were injected intra-peritoneally at 60 min of torsion. After 90 rain of surgically induced torsion, the testicular cord was restored to its anatomical position. Twenty-four hour after torsion, blood and tissue samples were obtained for further examination. Testicular tissue malondialdehyde （MDA） and nitric oxide （NO） levels and serum total oxidant status （TOS） were higher in group B than in group A （P 〈 0.05）. Group A had higher serum total antioxidant status （TAS） than group B. （P 〈 0.05） QE and RSV significantly lowered MDA, NO, and TOS levels and TAS consumption （P 〈 0.05）. QE reduced the MDA and TOS levels more than RSV （P〈 0.05）, but their effects on NO reduction and TAS consumption were similar （P〉 0.05）. Group A had normal testicular architecture （grade 1）. Groups C （mean grade 2.60） and D （mean grade 3.00） had lower testicular injury grades than group B （mean grade 3.45） （P 〈 0.05）. Group C had lower testicular injury grade than group D （P 〈 0.05）. Treatment with QE and RSV protects against I/R injury after testicular T/D. QE may exhibit better function than RSV at the doses tested in this study.

Establishment and internal validation of preoperative nomograms for predicting the possibility of testicular salvage in patients with testicular torsion

This study aimed to establish nomograms to preoperatively predict the possibility of testicular salvage(TS)in patients with testicular torsion.The clinical data of 204 patients with testicular torsion diagnosed at Xijing Hospital and Tangdu Hospital(Xi'an,China)between August 2008 and November 2019 were retrospectively analyzed.Univariate and multivariate logistic regression analyses were used to determine the independent predictors of TS.Based on multivariate regression coefficients,nomograms to predict possibility of TS were established.The predictive ability of the nomograms was internally validated by receiver operating characteristic(ROC)curves and calibration plots.The duration of symptoms ranged from 2 h to 1 month,with a median of 3.5 days.Thirty(14.7%)patients underwent surgical reduction and contralateral orchiopexy,while the remaining 174(85.3%)underwent orchiectomy and contralateral orchiopexy.Finally,long symptom duration was an independent risk predictor for TS,while visible intratesticular blood flow and homogeneous testicular echotexture under color Doppler ultrasound were independent protective predictors.Internal validation showed that the nomograms,which were established by integrating these three predictive factors,had good discrimination ability in predicting the possibility of TS(areas under the ROC curves were 0.851 and 0.828,respectively).The calibration plots showed good agreement between the nomogram-predicted possibility of TS and the actual situation.In conclusion,this brief preoperative prediction tool will help clinicians to quickly determine the urgency of surgical exploration.

Long-term follow-up results of testicular torsion in children

December 2020 to investigate the long-term follow-up results after testicular torsion(TT)in children.Boys with TT were divided into the salvage orchiopexy group and the orchiectomy group,and the baseline characteristics,ultrasonographic indications,intraoperative findings,testicular volumes,and adverse events during follow-up were compared.A total of 145 cases were included in this study.Approximately 56.6%of patients who underwent salvage orchiopexy had testicular atrophy(TA),and the median testicular volume loss of the testes was 57.4%.Age less than 6 years,delayed surgery,and intraoperative poor blood supply were associated with TA in pediatric TT after orchiopexy.Most atrophied testes appeared within 3-6 months after surgery.Compared with the corresponding age-matched healthy controls,the contralateral testicular volumes were larger in the orchiopexy(P=0.o01 without TA,and P=0.042 with TA)and orchiectomy groups(P=0.033).The adverse events were comparable in patients with orchiectomy or orchiopexy.In summary,follow-up before 3 months after surgery may not offer sufficient clinical value,while that 3 months after surgery should be regarded as the first follow-up time for testicular monitoring.The contralateral testes of patients with TT showed compensatory hypertrophy.We suggest performing orchiectomy when torsed testes are surgically assessed as Arda gradeⅢor inviable.

Cryptorchid testicular torsion in children characteristics and treatment outcomes

This study aimed to review and compare the characteristics and treatment outcomes of cryptorchid testicular torsion in pre-and postpubertal children.We reviewed the clinical data of 22 patients with testicular torsion complicated by cryptorchidism who were treated between January 2010 and December 2019.Patients were categorized into prepubertal(1 month to 9 years;n=12)and postpubertal groups(10-16 years;n=10).The age at presentation,clinical presentations,physical examination,and operation outcomes were assessed.The common clinical presentations in both groups were inguinal pain and a tender inguinal mass.Patients in the prepubertal group were significantly more likely to present with restlessness(33.3%)than those in the postpubertal group(0%;P-0.044).After detorsion,testicular blood flow recovered during surgery in 25.0%of the prepubertal and 80.0%of the postpubertal patients(P=0.010).Orchiectomy was required in 50.0%of the prepubertal and 20.0%of the postpubertal patients(P=0.145).Of the 22 patients with follow-up data,the rates of testicular salvage were significantly different,at 16.7%in the prepubertal patients and 60.0%in the postpubertal patients(P=0.035).Cryptorchid testicular torsion has various manifestations.Although an empty hemiscrotum and a painful groin mass were common in both groups,restlessness was more prevalent in the prepubertal patients during early testicular torsion onset than that in the postpubertal patients.Notably,the testicular salvage rate was significantly lower in the prepubertal patients than that in the postpubertal patients.

Collagen fleece(Tachosil®)for treating testis torsion:A case report

BACKGROUND Testicular torsion is an emergent disease in urology,and there has been discussion of the treatment of testicular torsion.Testicular decompression has been established as a critical treatment for testicular compartment syndrome(TCS),which occurs after detorsion in a patient who is diagnosed with testis torsion.Until now,testicular fasciotomy and incision of tunica albuginea with tunica vaginalis flap(TVF)graft have been suggested for decompression,and some studies about the efficacy of TVF were reported.However,this method is time consuming and needs meticulous technique,so other methods such as orchio-septopexy are suggested.The objective of this clinical case report was to propose new surgical method using collagen fleece(Tachosil®)instead of tunica vagina flap.CASE SUMMARY A 5-year-old boy with scrotal pain visited our hospital 24 h after symptom onset.After history taking,physical examination,and scrotum ultrasonography,he was diagnosed with testis torsion.Emergency surgery was performed after diagnosis.Following the incision of scrotum and fasciotomy,we covered his tunica albuginea with collagen fleece called Tachosil®instead of covering with TVF.CONCLUSION Short-term follow-up showed normal blood flow in testis without a TCS.This is the first case report of using Tachosil®in testicular torsion surgery,and its advantages were already reported in other surgeries like Peyronie’s disease.Our case suggests this new technique is an appropriate method because of its advantages including its cost-effective and time-saving characteristics.The main limitation is the short follow-up,so more studies are needed to provide a high level of evidence about its efficacy and safety.

Tsc1/Tsc2 complex: A molecular target of capsaicin for protection against testicular torsion induced injury in rats

Objective: The detailed knowledge about protective effects of capsaicin(cap) and involved mechanisms against testicular torsion(TT) is still not available completely.Methods: Male Wistar rats were assigned into four major cohorts:(i) sham,(ii) TT,(iii) three subgroups subjected to TT and different doses of cap(100, 500, and 1000 μg/mL), and(iv) three subgroups of healthy animals subjected to various concentrations of cap. The animals were decapitated at 24 h after reperfusion, and the evaluation of protein expression was performed by Western blotting assay. At 72 h after reperfusion, apoptotic cell death and tissue injury were evaluated by TUNEL nuclear and H&E staining,respectively.Results: The results showed that cap administration following TT significantly increased the expression of tuberous sclerosis proteins 1 and 2(Tsc1/Tsc2) in a dose-dependent manner(P < 0.05). Cap decreased cell apoptosis at highest dose. Likewise, cap contributed to the preservation of tubular morphology and decreased tissue injury at the highest tested concentration(1000 μg/m L).Conclusion: Collectively, our findings demonstrate the validity of cap as a therapeutic agent against TT through targeting Tsc1/Tsc2 in a dose-dependent manner.

Torsion of the Spermatic Cord in Adults: Epidemiological, Diagnostic and Therapeutic Aspects Observed in 46 Patients at the Bouake Teaching Hospital

Introduction: Torsion of the spermatic cord (TSC) is a serious surgical emergency because it is responsible for acute ischemia that can lead to the loss of the testicle. Very few studies have been carried out in C?te d’Ivoire and particularly in Bouaké, on torsion of the testicle. The general objective of this work was to describe the epidemiological, diagnostic and therapeutic aspects of testicular torsion in our context. Materials and Methods: This is a retrospective study on 46 patients received urgently at the Teaching Hospital of Bouaké over a period of nine (9) years from December 01, 2010 to November 30, 2019 for torsion of the spermatic cord in adults. Results: The mean age of patients was 26.6 years with extremes of 17 to 41 years. 33 patients were seen before the sixth hour and 13 beyond. Scrotal pain, swelling of the hemibursa and testicular ascent were the dominant physical signs. Orchiectomy + contralateral testicular fixation was performed in 11 patients (23.9%). The average length of hospital stay was three (3) days. The immediate post-operative follow-up was simple. Late complications were marked by two testicular atrophy. Conclusion: Our series was marked by a high rate of orchiectomy. Actions to raise caregivers’ awareness of the population must be carried out so that they consult quickly in front of any painful stock market board to avoid the delay in diagnosis and management detrimental to the vitality of the torsional testicle.

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.

自噬在大鼠睾丸扭转致缺血再灌注损伤中的作用机制

目的探讨自噬在大鼠睾丸扭转所致缺血再灌注损伤(I/RI)中的作用机制。方法将40只健康雄性SD大鼠随机分为假手术组、I/RI组、I/RI+雷帕霉素(RAPA)组和I/RI+3-甲基腺嘌呤(3-MA)组,每组10只。后3组大鼠建立左侧睾丸扭转(720°,1 h)复位模型,I/RI+RAPA组和I/RI+3-MA组大鼠造模前分别给予自噬激动剂RAPA和自噬抑制剂3-MA干预。于睾丸复位12 h后取各组大鼠左侧睾丸和附睾,收集精子进行精子质量分析,采用H-E染色观察睾丸组织病理变化,采用试剂盒检测睾丸组织中超氧化物歧化酶(SOD)活性、丙二醛(MDA)含量、总抗氧化能力(T-AOC),采用TUNEL染色检测睾丸组织细胞凋亡水平,通过蛋白质印迹法检测睾丸组织中自噬相关蛋白(Beclin1、p62)和凋亡相关蛋白(Bcl2、Bax、cleaved caspase 3)表达水平。结果与假手术组比较,I/RI组大鼠精子质量下降,睾丸曲细精管排列松散,生殖细胞减少、脱落,睾丸组织SOD活性、T-AOC降低(均P<0.05),MDA含量升高(P<0.05),p62和Bcl2蛋白表达水平降低(均P<0.05),Beclin1、Bax和cleaved caspase 3蛋白表达水平升高(均P<0.05),凋亡生殖细胞明显增多。与I/RI组比较,I/RI+RAPA组大鼠精子质量提高,睾丸曲细精管排列正常,睾丸组织SOD活性、T-AOC升高(均P<0.05),MDA含量降低(P<0.05),Beclin1和Bcl2蛋白表达水平升高(均P<0.05),p62、Bax和cleaved caspase 3蛋白表达水平降低(均P<0.05),凋亡生殖细胞减少;I/RI+3-MA组大鼠精子质量下降,睾丸曲细精管排列松散,睾丸组织SOD活性、T-AOC降低(均P<0.05),MDA含量升高(P<0.05),Beclin1和Bcl2蛋白表达水平降低(均P<0.05),p62、Bax和cleaved caspase 3蛋白表达水平升高(均P<0.05),凋亡生殖细胞增多。结论激活自噬可改善I/RI大鼠精子质量和睾丸组织病理损伤,缓解氧化应激,抑制生殖细胞凋亡。

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.