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Dias AC, Cruz PRCD, Ribeiro PRF, Riccetto CLZ. Testicular volume and Tanner stage: determinant factors for testicular torsion. EINSTEIN-SAO PAULO 2022; 20:eAO6605. [PMID: 35476083 PMCID: PMC9000982 DOI: 10.31744/einstein_journal/2022ao6605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/12/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To assess testicular volumes and sexual maturation in patients with testicular torsion. Methods A retrospective analysis of consecutively treated patients with testicular torsion between 2016 and 2018. Age, pubic hair staging (Tanner), and by ultrasonography, volume of the unaffected testis (in cubic centimeters) were evaluated either immediately before surgery or at the first postoperative visit. Patients with previous testicular disease, such as cryptorchidism, or with no records of testicular volume were excluded. The analysis included descriptive statistics and Bayesian regression. Results We treated 149 patients during the study period, and 141 (94.6%, median age 17.3 years) met the inclusion criteria. Median testicular volume was 13.0cm3 (interquartile range of 10.5-15.2), with similar right and left volumes (12.9cm3versus 13.3cm3; p=0.94). Sixty-five (46.1%) patients were Tanner stage IV, 17 (12.1%) stage III, and 59 (41.8%) stage V. Conclusion In this study, we were able to estimate volumes of testicular torsion, which aggregated around late puberty values (13.0cm3 for the whole dataset, 12.2cm3 for patients <25 years), suggesting that testicular hypermobility, due to congenital anatomical abnormalities, remains quiescent until the organ reaches a critical volume, after which torsion becomes possible. These findings provide a tentative explanation for the disease’s age distribution.
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Yang M, Wen S, Lin T, Liu X, Zhang DY, Liu F, Wu SD, Wei GH, He PR, Hua Y. Diagnosis, treatment, outcome, and reasons for delayed treatment of cryptorchidism with torsion in children: a 16-year retrospective study in a large pediatric medical center. Asian J Androl 2021; 24:386-389. [PMID: 34916477 PMCID: PMC9295475 DOI: 10.4103/aja202184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe and summarize the diagnosis, treatment, and reasons for delayed treatment of children with cryptorchidism torsion in Children's Hospital of Chongqing Medical University. The study included 19 cases of cryptorchidism torsion. The age of the children ranged from 16 days to 12 years (median: 6 years). The interval from diagnosis to surgery varied from 4 h to 16 days (median: 3 days). Ultrasound was performed in all cases. Fifteen cases had cryptorchidism torsion, 2 cases had a soft tissue mass in the inguinal region, and 2 cases had an inguinal/abdominal teratoma. Five cases were treated with an orchidopexy, 12 cases were treated with orchiectomy, and 2 cases received resection of a testicular tumor. The 5 children with an orchidopexy were followed up from 1 month to 7 years (median: 3 years), with 1 child having a testis retraction and no blood supply. Of the 12 children who had an orchiectomy, three had delayed diagnosis due to family unawareness of the condition, while other delays were due to delayed referral from primary care facilities. The relative rarity and insufficient awareness of cryptorchidism torsion resulted in a low rate of testicular salvage. Therefore, hospitals of all levels should be fully aware of cryptorchidism with torsion and ensure a male child's genital system and inguinal region are examined to improve the success rate of testicular salvage.
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Affiliation(s)
- Meng Yang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing 400000, China.,Pediatrics Research Institute, Children's Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Children's Hospital of Chongqing Medical University, Chongqing 400000, China.,Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400000, China
| | - Sheng Wen
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing 400000, China.,Pediatrics Research Institute, Children's Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Children's Hospital of Chongqing Medical University, Chongqing 400000, China.,Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400000, China
| | - Tao Lin
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing 400000, China.,Pediatrics Research Institute, Children's Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Children's Hospital of Chongqing Medical University, Chongqing 400000, China.,Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400000, China
| | - Xing Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing 400000, China.,Pediatrics Research Institute, Children's Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Children's Hospital of Chongqing Medical University, Chongqing 400000, China.,Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400000, China
| | - De-Ying Zhang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing 400000, China.,Pediatrics Research Institute, Children's Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Children's Hospital of Chongqing Medical University, Chongqing 400000, China.,Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400000, China
| | - Feng Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing 400000, China.,Pediatrics Research Institute, Children's Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Children's Hospital of Chongqing Medical University, Chongqing 400000, China.,Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400000, China
| | - Sheng-De Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing 400000, China.,Pediatrics Research Institute, Children's Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Children's Hospital of Chongqing Medical University, Chongqing 400000, China.,Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400000, China
| | - Guang-Hui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing 400000, China.,Pediatrics Research Institute, Children's Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Children's Hospital of Chongqing Medical University, Chongqing 400000, China.,Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400000, China
| | - Pei-Ru He
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
| | - Yi Hua
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing 400000, China.,Pediatrics Research Institute, Children's Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Children's Hospital of Chongqing Medical University, Chongqing 400000, China.,Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400000, China
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3
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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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[ACUTE SCROTUM IN THE PEDIATRIC EMERGENCY ROOM: A SINGLE CENTER RETROSPECTIVE STUDY]. Nihon Hinyokika Gakkai Zasshi 2018; 109:131-136. [PMID: 31327852 DOI: 10.5980/jpnjurol.109.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
(Objective) The objective of this study was to survey cases of acute scrotum examined at the pediatric emergency room (ER). (Subjects and methods) All patients examined for acute scrotum at the emergency outpatient unit between March 2010 and March 2014 were designated subjects of the study. Medical records were used to retrospectively investigate the final diagnoses including testicular torsion (TT), torsion of the testicular appendage, epididymitis, orchitis, incarcerated inguinal hernia, idiopathic scrotal edema, Schönlein-Henoch purpura, hydrocele, external trauma, as well as those with no confirmed diagnosis. (Results) A total of 257 patients presented with acute scrotum at the emergency outpatient unit. The patients had an average age of 6.7 years, with symptoms present on the right side in 120 cases (47%), left side in 108 cases (42%), and both sides in 29 cases (11%). Observing the frequency of each condition, TT was present in 33 cases (13%), torsion of the testicular appendage in eight cases (3%), epididymitis in 85 cases (33%), orchitis in four cases (2%), incarcerated inguinal hernia in 59 cases (23%), idiopathic scrotal edema in six cases (2%), Schönlein-Henoch purpura in nine cases (4%), hydrocele in 10 patients (4%), external trauma in 12 patients (5%), and unconfirmed diagnosis in 31 cases (12%). Average time between onset and presentation at the ER was 0.6 days for TT, with patients having previously been examined at other hospitals before coming to this institution in 12 cases (36%). Emergency urological surgery was performed in 31 cases (12%), with TT comprising 28 cases (90%), and orchiectomy performed in six cases (21%). (Conclusion) Of all patients examined for acute scrotum, epididymitis were high and TT in 13% at the pediatric ER. Average time for TT patients from symptom onset to ER presentation were longer, we must ensure that patients present at earliest possible opportunity requires educating the general population.
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5
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Nistal M, Paniagua R, González-Peramato P, Reyes-Múgica M. Perspectives in Pediatric Pathology, Chapter 19. Testicular Torsion, Testicular Appendix Torsion, and Other Forms of Testicular Infarction. Pediatr Dev Pathol 2017; 19:345-359. [PMID: 25105275 DOI: 10.2350/14-06-1514-pb.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Among the most frequent specimens at the pediatric surgical pathology bench, orchiectomy performed after testicular torsion deserves significant attention. Multiple implications, including fertility, legal complications, possibility of occult lesion, and others, need to be considered. Furthermore, torsion of testicular and other appendices represents common urological emergencies frequently encountered in surgical pathology. Here we present a review of testicular torsion and infarction, including theories about their pathogenesis and the appropriate handling by the diagnostic pathologist.
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Affiliation(s)
- Manuel Nistal
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Madrid 28029, Spain
| | - Ricardo Paniagua
- 2 Department of Cell Biology, Universidad de Alcala, Madrid, Spain
| | - Pilar González-Peramato
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Madrid 28029, Spain
| | - Miguel Reyes-Múgica
- 3 Department of Pathology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15224, USA
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6
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Kitami M. Ultrasonography of pediatric urogenital emergencies: review of classic and new techniques. Ultrasonography 2017; 36:222-238. [PMID: 28494525 PMCID: PMC5494863 DOI: 10.14366/usg.17011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/18/2017] [Accepted: 03/30/2017] [Indexed: 12/28/2022] Open
Abstract
Urogenital emergencies are fairly common in the pediatric population, and a timely and correct diagnosis is necessary to avoid possible future infertility. In this field, ultrasonography is essential, as it has the advantages of being radiation-free and readily accessible. In particular, a high-frequency transducer allows precise evaluation of the morphology and vascularity of the scrotum, which is on the surface of the body. Beyond conventional techniques, new advanced imaging techniques have been developed, including elastography and contrast-enhanced ultrasonography. However, several pitfalls remain in the diagnosis of urogenital diseases using ultrasonography. Thus, accurate knowledge and sufficient experience with the technique are essential for making a correct diagnosis. This review provides an overview of pediatric urogenital emergency pathologies and recent ultrasonography techniques.
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Affiliation(s)
- Masahiro Kitami
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
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7
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Al-Kandari AM, Kehinde EO, Khudair S, Ibrahim H, ElSheemy MS, Shokeir AA. Intermittent Testicular Torsion in Adults: An Overlooked Clinical Condition. Med Princ Pract 2017; 26:30-34. [PMID: 27648954 PMCID: PMC5588398 DOI: 10.1159/000450887] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 09/19/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aim of this study was to describe the management protocol for intermittent testicular torsion (ITT) in adults and report the outcome of this clinical condition, which is commonly overlooked in adults. SUBJECTS AND METHODS Sixty-three patients were included in the study. The inclusion criterion was the presence of sudden intermittent testicular pain over a duration of 3 months. All the patients underwent clinical examination, urine analysis, culture, and scrotal ultrasound with Doppler. The testicle was in an abnormal or in transverse lie and/or could easily be twisted. Scrotal support and analgesia were given for 1 month, then patients were offered orchidopexy or conservative treatment. Nineteen patients chose orchidopexy while 44 chose conservative treatment. Follow-up ranged from 3 months to 2 years. The improvement was assessed using a visual analog pain score. The outcome of the treatment was compared between the surgical and conservative groups using a χ2 test. RESULTS The median age of the patients was 28 years (range: 17-50). Of the 19 patients who underwent orchidopexy, the pain resolved or visual analog pain scores improved (median 1/10) in 18 (94.7%) cases. On the other hand, 21 of the 44 (47.7%) cases that chose the conservative approach claimed their pain resolved or improved (visual analog pain scores: median 3/10) with a median of 13 months of follow-up. CONCLUSION In this study, scrotal orchidopexy proved to be superior to conservative measures in cases of ITT in adults.
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Affiliation(s)
- Ahmed M. Al-Kandari
- Department of Surgery (Urology), Faculty of Medicine, Kuwait University, Kuwait City, Kuwait, Egypt
- *Ahmed M. Al-Kandari, Department of Surgery (Urology), Faculty of Medicine, Kuwait University, Jabryiah, 4th ring road, P.O. Box 24923, Safat 13110 (Kuwait), E-Mail
| | - Elijah O. Kehinde
- Department of Surgery (Urology), Faculty of Medicine, Kuwait University, Kuwait City, Kuwait, Egypt
| | - Salah Khudair
- Department of Surgery (Urology), Faculty of Medicine, Kuwait University, Kuwait City, Kuwait, Egypt
| | - Hamdy Ibrahim
- Department of Urology, Fayoum University, Fayoum, Egypt
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8
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Lin C, Shin DG, Park SG, Chu SB, Gwon LW, Lee JG, Yon JM, Baek IJ, Nam SY. Curcumin dose-dependently improves spermatogenic disorders induced by scrotal heat stress in mice. Food Funct 2015; 6:3770-7. [DOI: 10.1039/c5fo00726g] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Curcumin significantly improves testicular injuries (B & C) induced by scrotal heat stress in a dose-dependent manner (20, 40, and 80 mg kg−1; D–F, respectively).
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Affiliation(s)
- Chunmei Lin
- College of Veterinary Medicine and Research Institute of Veterinary Medicine
- Chungbuk National University
- Cheongju 28644
- South Korea
| | - Dong-Geun Shin
- College of Veterinary Medicine and Research Institute of Veterinary Medicine
- Chungbuk National University
- Cheongju 28644
- South Korea
| | - Seul Gi Park
- College of Veterinary Medicine and Research Institute of Veterinary Medicine
- Chungbuk National University
- Cheongju 28644
- South Korea
| | - Sl Bi Chu
- College of Veterinary Medicine and Research Institute of Veterinary Medicine
- Chungbuk National University
- Cheongju 28644
- South Korea
| | - Lee Wha Gwon
- College of Veterinary Medicine and Research Institute of Veterinary Medicine
- Chungbuk National University
- Cheongju 28644
- South Korea
| | - Jong-Geol Lee
- College of Veterinary Medicine and Research Institute of Veterinary Medicine
- Chungbuk National University
- Cheongju 28644
- South Korea
- Asan Institute for Life Sciences
| | - Jung-Min Yon
- College of Veterinary Medicine and Research Institute of Veterinary Medicine
- Chungbuk National University
- Cheongju 28644
- South Korea
| | - In-Jeoung Baek
- Asan Institute for Life Sciences
- University of Ulsan College of Medicine
- Seoul 05505
- South Korea
| | - Sang-Yoon Nam
- College of Veterinary Medicine and Research Institute of Veterinary Medicine
- Chungbuk National University
- Cheongju 28644
- South Korea
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9
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Intermittent Testicular Torsion in the Pediatric Patient: Sonographic Indicators of a Difficult Diagnosis. AJR Am J Roentgenol 2013; 201:912-8. [DOI: 10.2214/ajr.12.9448] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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10
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Patel NU, Drose JA, Russ P. Partial Testicular Torsion and Torsion-Detorsion Syndrome. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2013. [DOI: 10.1177/8756479313503212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Testicular torsion (TT) is a common cause of acute scrotal pain in young men and accounts for as many as 26% of cases of acute scrotum. Accurate diagnosis and differentiation of TT from acute epididymo-orchitis is essential because TT is treated surgically and epididymitis with or without orchitis is treated medically. Distinguishing TT from epididymo-orchitis is generally a clinical dilemma. Sonography remains the best imaging modality for these entities, but the sonographic findings can be complex and can mimic complicated epididymo-orchitis when dealing with partial TT and torsion-detorsion syndrome. This case report illustrates the complex sonography findings of surgically proven partial TT with torsion-detorsion syndrome.
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Affiliation(s)
- Nayana U. Patel
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Julia A. Drose
- Divisions of Ultrasound and Prenatal Diagnosis and Genetics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Paul Russ
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
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11
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Abstract
The current opinion on spermatic cord torsion is discussed in this review, with special attention to natural history, value of diagnostic tools, evidence for surgical management, outcome and management of atypical forms of torsion.
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Affiliation(s)
- Marcel Drlík
- Department of Urology, General Teaching Hospital and 1st Medical School of Charles University, Ke Karlovu 6, 128 08 Praha 2, Czech Republic.
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12
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Torsion du cordon spermatique chez l’enfant : impact du mode de consultation sur le délai de prise en charge et le taux d’orchidectomie. Arch Pediatr 2013; 20:364-8. [DOI: 10.1016/j.arcped.2013.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 11/20/2012] [Accepted: 01/08/2013] [Indexed: 11/22/2022]
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13
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Ramos-Fernandez MR, Medero-Colon R, Mendez-Carreno L. Critical urologic skills and procedures in the emergency department. Emerg Med Clin North Am 2013; 31:237-60. [PMID: 23200334 PMCID: PMC5554872 DOI: 10.1016/j.emc.2012.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The evaluation and management of genitourinary emergencies is a fundamental component of the training and practice of emergency physicians. Urologic procedures are common in the emergency room. Emergency physicians play a vital role in the initial evaluation and treatment because delays in management can lead to permanent damage. This article discusses the most common urologic procedures in which emergency physicians must be proficient for rapid intervention to preserve function and avoid complications. An overview of each procedure is discussed as well as indications, contraindications, equipment, technique, and potential complications.
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Affiliation(s)
- Maria R Ramos-Fernandez
- Department of Emergency Medicine, University of Puerto Rico School of Medicine, 65th Infantry Avenue Km 3.8, Carolina, PR 00985, USA.
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Figueroa V, Pippi Salle JL, Braga LH, Romao R, Koyle MA, Bägli DJ, Lorenzo AJ. Comparative Analysis of Detorsion Alone Versus Detorsion and Tunica Albuginea Decompression (Fasciotomy) with Tunica Vaginalis Flap Coverage in the Surgical Management of Prolonged Testicular Ischemia. J Urol 2012; 188:1417-22. [DOI: 10.1016/j.juro.2012.02.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Indexed: 11/27/2022]
Affiliation(s)
- Victor Figueroa
- Division of Urology, the Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Joao L. Pippi Salle
- Division of Urology, the Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Luis H.P. Braga
- Division of Urology, McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
| | - Rodrigo Romao
- Division of Urology, the Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Martin A. Koyle
- Division of Urology, the Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Darius J. Bägli
- Division of Urology, the Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Armando J. Lorenzo
- Division of Urology, the Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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15
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Saxena AK, Castellani C, Ruttenstock EM, Höllwarth ME. Testicular torsion: a 15-year single-centre clinical and histological analysis. Acta Paediatr 2012; 101:e282-6. [PMID: 22385478 DOI: 10.1111/j.1651-2227.2012.02644.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM This study reviewed the demographic, epidemiological and clinical factors of boys seen at a single centre who underwent surgical exploration for testicular torsion. METHODS Retrospective single-centre review of boys with testicular torsion between 1996 and 2011 was made. RESULTS Testicular torsion (right n = 43, left n = 60, bilateral n = 1) was identified in 104 boys between 0 and 18 years. Ten newborns presented with 11 intrauterine torsions. Nine torsions presented in undescended inguinal testes (one intrauterine). In 94 boys with descended testes, presentation included pain (76%), scrotal swelling (65%) and abdominal symptoms (22%). Ultrasonography was performed in 85 patients with false-negative results in 4 (4.7%). Orchiectomy was performed during initial exploration in 41, with significantly higher rates of orchiectomies in patients with late (>6 h) versus patients with early referrals (<6 h) (56% vs. 9.1%). Histological evaluation was carried out in 68 testes, with 43 resected testes demonstrating haemorrhagic necrosis. In 25 biopsied testes, histology revealed acute parenchymal bleeding (n = 14), onset of parenchymal infarction (n = 8), orchitis (n = 1) and normal tissue (n = 2). Eighty-two patients were followed up with pathological findings in four patients: testicular atrophies requiring orchiectomy (n = 2), testicular autolysis (n = 1) and small testicular vein thrombosis (n = 1). CONCLUSION Chances of testicular salvage after torsion are higher if patients present early. The majority of patients presenting late (>6 h) require orchiectomy owing to testicular necrosis.
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Affiliation(s)
- A K Saxena
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Austria.
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16
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Imaging of segmental testicular infarction: our experience and literature review. Radiol Med 2012; 117:1161-75. [DOI: 10.1007/s11547-012-0798-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 04/11/2011] [Indexed: 10/14/2022]
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17
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Li W, Wu ZQ, Zhao J, Guo SJ, Li Z, Feng X, Ma L, Zhang JS, Liu XP, Zhang YQ. Transient protection from heat-stress induced apoptotic stimulation by metastasis-associated protein 1 in pachytene spermatocytes. PLoS One 2011; 6:e26013. [PMID: 22022494 PMCID: PMC3192157 DOI: 10.1371/journal.pone.0026013] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 09/15/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Deregulated thermal factors have been frequently implicated in the pathogenesis of male infertility, but the molecular basis through which certain responses are directed remain largely unknown. We previously reported that overexpression of exogenous Metastasis-associated protein 1 (MTA1) protects spermatogenic tumor cells GC-2spd (ts) against heat-induced apoptosis. To further dissect the underlying mechanism, we addressed here the fine coordination between MTA1 and p53 in pachytene spermatocytes upon hyperthermal stimulation. METHODOLOGY/PRINCIPAL FINDINGS High level of MTA1 expression sustained for 1.5 h in primary spermatocytes after heat stress before a notable decrease was detected conversely correlated to the gradual increase of acetylation status of p53 and of p21 level. Knockdown of the endogenous MTA1 in GC-2spd (ts) elevated the acetylation of p53 by diminishing the recruitment of HDAC2 and thereafter led to a dramatic increase of apoptosis after heat treatment. Consistent with this, in vivo interference of MTA1 expression in the testes of C57BL/6 mice also urged an impairment of the differentiation of spermatocytes and a disruption of Sertoli cell function due to the elevated apoptotic rate after heat stress. Finally, attenuated expression of MTA1 of pachytene spermatocytes was observed in arrested testes (at the round spermatid level) of human varicocele patients. CONCLUSIONS These data underscore a transient protective effect of this histone modifier in primary spermatocytes against heat-stress, which may operate as a negative coregulator of p53 in maintenance of apoptotic balance during early phase after hyperthermal stress.
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Affiliation(s)
- Wei Li
- Department of Human Anatomy, Histology and Embryology, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Zhi-qun Wu
- Department of Interventional Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Jie Zhao
- Department of Human Anatomy, Histology and Embryology, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Sheng-jie Guo
- Department of Urology, Cancer Center, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zhen Li
- Department of Human Anatomy, Histology and Embryology, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Xiao Feng
- Department of Human Anatomy, Histology and Embryology, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Li Ma
- Department of Human Anatomy, Histology and Embryology, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Jin-shan Zhang
- Department of Human Anatomy, Histology and Embryology, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Xin-ping Liu
- Department of Biochemistry and Molecular Biology, The State Key Laboratory of Cancer Biology, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Yuan-qiang Zhang
- Department of Human Anatomy, Histology and Embryology, Fourth Military Medical University, Xi'an, People's Republic of China
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18
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Ellati RT, Kavoussi PK, Turner TT, Lysiak JJ. Twist and Shout: A Clinical and Experimental Review of Testicular Torsion. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.12.1159] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Riyad T. Ellati
- Department of Urology, University of Virginia Health System, USA
| | | | - Terry T. Turner
- Department of Urology, University of Virginia Health System, USA
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