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Mao CK, Cao YS, Liu X, Peng B, Chu H, Deng QF, Yu X, Tao CP, Zhang T, Yang C, Peng S. The diagnosis and treatment of testicular torsion in children with non-scrotal initial symptoms. Front Pediatr 2023; 11:1176345. [PMID: 37397154 PMCID: PMC10311083 DOI: 10.3389/fped.2023.1176345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
Objective To explore the clinical characteristics of testicular torsion in children with non-scrotal initial symptoms who were misdiagnosed. Methods A retrospective analysis of 73 cases children with testicular torsion and non-scrotal symptoms who were admitted to our department from October 2013 to December 2021 was performed. Patients were divided into misdiagnosis (27 cases) and clear diagnosis at first visit (46 cases) groups. Clinical data, including age at surgery, clinical presentation, physical examination, number of visits (≥2 times), affected side, time from initial symptoms to surgery, and surgical outcomes, were collected. The TWIST (Testicular Workup for Ischemia and Suspected Torsion) score was calculated and analyzed. Results Statistically significant differences between the misdiagnosis and clear diagnosis groups were seen in the time from initial symptoms to surgery, the number of visits, the degree of testicular torsion, and the rate of orchiectomy (P < 0.05). There were no statistically significant differences (P > 0.05) in age, affected side, TWIST score, guardian, direction of testicular torsion, intra-vaginal or extra-vaginal torsion, and Arda classification. Postoperative follow-up was 6-40 months. Of the 36 patients who required an orchiopexy, 1 had testicular atrophy at six months and 2 were lost to follow-up. The contralateral testis of the 37 children who underwent orchiectomies developed normally without torsion. Conclusions The clinical manifestations of testicular torsion in children are diverse and can easily lead to misdiagnosis. Guardians should be aware of this pathology and seek timely medical attention. When the initial diagnosis and treatment of testicular torsion is difficult, the TWIST score during the physical examination may be useful, especially for patients with intermediate-to-high risk scores. Color Doppler ultrasound can assist in making the diagnosis, but when testicular torsion is highly suspected, routine ultrasound is not necessary as it may lead to delayed surgical treatment.
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Alzahrani MA, Alasmari MM, Altokhais MI, Alkeraithe FW, Alghamdi TA, Aldaham AS, Hakami AH, Alomair S, Hakami BO. Is There a Relationship Between Waking Up from Sleep and the Onset of Testicular Torsion? Res Rep Urol 2023; 15:91-98. [PMID: 36855423 PMCID: PMC9968432 DOI: 10.2147/rru.s404073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
Testicular torsion is a serious urologic emergency that can present with unusual or atypical history and examination. Classical pain from testicular torsion is of sudden onset, significantly severe, and is accompanied by nausea and vomiting. However, in some patients, the initial scrotal pain appears to considerably subside within the next few hours. In others, testicular torsion tends to occur while sleeping, and many patients recount a history of being woken up from sleep by intense pain. Furthermore, some patients in this subset can resume normal activities and even sleep through the night with little or no discomfort, without a perceived need for pain medications. Other patients initially experience mild pain, which worsens over time. Consequently, these patients are less likely to be evaluated immediately. In view of these atypical cases, the question remains unanswered regarding sleep as a predisposing factor for testicular torsion. This narrative review focuses on exploring the association between sleep and testicular torsion.
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Affiliation(s)
- Meshari A Alzahrani
- Department of Urology, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia,Correspondence: Meshari A Alzahrani, Department of Urology, College of Medicine, Majmaah University, Al-Majmaah, 11952, Saudi Arabia, Tel +966569990693, Fax +966164042500, Email
| | | | - Moataz I Altokhais
- Department of Urology, King Khalid University Hospital, Riyadh, Saudi Arabia
| | | | - Talal A Alghamdi
- Department of Urology, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Alwaleed H Hakami
- College of Medicine and Surgery, Jazan University, Jazan, Saudi Arabia
| | - Saud Alomair
- College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Basel O Hakami
- Department of Urology, King Faisal Medical City for Southern Region (KFMC), Abha, Saudi Arabia
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Ayobami AFOLABI O, Adebola ALABI B, Adedamola AJIKE R, Simeon OYEKUNLE O, ADEGOKE W, Adebayo OJETOLA A. Evaluation of testicular torsion management in Ogbomoso, South-Western Nigeria and surgical detorsion-augmented treatment with phytochemical fractions of Corchorus olitorius leaf in expermiental rats. Saudi J Biol Sci 2022; 30:103495. [DOI: 10.1016/j.sjbs.2022.103495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/12/2022] [Accepted: 11/07/2022] [Indexed: 11/17/2022] Open
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Şencan A, Tanrıverdi Hİ, Şimşek FB, Usta İB, Üçöz M, Özbilgin K. Intraoperative evaluation of testicular vascularization and perfusion in rat testicles with indocyanine green (ICG)/near-infrared (NIR) fluorescent imaging after torsion-detorsion and reperfusion. Pediatr Surg Int 2022; 38:1625-1633. [PMID: 36087144 DOI: 10.1007/s00383-022-05211-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate testicular perfusion and vascularization with intraoperative ICG/NIR imaging in a testicular ischemia-reperfusion model and to investigate the effects of ICG on testicular tissue. MATERIALS AND METHODS 24 male rats were divided into four groups. In the ICG group, only ICG was given and images of the testicles were recorded with NIR camera. In the torsion group, the testicles were left in torsion for 4 h. ICG/NIR images were obtained after torsion and detorsion. In the reperfusion group, ICG/NIR images of the testicles were obtained at the 4th hour of reperfusion. After the procedures, testicles were collected and evaluated with histological, immunohistochemical examination and qRT-PCR. RESULTS There was no histologically negative effect of ICG on testicular tissue. There was no testicular perfusion in the torsion group, but perfusion started after detorsion. At the 4th hour of reperfusion, testicular perfusion continued. TNF-a, IL-6, MCP-1 and caspase-3 immunoreactivity were found to be at low levels in the control and ICG groups, while high in the torsion and reperfusion groups (p < 0.05). In qRT-PCR, TNF-a, IL-6, MCP-1 and caspase-3 expressions were lower in the control and ICG groups, but higher in the torsion and reperfusion groups. CONCLUSION There was no histologically negative effect of ICG on testicles. The ICG/NIR imaging technique seems to be a feasible method in testicular torsion and may contribute to the surgeon in the intraoperative management of testicular torsion. In testicles that started to be perfused after detorsion, perfusion still continued at the 4th hour of reperfusion. Our next goal is to test whether testicles showing ICG fluorescence in during reperfusion maintain their viability for long term.
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Affiliation(s)
- Aydın Şencan
- Faculty of Medicine, Department of Pediatric Surgery, Manisa Celal Bayar University, Manisa, Turkey.
| | - Halil İbrahim Tanrıverdi
- Faculty of Medicine, Department of Pediatric Surgery, Manisa Celal Bayar University, Manisa, Turkey
| | - Fatma Bilgecan Şimşek
- Faculty of Medicine, Department of Pediatric Surgery, Manisa Celal Bayar University, Manisa, Turkey
| | - İbrahim Berkan Usta
- Faculty of Medicine, Department of Pediatric Surgery, Manisa Celal Bayar University, Manisa, Turkey
| | - Meltem Üçöz
- Faculty of Medicine, Department of Histology-Embryology, Manisa Celal Bayar University, Manisa, Turkey
| | - Kemal Özbilgin
- Faculty of Medicine, Department of Histology-Embryology, Manisa Celal Bayar University, Manisa, Turkey
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Delgado-Miguel C, García A, Muñoz-Serrano AJ, López-Pereira P, Martínez-Urrutia MJ, Martínez L. The role of neutrophil-to-lymphocyte ratio as a predictor of testicular torsion in children. J Pediatr Urol 2022; 18:697.e1-697.e6. [PMID: 36175289 DOI: 10.1016/j.jpurol.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/16/2022] [Accepted: 09/12/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Doppler ultrasound constitutes the gold standard for the diagnosis of testicular torsion (TT), although sometimes the spermatic cord twisting and absence of testicular flow are difficult to visualize. To date, no laboratory markers have been shown to be useful for preoperative TT diagnosis. OBJECTIVE Our aim is to analyze the role of the neutrophil-to-lymphocyte ratio (NLR) as a predictor of pediatric TT. STUDY DESIGN A retrospective single-center case-control study was performed in patients with ultrasound suspicion of TT, in whom surgical testicular examination was performed between 2016 and 2020. Patients were divided into two groups according to the intraoperative findings: TT group (testicular torsion), defined as spermatic cord twisting on itself around its longitudinal axis at least 360°, and non-TT group (no torsion). Demographics, clinical, ultrasound and laboratory features at admission were analyzed. Sensitivity and specificity were determined by the area under the curve (AUC) represented on the receiver operating characteristic (ROC) curves. RESULTS A total of 159 patients were included (117 TT group; 42 non-TT group), with no demographic or clinical differences. TT group patients presented significantly shorter median time since symptoms onset (4 vs. 8 h; p < 0.012). Laboratory inflammatory test were significantly higher in TT group: Leukocytes (10,900 × 103/μl vs. 7,980 × 103/μl; p < 0.001), neutrophils (8,050 × 103/μl vs. 3,350 × 103/μl; p < 0.001) and NLR (4.6 vs. 1.1; p < 0.001). In ROC curve analysis, NLR presented the highest AUC (0.903), significantly higher than all other laboratory and ultrasound parameters. NLR of 2.3 was the cut-off point with maximum sensitivity (86.9%) and specificity (94.8%). DISCUSSION This is, to the best of our knowledge, the first study to analyze the usefulness of NLR in predicting the diagnosis of TT in patients with clinical and ultrasound suspicion. The limitations are mainly derived from being a single-center retrospective study. For this reason, multicenter studies with a higher number of patients and prospective design may be useful to minimize these biases. The sample size of our study, although not large, has allowed us to identify significant differences between the distinct parameters analyzed as predictors of TT. However, the absence of other similar studies in pediatric patients has hindered the comparison of our results. CONCLUSION NLR should be considered as a predictor of pediatric TT in cases with nuclear ultrasound suspicion that may help to anticipate the urgent surgical treatment in these patients.
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Affiliation(s)
| | - Antonella García
- Department of Pediatric Surgery, La Paz Children´s Hospital, Madrid, Spain
| | | | | | | | - Leopoldo Martínez
- Department of Pediatric Surgery, La Paz Children´s Hospital, Madrid, Spain; Institute for Biomedical Resarch La Paz (IdiPaz), Network for Maternal and Children Health (SAMID), La Paz Children's Hospital, Madrid, Spain
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Peeraully R, John M, Ellis R, Green S, Jancauskaite M, Smart T, Thompson A, Sarmah P, Fraser N. Does decentralisation of surgical management improve outcomes for paediatric testicular torsion? J Pediatr Urol 2022; 18:302.e1-302.e8. [PMID: 35410806 DOI: 10.1016/j.jpurol.2022.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/26/2022] [Accepted: 03/19/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In testicular torsion (TT), delayed emergency scrotal exploration (ESE) increases the risk of orchidectomy. Transfer of a patient with suspected TT from a district general hospital (DGH) to a paediatric surgical centre (PSC) delays ESE and potentially puts them at increased risk of testicular loss. Prior to 1st January 2017, all boys under aged <16 years presenting to a DGH within the East Midlands Clinical Network (EMCN) would be referred to the PSC. From this date, it was agreed within the EMCN that boys aged ≥5 years with suspected TT presenting to a network DGH would be managed locally, barring exceptional circumstances. Boys aged <5 years would be referred to the PSC for management. AIM This study aimed to assess the impact of decentralisation of ESE for suspected TT on orchidectomy rates in the EMCN. METHODS All patients who underwent ESE under the care of paediatric surgery in the PSC, and all patients <16 years old who underwent ESE in 4 EMCN DGHs between January 2017 and December 2019 were identified. Neonatal cases and inpatient referrals were excluded. Comparison was made with published data on ESE performed in the PSC over the 9 years 2008-2016 prior to decentralisation. RESULTS In the 9 years prior to decentralisation, there were 110 cases of TT in the PSC. In the subsequent 3 years, there were 40 in the PSC and 37 in the DGHs. The orchidectomy rate of boys with TT presenting to DGHs and undergoing exploration locally (16%, 6/37) contrasts with the rate in those transferred from DGHs to the PSC for exploration (58%, 15/26). The difference is highly significant (p = 0.00059, RR 0.28 [95% CI 0.13-0.63]) and indicates that in the EMCN, avoiding hospital transfer and performing ESE at the presenting DGH reduces the risk of orchidectomy by 72%. CONCLUSION Decentralisation of the provision of ESE in boys with TT has resulted in a significantly lower orchidectomy rate in boys undergoing ESE in the presenting hospital than when transferred to the PSC. This study reinforces existing literature that demonstrates the effect of delayed ESE on orchidectomy rate, and supports the recommendations of national guidelines in the UK that transfer of boys to a PSC for ESE should only occur in exceptional circumstances.
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Affiliation(s)
- Riyad Peeraully
- Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom.
| | - Michael John
- Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom
| | - Ricky Ellis
- King's Mill Hospital, Mansfield, NG17 4JL, United Kingdom
| | - Sophie Green
- Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom
| | | | - Thomas Smart
- Royal Derby Hospital, Derby, DE22 3NE, United Kingdom
| | - Amari Thompson
- Lincoln County Hospital, Lincoln, LN2 5QY, United Kingdom
| | | | - Nia Fraser
- Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom
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Steeman A, Ngatchou W, Ramadan AS, Entezari K, Kirkove P, Mélot C, Mols P, Bartiaux M, Youatou Towo P. Impact of treatment delays on outcome of acute testicular torsion: a 15-year retrospective study. Acta Chir Belg 2022; 122:116-122. [PMID: 33538652 DOI: 10.1080/00015458.2021.1883391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Preservation of the testicle is directly associated with the duration of torsion. The aim in this retrospective study was to identify factors that influence pre-and in-hospital times and measure the extent to which these times affect testicle survival. PATIENTS AND METHODS A retrospective review of 116 patients who underwent exploration for testicular torsion between 2000 and 2015. Patients were divided into orchiectomy and salvaged testicle groups. Times in patient management and clinical features were compared with Mann-Whitney, chi-squared, and Fisher exact tests. Multivariate logistical regression was used to identify independent factors associated with orchiectomy. RESULTS The median prehospital time of 48 h (15.4-138 h) in the orchiectomy group was longer than the 2.4 h (1.6 h-5.2h) in the salvaged group. Patients examined by a general practitioner (GP) prior to presenting at hospital had a median prehospital time of 48 h, compared to 3 h for patients not examined before presentation at hospital. In-hospital times between admission and operation room, as well as times between ultrasonography and operation room, were also longer in the orchiectomy group. Previous GP consultation (OR = 27.26, 95% CI 2.32-320.59, p = .009), prehospital time (OR = 1.04, 95% CI 1.01-1.07, p = .003) and nausea (OR = 9.25, 95% IC 1.33-64.52, p = .025) were independent predictive factors associated with orchiectomy. CONCLUSION Prehospital time was a determining factor in orchiectomy. For each extra hour of prehospital delay, the risk of orchiectomy increased by 4%. The rate of orchiectomy was higher among patients who first consulted a GP.
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Affiliation(s)
| | | | | | - Kim Entezari
- Urology Department, CHU Saint-Pierre, Brussels, Belgium
| | | | | | - Pierre Mols
- Emergency Department, CHU Saint-Pierre, Brussels, Belgium
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Hosokawa T, Tanami Y, Sato Y, Ishimaru T, Kawashima H, Oguma E. Role of ultrasound in manual detorsion for testicular torsion. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:860-869. [PMID: 34240428 DOI: 10.1002/jcu.23039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/03/2021] [Accepted: 06/27/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE Manual detorsion can be performed for testicular torsion before scrotal exploration. Using sonographic findings, this study investigated the need for additional treatments after manual detorsion for testicular torsion. METHODS This study evaluated 13 retrospective cases of testicular torsion subjected to manual detorsion. Manual detorsion was classified as failure or success based on residual spermatic cord twist. The following sonographic findings of the affected testis were compared using the Fisher exact test: whirlpool sign, horizontal or altered lie, and hypoperfusion. RESULTS Manual detorsion failed in five patients. There was a significant difference in the incidence of the whirlpool sign between the two groups (present/absent sign in the failure vs. success groups: 4/1 vs. 0/8, p = 0.007). Horizontal or altered lie and hypoperfusion in the affected testis were not significantly different between groups (5/0 vs. 3/4, p = 0.07, one case excluded, and 5/0 vs. 4/4, p = 0.10, respectively). CONCLUSIONS Ultrasound findings after manual detorsion, particularly, the whirlpool sign, were useful for planning subsequent treatment such as additional manual detorsion or surgical intervention. The testicular axis and the perfusion of the twisted testis may not recover to normal after successful manual detorsion, but if they recover, this procedure could be judged a success.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Tetsuya Ishimaru
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
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The bell-clapper deformity of the testis: The definitive pathological anatomy. J Pediatr Surg 2021; 56:1405-1410. [PMID: 32762939 DOI: 10.1016/j.jpedsurg.2020.06.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 06/16/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The bell-clapper deformity (BCD) predisposes to intravaginal torsion (IVT) and is classically bilateral. The precise pathological definition of what constitutes a BCD is not clear. The current study aims to clarify the specific anatomic details of this anomaly. METHODS A systematic review was performed utilizing the PRISMA principles. Studies are presented chronologically based on their level of evidence. They are further divided into study types: autopsy and operative studies of acute torsion, intermittent torsion and studies of the contralateral testis in vanishing testis. RESULTS The bell-clapper deformity is best defined by complete investment of the testis, epididymis and a length of the spermatic cord by the tunica vaginalis. Based on autopsy studies the rate of BCD in scrotal testis varied from 4.9% to 16%; with bilaterality in 66%-100%. In cases of acute IVT bilaterality was noted in 54%-100%. The most disparate results were in cases of testicular regression syndrome where contralateral BCD was noted in 0%-87% of cases. CONCLUSION We suggest future studies employ the strict anatomical definition above. As there is evidence of age-dependent investment of the testes, it will be important to develop age-standardized measurements of intravaginal length of spermatic cord. This critical morphometric measurement will allow a better understanding of the risk of IVT. LEVEL OF EVIDENCE Systematic review of diagnostic studies: lowest level of evidence of included manuscripts Level IV (case-control studies with a poor reference standard).
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Unsal V, Kolukcu E, Gevrek F, Firat F. Sinapic acid reduces ischemia/reperfusion injury due to testicular torsion/detorsion in rats. Andrologia 2021; 53:e14117. [PMID: 34081348 DOI: 10.1111/and.14117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 01/28/2023] Open
Abstract
This study aimed to investigate the protective effect of sinapic acid (SA) on biochemical and histopathological changes in an experimental testicular torsion-detorsion rat model. Twenty-four rats were randomised into four groups: sham group, ischemia/reperfusion (IR) group subjected to testicular torsion for 2 hr and then detorsion for 4 hr, and two groups treated with SA1 and SA2 (10 mg/kg and 20 mg/kg, by single intraperitoneal injection, 30 min before reperfusion). Serum testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were measured by an autoanalyzer, superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), malondialdehyde (MDA), protein carbonyl (PC), and nitric oxide (NO) oxidative stress parameters by spectrophotometric methods, and tumour necrosis factor (TNF-α), interleukin-1 beta (IL-1β), and interleukin 6 (IL-6) parameters by the Elisa method. In addition, immunohistochemical and histopathological examinations were performed on testicular tissues. There was no significant difference between the groups in terms of serum testosterone, FSH and LH levels (p > .05). SA significantly reduced increased testicular damage, oxidative stress, inflammation, cell death and also restored decreased antioxidant enzyme activities (p < .05). Pre-treatment of rats with SA reduced testicular dysfunction and morphological changes IRI. SA's antioxidant, anti-inflammatory, and antiapoptotic properties were found to be protective against testicular IR.
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Affiliation(s)
- Velid Unsal
- Faculty of Health Sciences and Central Research Laboratory, Mardin Artuklu University, Mardin, Turkey
| | - Engin Kolukcu
- Department of Urology, Faculty of Medicine, Gaziosmanpaşa University, Tokat, Turkey
| | - Fikret Gevrek
- Department of Histology and Embryology, Faculty of Medicine, Gaziosmanpaşa University, Tokat, Turkey
| | - Fatih Firat
- Department of Urology, Tokat State Hospital, Tokat, Turkey
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Vasconcelos-Castro S, Flor-de-Lima B, Campos JM, Soares-Oliveira M. Manual detorsion in testicular torsion: 5 years of experience at a single center. J Pediatr Surg 2020; 55:2728-2731. [PMID: 32169343 DOI: 10.1016/j.jpedsurg.2020.02.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/25/2020] [Accepted: 02/19/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Testicular torsion is one of the most common causes of acute scrotum in pediatric age. The present study aimed to evaluate the role of preoperative manual detorsion in the management of testicular torsion. METHODS Retrospective data analysis of pediatric patients treated for acute testicular torsion at a tertiary center over the last 5 years. Manual detorsion was attempted by surgeon's preference. Successful manual detorsion was defined as complete pain resolution with a normal color Doppler ultrasound. All patients underwent surgical exploration. Patient data analyzed included: age, pain duration, site of onset, attempt of manual detorsion, pain relief after manual detorsion, color Doppler ultrasound results, surgical findings and outcome. RESULTS One hundred twenty-two patients were included. Manual detorsion was attempted in 48% (58/122) cases. Manual detorsion was successful in 26% (15/58) patients. In the unsuccessful, residual cord torsion was found at surgery in 27.5% (16/58); in the remaining 27, there was no cord torsion at surgery. Five patients (5/15) with successful manual detorsion underwent elective orchiopexy. Gonadal loss after manual detorsion (9%, 5/58) occurred after unsuccessful manual detorsion, all submitted to emergency surgery. CONCLUSIONS Testicular torsion warrants prompt detorsion. Manual detorsion is simple, immediately available, and maximizes testis salvage. A successful maneuver permits nonemergency orchiopexy. An algorithm for the management of testicular torsion that includes an attempt of manual detorsion prior to surgery is proposed. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Sofia Vasconcelos-Castro
- Department of Pediatric Surgery, Centro Hospitalar Universitário São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Beatriz Flor-de-Lima
- Department of Radiology, Centro Hospitalar Universitário São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - José Miguel Campos
- Department of Pediatric Surgery, Centro Hospitalar Universitário São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Miguel Soares-Oliveira
- Department of Pediatric Surgery, Centro Hospitalar Universitário São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Faculty of Medicine, Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
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Seker U, Nergiz Y, Aktas A, Akkus M, Ozmen MF, Uyar E, Soker S. Trolox is more successful than allopurinol to reduce degenerative effects of testicular ischemia/reperfusion injury in rats. J Pediatr Urol 2020; 16:465.e1-465.e8. [PMID: 32595071 DOI: 10.1016/j.jpurol.2020.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/20/2020] [Accepted: 05/10/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Reperfusion surgery following testicular ischemia is a reproductive health threatening status and may result with organ dysfunction in men. The high level of reactive oxygen species (ROS) and cease of blood flow to the testis are the most important reasons of this testicular injury. Until today, numerous experimental studies reported that antioxidants might be efficient to alleviate oxidative stress induced organ dysfunction. For this purpose, in this study, we have investigated the protective effects of xanthine oxidase (XO) inhibitor, allopurinol, and ROS scavenger, trolox, in a comparative perspective in testicular ischemia reperfusion injury subjected rats. MATERIALS AND METHODS Twenty-eight adult male Sprague Dawley rats were divided into four groups of seven animals in each; control, ischemia/reperfusion (I/R), allopurinol and trolox. The rats in control group did not receive any application. Animals in I/R, allopurinol and trolox groups were subjected to 2 h testicular reperfusion injury following 5 h ischemia. Intraperitoneally (i.p.) 1 ml isotonic, 200 mg/kg allopurinol and 50 mg/kg trolox were administered to the animals in these groups 30 min prior reperfusion. At the end of experiment, all animals were sacrificed and blood serum malondialdehyde (MDA) levels were measured. Histological sections were obtained from the testis and stained with hematoxylin and eosin (H&E), proliferating cell nuclear antigen (PCNA) and cleaved caspase-3. Apoptotic index was evaluated with TUNEL Assay. RESULTS Severe morphological degenerations, increased serum MDA, cleaved caspase-3 and TUNEL Assay positivity rate, but reduced PCNA positivity rate was observed in ischemia and reperfusion group. Morphological degenerations, MDA level, apoptotic index and PCNA positive cell rate were slightly alleviated in allopurinol administered animals compared with ischemia and reperfusion group. Protection with trolox was more successful and the results of the analysis were similar to the control group. DISCUSSION Ischemia that leading to testicular torsion is a reproductive health affecting problem and current surgical treatment methods might be insufficient to recover testis. Various types of ROS generating mechanisms in cell are limiting protective potency of allopurinol, and cocktail administration of different ROS inhibitors might be more effective. However, our results indicate that free radical scavenger trolox might be a candidate drug to alleviate degenerative effects of testicular ischemia reperfusion injury. CONCLUSIONS This is the first study that demonstrates antioxidant trolox was more successful than XO inhibitor allopurinol to protect testis against ischemia and reperfusion injury in rats.
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Affiliation(s)
- Ugur Seker
- Department of Histology and Embryology, Faculty of Medicine, Dicle University, Turkey.
| | - Yusuf Nergiz
- Department of Histology and Embryology, Faculty of Medicine, Dicle University, Turkey
| | - Ayfer Aktas
- Department of Histology and Embryology, Faculty of Medicine, Dicle University, Turkey
| | - Murat Akkus
- Department of Histology and Embryology, Faculty of Medicine, Dicle University, Turkey
| | - Mehmet Ferit Ozmen
- Department of Reproduction and Artificial Insemination, Faculty of Veterinary Medicine, Dicle University, Turkey
| | - Emre Uyar
- Department of Pharmacology, Faculty of Medicine, Dicle University, Turkey
| | - Sevda Soker
- Department of Histology and Embryology, Faculty of Medicine, Dicle University, Turkey
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Acute scrotal pain in pediatric patients: diagnosis with an innovative Doppler technique (MicroV). Emerg Radiol 2020; 28:209-214. [PMID: 32591921 DOI: 10.1007/s10140-020-01812-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/19/2020] [Indexed: 10/24/2022]
Abstract
Acute scrotal pain is one of the most frequent symptoms in pediatric patients visited in the Emergency Department. Ultrasonography with color and power Doppler represents the first-line method that clinicians use to carry out the differential diagnosis between spermatic cord torsion and inflammation, but sensitivity and specificity are 63-100% and 97-100%, respectively; this variability may be related to operator's experience and testis vascular hemodynamics and also to machine performance and patient age. Recent technological innovations have made possible to create a new Doppler mode called ultrasound microvascular imaging. This technique exploits algorithms capable of separating low frequencies of static tissue artifacts from ones of very weak flows. It is known as MicroV (from Esaote) and Superb microvascular imaging (from Toshiba). It provides both macrocirculation vascular maps, as a typical Doppler feature, and microcirculation vascular maps. Furthermore, the use of background subtraction could improve the visibility of small vascular structures. We report a case of a pediatric patient suffering from acute scrotal pain assessed ultrasonographically with this innovative Doppler technique (MicroV) that may give more confidence in detecting testicular vascular signals if compared with traditional Doppler techniques.
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SOLAK T, SALİHOĞLU YS, ERDEMİR RU. Deneysel Testis Torsiyon-Detorsiyonunda Agmatine’nin Etkisinin Tc-99m Perteknetat Sintigrafisi İle Değerlendirilmesi. DICLE MEDICAL JOURNAL 2020. [DOI: 10.5798/dicletip.755749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Lin W, Li Z, Xue E, Chen S, Liang R. Using shear wave elastography method to evaluate testicular compartment syndrome after testicular torsion. Andrologia 2020; 52:e13618. [PMID: 32401369 DOI: 10.1111/and.13618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 03/30/2020] [Accepted: 04/03/2020] [Indexed: 12/14/2022] Open
Abstract
The measurement of compartment pressure is a direct method to objectively evaluate suspected compartment syndrome. However, to evaluate the evolving compartment syndrome, one needs to measure the pressure repeatedly, which may aggravate the damage of tissue. Despite several suggested approaches, an effective, noninvasive and sustainable method to detect testicular compartment syndrome is still lacking. In this context, using the method of shear wave elastography, we assessed the correlation between the intratesticular pressure and the testicular compartment elasticity (Emean) after testicular torsion in rabbits. It was found that a strong correlation between the intratesticular pressure and the Emean in the testicular border area (p < .001) or the central area (p = .001) was present. This result suggests that shear wave elastography is a reliable method to evaluate intratesticular pressure in rabbits, and it may have further potential clinical application in detecting testicular compartment syndrome.
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Affiliation(s)
- Wenjin Lin
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhiyong Li
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ensheng Xue
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, China
| | - Shun Chen
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, China
| | - Rongxi Liang
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, China
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Afsarlar CE, Cakmakci E, Demir E, Guney G, Komut E, Elizondo R, Seth A, Koh CJ. Novel prognostic grayscale ultrasonographic findings in the testis from a comprehensive analysis of pediatric patients with testicular torsion. J Pediatr Urol 2019; 15:480.e1-480.e7. [PMID: 31495779 DOI: 10.1016/j.jpurol.2019.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/01/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Although grayscale and Doppler ultrasound (US) findings of testicular torsion (TT) have previously been described in the literature, other US findings may provide more prognostic information to families. OBJECTIVE The authors hypothesized that a comprehensive analysis of US findings of TT that focused on time-dependent changes would lead to additional ultrasonographic morphologic findings and clinically relevant prognostic information. STUDY DESIGN The authors reviewed the records of pediatric patients with acute TT from 2010 to 2017. The sizes and parenchymal characteristics of the torsed and contralateral testes on US were analyzed in relation to the time duration from the onset of scrotal pain to the time of surgery (0-6 h, 6-12 h, 12-24 h, 24-48 h, and >48 h), torsion degree, and clinical outcomes of the testes. RESULTS Patient demographics, time intervals, and US measurements of the torsed and contralateral testes showed significant differences with respect to testicular viability (Summary Table). The mean volume ratios of torsed to contralateral testis showed significant differences between the 0-6 h and the 12-24 h time groups as well as the 6-12 h and the 12-24 h time groups (P = 0.003 and P = 0.035, respectively), as well as significant differences between the viable and non-viable testes (P = 0.005). Regarding testicular heterogeneity, two novel grayscale sonographic findings were noted: (1) multiple hypoechoic lines that were termed 'testicular fragmentation' and (2) hyperechoic patches that were termed 'testicular patching'. The presence of these two findings were significantly increased as TT time duration increased (P < 0.001), and these findings were significantly associated with testicular non-viability (P < 0.001). Torsion degree was also noted to be significantly higher in the non-viable testes (P < 0.001). Presence of hydrocele or scrotal edema also showed significant differences between the TT time groups (P < 0.001). DISCUSSION The results of this study demonstrated ultrasonographic findings related to time dependent changes in TT and provided prognostic information regarding testicular viability. CONCLUSIONS Specific US grayscale findings in torsed testes (testicular fragmentation and testicular patching) were identified that provide prognostic information regarding time duration of testicular torsion and testicular viability. Testicular fragmentation and testicular patching significantly increased as TT time increased, with increasing risk for testicular non-viability.
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Affiliation(s)
- Cagatay E Afsarlar
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Department of Pediatric Surgery, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Emin Cakmakci
- Department of Radiology, Dr.Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Emre Demir
- Department of Biostatistics, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Guven Guney
- Department of Pathology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Erdal Komut
- Department of Radiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Rodolfo Elizondo
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Abhishek Seth
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Chester J Koh
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
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Xiang H, Han J, Ridley WE, Ridley LJ. Snail shell sign: Testicular/ovarian torsion. J Med Imaging Radiat Oncol 2018; 62 Suppl 1:106. [DOI: 10.1111/1754-9485.50_12784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hao Xiang
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Jason Han
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | | | - Lloyd J Ridley
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Medical Imaging, University of Sydney, Sydney, New South Wales, Australia
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Genetic analysis of the human insulin-like 3 gene in pediatric patients with testicular torsion. Pediatr Surg Int 2018; 34:807-812. [PMID: 29785651 DOI: 10.1007/s00383-018-4280-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Testicular torsion (TT) mainly affects boys under 18 years old. To avoid orchiectomy, TT requires an immediate operative management. The etiology of TT is still controversial. Observed familiar recurrence suggests the presence of a genetic involvement. The INSL3 gene consists of two exons, and it is specifically expressed in fetal and adult Leydig cells. In transgenic mice, deletion of this gene was observed an increased testicular mobility and testicular torsion. We have hypothesized the possible involvement of the INSL3 gene as a predisposing factor of human TT. METHODS We performed genetic analysis in 25 pediatric patients with unilateral and intravaginal TT (left, n = 13, 56%; right, n = 12, 48%). The age of the patients ranged from 1 to 16 years (median age n = 10.4 ± 5.46 years). In this study, we included two first male cousins affected by TT. Venous peripheral blood samples was obtained after parental written informed consent. RESULTS The Thr60Ala polymorphism was detected in exon 1 of INSL3 gene and other 2 rarer variants (rs1047233 and rs1003887) were identified in the 3' untranslated region. These variants are prevalent in patients with TT instead of healthy subjects. CONCLUSIONS Additional studies in a larger population are needed to better understand the clinical consequence of the INSL 3 variations founded. This would allow in the future to identify the patients at risk of TT to improve clinical management.
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Tusat M, Mentese A, Demir S, Alver A, Imamoglu M. Medical ozone therapy reduces oxidative stress and testicular damage in an experimental model of testicular torsion in rats. Int Braz J Urol 2018; 43:1160-1166. [PMID: 28727368 PMCID: PMC5734081 DOI: 10.1590/s1677-5538.ibju.2016.0546] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 01/04/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Testicular torsion (TT) refers to rotation of the testis and twisting of the spermatic cord. TT results in ischemia-reperfusion (I/R) injury involving increased oxidative stress, inflammation and apoptosis, and can even lead to infertility. The aim of this study was to investigate the effect of ozone therapy on testicular damage due to I/R injury in an experimental torsion model. MATERIALS AND METHODS 24 male Sprague-Dawley rats were divided into 3 groups; sham-operated, torsion/detorsion (T/D), and T/D+ozone. Ozone (1mg/kg) was injected intraperi-toneally 120 minutes before detorsion and for the following 24h. Blood and tissue samples were collected at the end of 24h. Johnsen score, ischemia modified albumin (IMA), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) levels were determined. RESULTS Levels of IMA, TOS, OSI, and histopathological scores increased in the serum/tissue of the rats in the experimental T/D group. Serum IMA, TOS, and OSI levels and tissue histo-pathological scores were lower in the rats treated with ozone compared with the T/D group. CONCLUSION Our study results suggest that ozone therapy may exhibit beneficial effects on both biochemical and histopathological findings. Clinical trials are now necessary to confirm this.
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Affiliation(s)
- Mustafa Tusat
- Department of Pediatric Surgery, Kilis State Hospital, Kilis, Turkey
| | - Ahmet Mentese
- Program of Medical Laboratory Techniques, Vocational School of Health Sciences, Karadeniz Technical, University, Trabzon, Turkey
| | - Selim Demir
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey
| | - Ahmet Alver
- Department of Medical Biochemistry, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.,Department of Medical Biochemistry, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Mustafa Imamoglu
- Department of Pediatric Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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20
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Bandarkar AN, Blask AR. Testicular torsion with preserved flow: key sonographic features and value-added approach to diagnosis. Pediatr Radiol 2018; 48:735-744. [PMID: 29468365 PMCID: PMC5895684 DOI: 10.1007/s00247-018-4093-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/02/2018] [Accepted: 01/19/2018] [Indexed: 11/30/2022]
Abstract
Testicular sonography has contributed greatly to the preoperative diagnosis of testicular torsion in the pediatric patient and is the mainstay for evaluation of acute scrotal pain. Despite its high sensitivity and specificity, both false-negative and false-positive findings occur. Presence of documented Doppler flow within the testis might be a dissuading factor for surgical exploration with resultant testicular loss in the false-negative cases. Our goal is to illustrate key sonographic features in the spectrum of testicular torsion with preserved testicular flow, and to describe how to differentiate testicular torsion from epididymitis in order to avoid the under-diagnosis of testicular torsion. We simplify the anatomy of the bell clapper testis. We also describe our sonographic protocol for testicular torsion and share valuable tips from our approach to challenging cases.
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Affiliation(s)
- Anjum N. Bandarkar
- Department of Radiology, Mid-Atlantic Permanente Medical Group, 1890 Metro Center Drive, Reston, VA 20190 USA
| | - Anna R. Blask
- Department of Radiology, Children’s National Health System, Washington, DC USA
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21
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Sangüesa Nebot C, Llorens Salvador R, Picó Aliaga S, Garcés Iñigo E. Perinatal testicular torsion: Ultrasound assessment and differential diagnosis. RADIOLOGIA 2017. [DOI: 10.1016/j.rxeng.2017.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Afsarlar CE, Elizondo R, Yilmaz E, Cakmakci E, Ballow DJ, Demir E, Guney G, Koh CJ. Ultrasonographic findings in the epididymis of pediatric patients with testicular torsion. J Pediatr Urol 2017; 13:393.e1-393.e6. [PMID: 28713006 DOI: 10.1016/j.jpurol.2017.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/20/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Although grayscale ultrasound and color Doppler ultrasound characteristics of the torsed testis are well established in the literature, less is known about its anatomic partner: the epididymis. OBJECTIVE The purpose of this study was to describe the ultrasound characteristics of the epididymis in pediatric patients with testicular torsion, and to describe their potential role as prognostic criteria for testicular salvage outcomes. STUDY DESIGN During a retrospective review of 217 pediatric patients with acute testicular torsion during 2009-2016, morphological features of the epididymis from scrotal ultrasounds (size, parenchymal characteristics, and vascular flow of both epididymis heads), as well as patient demographics, time duration, surgical outcomes, histopathology results, and follow-up periods were analyzed. RESULTS Mean epididymis size and twisting degree were significantly higher in the torsed testes than in the contralateral epididymis (P < 0.001) (Summary table). Cystic structures in the epididymis were identified: a higher number of cysts was associated with testicular non-viability (P = 0.025) and higher twisting degree (P = 0.017). Histopathologic examination showed that these spaces were infiltrated connective tissue most likely formed by venous congestion and vessel rupture. DISCUSSION Scrotal ultrasound can provide information on testicular morphology and viability, as well as morphological changes in the epididymis over time in pediatric patients with testicular torsion. These findings may provide potential prognostic information regarding testicular viability, as a higher number of cystic spaces in the epididymis was associated with a higher rate of testicular non-viability and a higher twisting degree. In addition, the epididymis size (volume) can change during the time course of the ischemic state. CONCLUSIONS This was the first study to describe and analyze epididymis ultrasound findings in pediatric patients with testicular torsion and to correlate them with testicular salvage outcomes. Further prospective studies are needed to determine the role of epididymis ultrasound findings as a potential pre-operative prognostic tool.
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Affiliation(s)
- C E Afsarlar
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Department of Pediatric Surgery, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - R Elizondo
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - E Yilmaz
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Department of Pediatric Surgery, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - E Cakmakci
- Department of Radiology, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - D J Ballow
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - E Demir
- Department of Biostatistics, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - G Guney
- Department of Pathology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - C J Koh
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
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Vaos G, Zavras N. Antioxidants in experimental ischemia-reperfusion injury of the testis: Where are we heading towards? World J Methodol 2017; 7:37-45. [PMID: 28706858 PMCID: PMC5489422 DOI: 10.5662/wjm.v7.i2.37] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/07/2017] [Accepted: 05/15/2017] [Indexed: 02/06/2023] Open
Abstract
Testicular torsion (TT) is a medical emergency that primary affects newborns and young adolescents. It causes testicular injury due to the torsion of the spermatic cord and its components, initially in the venous blood flow and finally in the arterial blood flow. Prompt diagnosis and early surgical management are necessary in managing this urgent situation. The process of the pathophysiological events in ischemia-reperfusion is multifactorial and deals with the perception of the oxidative stress responsible for the consequences of ischemia/reperfusion (I/R) stress following TT. Duration and severity of torsion also play a significant role in the oxidative stress. A detrimental result of the defense system of the testes takes place resulting finally in testicular atrophy and impaired function. Antioxidant factors have been experimentally studied in an effort to front this state. They have been classified as endogenous or exogenous antioxidants. Endogenous antioxidants comprise a structure of enzymic enzymatic and non-enzymic enzymatic particles presented within cytoplasm and numerous other subunits in the cells. Exogenous antioxidants include a variety of natural and pharmaceutical agents that may prevent or ameliorate the harmful effects of I/R injury. In this study we review those factors and their ability to enhance the oxidative status of the testis. A feature insight into where we are heading is attempted.
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The paediatric acute scrotum. ANNALS OF PEDIATRIC SURGERY 2017. [DOI: 10.1097/01.xps.0000511422.16408.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Gholami M, Abbaszadeh A, Khanipour Khayat Z, Anbari K, Baharvand P, Gharravi AM. Honey improves spermatogenesis and hormone secretion in testicular ischaemia-reperfusion-induced injury in rats. Andrologia 2017; 50. [PMID: 28370451 DOI: 10.1111/and.12804] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2017] [Indexed: 11/27/2022] Open
Abstract
This study was conducted to survey the protective effect of pre-treatment with Persian honey during post-ischaemia reperfusion on ischaemia-reperfusion (IR)-induced testis injury. Animals were divided into four groups of IR, honey + ischaemia- reperfusion (HIR), vitamin C + ischaemia- reperfusion (VIR) and carbohydrates + ischaemia- reperfusion (CIR). The testes were examined for spermatogenesis index. Detection of single- and double-stranded DNA breaks at the early stages of apoptosis was performed. Total serum concentration of FSH, LH and testosterone was measured using ELISA. All data were expressed as mean ± SD in each group, and significance was set at p ≤ .05. Spermatogenesis index was significant in the HIR group (p < .001). Serum levels of FSH and LH were significantly higher in the CIR and HIR groups. Serum levels of testosterone were significantly higher in VIR and HIR groups. Apoptotic cells in IR and CIR groups increased significantly statistically (p < .001), while in HIR and VIR groups, the number of apoptotic cells decreased and the positive cells of TUNEL staining were detected in spermatocytes and spermatid. The present study indicates that honey decreases the cellular damage and apoptosis during testicular I/R injury, with significant protective effects on reproductive hormone production.
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Affiliation(s)
- M Gholami
- Razi Herbal Medicines Research Center and Department of Anatomy, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - A Abbaszadeh
- Department of Surgery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Z Khanipour Khayat
- Razi Herbal Medicines Research Center and Department of Anatomy, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - K Anbari
- Department of Social Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - P Baharvand
- Department of Social Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - A M Gharravi
- School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
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Sangüesa Nebot C, Llorens Salvador R, Picó Aliaga S, Garcés Iñigo E. Perinatal testicular torsion: ultrasound assessment and differential diagnosis. RADIOLOGIA 2017; 59:391-400. [PMID: 28117098 DOI: 10.1016/j.rx.2016.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 11/08/2016] [Accepted: 11/09/2016] [Indexed: 10/20/2022]
Abstract
Perinatal testicular torsion, defined as torsion occurring in the prenatal period or in the first month after birth, accounts for 10% of all cases of testicular torsion in pediatric patients. Most are extravaginal, and intravaginal torsion is rare. Its management is controversial, due to the low viability of the testis and the possibility of bilateral torsion. Ultrasonography is the method of choice to study testicular torsion. Combining B-mode and power Doppler imaging facilitates a fast reliable diagnosis. We review the ultrasonographic appearance of neonatal testicular torsion for each presentation, the differential diagnosis with other causes of increased scrotal volume in neonates, and its treatment.
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Affiliation(s)
- C Sangüesa Nebot
- Área de Imagen médica, Sección de Pediatría, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - R Llorens Salvador
- Área de Imagen médica, Sección de Pediatría, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - S Picó Aliaga
- Área de Imagen médica, Sección de Pediatría, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - E Garcés Iñigo
- Área de Imagen médica, Sección de Pediatría, Hospital Universitario y Politécnico La Fe, Valencia, España
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Investigation of N-acetylcysteine on contralateral testis tissue injury by experimental testicular torsion: long-term effect. Am J Emerg Med 2016; 34:1069-74. [DOI: 10.1016/j.ajem.2016.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 03/07/2016] [Indexed: 11/20/2022] Open
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Shih HJ, Yen JC, Chiu AW, Chow YC, Pan WH, Huang CJ. FTY720 inhibits germ cell apoptosis in testicular torsion/detorsion. J Surg Res 2016; 202:155-64. [DOI: 10.1016/j.jss.2015.12.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 12/03/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022]
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Fehér ÁM, Bajory Z. A review of main controversial aspects of acute testicular torsion. JOURNAL OF ACUTE DISEASE 2016. [DOI: 10.1016/j.joad.2015.06.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Hsiao CH, Ji ATQ, Chang CC, Cheng CJ, Lee LM, Ho JHC. Local injection of mesenchymal stem cells protects testicular torsion-induced germ cell injury. Stem Cell Res Ther 2015; 6:113. [PMID: 26025454 PMCID: PMC4449584 DOI: 10.1186/s13287-015-0079-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 12/22/2014] [Accepted: 04/10/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction Testicular torsion is a urological emergency and infertility is a common complication due to ischemic injury. Surgical reduction and orchiopexy is indicated, but to date there is no effective method for restoration of spermatogenesis. The effects of mesenchymal stem cells (MSCs) on acute tissue injury have been demonstrated, and the abilities of paracrine support, differentiation and immune-modulation may benefit to testicular torsion-induced infertility. We investigate the therapeutic efficacy and the mechanisms of MSCs in testicular torsion-induced germ cell injury when injected locally. Methods Six to eight-week-old Sprague–Dawley rats received surgical 720 degree torsion for 3 hours, followed by detorsion on the left testis. 20 μl of phosphate-buffered saline (PBS) without or with 3 x 104 MSCs from human orbital fat tissues (OFSCs) were given for 10 rats, respectively, via local injection into the left testis 30 minutes before detorsion. 20 μl of PBS injection for 6 rats with surgical exposure without torsion served as sham control. Histopathology with Johnsen’s score analysis, Western blot analysis for superoxide dismutase 2, Bax, Caspase-3, human insulin growth factor-1 and human stem cell factor, malondialdehyde (MDA) assay in testis and plasma, hormones level including testosterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) by ELISA Kits, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay and fluorescence staining for P450, Sox-9 and VASA were performed. Results Animals were sacrificed and bilateral orchiectomy was performed 7 days after torsion-detorsion. Local injections of OFSCs prevented torsion-induced infertility judging from Johnsen's score. TUNEL assay and Western blot analysis on caspase 3 and Bax demonstrated that OFSCs prevented ischemic/reperfusion induced intrinsic apoptosis. MDA assay revealed that OFSCs significantly reduced the oxidative stress in the damaged testicular tissues. After the OFSC injection, serum testosterone secretion was increased, while the elevation of FSH triggered by testicular injury was balanced. OFSCs also produced stem cell factor in the damaged testis. Immunofluorescence staining revealed that most transplanted cells surrounded the Leydig cells. Some of transplanted cells differentiated into p450 expressing cells within 7 days. Conclusions Local injection of allogenic MSCs before surgical detorsion is a simple, clinical friendly procedure to rescue torsion-induced infertility.
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Affiliation(s)
- Chi-Hao Hsiao
- Department of Urology, Wan Fang Hospital, Taipei Medical University, #111, Section 3, Hsing-Long Road, Taipei, 116, Taiwan. .,Graduate Institute of Clinical Medicine, Taipei Medical University, #250 Wu-Hsing Street, Taipei, 110, Taiwan.
| | - Andrea Tung-Qian Ji
- Center for Stem Cell Research, Wan Fang Hospital, Taipei Medical University, #111, Section 3, Hsing-Long Road, Taipei, 116, Taiwan.
| | - Chih-Cheng Chang
- Graduate Institute of Clinical Medicine, Taipei Medical University, #250 Wu-Hsing Street, Taipei, 110, Taiwan. .,Department of Pulmonary Medicine, Shuang Ho Hospital, Taipei Medical University, #291, Zhongzheng Road, Zhonghe District, New Taipei, 235, Taiwan.
| | - Chien-Jui Cheng
- Department of Pathology, College of Medicine, Taipei Medical University, #250, Wu-Hsing Street, Taipei, Taiwan. .,Department of Pathology, Taipei Medical University Hospital, Taipei Medical University, #250, Wu-Hsing Street, Taipei, 110, Taiwan.
| | - Liang-Ming Lee
- Department of Urology, Wan Fang Hospital, Taipei Medical University, #111, Section 3, Hsing-Long Road, Taipei, 116, Taiwan.
| | - Jennifer Hui-Chun Ho
- Graduate Institute of Clinical Medicine, Taipei Medical University, #250 Wu-Hsing Street, Taipei, 110, Taiwan. .,Center for Stem Cell Research, Wan Fang Hospital, Taipei Medical University, #111, Section 3, Hsing-Long Road, Taipei, 116, Taiwan.
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Emergencies in pediatric surgery. Indian J Pediatr 2014; 81:791-6. [PMID: 24243445 DOI: 10.1007/s12098-013-1273-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 10/16/2013] [Indexed: 10/26/2022]
Abstract
Primary care physicians are often required to initially manage the children with surgical emergencies. Many neonates with congenital malformations delivered without supervision may also be managed initially by the family physicians. The role of the primary care physician in such cases should be to diagnose the condition correctly, provide immediate care and then refer the newborn or child to higher centre for appropriate management.
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Moslemi MK, Kamalimotlagh S. Evaluation of acute scrotum in our consecutive operated cases: a one-center study. Int J Gen Med 2014; 7:75-8. [PMID: 24470769 PMCID: PMC3896279 DOI: 10.2147/ijgm.s52413] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose The purpose of the present study was to evaluate the clinical history, demographic data, surgical exploration findings, and final diagnoses in all young males presenting with acute scrotum to our center. Materials and methods This was a descriptive–retrospective study in which all consecutive cases of acute scrotum treated in our department from March 2008 to March 2012 were evaluated. Results A total of 116 cases were included in the study. Out of these cases, 100 cases underwent surgical exploration, and the remaining 16 cases were managed conservatively. Our eligible cases were divided into three groups: the testicular torsion (TT) group (68%); the torsion of the appendix testis (AT) group (20%); and the epididymo-orchitis (EO) group (9%). Testicular preservation was achieved in 39 cases of the TT group, while due to delayed referral, orchiectomy was performed in 29 cases. Thus, our testicular salvage rate was 57.5% and missed testicular torsion rate was 42.5%. Conclusion It was observed that our testicular salvage rate was lower than the expected figures published in the literature. This is may be attributed to different causes, including delayed referral or presentation of acute scrotum cases, inadequate knowledge of the general practitioners working in emergency departments, or poor knowledge of parents.
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Affiliation(s)
- Mohammad Kazem Moslemi
- Department of Urology, Kamkar Hospital, School of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Sharifeh Kamalimotlagh
- Department of Urology, Kamkar Hospital, School of Medicine, Qom University of Medical Sciences, Qom, Iran
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Sharifi LK, Patten DK, Thomas R, Alchikhali T, Vig S. Compartment syndrome of the testicle: a case report and review of the literature. JOURNAL OF CLINICAL UROLOGY 2013. [DOI: 10.1177/2051415813505561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this case report we describe a patient presenting with symptoms of right sided testicular torsion who, upon surgical exploration, was noted to no longer have a torsion of the spermatic cord but persisted in having an ischaemic testicle refractory to reperfusion. A testicular compartment syndrome was suspected and the patient underwent fasciotomy of the tunica albuginea, leading to full reperfusion and good clinical outcome at three weeks and 10 months. This case raises the question of the value of performing such fasciotomies in patients who would otherwise undergo orchidectomy. Following a review of the literature, we feel the technique may well have a place in the management of torsion, pending further study. Databases searched were Medline, Embase, Cochrane, Trip and NHS Evidence. Search criteria included ‘compartment’, ‘testicle’, ‘testicular’, ‘syndrome’, ‘compartment syndrome’ and testis’ and combinations of these key words.
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Affiliation(s)
- LK Sharifi
- Department of Surgery, Croydon University Hospital, Croydon Health Services NHS Trust, UK
| | - DK Patten
- Department of Surgery, Croydon University Hospital, Croydon Health Services NHS Trust, UK
- Department of Biosurgery and Surgical Oncology, St Mary’s Hospital, Imperial College Healthcare NHS Trust, UK
- Department of General and Breast Surgery, North Middlesex University Hospital NHS Trust, London, UK
| | - R Thomas
- Department of Surgery, Croydon University Hospital, Croydon Health Services NHS Trust, UK
| | - T Alchikhali
- Department of Surgery, Croydon University Hospital, Croydon Health Services NHS Trust, UK
| | - S Vig
- Department of Surgery, Croydon University Hospital, Croydon Health Services NHS Trust, UK
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