1
|
Demir S, Kazaz IO, Mungan SA, Alemdar NT, Perolli N, Demir EA, Mentese A. Usnic acid alleviates testicular ischemia/reperfusion injury in rats by modulating endoplasmic reticulum stress. Reprod Toxicol 2024; 128:108654. [PMID: 38960207 DOI: 10.1016/j.reprotox.2024.108654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/09/2024] [Accepted: 06/30/2024] [Indexed: 07/05/2024]
Abstract
Testicular torsion (TT) is a urological condition that can result in infertility in men. The etiopathogenesis of TT includes ischemia/reperfusion injury (IRI) characterized by oxidative stress (OS), inflammation and apoptosis resulting from increased levels of free radicals. Usnic acid (UA), a dibenzofuran, is one of the most common metabolites found in lichens and is known to possess powerful antioxidant properties. The aim of this study was to investigate the potential protective activity of UA in an experimental testicular IRI model for the first time. A total of 18 rats were randomly assigned to three groups (n=6): sham control, IRI and IRI+UA. The IRI groups underwent a four-hour period of ischemia and a two-hour period of reperfusion. The OS, inflammation, endoplasmic reticulum stress (ERS) and apoptosis markers in testicular tissue were evaluated using colorimetric methods. Furthermore, tissue samples were subjected to histological examination, with staining using hematoxylin and eosin. Histopathological findings supported by increased OS, inflammation, ERS and apoptosis levels were obtained in IRI group compared with sham control group. However, UA treatment restored these pathological and biochemical changes. Although this study provides the first preliminary evidence that UA may be used as a useful molecule against testicular IRI, further extensive molecular preclinical studies should be performed before clinical use is considered.
Collapse
Affiliation(s)
- Selim Demir
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Karadeniz Technical University, 61080 Trabzon, Turkiye.
| | - Ilke Onur Kazaz
- Department of Urology, Faculty of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkiye
| | - Sevdegul Aydin Mungan
- Department of Medical Pathology, Faculty of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkiye
| | - Nihal Turkmen Alemdar
- Department of Medical Biochemistry, Graduate School of Health Sciences, Karadeniz Technical University, 61080 Trabzon, Turkiye; Department of Medical Services and Techniques, Vocational School of Health Services, Recep Tayyip Erdogan University, 53100 Rize, Turkiye
| | - Nijazi Perolli
- Department of Urology, Faculty of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkiye
| | - Elif Ayazoglu Demir
- Department of Chemistry and Chemical Processing Technologies, Macka Vocational School, Karadeniz Technical University, 61750 Trabzon, Turkiye
| | - Ahmet Mentese
- Department of Medical Services and Techniques, Vocational School of Health Services, Karadeniz Technical University, 61080 Trabzon, Turkiye
| |
Collapse
|
2
|
Minas A, Mahmoudabadi S, Gamchi NS, Antoniassi MP, Alizadeh A, Bertolla RP. Testicular torsion in vivo models: Mechanisms and treatments. Andrology 2023; 11:1267-1285. [PMID: 36825607 DOI: 10.1111/andr.13418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 02/13/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Testicular torsion is a condition in which a testis rotates around its longitudinal axis and twists the spermatic cord. This in turn results in a significant decrease in blood flow and perfusion of testicular tissue. During Testicular torsion, the testicular tissue is affected by ischemia, heat stress, hypoxia, and oxidative and nitrosative stress. The testicular torsion should be considered an emergency condition and surgical intervention (testicular detorsion ) as the sole treatment option in viable cases involves counter-rotation on twisted testes associated, when possible, to orchipexy, in order to avoid recurrence. Possible testicular detorsion side-effects occur due to reperfusion and endothelial cells injury, microcirculation disturbances, and intense germ cells loss. OBJECTIVES To discuss testicular torsion surgery-based methods, different time frames for testicular torsion induction, and the associated pathophysiology by emphasizing cellular and molecular events as well as different therapeutic agent applications for testicular torsion. MATERIALS AND METHODS We reviewed all original research and epidemiological papers related to testicular torsion condition. RESULTS Testicular torsion causes germ cell necrosis, arrested spermatogenesis, and diminished testosterone levels, with consequent infertility. Among different involved pathophysiological impacts, testicular torsion/detorsion-induced ischemia seems to play the key role by leading the tissue toward other series of events in testis. Numerous studies have used adjuvant antioxidants, calcium channel blockers, anti-inflammatory agents, or vasodilating agents in order to decrease these effects. DISCUSSION AND CONCLUSION To the best of our knowledge, no previously conducted study examined therapeutical agents' beneficial effects post clinical I/R condition in humans. Different agents targeting different pathophysiological conditions were used to ameliorate the ischemia/reperfusion-induced condition in animal models, however, none of the administrated agents were tested in human cases. Although considering testicular detorsion surgery is still the golden method to reverse the testicular torsion condition and the surgical approach is undeniable, the evaluated agents with beneficial effects, need to be investigated furthermore in clinical conditions. Thus, furthermore clinical studies and case reports are required to approve the animal models proposed agents' beneficial impacts.
Collapse
Affiliation(s)
- Aram Minas
- Department of Surgery, Division of Urology, Human Reproduction Section, São Paulo Federal University, São Paulo, Brazil
| | - Sina Mahmoudabadi
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Naeimeh Shamsi Gamchi
- Division of Pharmacology and Toxicology, Department of Basic Science, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Mariana Pereira Antoniassi
- Department of Surgery, Division of Urology, Human Reproduction Section, São Paulo Federal University, São Paulo, Brazil
| | - Arash Alizadeh
- Division of Pharmacology and Toxicology, Department of Basic Science, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Ricardo Pimenta Bertolla
- Department of Surgery, Division of Urology, Human Reproduction Section, São Paulo Federal University, São Paulo, Brazil
| |
Collapse
|
3
|
Sarikaya K, Kölükçü E, Unsal V, Özdemir S. Protective Effects of Syringic Acid on Ischemia-Reperfusion Injury in Testicular Torsion: An Experimental Study in a Rat Model. Cureus 2023; 15:e42390. [PMID: 37492038 PMCID: PMC10365399 DOI: 10.7759/cureus.42390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 07/27/2023] Open
Abstract
AIM The purpose of this study was to assess the effectiveness of syringic acid in preventing ischemia-reperfusion injury following detorsion in a rat model of induced testicular torsion. MATERIAL AND METHODS In our study, a total of 24 rats, eight in each group, were used. Group 1 served as the control group. Group 2 underwent testicular torsion and detorsion. Group 3 underwent the same procedures as Group 2, but also received 100 mg/kg syringic acid immediately following ischemia. Spectrophotometric analysis was performed on blood samples, and the activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), as well as the values of malondialdehyde (MDA), were evaluated under direct microscopic examination of the testis to determine tissue injury. The architecture of the seminiferous tubules and spermatogenesis processes were graded using the Johnsen and Cosentino scoring systems. RESULTS The mean value of MDA was higher in Group 2 compared to the other groups (p < 0.001). Group 3 demonstrated a decline in the concentrations of proinflammatory cytokines, such as tumor necrosis factor-alpha, interleukin-6, and interleukin-1 beta, as indicated by biochemical analysis of blood samples, when compared to Group 2 (p-values: 0.045, 0.001, and <0.001, respectively). In addition, the improvement in Johnsen and Cosentino scores was significantly higher in Group 3 compared to Group 2 (p = 0.028 and p = 0.001, respectively). CONCLUSION These findings suggest that syringic acid has a protective effect against testicular oxidative damage.
Collapse
Affiliation(s)
- Kubilay Sarikaya
- Urology, Health Sciences University Ankara Etlik City Hospital, Ankara, TUR
| | - Engin Kölükçü
- Urology, Tokat Gaziosmanpaşa University School of Medicine, Tokat, TUR
| | - Velid Unsal
- Biochemistry, Faculty of Health Sciences and Central Research Laboratory, Mardin Artuklu University, Mardin, TUR
| | - Süleyman Özdemir
- Pathology, Faculty of Medicine, Gaziosmanpaşa University, Tokat, TUR
| |
Collapse
|
4
|
Savoie-White FH, Mailloux O. Use of intraoperative indocyanine green fluorescence in determining testicular viability in testicular torsion patients in rural settings: A case report. Int J Surg Case Rep 2023; 106:108247. [PMID: 37087930 PMCID: PMC10149194 DOI: 10.1016/j.ijscr.2023.108247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 04/25/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Testicular torsion (TT) is the result of spermatic cord twisting which can lead to significant ischemia, making it a time-sensitive surgical emergency. General surgeons in rural centers may lack the resources to adequately evaluate the viability of the affected testicle. Indocyanine green fluorescence (IGF) has been increasingly used to assess vascular perfusion in general surgery cases. In this case report, we show the use of IGF in a rural setting to assess testicular viability in TT. CASE PRESENTATION A 17-year-old male was transferred to our rural regional hospital emergency department for sudden and persistent right scrotal pain. The onset of symptoms was approximately 52 h at presentation. TT was diagnosed with a doppler ultrasound by a radiologist. Urgent detorsion surgery was performed. Intraoperative assessment of viability was unclear after the usual means and IGF helped confirm the absence of testicle vascularization and the need for orchiectomy. CLINICAL DISCUSSION General surgeons in rural communities are called to manage TT with limited resources and experience. IGF is widely used in general surgery and urology. Animal studies and two case reports show potential benefits of IGF in TT. In our patient, IGF was useful to confirm without a doubt that the right testicle was ischemic and non-viable. CONCLUSION In a rural setting with limited access to radiology and distant urology coverage, IGF is an excellent resource to determine intraoperative blood flow in TT with uncertain viability.
Collapse
Affiliation(s)
| | - Olivier Mailloux
- Department of Surgery, Université Laval, Baie-Comeau, Québec, Canada.
| |
Collapse
|
5
|
Chanchlani R, Acharya H. Acute Scrotum in Children: A Retrospective Study of Cases With Review of Literature. Cureus 2023; 15:e36259. [PMID: 37073197 PMCID: PMC10105644 DOI: 10.7759/cureus.36259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/16/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Testicular pain or swelling, often referred to as acute scrotum, can have a number of causes and presentations. Testicular torsion is an emergency condition requiring early diagnosis and surgery to salvage the involved testis in order to preserve testicular fertility. The study is aimed to know the incidence, aetiology, and management of acute scrotal conditions with a particular focus on testicular torsion. Epididymorchitis, trauma, and scrotal cellulitis are other causes of acute scrotum which are managed conservatively after proper investigations. MATERIAL AND METHODS The authors retrospectively reviewed 10-year epidemiological data of all children age under 14 years admitted to the tertiary care hospital with the diagnosis of acute scrotum. Data were collected about the clinical history, physical examination, biochemical investigations, Doppler ultrasound, and management done. RESULTS 133 children aged between 0 days and 14 years (mean age, 7.5 years) were found to have acute scrotum out of which 67 (50.37%) patients had epididymitis, 54 (40.60%) patients presented with Torsion testis, three (2.25%) had torsion of testicular appendages, eight (6.01%) had scrotal cellulitis and one (0.75%) presented with a strangulated hernia. Due to late presentation, testis could be salvaged in only eight of the 54 patients with torsion testis. The testicular loss was seen more in bigger children and those with signs of infection in blood reports and colour Doppler showing no blood flow in the testis. CONCLUSION The study results indicate that non-recognition of the severity of paediatric acute scrotum results in late presentation leading to testicular loss. Timely diagnosis will require sensitization of the parents, primary care providers, and paediatricians for this grave condition which leads to permanent testicular loss.
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
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
|
8
|
Desai C, Raghuvanshi K, Panesar H, Murali V. Importance of Touch: Managing Testicular Torsion in a 28-Year-Old With Duchenne Muscular Dystrophy. Cureus 2022; 14:e22775. [PMID: 35371864 PMCID: PMC8971100 DOI: 10.7759/cureus.22775] [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] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
This case report highlights a case of testicular torsion in a man over the age of 25 with Duchenne muscular dystrophy (DMD), who presented with an atypical pain history, and a Testicular Workup for Ischaemia and Suspected Torsion (TWIST) score negative for exploration. However, based purely on the examination findings, scrotal exploration was performed and a torted testis was found. The report demonstrates that in this cohort of patients, a higher index of suspicion is needed to ensure early recognition of the condition. Furthermore, scrotal exploration can be safely conducted under local anaesthesia given the multiple cardiovascular and spinal co-morbidities attributed to DMD.
Collapse
|
9
|
Rew KT. Surgery of the Male Genital Tract. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
10
|
Murali TV, Jaya KV, Kumar R. Testicular torsion - symptomatology and outcomes of 101 scrotal explorations. Urol Ann 2022; 14:167-171. [PMID: 35711480 PMCID: PMC9197001 DOI: 10.4103/ua.ua_142_20] [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: 09/05/2020] [Accepted: 12/21/2020] [Indexed: 11/18/2022] Open
Abstract
Objective: The objective was to study the symptomatology of testicular torsion of patients operated in our hospital and their operative results in relation to the duration of symptoms. Materials and Methods: Data of all patients operated for acute scrotum at all ages over a 14 months’ time were collected from hospital records. Symptomatology and operative results were studied. Results: Out of 101 consecutive scrotal explorations done in this time, 63.4% of all scrotal explorations were testicular torsion (n = 64). 22.8% were appendage torsion (n = 23) and 13.9% were epididymo-orchitis (n = 14). The peak age of testicular torsion was in the 11–15 years range and the left side is more common (65.6%). Symptoms of scrotal pain (92.2%), abdominal pain (18.8%), nausea/vomiting (18.8%), fever (9.4%), and urinary symptoms (3.1%) were seen in decreasing order of frequency. Among acute scrotum patients who had symptoms of nausea/vomiting or abdominal pain, testicular torsion was found to be significantly higher compared to those who did not have these symptoms (χ2 = 0.044, P < 0.05). In all cases presented within 6 h of symptom onset, testicles were saved and salvage rates reduced with delay in presentation. The testicular salvage rates were 28.1% (18 out of 64 torsions). Patients below 18 years had more chance of going for orchiectomy than others (75% vs 66.7%). Patients who presented after 24 h had a statistically significantly lower salvage rate of 7.7% compared to those who presented within 24 h duration, 52.2%(χ2 = 0.001, P < 0.05). Those with orchiopexy had a median duration of symptom of 6.5 h and the same for orchiectomy patients were 72 h. Our median symptom duration for testicular torsion was 36 h and it is higher than many other countries. Conclusions: Delay in presentation to the health-care facility is the major cause of poor salvage rates in the state and its improvement requires public health interventions and health education.
Collapse
|
11
|
Tanaka K, Kato H, Nikai K, Mikami T, Okazaki T. Testicular appendage torsion in children. Pediatr Int 2022; 64:e15010. [PMID: 34597452 DOI: 10.1111/ped.15010] [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: 04/08/2021] [Revised: 08/10/2021] [Accepted: 08/18/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Testicular appendage torsion (TAT) is a medical emergency that presents as an acute scrotum, usually in children and preadolescents. In previous reports of TAT, most cases have been treated conservatively, but some necessitate surgical treatment. Our aim was to examine the incidence, clinical examination findings, etiology, and treatment of TAT. METHODS We retrospectively reviewed records of all patients with TAT (aged ≤15 years) treated at the Juntendo University Urayasu Hospital between January 2012 and September 2020. Surgical treatment was performed when a diagnosis of testicular torsion could not be completely ruled out or if pain recurred after conservative treatment. Patients with a hard scrotum or scrotal erythema were hospitalized for conservative treatment. Data regarding age, diagnosis, blood test results, and clinical findings were analyzed. RESULTS Among 101 boys with TAT, the median age was 10 years. The incidence of TAT varied significantly according to age and was highest among patients aged 8-11 years. Sixty-seven boys (66.3%) underwent inpatient surgical treatment, 10 boys (9.9%) received inpatient conservative treatment, and 24 boys (23.8%) received outpatient conservative treatment. The median duration of hospitalization was significantly shorter among those who underwent surgery (2.0 days) than among those who received inpatient conservative treatment group (3.5 days). CONCLUSIONS Operations were short, uncomplicated, and safe; they shortened the hospital stay; and they would certainly prevent recurrence of TAT and testicular torsion on one side. Furthermore, we recommended that TAT patients presenting with signs of severe inflammation, such as hard scrotum or scrotal erythema, receive early surgical treatment to minimize duration of hospitalization.
Collapse
Affiliation(s)
- Keiichiro Tanaka
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, Urayasu-shi, Japan
| | - Haruki Kato
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, Urayasu-shi, Japan
| | - Koki Nikai
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, Urayasu-shi, Japan
| | - Takafumi Mikami
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, Urayasu-shi, Japan
| | - Tadaharu Okazaki
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, Urayasu-shi, Japan
| |
Collapse
|
12
|
Mousavi A, Gharzi A, Gholami M, Beyranvand F, Takesh M. The therapeutic effect of cerium oxide nanoparticle on ischaemia/reperfusion injury in rat testis. Andrologia 2021; 53:e14231. [PMID: 34455607 DOI: 10.1111/and.14231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/14/2021] [Accepted: 08/10/2021] [Indexed: 11/26/2022] Open
Abstract
Testicular torsion is a dangerous urogenital disorder which is caused by twisting of spermatic cord, and unless immediate treatments happen at a proper time, oxidative stress, occurred during ischaemia reperfusion, finally leads to irreversible disintegration of testicular tissue. One of the first preventive lines is to administrate antioxidant factors. In the present study, we investigate the therapeutic effect of cerium oxide nanoparticle on the injury. We divided 45 rats into nine groups, subjected eight groups to testicular torsion-detorsion, injected different doses of cerium oxide nanoparticle into the peritoneum of six groups and analysed all the groups regarding spermatogenetic indices including sperm count, sperm viability and Johnson mean. Our results showed that cerium oxide nanoparticle can alleviate oxidative stress in testis, and this alleviation promotes the reproductive indices as the concentration of cerium oxide nanoparticles increases. The catalase-mimetic and superoxide dismutase-mimetic activities of cerium oxide nanoparticle are the most probable theories to explain the antioxidant effect of the nanoparticle.
Collapse
Affiliation(s)
- Ali Mousavi
- Department of Biology, Faculty of Science, Razi University, Kermanshah, Iran
| | - Ahmad Gharzi
- Department of Biology, Faculty of Science, Razi University, Kermanshah, Iran
| | - Mohammadreza Gholami
- Department of Anatomical Sciences, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fatemeh Beyranvand
- Department of Surgery, Razi Herbal Medicines Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohsen Takesh
- Department of Biology, Faculty of Science, Razi University, Kermanshah, Iran
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Kwenda EP, Locke RA, DeMarco RT, Bayne CE. Impact of hospital transfer on testicular torsion outcomes: A systematic review and meta-analysis. J Pediatr Urol 2021; 17:293.e1-293.e8. [PMID: 33610457 DOI: 10.1016/j.jpurol.2021.01.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/08/2021] [Accepted: 01/19/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Testicular torsion is an emergent condition requiring prompt treatment. Previous studies have suggested transfer of pediatric testicular torsion cases may be detrimental to patient outcomes. Findings have not reached statistical significance. No study has quantitatively analyzed all literature reporting outcomes for transferred torsion patients. The aim of this study was to elucidate the impact of hospital transfer on pediatric testicular torsion outcomes through a systematic review and meta-analysis. METHODS A predefined study protocol registered with PROSPERO was developed according to PRISMA. A comprehensive literature review of articles investigating outcomes for pediatric testicular torsion for transferred and non-transferred (treated "directly" at presentation institution) patients with orchiectomy as the primary outcome was conducted by systematically searching PubMed and Embase. Potential studies were screened against a predefined study protocol. Meta-analysis using a random effects model with transferred status as the "intervention" was performed using Review Manager 5.3. RESULTS Of 18 eligible studies, 9 retrospective studies comprised of 2564 patients (532 transferred and 2032 direct) were suitable for quantitative analysis. Main analysis showed transfer status does not have a significant effect on torsion outcomes (RR 0.96 [95% CI 0.78-1.17]; I2 = 44%). Subgroup analysis for torsion patients presenting within 24 h of symptom onset shows patients who are transferred to another facility for management are more likely to undergo orchiectomy than those treated at their presenting institution (RR 0.35 [95% CI 0.24-0.51]; I2 = 4%). CONCLUSIONS In this meta-analysis, hospital transfer does not affect orchiectomy rate in pediatric patients with testicular torsion when pooling data from all presentation timeframes. Subgroup analysis of patients presenting with testicular torsion in an acute setting (<24 h of symptom onset) suggests the delay associated with hospital transfer has a deleterious effect on testicular viability.
Collapse
Affiliation(s)
- Elizabeth P Kwenda
- Department of Urology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Rachel A Locke
- Department of Urology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Romano T DeMarco
- Department of Urology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Christopher E Bayne
- Department of Urology, University of Florida College of Medicine, Gainesville, FL, USA.
| |
Collapse
|
15
|
Testicular torsion induced by epididymo-orchitis: A case report. Int J Surg Case Rep 2021; 83:106038. [PMID: 34062357 PMCID: PMC8178082 DOI: 10.1016/j.ijscr.2021.106038] [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: 04/03/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction and importance Acute scrotum is considered a urological emergency requiring early intervention depending on the cause. There are multiple causes of acute scrotum with testicular torsion being the most feared as delayed treatment leads to testicular loss. However, differentiating between epididymo-orchitis and torsion can be very difficult. Case presentation We present a case of an 18-year old male patient with 2 separate episodes of acute scrotum. He had epididymo-orchitis as the first presentation followed by testicular torsion 5 days later. To our knowledge this is the first case of testicular torsion secondary to epididymo-orchitis. Clinical discussion Differentiating between epididymo-orchitis and torsion is challenging but important due to risk of loss of testis with a wrong diagnosis. Once you establish epididymo-orchitis the suspicion for subsequent torsion should be high with close follow up and adequate counselling. Conclusion He ultimately had orchiectomy, although a rare presentation, enlarged testis due to epididymo-orchitis can predispose an individual to developing testicular torsion thus adequate counselling on warning signs to patients with epididymo-orchitis is of particular importance so as to intervene early and ultimately save the testis. 18-year old male presenting with 2 separate episodes of acute scrotum. Initially diagnosed to have epididymo-orchitis with confirmation of color doppler ultrasound Second acute scrotum 5 days after and diagnosed to have torsion Unsalvageable testis due to delay in second presentation Epididymo-orchitis as a preceding risk factor to develop torsion
Collapse
|
16
|
Ali MA, Oyortey M, Maalman RS, Donkor OY, Quarshie H. Testicular torsion in a catheterized geriatric 73-year-old patient, making an early diagnosis: a case report. J Surg Case Rep 2021; 2021:rjab191. [PMID: 34025976 PMCID: PMC8130873 DOI: 10.1093/jscr/rjab191] [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: 03/19/2021] [Revised: 04/13/2021] [Accepted: 04/18/2021] [Indexed: 11/13/2022] Open
Abstract
Testicular torsion is a urologic emergency that requires surgical intervention. Its diagnosis is rarely made in elderly men especially the subset of men on urethral catheter. As a result, delayed diagnosis and surgical exploration occur leading to testicular infarction with necrosis, abscess formation and ultimately orchidectomy. We report a 73-year-old urologic patient referred with a 2-month history of transurethral catheterization to relieve retention of urine with subsequent scrotal pains and fever. Physical examination showed left hemi-scrotal swelling and normal right hemi-scrotal findings. A Doppler scan done showed an intratesticular fluid collection with no blood flow in the left testes. This case illustrates the need to include testicular torsion when diagnosing geriatric men with transurethral catheter presenting with any acute scrotal pains. We, therefore, recommend a detailed history and physical examination in addition to a colour Doppler ultrasound scan in making a diagnosis.
Collapse
Affiliation(s)
- Mahamudu A Ali
- Department of Surgery, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Mawuenyo Oyortey
- Department of Surgery, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Raymond S Maalman
- Department of Basic Medical Sciences, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Otchere Y Donkor
- Department of Basic Medical Sciences, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | | |
Collapse
|
17
|
Alawamlh OAH, Flannigan R, Hayden R, Goldstein M, Li PS, Lee RK. Testicular Torsion and Spermatogenesis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1288:287-306. [PMID: 34453742 DOI: 10.1007/978-3-030-77779-1_14] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Testicular torsion (TT) is a common urologic emergency that can occur at any age. It is most common in newborns and during puberty. Prompt evaluation and management is required to salvage the testis following an episode of torsion. TT brings about damage to testicular tissue and spermatogenesis through various hypothesized mechanisms; however there is a consensus that the effects of ischemia, ischemia-reperfusion injury, and oxidative stress account for the most destructive effects. Numerous studies have examined the effects of various agents and therapies in limiting the effects of TT on the testis.
Collapse
Affiliation(s)
- Omar Al Hussein Alawamlh
- James Buchanan Brady Foundation, Department of Urology, Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Ryan Flannigan
- James Buchanan Brady Foundation, Department of Urology, Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Russell Hayden
- James Buchanan Brady Foundation, Department of Urology, Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Marc Goldstein
- James Buchanan Brady Foundation, Department of Urology, Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Philip S Li
- James Buchanan Brady Foundation, Department of Urology, Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Richard K Lee
- James Buchanan Brady Foundation, Department of Urology, Weill Cornell Medical College of Cornell University, New York, NY, USA.
| |
Collapse
|
18
|
Ekşi E, Yalçın Cömert HS, Imamoğlu M, Alver A, Aydin Mungan S, Sarıhan H. Effects of myricetin on testicular torsion-detorsion injury in rats. Andrologia 2020; 52:e13775. [PMID: 32786086 DOI: 10.1111/and.13775] [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: 05/16/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 12/12/2022] Open
Abstract
Testicular torsion is an emergency, and unless there is an urgent intervention, irreversible ischaemic damage and gonad loss occur in the testicle. We aimed to investigate myricetin's antioxidant properties as well as its protective effect against ischaemia-reperfusion (I/R) damage in the testicular torsion model. A total of 18 rats were divided into three equal groups. Group 1 was the sham group. Group 2: testicular torsion was performed, and orchiectomy was done 2 hr after detorsion. Group 3: received torsion and 1 mg/kg intraperitoneal myricetin was given 30 min before detorsion, and orchiectomy was applied 2 hr after detorsion. We evaluated tissue malondialdehyde, superoxide dismutase, and catalase levels and Johnsen Testicular Biopsy Score to show its histopathological effect. There was a statistically significant decrease in MDA values in myricetin group compared to Group 2 (p < .017). There was no significant difference in the statistical analysis of SOD and CAT values (p = .337 and p = .025). There was a statistically significant difference in testicular I/R damage in the myricetin group compared to Group 1 and Group 2 (p < .017). Myricetin treatment significantly decreased testicular tissue damage compared to the torsion group but did not reach the values close to the control group.
Collapse
Affiliation(s)
- Esra Ekşi
- Department of Pediatric Surgery of Gumushane Hospital, Gumushane, Turkey
| | | | - Mustafa Imamoğlu
- Department of Pediatric Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Ahmet Alver
- Department of Biochemistry, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Sevdegül Aydin Mungan
- Department of Pathology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Haluk Sarıhan
- Department of Pediatric Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| |
Collapse
|
19
|
Moore SL, Chebbout R, Cumberbatch M, Bondad J, Forster L, Hendry J, Lamb B, MacLennan S, Nambiar A, Shah TT, Stavrinides V, Thurtle D, Pearce I, Kasivisvanathan V. Orchidopexy for Testicular Torsion: A Systematic Review of Surgical Technique. Eur Urol Focus 2020; 7:1493-1503. [DOI: 10.1016/j.euf.2020.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 06/25/2020] [Accepted: 07/31/2020] [Indexed: 12/01/2022]
|
20
|
Merder E, Bozkurt M, Ariman A, Sezgin MA, Culha MG, Altunrende F. Comprehensive examination of haematological parameters of patients operated due to testicular torsion. Andrologia 2020; 52:e13674. [PMID: 32501588 DOI: 10.1111/and.13674] [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: 04/10/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 12/16/2022] Open
Abstract
We aimed to investigate the pre-operative predictive role of haematological parameters in patients with testicular torsion. The medical records of patients operated between January 2016 and November 2018 were retrospectively analysed. The demographic characteristics and complete blood count of the patients were recorded. We divided the patients who operated with testicular torsion into two groups: detorsion (Group 1) and orchiectomy (Group 2). A control group (Group 3) was created from healthy volunteers. All haematological parameters and other demographic data were compared between three groups. A total of 144 participants were included; Group 1, Group 2 and Group 3; 61, 27 and 56 respectively. The duration of symptoms and monocyte counts were found statistically significantly higher in patients undergoing orchiectomy than detorsion (p < .01). We found a significant difference in terms of neutrophil, lymphocyte, monocyte counts and neutrophil-lymphocyte ratio between patients with testicular torsion and controls. We also found that the monocytes count and symptom duration differed significantly between the detorsion group and the orchiectomy group. It is obvious that there is contradictory information according to the studies in the literature. We can say that the duration of symptoms and the number of monocytes are predictors of testicular viability.
Collapse
Affiliation(s)
- Erkan Merder
- Department of Urology, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Muammer Bozkurt
- Department of Urology, Bahat Hospitals Group, Istanbul, Turkey
| | - Ahmet Ariman
- Department of Urology, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Ali Sezgin
- Department of Urology, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Gokhan Culha
- Department of Urology, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Fatih Altunrende
- Department of Urology, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| |
Collapse
|
21
|
Surgery of the Male Genital Tract. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_141-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
22
|
Klinke M, Elrod J, Stiel C, Ghadban T, Wenskus J, Herrmann J, Junge CM, Reinshagen K, Boettcher M. The BAL-Score Almost Perfectly Predicts Testicular Torsion in Children: A Two-Center Cohort Study. Front Pediatr 2020; 8:601892. [PMID: 33365292 PMCID: PMC7750324 DOI: 10.3389/fped.2020.601892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/17/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction: Testicular torsion (TT) is a common emergency that warrants immediate exploration to prevent infertility or testicular loss. To improve diagnostic reliability, various scoring systems have been published. The aim of this study was to evaluate and validate different testicular torsion scores in a large cohort of children with acute scrotum. Methods: Retrospective analysis of all male children that were admitted for acute scrotum at the Pediatric Surgery Department of the Altonaer Kinderkrankenhaus and University medical Center Hamburg-Eppendorf from 01/2013 to 03/2019. Two testicular torsion scores (Boettcher Alert Score, Testicular Workup for Ischemia and Suspected Torsion Score) were applied to all data sets. Furthermore, an artificial intelligence (AI)-based score was developed and compared to the two current scores. Results: In total, 460 boys were included in the study. Of those, 48 (10.4%) had TT. Children with TT suffered most often from short duration of pain, nausea and vomiting, high riding testicle and absent cremasteric reflex. The BALS and the AI-based score had excellent predictive values and all patients with TT would have been detected. Conclusion: The BAL and the AI score show excellent predictive capabilities and may be used to identify all cases of TT in a pediatric population. The scores are easy to apply. As the BALS was slightly better, we advocate to use this score but to validate our findings in prospective multicenter studies.
Collapse
Affiliation(s)
- Michaela Klinke
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Elrod
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carolin Stiel
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tarik Ghadban
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Wenskus
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Herrmann
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Section of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carl-Martin Junge
- Department of Pediatric Radiology, Altonaer Kinderkrankenhaus, Hamburg, Germany
| | - Konrad Reinshagen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
23
|
Sarıbal D, Erdem E, Güngör‐Ordueri NE, Usta A, Karakuş C, Karacan M. Metformin decreases testicular damages following ischaemia/reperfusion injury in rats. Andrologia 2019; 52:e13481. [DOI: 10.1111/and.13481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/21/2019] [Accepted: 10/11/2019] [Indexed: 01/14/2023] Open
Affiliation(s)
- Devrim Sarıbal
- Department of Biophysics Cerrahpasa Medical Faculty Istanbul University-Cerrahpasa Istanbul Turkey
| | - Erkan Erdem
- Vocational School of Health Services Bilgi University Istanbul Turkey
| | | | - Akın Usta
- Department of Gynecology and Obstetrics Balıkesir University Medical Faculty Balikesir Turkey
| | - Cemil Karakuş
- Vocational School of Health Services Beykent University Istanbul Turkey
| | - Meriç Karacan
- İstanbul Yeniyuzyil University Medical Faculty Istanbul Turkey
| |
Collapse
|
24
|
Pediatric testicular torsion: does patient transfer affect time to intervention or surgical outcomes at a rural tertiary care center? BMC Urol 2019; 19:39. [PMID: 31101044 PMCID: PMC6525388 DOI: 10.1186/s12894-019-0473-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 05/06/2019] [Indexed: 12/16/2022] Open
Abstract
Background Testicular torsion (TT) is a urologic emergency that requires prompt surgical intervention. In rural Appalachia, patients are often transferred from surrounding communities due to lack of urologic care. We hypothesized that those transferred would have delayed intervention and higher rates of orchiectomy when compared to those who presented directly to our hospital. Methods We performed a retrospective review of patient charts with an ICD-9 diagnosis of TT from 2008 to 2016. Patients met inclusion criteria if diagnosis was confirmed by operative exploration. We compared rate of testicular loss and time until surgical intervention between groups. Results Twenty-three patients met inclusion criteria (12 transferred, 11 direct). Patient demographics did not significantly differ between groups. Transferred patients had a higher orchiectomy rate (33% v 22%,p = 0.41) although this was not statistically significant. Time to surgery from symptom onset was significantly longer in those transferred (12.9 h) compared to those not transferred (6.9 h, p = 0.02). Distance of transfer was not correlated with time of delay (r2 = 0.063). Conclusions Transferred patients with TT have numerically higher rates of orchiectomy which may reach significance in an appropriately powered study, and relative delays in surgical intervention. This study highlights the need for improved access to urologic care in rural areas.
Collapse
|
25
|
Wang CL, Aryal B, Oto A, Allen BC, Akin O, Alexander LF, Bardo DM, Chong J, Froemming AT, Fulgham PF, Heller MT, Maranchie JK, Mody RN, Patel BN, Schieda N, Turkbey IB, Venkatesan AM, Yoo DC, Lockhart ME. ACR Appropriateness Criteria® Acute Onset of Scrotal Pain-Without Trauma, Without Antecedent Mass. J Am Coll Radiol 2019; 16:S38-S43. [DOI: 10.1016/j.jacr.2019.02.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 10/26/2022]
|
26
|
Almaramhy HH. Surgical practice among pediatric surgeons and pediatric urologists in the Kingdom of Saudi Arabia for the management of suspected testicular torsion. Saudi Med J 2018; 39:1232-1237. [PMID: 30520506 PMCID: PMC6344661 DOI: 10.15537/smj.2018.12.22958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To review and compare clinical practice and experience among pediatric surgeons (PS) and pediatric urologists (PU) for the management of testicular torsion (TT) in the Kingdom of Saudi Arabia (KSA). Methods: This was a cross-sectional study conducted between August 2016 and November 2017, among all PU and PS involved in the management of suspected TT in KSA. A questionnaire was distributed to participants through the Survs.com platform, and direct email when requested by participant. Results: Most PU (12/20, 60%) utilized ultrasound with Doppler before exploration, while 29 (74.4%) PS performed immediate exploration without imaging, representing a statistically significant difference (p=0.03). When the explored testis was dusky (not frank gangrenous), 27 PS (69.2%) performed fixation, 6 (15.4%) followed the second look policy, and 6 (15.4%) performed orchiectomy. With respect to PU, 6 (30%) performed fixation, 8 (40%) followed the second look policy, and 6 (30%) performed orchiectomy. The differences between the 2 specialties were statistically significant (p=0.02). Most consultants in both specialties performed fixation of the contralateral testis during the same operation. Also, there is a variation in practice when there is other pathology than TT. Conclusion: There were significant variations between the 2 specialties in the management of TT. National guidelines are needed to provide homogenous clinical practice and training of trainees.
Collapse
Affiliation(s)
- Hamdi H Almaramhy
- Division of Pediatric Surgery, Department of Surgery, College of Medicine, Taibah University, Almadinah Al-munawarah, Kingdom of Saudi Arabia. E-mail.
| |
Collapse
|
27
|
Nisly D, Barnett S, Herzing K, Aranda A. Concurrent testicular torsion and acute incarcerated inguinal hernia in an adolescent boy. BMJ Case Rep 2018; 2018:bcr-2018-227087. [PMID: 30368478 DOI: 10.1136/bcr-2018-227087] [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: 11/04/2022] Open
Abstract
Testicular torsion and acute incarcerated inguinal hernia are both common surgical emergencies in the paediatric population. We present the unusual case of a 16-year-old adolescent boy who presented with both of these conditions concurrently. He had a history of a right inguinal hernia, but ultrasound confirmed a testicular torsion and we employed manual detorsion in the emergency department prior to taking him to the operating room. We successfully salvaged the testicle in addition to performing inguinal hernia reduction and repair. The goal of this report is to emphasise the importance of maintaining a broad differential and early utilisation of ultrasound in the patient with acute groin pain.
Collapse
Affiliation(s)
- Darren Nisly
- Surgery, Henry Ford Allegiance Health, Jackson, Michigan, USA
| | - Sean Barnett
- Department of Pediatric Surgery, Dayton Children's Hospital/Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA
| | - Karen Herzing
- Department of Pediatric Surgery, Dayton Children's Hospital/Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA
| | - Arturo Aranda
- Department of Pediatric Surgery, Dayton Children's Hospital/Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA
| |
Collapse
|
28
|
Immediate and delayed effects of atmospheric temperature in the incidence of testicular torsion. J Pediatr Urol 2018; 14:170.e1-170.e7. [PMID: 29295782 DOI: 10.1016/j.jpurol.2017.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 11/09/2017] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Ongoing controversy surrounds the role of atmospheric temperature in the incidence of intravaginal testicular torsion (iTT). This debate may be attributed to inadequate research methodology. As environmental risk factors have been successfully investigated with distributed lag non-linear model regression (DLNM), we applied this methodology to investigate the association between daily mean atmospheric temperatures (Tmean) and daily incidences of intravaginal testicular torsion (iTT) in our region. STUDY DESIGN We analyzed time series consisting of the daily incidences of surgically confirmed iTT according to Tmean, in a circumscribed region in central Brazil from 2012 to 2015, with non-parametric tests, unadjusted and seasonally and long-term trend adjusted time series regression, as well as with DLNM. RESULTS We recovered 218 cases of iTT in 1125 days of study. Most patients were teenagers (median 15.8 years, interquartile range 14.1-18.5 years). Within the 188 days with events, a single event was recorded on 161 days, two events were recorded on 24 days, and three events were recorded on 3 days. Tmean was lower in days with iTT compared with days without iTT (median 21.4 °C vs. 20.9 °C, p = 0.0002). We found decreasing magnitude and uncertainty of the direction of the effect of Tmean as a risk factor for iTT as the time series regression model was adjusted for seasonal and long-term trends. DLNM indicated a more complex exposure-response relation, with a proportional increase in risk when Tmean fell below 19.4 °C at the day of exposure (for 18.0 °C, RR 4.35) and a protective effect, for similar temperatures, after 1-2 and 7-12 days of exposure (RR 0.44 and 0.78, respectively). DISCUSSION The association between lower Tmean and higher incidences of iTT at first observed with conventional non-parametric tests and unadjusted time series regression disappeared with adjusted time series regression models, reproducing the conflicting results of the literature. In contrast, DLNM revealed both a proportional effect of Tmean with decreasing temperatures and a delayed decrease in risk, suggesting a harvesting effect, seen when the pool of susceptible patients is depleted at exposure leading to a subsequent decrease in the incidence of the disease. CONCLUSION According to DLMN, exposures to lower Tmean were associated with immediate greater risk and delayed reduction in risk for iTT. This pattern, indicating a harvesting effect, strongly argues that low temperatures do constitute a risk factor for iTT.
Collapse
|
29
|
Grimsby GM, Schlomer BJ, Menon VS, Ostrov L, Keays M, Sheth KR, Villanueva C, Granberg C, Dajusta D, Hill M, Sanchez E, Harrison CB, Jacobs MA, Burgu B, Hennes H, Baker LA. Prospective Evaluation of Predictors of Testis Atrophy After Surgery for Testis Torsion in Children. Urology 2018; 116:150-155. [PMID: 29572055 DOI: 10.1016/j.urology.2018.03.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/25/2018] [Accepted: 03/05/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To prospectively correlate pain duration, red scrotal skin, ultrasound appearance of testis, and intraoperative testis color to future testis atrophy after acute testicular torsion. METHODS Patients 2 months-18 years old with unilateral acute scrotum were consecutively enrolled in a National Institutes of Health transcutaneous near-infrared spectroscopy study, with a subgroup analysis of the true torsion group. Presence or absence of red scrotal skin, pain duration, testicular heterogeneity on preoperative ultrasound, and intraoperative testis color based on a novel visual chart 5 minutes after detorsion were recorded. All testes underwent orchiopexy regardless of appearance. Percent volume difference between normal and torsed testicles on follow-up ultrasound was compared between patients with and without risk factors. RESULTS Thirty of 56 patients who had surgical detorsion underwent scrotal ultrasound at a mean of 117 days after surgery. A color of black or hemorrhagic 5 minutes after detorsion, pain duration >12 hours, and heterogeneous parenchyma on preoperative ultrasound were associated with significant testis volume loss in follow-up compared with normal testis. All patients with a black or hemorrhagic testis had >80% volume loss. Erythematous scrotal skin was not significantly associated with smaller affected testis volume in follow-up. CONCLUSION Based on the high atrophy rate, orchiectomy can be considered for testes that are black or hemorrhagic 5 minutes after detorsion. Pain duration >12 hours and parenchymal heterogeneity on preoperative ultrasound were also associated with testis atrophy. Red scrotal skin was not a reliable predictor of atrophy and should not delay exploration.
Collapse
Affiliation(s)
- Gwen M Grimsby
- Division of Pediatric Urology, Phoenix Children's Hospital, Phoenix, AZ
| | - Bruce J Schlomer
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Division of Pediatric Urology, Children's Health, Dallas, TX
| | - Vani S Menon
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Division of Pediatric Urology, Children's Health, Dallas, TX
| | - Lauren Ostrov
- Division of Pediatric Urology, Children's Health, Dallas, TX
| | - Melise Keays
- Division of Pediatric Urology, Children's Hospital of East Ontario, Ottawa, Ontario, Canada
| | - Kunj R Sheth
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Carlos Villanueva
- Division of Pediatric Urology, Children's Hospital & Medical Center, Omaha, NE
| | | | - Daniel Dajusta
- Division of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH
| | - Martinez Hill
- Division of Pediatric Urology, Children's Health, Dallas, TX
| | - Emma Sanchez
- Division of Pediatric Urology, Children's Health, Dallas, TX
| | - Clanton B Harrison
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Division of Pediatric Urology, Children's Health, Dallas, TX
| | - Micah A Jacobs
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Division of Pediatric Urology, Children's Health, Dallas, TX
| | - Berk Burgu
- Department of Urology, Ankara Üniversitesi Tıp Fakültesi, Ankara, Turkey
| | - Halim Hennes
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Division of Pediatric Urology, Children's Health, Dallas, TX
| | - Linda A Baker
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Division of Pediatric Urology, Children's Health, Dallas, TX.
| |
Collapse
|
30
|
Yan Y, Chen S, Chen Z, Pei X, Zhou J, Xiao Y, Wang X. The applied value of medical history, physical examination, colour-Doppler ultrasonography and testis scintigraphy in the differential diagnosis of acute scrotum. Andrologia 2018; 50:e12973. [PMID: 29460432 DOI: 10.1111/and.12973] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2017] [Indexed: 11/28/2022] Open
Abstract
Acute scrotum, especially testicular torsion, is a common surgical emergency. A delay in diagnosis or management may lead to permanent testicular ischaemic damage. Thus, it is particularly important to differentiate testicular torsion from other acute scrotum conditions as soon as possible. Our study has retrospectively investigated 358 patients with acute scrotum admitted to our hospital from the year 2007 to 2016. We have collected a thorough history and clinical data and drew the conclusion by comparing clinical features of different acute scrotum cases, medical history, imaging and surgical findings. Therefore, we propose an innovative "Testicular Torsion (TT) Green Channel" concept. Through the combination of a comprehensive medical history, physical examination and auxiliary colour-Doppler ultrasonography, the diagnosis of testicular torsion is definite in most circumstances. Testis scintigraphy is a novel and complementary diagnostic modality that can reduce the negative exploration rate in ambiguous and certain cases. The TT Green Channel is a new concept in the management of testicular torsion.
Collapse
Affiliation(s)
- Y Yan
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - S Chen
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Z Chen
- Department of Urology, Jingzhou Central Hospital, The Second Clinical College, Yangtze University, Jingzhou, China
| | - X Pei
- Department of Emergency, Jingzhou Central Hospital, The Second Clinical College, Yangtze University, Jingzhou, China
| | - J Zhou
- Department of Urology, Jingzhou Central Hospital, The Second Clinical College, Yangtze University, Jingzhou, China
| | - Y Xiao
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Laboratory of Precision Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - X Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
31
|
McBride CA, Patel B. Acutely painful scrotum: Tips, traps, tricks and truths. J Paediatr Child Health 2017; 53:1054-1059. [PMID: 29148188 DOI: 10.1111/jpc.13766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 09/28/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Craig A McBride
- Surgical Team: Infants, Toddlers, Children (STITCh), Lady Cilento Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia.,Discipline of Paediatrics and Child Health, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Bhaveshkumar Patel
- Surgical Team: Infants, Toddlers, Children (STITCh), Lady Cilento Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia.,Discipline of Paediatrics and Child Health, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
32
|
Demirbas A, Demir DO, Ersoy E, Kabar M, Ozcan S, Karagoz MA, Demirbas O, Doluoglu OG. Should manual detorsion be a routine part of treatment in testicular torsion? BMC Urol 2017; 17:84. [PMID: 28915866 PMCID: PMC5602835 DOI: 10.1186/s12894-017-0276-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 09/05/2017] [Indexed: 11/17/2022] Open
Abstract
Background It was aimed to investigate the efficiency and reliability of the manual detorsion (MD) procedure in patients diagnosed with testicular torsion (TT). Methods A retrospective analysis was made of the data of 57 patients diagnosed with TT, comprising 20 patients with successful MD (Group I), 28 patients who underwent emergency orchiopexy (Group II), and 9 patients applied with orchiectomy (Group III). The groups were compared in respect of age, and duration of pain. The success rate of MD, the time of testicular fixation (TF), any problems encountered in follow-up, and follow-up times were analyzed in Group I. Data were analyzed with P-P pilot, Mann-Whitney U, Kruskal Wallis and Chi-square tests. A value of p < 0.05 was considered statistically significant. Results MD was successful and detorsion could be achieved in 20 of 26 patients. The groups were similar in respect of age (p = 0.217). The median duration of pain was 3 (1–8), 4 (1–72), and 48 (12–144) hours in Groups I, II, and III, respectively, and determined as similar in Groups I and II (p = 0.257), although a statistically significant difference was determined between the 3 groups (p < 0.001). TF was applied to Group I after median 10 (0–45) days, and no parenchymal disorder was determined in the median follow-up period of 21.5 (2–40) months. Conclusion MD that can be easily and immediately performed after the diagnosis of TT decreases ischemia time. This seems to be an efficient and reliable procedure when applied together with elective orchiopexy, as a part of the treatment. Electronic supplementary material The online version of this article (10.1186/s12894-017-0276-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Arif Demirbas
- Department of Urology, Ankara Training and Research Hospital, 06340, Sukriye, Altındağ Ankara, Turkey.
| | - Demirhan Orsan Demir
- Department of Urology, Ankara Training and Research Hospital, 06340, Sukriye, Altındağ Ankara, Turkey
| | - Erim Ersoy
- Department of Urology, Ankara Training and Research Hospital, 06340, Sukriye, Altındağ Ankara, Turkey
| | - Mucahit Kabar
- Department of Urology, Ankara Training and Research Hospital, 06340, Sukriye, Altındağ Ankara, Turkey
| | - Serkan Ozcan
- Department of Urology, Ankara Training and Research Hospital, 06340, Sukriye, Altındağ Ankara, Turkey
| | - Mehmet Ali Karagoz
- Department of Urology, Ankara Training and Research Hospital, 06340, Sukriye, Altındağ Ankara, Turkey
| | - Ozgecan Demirbas
- Department of Pediatrics, Ankara Dr. Sami Ulus Women Health, Children's Training and Research Hospital, 06340, Ankara, Turkey
| | - Omer Gokhan Doluoglu
- Department of Urology, Ankara Training and Research Hospital, 06340, Sukriye, Altındağ Ankara, Turkey
| |
Collapse
|
33
|
Kostakis ID, Zavras N, Damaskos C, Sakellariou S, Korkolopoulou P, Misiakos EP, Tsaparas P, Vaos G, Karatzas T. Erythropoietin and sildenafil protect against ischemia/reperfusion injury following testicular torsion in adult rats. Exp Ther Med 2017; 13:3341-3347. [PMID: 28587411 PMCID: PMC5450555 DOI: 10.3892/etm.2017.4441] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 09/22/2016] [Indexed: 11/06/2022] Open
Abstract
Testicular torsion/detorsion causes severe tissue damage due to ischemia/reperfusion injury. The present study investigated the protective effect of erythropoietin and sildenafil against ischemia/reperfusion injury following unilateral testicular torsion/detorsion in adult rats. A total of 28 adult male rats were included, and were divided into the following groups: Group A (n=5), sham operated; groups B (n=5), C (n=5), D (n=5) and E (n=8), undergoing right testis torsion and detorsion after 90 min. Group B received no drug treatment. Rats in the groups C and D received low-dose (1,000 IU/kg) or high-dose (3,000 IU/kg) erythropoietin, while those in group E received sildenafil (0.7 mg/kg), through intraperitoneal injection after 60 min of torsion. The right testis was extracted 24 h after detorsion, and the tissue was subjected to histopathological examination and immunohistochemical assessment of cleaved caspase-3 expression. Histological alterations and the quality of spermatogenesis were scored according to the Cosentino and the Johnsen scoring systems, respectively. The results demonstrated normal testicular architecture in group A, while the other groups showed ischemic cellular damages, with the worst scores observed in group B. Groups D and E presented better scores compared with group C. Regarding the quality of spermatogenesis, the best scores were observed in group A, and the worst in group B. Groups C, D and E presented similar results, which were improved in comparison to group B, however, not compared to group A. Furthermore, cleaved caspase-3 levels were lower in groups A, D and E, with equal results observed. Group C had higher levels of cleaved caspase-3 compared with these groups, but lower than group B, which presented the highest cleaved caspase-3 levels. In conclusion, erythropoietin and sildenafil protect testis from ischemia/reperfusion injury by decreasing cellular damage and attenuating apoptosis.
Collapse
Affiliation(s)
- Ioannis D Kostakis
- Laboratory of Experimental Surgery and Surgical Research 'N.S. Christeas', National and Kapodistrian University of Athens, Medical School, 11527 Athens, Greece.,Second Department of Propedeutic Surgery, 'Laiko' General Hospital, National and Kapodistrian University of Athens, Medical School, 11527 Athens, Greece
| | - Nick Zavras
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, 12462 Athens, Greece
| | - Christos Damaskos
- Laboratory of Experimental Surgery and Surgical Research 'N.S. Christeas', National and Kapodistrian University of Athens, Medical School, 11527 Athens, Greece.,Second Department of Propedeutic Surgery, 'Laiko' General Hospital, National and Kapodistrian University of Athens, Medical School, 11527 Athens, Greece
| | - Stratigoula Sakellariou
- First Department of Pathology, National and Kapodistrian University of Athens, Medical School, 11527 Athens, Greece
| | - Penelope Korkolopoulou
- First Department of Pathology, National and Kapodistrian University of Athens, Medical School, 11527 Athens, Greece
| | - Evangelos P Misiakos
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, 12462 Athens, Greece
| | - Petros Tsaparas
- Laboratory of Experimental Surgery and Surgical Research 'N.S. Christeas', National and Kapodistrian University of Athens, Medical School, 11527 Athens, Greece.,Second Department of Propedeutic Surgery, 'Laiko' General Hospital, National and Kapodistrian University of Athens, Medical School, 11527 Athens, Greece
| | - George Vaos
- Department of Pediatric Surgery, Alexandroupolis University Hospital, Democritus University of Thrace, Medical School, 68100 Alexandroupolis, Greece
| | - Theodoros Karatzas
- Laboratory of Experimental Surgery and Surgical Research 'N.S. Christeas', National and Kapodistrian University of Athens, Medical School, 11527 Athens, Greece.,Second Department of Propedeutic Surgery, 'Laiko' General Hospital, National and Kapodistrian University of Athens, Medical School, 11527 Athens, Greece
| |
Collapse
|
34
|
Schlomer BJ, Keays MA, Grimsby GM, Granberg CF, DaJusta DG, Menon VS, Ostrov L, Sheth KR, Hill M, Sanchez EJ, Harrison CB, Jacobs MA, Huang R, Burgu B, Hennes H, Baker LA. Transscrotal Near Infrared Spectroscopy as a Diagnostic Test for Testis Torsion in Pediatric Acute Scrotum: A Prospective Comparison to Gold Standard Diagnostic Test Study. J Urol 2017; 198:694-701. [PMID: 28392394 DOI: 10.1016/j.juro.2017.03.134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE A rapid test for testicular torsion in children may obviate the delay for testicular ultrasound. In this study we assessed testicular tissue percent oxygen saturation (%StO2) measured by transscrotal near infrared spectroscopy as a diagnostic test for pediatric testicular torsion. MATERIALS AND METHODS This was a prospective comparison to a gold standard diagnostic test study that evaluated near infrared spectroscopy %StO2 readings to diagnose testicular torsion. The gold standard for torsion diagnosis was standard clinical care. From 2013 to 2015 males with acute scrotum for more than 1 month and who were less than 18 years old were recruited. Near infrared spectroscopy %StO2 readings were obtained for affected and unaffected testes. Near infrared spectroscopy Δ%StO2 was calculated as unaffected minus affected reading. The utility of near infrared spectroscopy Δ%StO2 to diagnose testis torsion was described with ROC curves. RESULTS Of 154 eligible patients 121 had near infrared spectroscopy readings. Median near infrared spectroscopy Δ%StO2 in the 36 patients with torsion was 2.0 (IQR -4.2 to 9.8) vs -1.7 (IQR -8.7 to 2.0) in the 85 without torsion (p=0.004). AUC for near infrared spectroscopy as a diagnostic test was 0.66 (95% CI 0.55-0.78). Near infrared spectroscopy Δ%StO2 of 20 or greater had a positive predictive value of 100% and a sensitivity of 22.2%. Tanner stage 3-5 cases without scrotal edema or with pain for 12 hours or less had an AUC of 0.91 (95% CI 0.86-1.0) and 0.80 (95% CI 0.62-0.99), respectively. CONCLUSIONS In all children near infrared spectroscopy readings had limited utility in diagnosing torsion. However, in Tanner 3-5 cases without scrotal edema or with pain 12 hours or less, near infrared spectroscopy discriminated well between torsion and nontorsion.
Collapse
Affiliation(s)
- Bruce J Schlomer
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas.
| | | | | | | | | | - Vani S Menon
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas
| | | | - Kunj R Sheth
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Clanton B Harrison
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas
| | - Micah A Jacobs
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas
| | | | - Berk Burgu
- Ankara Üniversitesi Tıp Fakültesi, Ankara, Turkey
| | - Halim Hennes
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas
| | - Linda A Baker
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas
| |
Collapse
|
35
|
Arena S, Iacona R, Antonuccio P, Russo T, Salvo V, Gitto E, Impellizzeri P, Romeo C. Medical perspective in testicular ischemia-reperfusion injury. Exp Ther Med 2017; 13:2115-2122. [PMID: 28565817 DOI: 10.3892/etm.2017.4289] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 01/06/2017] [Indexed: 01/01/2023] Open
Abstract
Testicular torsion or torsion of the spermatic cord is one of the most serious urological conditions. It causes testicular injury, which potentially leads to male subfertility. The turning of the spermatic cord and spermatic structures around themselves results in biochemical and histological changes; however, following testicular detorsion, tissues undergo reperfusion that causes more severe damage than that induced by ischemia. Since the primary causes of testicular damage are reactive oxygen species production, an increase in intra-mitochondrial calcium concentration and an increased rate of cellular apoptosis, different medications may potentially be effective. It seems that several medications, experimentally and sometimes clinically, serve an adjuvant role in the cellular damage that occurs following ischemia-reperfusion. Antioxidants, calcium channel blockers, phytotherapeutical medicinals, anaesthetics, hormones and platelet inhibitors may potentially create a solid basis for an adjuvant restoring therapy and ameliorate testicular function following torsion. The current study aimed to review the relevant literature and discuss the actions of a number of molecules that may protect the testes during ischemia/reperfusion injury.
Collapse
Affiliation(s)
- Salvatore Arena
- Department of Human Pathology in Adult and Developmental Age 'Gaetano Barresi', Unit of Paediatric Surgery, University of Messina, I-98125 Messina, Italy
| | - Roberta Iacona
- Department of Paediatric Surgery, John Radcliffe Hospital, Oxford University Hospital, Oxford OX3 9DU, UK
| | - Pietro Antonuccio
- Department of Human Pathology in Adult and Developmental Age 'Gaetano Barresi', Unit of Paediatric Surgery, University of Messina, I-98125 Messina, Italy
| | - Tiziana Russo
- Department of Human Pathology in Adult and Developmental Age 'Gaetano Barresi', Unit of Paediatric Surgery, University of Messina, I-98125 Messina, Italy
| | - Vincenzo Salvo
- Department of Human Pathology in Adult and Developmental Age 'Gaetano Barresi', Neonatal and Intensive Care Unit, University of Messina, I-98125 Messina, Italy
| | - Eloisa Gitto
- Department of Human Pathology in Adult and Developmental Age 'Gaetano Barresi', Neonatal and Intensive Care Unit, University of Messina, I-98125 Messina, Italy
| | - Pietro Impellizzeri
- Department of Human Pathology in Adult and Developmental Age 'Gaetano Barresi', Unit of Paediatric Surgery, University of Messina, I-98125 Messina, Italy
| | - Carmelo Romeo
- Department of Human Pathology in Adult and Developmental Age 'Gaetano Barresi', Unit of Paediatric Surgery, University of Messina, I-98125 Messina, Italy
| |
Collapse
|
36
|
Güneş M, Altok M, Özmen Ö, Değirmenci B, Özyildiz Z, Baş E, Kara M, Kaya C. The effectiveness of extra-scrotal fixation following manual detorsion for testicular torsion: a pilot study in a rabbit model. Cent European J Urol 2017; 69:411-416. [PMID: 28127460 PMCID: PMC5260460 DOI: 10.5173/ceju.2016.888] [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: 07/11/2016] [Revised: 08/04/2016] [Accepted: 10/11/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION To investigate the effectiveness of manual detorsion (MD) and applicability of extra-scrotal fixation for testicular torsion in a rabbit model. MATERIAL AND METHODS Twelve New Zealand male rabbits were randomized into six groups of two rabbits each. A single-side testicular torsion (TT) model (different degrees, time and sides) was performed in all groups except the Sham group. The groups included: Group 1 (180°; 4 h), Group 2 (720°; 6 h), Group 3 (1080°; 9 h), Group 4 (540°; 1 h), Group 5 (900°; 2 h), and Group 6 (sham-only). Testes were examined by another urologist and radiologist with Color Doppler Ultrasonography (CDU). MD was performed with CDU until blood flow was observed in the affected testis. Extra-scrotal fixation was then conducted in these animals. The testes were then harvested for blinded histopathological examinations. RESULTS TT was detected in all animals except the control group. The CDU examination detected decreased blood flow only in Group 1. An opposite rate was observed between the spermatic cord diameter and torsion degree. A wrong direction of MD in the first step was observed in two rabbits in Groups 4 and 5. Torsion signs were observed only in Group 3. Rest torsion was observed in Groups 3 and 5 after extra-scrotal fixation. Histopathological examinations showed that testicular damage increased in parallel to torsion duration. CONCLUSIONS Extra-scrotal fixation after MD along with CDU may be a simple and minimally invasive treatment option in TT therapy. However, this must be verified with further studies.
Collapse
Affiliation(s)
- Mustafa Güneş
- Süleyman Demirel University, Faculty of Medicine, Department of Urology, Isparta, Turkey
| | - Muammer Altok
- Süleyman Demirel University, Faculty of Medicine, Department of Urology, Isparta, Turkey
| | - Özlem Özmen
- Mehmet Akif Ersoy University, Faculty of Veterinary Medicine, Department of Pathology, Burdur, Turkey
| | - Bumin Değirmenci
- Süleyman Demirel University, Faculty of Medicine, Department of Radiology, Isparta, Turkey
| | - Zafer Özyildiz
- Mehmet Akif Ersoy University, Faculty of Veterinary Medicine, Department of Pathology, Burdur, Turkey
| | - Ercan Baş
- Süleyman Demirel University, Faculty of Medicine, Department of Urology, Isparta, Turkey
| | - Mustafa Kara
- Süleyman Demirel University, Faculty of Medicine, Department of Radiology, Isparta, Turkey
| | - Cevdet Kaya
- Marmara University, Faculty of Medicine, Department of Urology, Istanbul, Turkey
| |
Collapse
|
37
|
Surgery of the Male Genital System. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
38
|
Chi KK, Zhang WH, Wang GC, Chen Z, He W, Wang SG, Cui Y, Lu P, Wang XJ, Chen H. Comparison of Intraperitoneal and Intraepididymal Quercetin for the Prevention of Testicular Torsion/Detorsion-induced Injury. Urology 2017; 99:106-111. [DOI: 10.1016/j.urology.2016.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/24/2016] [Accepted: 09/12/2016] [Indexed: 01/20/2023]
|
39
|
Kim HJ, Lee JW, Hwang BR, Lee YA, Kim JI, Cho YJ, Jhun HJ, Han JS. Protective effect of pterostilbene on testicular ischemia/reperfusion injury in rats. J Pediatr Surg 2016; 51:1192-6. [PMID: 26976774 DOI: 10.1016/j.jpedsurg.2016.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/28/2015] [Accepted: 01/21/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate protective effect of pterostilbene against testicular ischemia/reperfusion (I/R) injury, which results in increased formation of oxidative stress, leading to testicular apoptosis and impaired spermatogenesis. METHODS Thirty two pubertal male Sprague-Dawley rats weighing 180-220g were selected and randomly divided into the following four groups: group A (normal control group), group B (sham-operated group), group C (induced I/R injury group), group D (induced I/R injury group receiving pterostilbene treatment). Johnsen's scores and mean seminiferous tubule diameters were evaluated for histopathologic assessment; germinal cell apoptosis was evaluated by the transferase dUTP nick end labeling (TUNEL) assay and immunohistochemistry for caspases. Malondialdehyde (MDA) levels were assessed as an indicator of oxidative stress and total antioxidant capacity (TAC) was measured. RESULTS Germ cell apoptosis and MDA level significantly increased whereas TAC significantly decreased in group C; moreover, abnormal morphology and impaired spermatogenesis were observed in group C. In contrast, treatment with pterostilbene inhibited lipid peroxidation and apoptosis induced by ROS and restored the antioxidant capacity in group D. CONCLUSIONS These results show that treatment with pterostilbene may be a promising therapy for testicular I/R injury.
Collapse
Affiliation(s)
- Hyung Joon Kim
- The Institute for the 3Rs & Department of Laboratory Animal Medicine, College of Veterinary Medicine, Konkuk University, 1 Hwayang-dong, Gwangjin-gu, Seoul 143-701, Republic of Korea
| | - Jae-Won Lee
- The Institute for the 3Rs & Department of Laboratory Animal Medicine, College of Veterinary Medicine, Konkuk University, 1 Hwayang-dong, Gwangjin-gu, Seoul 143-701, Republic of Korea
| | - Bo Ram Hwang
- The Institute for the 3Rs & Department of Laboratory Animal Medicine, College of Veterinary Medicine, Konkuk University, 1 Hwayang-dong, Gwangjin-gu, Seoul 143-701, Republic of Korea
| | - Young-Ah Lee
- Department of Animal Science, Shingu College University, 2 Geumgwang-dong, Jungwon-gu, Seongnam-si, Gyeonggi-do 462-743, Republic of Korea
| | - Jong-In Kim
- The Institute for the 3Rs & Department of Laboratory Animal Medicine, College of Veterinary Medicine, Konkuk University, 1 Hwayang-dong, Gwangjin-gu, Seoul 143-701, Republic of Korea
| | - Yoon Ju Cho
- Department of Pet Science, Seojeong College University, Yongam-ri, Eunhyeon-m yeon, Yangju-si, Gyeonggi-do 482-777, Republic of Korea
| | - Hyun Jhung Jhun
- Laboratory Animal Research Center, Konkuk University, 1 Hwayang-dong, Gwangjin-gu, Seoul 143-701, Republic of Korea
| | - Jin Soo Han
- The Institute for the 3Rs & Department of Laboratory Animal Medicine, College of Veterinary Medicine, Konkuk University, 1 Hwayang-dong, Gwangjin-gu, Seoul 143-701, Republic of Korea.
| |
Collapse
|
40
|
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
|
41
|
|
42
|
Sheth KR, Keays M, Grimsby GM, Granberg CF, Menon VS, DaJusta DG, Ostrov L, Hill M, Sanchez E, Kuppermann D, Harrison CB, Jacobs MA, Huang R, Burgu B, Hennes H, Schlomer BJ, Baker LA. Diagnosing Testicular Torsion before Urological Consultation and Imaging: Validation of the TWIST Score. J Urol 2016; 195:1870-6. [PMID: 26835833 DOI: 10.1016/j.juro.2016.01.101] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE The TWIST (Testicular Workup for Ischemia and Suspected Torsion) score uses urological history and physical examination to assess risk of testis torsion. Parameters include testis swelling (2 points), hard testis (2), absent cremasteric reflex (1), nausea/vomiting (1) and high riding testis (1). While TWIST has been validated when scored by urologists, its diagnostic accuracy among nonurological providers is unknown. We assessed the usefulness of the TWIST score when determined by nonurological nonphysician providers, mirroring emergency room evaluation of acute scrotal pain. MATERIALS AND METHODS Children with unilateral acute scrotum were prospectively enrolled in a National Institutes of Health clinical trial. After undergoing basic history and physical examination training, emergency medical technicians calculated TWIST score and determined Tanner stage per pictorial diagram. Clinical torsion was confirmed by surgical exploration. All data were captured into REDCap™ and ROC curves were used to evaluate the diagnostic usefulness of TWIST. RESULTS Of 128 patients (mean age 11.3 years) 44 (13.0 years) had torsion. TWIST score cutoff values of 0 and 6 derived from ROC analysis identified 31 high, 57 intermediate and 40 low risk cases (positive predictive value 93.5%, negative predictive value 100%). CONCLUSIONS TWIST score assessed by nonurologists, such as emergency medical technicians, is accurate. Low risk patients do not require ultrasound to rule out torsion. High risk patients can proceed directly to surgery, with more than 50% avoiding ultrasound. In the future emergency medical technicians and/or emergency room triage personnel may be able to calculate TWIST score to guide radiological evaluation and immediate surgical intervention at initial assessment long before urological consultation.
Collapse
Affiliation(s)
- Kunj R Sheth
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Melise Keays
- Children's Hospital of East Ontario, Ottawa, Ontario, Canada
| | | | | | - Vani S Menon
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas
| | | | | | | | | | | | - Clanton B Harrison
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas
| | - Micah A Jacobs
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas
| | | | - Berk Burgu
- Nationwide Children's Hospital, Columbus, Ohio
| | - Halim Hennes
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas
| | - Bruce J Schlomer
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas
| | - Linda A Baker
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas.
| |
Collapse
|
43
|
Artul S, Fahoum B, Nseir W, Habib G. Testicular Ischemia Due to a Band Around the Spermatic Cord. J Clin Imaging Sci 2015; 5:36. [PMID: 26180659 PMCID: PMC4490577 DOI: 10.4103/2156-7514.157856] [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: 03/05/2015] [Accepted: 04/29/2015] [Indexed: 11/30/2022] Open
Abstract
We present a case of an 18-year-old boy who was admitted to our hospital with a 2-day history of pain in the right scrotum. Ultrasound examination showed signs of ischemia, with dampened testicular arterial flow and bell-clapper deformity. Surgery revealed a constricting fibrous band around the distal spermatic cord resembling the bell-clapper deformity.
Collapse
Affiliation(s)
- Suheil Artul
- Department of Radiology, Nazareth Hospital, Nazareth, Israel ; Department of Medicine, Bar-Ilan University, Safed, Israel
| | - Basel Fahoum
- Department of Urology, Urology Surgery Unit, Nazareth Hospital, Nazareth, Israel
| | - William Nseir
- Department of Medicine, Bar-Ilan University, Safed, Israel ; Department of Medicine, Nazareth Hospital, Nazareth, Israel
| | - George Habib
- Department of Medicine, Nazareth Hospital, Nazareth, Israel
| |
Collapse
|
44
|
Cvetkovic T, Stankovic J, Najman S, Pavlovic D, Stokanovic D, Vlajkovic S, Dakovic-Bjelakovic M, Cukuranovic J, Zivkovic V, Stefanovic V. Oxidant and antioxidant status in experimental rat testis after testicular torsion/detorsion. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2015; 9:121-8. [PMID: 25918600 PMCID: PMC4410030 DOI: 10.22074/ijfs.2015.4216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 01/28/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND The aim of this study was to determine oxidative stress (OS) parameters after testicular torsion/detorsion in adult rats. MATERIALS AND METHODS In this experimental study, male adult Wistar rats were divided into four groups, each consisting of seven animals: group I-one hour right testicular torsion with subsequent orchiectomy, group II-one hour right testicular torsion followed by detorsion, group III-unilateral right-sided orchiectomy without previous torsion and group IV-control. After 30 days, bilateral orchiectomies were performed in rats with both testes and unilateral orchiectomies in rats with single testicles. Parameters of OS were determined in testicular tissue and in plasma. RESULTS Plasma concentrations of advanced oxidation protein products (AOPP) and thiobarbituric acid reactive substances (TBARS) were higher (p<0.05 and p<0.01, respectively), whilst the plasma concentration of the total sulfhydryl (T-SH)-groups was lower (p<0.05) in group I compared to the control group. Group II had higher plasma concentrations of AOPP compared to group IV (p<0.05), as well as significantly increased TBARS and decreased T-SH-group levels compared to groups III (p<0.05 and p<0.01, respectively) and IV (p<0.01, for both parameters). There were significant differences in OS markers between the ipsilateral and contralateral testis, as well as significant correlations among levels of both plasma and tissue markers of OS. CONCLUSION The increase in TBARS levels seen throughout the experimental period indicated that OS development was caused by ischemia/reperfusion in the testicular tissue. The oxidant-antioxidant system of the testicular tissue was altered during torsion as well as detorsion.
Collapse
Affiliation(s)
- Tatjana Cvetkovic
- Department of Biochemistry, School of Medicine, University of Nis, Nis, Serbia ; Clinic of Nephrology, Clinical Centre Nis, Nis, Serbia
| | | | - Stevo Najman
- Department of Biology, School of Medicine, University of Nis, Nis, Serbia
| | - Dusica Pavlovic
- Department of Biochemistry, School of Medicine, University of Nis, Nis, Serbia
| | - Dragana Stokanovic
- Department of Pharmacology and Toxicology, School of Medicine, University of Nis, Nis, Serbia
| | - Slobodan Vlajkovic
- Department of Anatomy, School of Medicine, University of Nis, Nis, Serbia
| | | | - Jovana Cukuranovic
- Department of Anatomy, School of Medicine, University of Nis, Nis, Serbia
| | - Vladimir Zivkovic
- Department of Anatomy, School of Medicine, University of Nis, Nis, Serbia
| | | |
Collapse
|
45
|
Latham JL. Surgery of the Male Genital System. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_106-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
46
|
Zavras N, Kostakis ID, Sakellariou S, Damaskos C, Roupakas E, Tsagkari E, Spartalis E, Velaoras K, Dontas IA, Karatzas T. Comparison of erythropoietin and sildenafil protective role against ischemia/reperfusion injury of the testis in adult rats. Int Urol Nephrol 2013; 46:731-6. [PMID: 24097275 DOI: 10.1007/s11255-013-0569-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 09/17/2013] [Indexed: 12/27/2022]
Abstract
PURPOSE Tissue damage in testicular torsion/detorsion is caused not only by the ischemia, but also by the ischemia/reperfusion injury after detorsion. Erythropoietin and sildenafil are considered to protect against ischemia/reperfusion injury. Here, we studied and compared their actions in testicular torsion/detorsion in adult rats. METHODS Twenty-two adult male Wistar Albino rats were divided into four groups. Rats in group A (n = 5) were sham operated. Rats in group B (n = 5), group C (n = 6) and group D (n = 6) underwent torsion of the right testis and detorsion after 90 min. No pharmaceutical intervention was performed in group B. Erythropoietin (1,000 IU/kg) and sildenafil (0.7 mg/kg) were injected intraperitoneally in groups C and D, respectively, after 60 min of torsion. All animals were killed 24 h after detorsion, and their right testis was extracted, placed into 10 % formalin solution and sent for histopathological examination. The histological changes in the testes were scored according to the four-point grading system proposed by Cosentino et al. RESULTS All rats in group A had normal testicular architecture (grade 1). The untreated group B had a mean grade of 3.81 (range 3.65-4). The treated groups C (mean grade 3.24; range 3.05-3.45) and D (2.69, range 2.4-2.9) presented statistically significant better results (lower grades) compared with the untreated group B. Group D had significantly better results (lower grades) than group C. CONCLUSIONS The intraperitoneal injection of erythropoietin and sildenafil protects against ischemia/reperfusion injury after testicular torsion and detorsion. Sildenafil may have a stronger action than erythropoietin at the doses used in this study.
Collapse
Affiliation(s)
- Nick Zavras
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, 1 Rimini Street, Chaidari, 12462, Athens, Greece
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Pilot Feasibility Study of Transscrotal Near Infrared Spectroscopy in the Evaluation of Adult Acute Scrotum. J Urol 2013; 190:124-9. [DOI: 10.1016/j.juro.2013.01.080] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2013] [Indexed: 11/21/2022]
|
48
|
Hadway P, Reynard JM. The six-hour rule for testis fixation in testicular torsion: is it history? JOURNAL OF CLINICAL UROLOGY 2013. [DOI: 10.1177/2051415812472676] [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
Objectives: To explore the historical and recent evidence behind the urological rule that operative management within six hours of pain onset in testicular torsion is necessary for organ salvage To use this information to guide those involved in related medico-legal cases Methods: Focused search of the PubMed database. Translation from German to English of the sentinel work of Hellner from 1933. Results: Hellner’s canine studies showed that complete ischaemia of the testis beyond six hours resulted in necrosis and then atrophy. He also showed that the degree of torsion was a key determinant of outcome with organ salvage possible at up to 24 hours when the twist was less than 3600. Recent clinical series support these findings and suggest a success rate of ≥98% when exploration is performed within six hours. Testicular salvage may be as good as 89% when surgery is delayed to 12 hours. Related medico-legal cases may consider whether the operative delay was causative in testicular loss, and where liability may lie for any such delay. Specific literature in this area is sparse. Conclusion: Hellner’s work explains the basis of the six hour rule and its application remains valid in today’s clinical practice. Surgical exploration is indicated out to 24 hours, however, given that testes can still be saved and that the degree of torsion cannot be gleaned pre-operatively. Medico-legally, we believe that an operative delay of up to 8 hours is probably safe when considering the causation of testicular loss, but more data are needed. Liability is more complex in that many factors can contribute to the delay and may be beyond the control of the doctor or hospital.
Collapse
Affiliation(s)
- Paul Hadway
- Department of Urology, Oxford University Hospitals, Churchill Hospital, Oxford, UK
| | - John M Reynard
- Department of Urology, Oxford University Hospitals, Churchill Hospital, Oxford, UK
| |
Collapse
|
49
|
Baruga E, Guyton Munabi I. Case series on testicular torsion: an educational emergency for sub-Saharan Africa. Pan Afr Med J 2013; 14:18. [PMID: 23504299 PMCID: PMC3597862 DOI: 10.11604/pamj.2013.14.18.1736] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 09/11/2012] [Indexed: 11/11/2022] Open
Abstract
Testicular torsion remains a common surgical emergency of adolescent males presenting with sudden onset of intense scrotal pain in Africa. While the magnitude of testicular torsion is not known it has been identified as a cause of male infertility. Testicular loss in Africa is directly related to delay in surgery and the referral patterns at the point of first contact with health workers. This paper sets out to demonstrate the importance of the patient's age in the diagnosis of testicular torsion. A surgical audit was made of patients records collected over the last 30 years, for presentation of testicular related symptoms and analyzed to identify changes in the patterns of diagnosis over time and in different countries. There were 305 records found, for patients with an age range of 9-56 years. There were 195/305 (64%) with orchitis and 110/305 (36%) with testicular torsion. Testicular torsion is more common under the age of 18 years while orchitis was more common after 18 years of age (rho = -0.834, p value > 0.001 one tailed). This paper supports the development of educational interventions that promote the use of age in a simple diagnostic rule of the thumb for communities and lower cadre health workers in low resource settings.
Collapse
|
50
|
Affiliation(s)
- Anthony M Cox
- Department of Ear Nose and Throat Surgery, St Mary's Hospital, London W2 1NY.
| | | | | |
Collapse
|