The Effect of Testicular Cryoablation on Testosterone Level in Rats: An Experimental Model of Histopathological Orchiectomy

PURPOSE

To determine whether testicular cryoablation caused histopathological orchiectomy, and to show its effects on serum total testosterone (t-testosterone) levels in rats.

MATERIALS AND METHODS

A total of 12 Wistar albino male rats were used in this study. The animals were divided into two groups, as cryoablation (9 rats) and control (3 rats) groups. Bilateral cryoablation was performed in the cryoablation group. T-testosterone levels were measured in both groups before scrotal exploration. Bilateral or­chiectomy was performed in both groups 10 days after the cryoablation procedure. T-testosterone was measured immediately before orchiectomy. Mann-Whitney U test was used for intergroup comparisons.

RESULTS

Baseline t-testosterone levels were 1.31 (0.78-2.45) ng/mL and 0.98 (0.91-2.05) ng/mL in the cryoab­lation and the control groups, respectively (P = .92). T-testosterone levels were 0.23 (0.07-1.12) ng/mL and 2.87 (0.63-3.06) ng/mL in the cryoablation and the control groups, respectively, in the blood samples obtained at the time of orchiectomy (P = .03). Histopathological examination of rat testes revealed varying degrees of paratestic­ular inflammation and necrosis in 13 of 18 testes in the cryoablation group. None of 6 testes showed necrosis in the control group.

CONCLUSION

Our study showed that histopathological orchiectomy could be obtained by cryoablation in rat testes.

The Diagnostic Value of Plasma SCUBE1, a Novel Biomarker of Platelet Activation, in Testicular Torsion: A Randomized, Controlled, Experimental Study

OBJECTIVE

To investigate the potential diagnostic value of plasma signal peptide, CUB (complement proteins C1r/C1s, Uegf, Bmp1) domain, epidermal growth factor (EGF)-like 1 (SCUBE1) protein in experimentally induced testicular torsion (TT).

MATERIALS AND METHODS

In this randomized, controlled, experimental study, 24 mature male Wistar rats were divided into four groups: 2- and 4-hour control (groups I and III, respectively), and 2- and 4-hour torsion (groups II and IV, respectively) groups. Torsion was performed by rotating the left testis 720° clockwise and maintained by fixing the testis. Plasma SCUBE1 levels and histopathological damage scores were compared.

RESULTS

There was significantly greater histopathological damage in the 4-hour torsion group compared with the other groups. SCUBE1 levels in this group were also higher than those in the other groups, and the difference was significant. There were significant correlations between histopathological scores and SCUBE1 levels.

CONCLUSION

SCUBE1, a novel marker of platelet activation, is elevated in TT. According to our results, platelet activation may play an important pathological role in tissue injury associated with testicular ischemia. Plasma SCUBE1 measurement may have diagnostic, therapeutic, or prognostic value in TT.

The effect of dexketoprofen on ischemia reperfusion injury

OBJECTIVE

The purpose of this study was to demonstrate the effects of dexketoprofen on experimental ischemia/reperfusion injury induced in rat testicles.

METHODS

Twenty-four male Wistar albino-type rats were randomly separated into three groups. To develop testicular torsion, the right testicle was rotated 720° clockwise. After five hours of rotation, reperfusion was applied for 24 hours. The control group rats (Group C) had no procedures or treatments; basal numbers were used. Intraperitoneal 25 mg/kg dexketoprofen (1 cc) (Group D) or the same volume of serum physiologic (Group SP) were given to the Group D and Group SP rats 40 minutes before and 12 hours after detorsion. Twenty-four hours after detorsion, histopathological evaluation was performed by bilateral orchiectomy. Malondialdehyde (MDA) levels were detected in testicular tissue and in serum.

RESULTS

Histopathologic changes in the spermatic cells of torsioned testicles in Group D were significantly less than those of Group SP (p < 0.05). MDA levels in both testicles in Group D were similar to those of the control group. Although they were lower than Group SP, the difference was not statistically significant. Serum MDA levels were lower in Group D compared to the other groups (p < 0.05).

CONCLUSION

We detected that dexketoprofen decreases I/R injury in both the torsion-formed testicle and the contralateral testicle. Thus, in patients who have urgent surgery for testicular detorsion, dexketoprofen can be preferred as an analgesic to reduce I/R injury. Further study is warranted to demonstrate this effect of dexketoprofen (Tab. 3, Fig. 1, Ref. 30).

Is procalcitonin valuable in the differential diagnosis of testicular torsion and epididymo-orchitis

OBJECTIVE

To evaluate the efficacy of procalcitonin (PCT) in the differential diagnosis of testicular torsion and epididymo-orchitis.

METHODS

This experimental study was performed in the research laboratory of Dicle University, School of Medicine, Diyarbakir, Turkey between March and June 2008. The study included 24 male rats randomized equally in 3 groups: sham, epididymo-orchitis, and torsion groups. Blood samples were obtained from all rats at the beginning of the study. After torsion and infection occurred in the testes, new blood samples were obtained for PCT measurement. Then, all the right testes of the rats were excised for histopathological evaluation. The Wilcoxon signed test was used for statistical evaluation.

RESULTS

Pre- and post PCT levels were statically compared, and PCT levels were significantly higher in the epididymo-orchitis group.

CONCLUSION

Procalcitonin could be an easy, fast, and safe marker for use in the differential diagnosis of testicular torsion and epididymo-orchitis.

Late Hormonal Levels, Semen Parameters, and Presence of Antisperm Antibodies in Patients Treated for Testicular Torsion

In spite of prompt diagnosis and either orchiectomy or preservation of the affected testis, infertility remains a significant sequel to testicular torsion. The objective of this study was to evaluate the late endocrine profile, seminal parameters, and antisperm antibody levels after testicular torsion. We also analyzed the impact of orchiectomy or detorsion on the organ fate. Of 24 patients evaluated after testicular torsion, 15 were treated with orchiectomy (group 1) and 9 were treated with orchiopexy (group 2). All subjects were assessed by semen analysis, endocrine profile (levels of follicle-stimulating hormone, luteinizing hormone, and testosterone), and seminal antisperm antibody levels. A group of 20 proven fertile men was used as the control. Median ischemia time in group 1 (48 hours) was significantly higher than in group 2 (7 hours). Both groups demonstrated decreases in sperm count and morphology compared with controls. Group 1 showed a significantly higher motility than group 2 (P = .02). Group 1 also showed a significantly better morphology by World Health Organization and Kruger criteria than group 2 (P = .01). All patients presented endocrine profiles within the normal range, and no significant differences in antisperm antibody levels were detected between the groups. However, a trend for higher levels was found in patients treated for testicular torsion, regardless of the fate of the testis. Moreover, no significant correlation was found between antisperm antibody levels and age at torsion, ischemia time, seminal parameters, or treatment applied. In conclusion, we found that after torsion patients maintain late hormonal levels within the normal range. Testicular fate did not have any correlation with the formation of antisperm antibodies. Although sperm quality was preserved in most of the patients with the exception of sperm morphology, patients treated with orchiectomy presented better motility and morphology compared with the detorsion group. Further studies may clarify whether maintenance of a severely ischemic testicle may impair testicular function.

Protective effect of alpha-lipoic acid in experimental spermatic cord torsion

OBJECTIVE

We investigated the effect of alpha-lipoic acid (LA) in rats that were subjected to torsion/detorsion of the spermatic cord in a comparative controlled experiment.

METHODS

Forty-eight male Wistar rats, randomized in two groups, received intraperitoneal injections of LA (LA group; aqueous solution at 36 mg/kg of body weight per day) or equal volume of saline (control group) 21, 9, and 1 h before torsion of the spermatic cord. Rats in each group were distributed in four subgroups, each comprising six animals. All surgical procedures were performed under inhaled ether anesthesia. Ischemia was induced by 720-degree torsion of the spermatic cord for 3 h. The right testis was assessed through longitudinal scrotal incision. After each surgical procedure, scrotal incisions were closed with 4-0 nylon monofilament. Ipsilateral testes and arterial blood samples were collected at the end of ischemia and 1, 3, and 6 h after detorsion. Thiobarbituric acid-reactive substances and reduced glutathione levels (micromoles per gram of wet tissue) were assayed in testis. Total antioxidant power was measured in blood plasma.

RESULTS

LA pretreatment promoted a significant decrease in testicular concentrations of thiobarbituric acid-reactive substances and simultaneously induced an increase in reduced glutathione concentrations at all time points studied. Plasma total antioxidant power levels increased significantly during reperfusion (T-1) in LA-treated rats compared with control rats.

CONCLUSION

LA administered before torsion of the spermatic cord showed significant protective effects against ischemia/reperfusion injury by decreasing lipid peroxidation and regulating testicular reduced glutathione and plasma total antioxidant power levels.

Experimental testicular torsion: reperfusion blood flow and subsequent testicular venous plasma testosterone concentrations

OBJECTIVES

To examine the effect of torsion on subsequent testicular venous plasma testosterone concentrations (TVT) and to determine the relationship between the TVT values 30 days after torsion repair and testicular reperfusion immediately after torsion repair, because testicular torsion followed by repair induces an ischemia/reperfusion injury of the testis.

METHODS

Adult male rats were subjected to 1 hour of 720 degrees testicular torsion, a time and degree of torsion that has been shown to cause severe impairment of spermatogenesis. Testicular microvascular perfusion before torsion, during torsion, and 5 minutes after torsion repair was determined by laser Doppler flowmetry. The animals were evaluated 3 days and 30 days later for microvascular perfusion and TVT.

RESULTS

Experimental torsion significantly reduced testicular vascular perfusion. Five minutes after torsion repair, the mean flow values had returned to approximately 70% of the pretorsion values. Testicular torsion significantly reduced TVT at both 3 and 30 days after torsion repair. TVT 30 days after torsion repair was significantly, but inversely, related to reperfusion values immediately after torsion repair.

CONCLUSIONS

These results demonstrate that the minimal duration and degree of torsion known to cause loss of spermatogenesis in the rat also causes a significant reduction in testicular androgen production in the long term. This effect was inversely related to the reperfusion values immediately after torsion repair. This suggests that reperfusion/oxidative stress may play a role in Leydig cell dysfunction, as well as by acting directly in germ cell apoptosis.

Beneficial effects of melatonin compared with allopurinol in experimental testicular torsion

BACKGROUND/PURPOSE

Several antioxidant agents such as allopurinol have been used to prevent ischemia-reperfusion (I/R) injury-induced tissue damage after experimental testicular torsion so far. The current study was designed to determine the effect of melatonin, which is a potent antioxidant agent, in preventing testicular damage following torsion.

METHODS

Sixty prepubertal male Wistar-Albino rats were divided into 5 groups: control (C), torsion (T), torsion plus detorsion (TD), torsion plus allopurinol (200 mg/kg) plus detorsion (A), and torsion plus melatonin (50 mg/kg) plus detorsion (M). Left testes were rotated 720 degrees for 6 hours. The torsed testes were detorsed. Detorsion time was 6 hours. In all groups, left orchiectomies were performed to determine the tissue levels of malondialdehyde (MDA) and histopathologic changes. Blood samples were taken to measure serum creatine phosphokinase (CPK) levels. The results were analyzed statistically.

RESULTS

Serum CPK levels of groups A and M were found to be significantly lower than groups T and TD (P <.05). Tissue MDA levels in group M were statistically different from groups T and TD (P <.05). However, in groups A and T, MDA levels were similar (P >.05). The highest histologic grade was determined in group TD (3.8 +/- 0.5). Histologic grade of group M was significantly lower than group TD (P <.001), but there was no histologic difference between testes of groups A and TD (P >.05).

CONCLUSIONS

These results have shown that melatonin treatment prevents I/R injury both biochemically and histopathologically, whereas allopurinol treatment prevents it only biochemically in experimental testicular torsion. Melatonin is a potent antioxidant agent more effective than allopurinol in preventing testicular I/R injury.

The significance of measuring the time course of serum malondialdehyde concentration in patients with torsion of the testis

PURPOSE

We determined the time course of malondialdehyde, a measure of free radical damage, in patients undergoing standard surgical treatment for testicular torsion.

MATERIALS AND METHODS

Patients presenting with testicular torsion were studied prospectively. Blood samples were obtained after administering general anesthesia but before surgical incision, and 10 minutes, 30 minutes and 24 hours after detorsion. Orchiopexy was performed in patients with viable testes (group 1) and orchiectomy was performed in those with nonviable testes (group 2). Further blood samples were obtained 1 and 3 months after surgery. Similar blood samples were taken from controls, including patients younger than 40 years undergoing other operations involving manipulation of the testis, such as hydrocelectomy or orchiopexy (group 3). The level of malondialdehyde in each serum sample was determined by the thiobarbituric acid reaction.

RESULTS

A total of 65 patients were studied, including 56 with testicular torsion and 9 controls (group 3). Of the 56 patients 11 (19.6%) with testicular torsion underwent ipsilateral orchiectomy and contralateral orchiopexy (group 2). The remaining 45 patients (80.4%) underwent bilateral orchiopexy (group 1). However serum malondialdehyde was estimated in only 34 of the 56 patients with torsion. Mean malondialdehyde at 0, 10 and 30 minutes, 24 hours, and 3 and 6 months was 3.3, 3.69, 3.69, 2.9, 2.65 and 2.39 nmol./ml. on the 24 group 1 patients, 3.53, 4.56, 3.87, 2.87, 2.82 and 2.64 nmol./ml. in the 10 group 2 patients, and 3.6, 3.08, 3.18, 2.95, 2.88 and 2.65 nmol./ml. in the 9 group 3 controls, respectively. The highest serum malondialdehyde was at 10 minutes after detorsion in groups 1 and 2. There was a statistically significant difference in malondialdehyde between groups 1 and 2 compared with group 3 at 10 minutes (p <0.04). Serum malondialdehyde returned to baseline at 24 hours in all patients.

CONCLUSIONS

The results of this study indicate that testicular torsion and its treatment with detorsion is an example of ischemia-reperfusion injury, producing measurable changes in malondialdehyde in humans. Thus, serum malondialdehyde could be used to determine the extent of injury.

The effect of ATP-MgCl(2) on prevention of reperfusion injury after unilateral testicular torsion

This study was designed to investigate the effect of ATP-MgCl(2) administered before and after detorsion on the prevention of reperfusion injury after unilateral testicular torsion. The rats were divided into six groups, each containing six rats. Torsion was created by rotating the left testes 720 degrees in a clockwise direction. Group 1 functioned as a control group. Torsion only was carried out in Group 2. Detorsion was carried out in Group 3. ATP-MgCl(2) (100 micromol/kg) was injected intravenously immediately before detorsion in Group 4. ATP-MgCl(2) (100 micromol/kg) was injected intravenously immediately after detorsion in Group 5. Saline was injected intravenously immediately after detorsion in Group 6. The effect of ATP-MgCl(2) on reperfusion injury was investigated by determining the levels of thiobarbituric acid-reactive substances (TBAR) and resulting lipid peroxidation in the bilateral testicular tissue. Testicular torsion and detorsion caused a significant increase in the TBAR levels in the bilateral testicular tissue. TBAR levels decreased to approximately normal levels in Groups 4 and 5. It is concluded that if reperfusion injury has occurred in both testes after unilateral testicular torsion, ATP-MgCl(2) administered before or after detorsion may prevent reperfusion injury in testicular torsion.

Evaluation of contralateral testicular damage after unilateral testicular torsion by serum inhibin B levels

BACKGROUND/PURPOSE

It is still controversial whether unilateral testicular torsion (TT) affects contralateral testis. The authors wanted to evaluate contralateral testicular damage in a rat model by the serum inhibin B levels, which is suggested as a marker of Sertoli cell function and spermatogenesis.

METHODS

Fifty peripubertal male Wistar Albino rats were divided into 5 groups each containing 10 rats. Surgery was conducted under intraperitoneal 1-shot ketamine (50 mg/kg) anesthesia. Torsion-detorsion, torsion-detorsion-orchiectomies, orchiectomies, and sham operations were performed on the right testicle through a midline incision. Torsions were created by rotating the right testes 720 degrees in a clockwise direction and maintained by fixing the testes to the scrotum with a silk suture. Torsion duration was 4 hours. After each surgical intervention the incisions were closed. In group 1, 3-mL blood samples were taken to determine basal values of inhibin B in serum, and bilateral orchiectomies were performed. In group 2, 4 hours of torsion and detorsion was created and 1 month later, 3-mL blood samples were taken, and bilateral orchiectomies were performed. In group 3, 4 hours of torsion-4 hours of detorsion was created, and right orchiectomies were performed and 1 month later, 3-mL blood samples were taken and contralateral orchiectomies were added. In group 4, unilateral orchiectomies were performed, and 1 month later, 3-mL blood samples were taken, and contralateral orchiectomies were added. After the measurement of the serum inhibin B levels and histopathologic examinations, results are expressed as mean +/- SD.

RESULTS

Serum inhibin B levels expressed as mean +/- SD were 108.233 +/- 21.296 pg/mL for group 1, 54.065 +/- 16.910 pg/mL for group 2, 74.195 +/- 2.779 pg/mL for group 3, 108.335 +/- 26.078 pg/mL for group 4, and 107.645 +/- 4.705 pg/mL for group 5. Inhibin B levels in group 2 and group 3 were different from group 1, group 4, and group 5 (P <.05). In histologic examination, Johnsen's scores expressed as mean +/- SD of right testes were 9.74 +/- 0.08 for group 1, 3.64 +/- 3.36 for group 2, and 9.86 +/- 0.05 for group 5. Histologic findings in group 2 were different from group 1 and group 5 (P <.05). Johnsen's scores expressed as mean +/- SD of left testes were 9.78 +/- 0.09 for group 1, 9.75 +/- 0.14 for group 2, 9.76 +/- 0.15 for group 3, 9.79 +/- 0.07 for group 4, and 9.82 +/- 0.08 for group 5, and there was no difference between groups (P >.05).

CONCLUSIONS

The serum inhibin B levels decrease after unilateral TT reflecting contralateral testicular damage. Orchiectomy to prevent contralateral testicular damage after TT may not be effective after critical period. Measurement of inhibin B levels to evaluate contralateral testicular damage after unilateral TT is more effective than histopathologic examination.

The clinical utility of serologic markers in the evaluation of the acute scrotum

OBJECTIVE

To examine the presence of interleukin-1 (IL-1), interleukin-6 (IL-6), and creatine phosphokinase-MM (CPK-MM) in patients with acute scrotal pain and assess their clinical utility in the diagnosis of testicular torsion (TT) and epididymitis.

METHODS

Twenty-five patients with acute scrotal pain were prospectively enrolled over a two-year period. History, physical examination, complete blood count, urinalysis, and scrotal ultrasound were performed. Testicular torsion was confirmed by surgical exploration. Epididymitis was diagnosed using physical examination, scrotal ultrasound, and positive urinalysis. Venous blood was assayed for IL-1, IL-6, and CPK-MM in triplicate during the routine drawing of blood in the emergency department. The data are reported as medians +/- interquartile ranges (IQRs).

RESULTS

Twenty-five patients with acute scrotal pain were evaluated; 11 with TT, three with torsion of the appendix testis (TAT), ten with epididymitis, and one with varicocele. One patient had both TT and epididymitis. Interleukin-1 was not detectable in either group. The CPK-MM values between TT and epididymitis were virtually identical at 99.8 and 100 IU/L, respectively. The median value for IL-6 was 1. 03 (IQR = 0.19 to 2.86) vs 20.86 (IQR = 2.14 to 65.50) pg/mL in the torsion and epididymitis groups, respectively. The 97.5% CI for the difference of medians of 19.9 was 0.4 to 65.1, p = 0.02. Using receiver operating characteristic (ROC) curve analysis for IL-6, the area under the curve was 0.82 for torsion and 0.67 for epididymitis. Using a cutoff value of IL-6 >/= 1.41 pg/mL, the positive predictive value of IL-6 in diagnosing epididymitis was 78.6%, with a negative predictive value of 100% for TT. There were no cases of missed TT on follow-up.

CONCLUSIONS

This preliminary investigation of serologic markers demonstrates that IL-6 is significantly elevated in epididymitis as compared with TT. Creatine phosphokinase-MM and IL-1 were not found to be of diagnostic utility. The small sample size of this study precludes a definitive conclusion as to the utility of these markers in the emergency department. However, IL-6 may be clinically useful as an additional element in differentiating the causes of acute scrotal pain, and further study is warranted.

Rescue of testicular function after acute experimental torsion

PURPOSE

Spermatic cord torsion results in impairment of testicular function. The mechanism of this injury is unclear; however, intracellular Ca++ influx and reactive oxygen species have been implicated in the testicular damage following torsion and reperfusion. In the present study a model of testicular torsion in the rat was used to determine whether testicular function following torsion can be rescued by the administration of antioxidants and Ca++ channel blockers.

MATERIALS AND METHODS

Seventy-two animals were divided into 9 groups. Animals underwent 1 hr. or 2 hrs., 720 degrees experimental torsion. Animals received combinations of superoxide dismutase (SOD), catalase, allopurinol, and verapamil. Drugs were administered intravenously during the last 15 minutes of experimental torsion and the first hour of reperfusion. Bilateral testicular function was determined 60 days after experimental torsion by measuring testis weights, daily sperm production (DSP), and testicular venous testosterone concentrations. Ipsilateral values were compared to both control and contralateral values.

RESULTS

SOD + catalase and SOD + catalase+verapamil treatments caused significant rescue of tests function following 1 hr. experimental torsion. Mean +/- s.e. testis weights and DSP in control animals were 1.75 +/- 0.6 g. and 18.4 +/- 0.3 x 10(6) sperm/g./d. The same value for testes experiencing 1 hr. experimental torsion were 0.72 +/- 0.6 g. and 2.3 +/- 0.5 x 10(6) sperm/g./d. The values from testes receiving 1 hr. experimental torsion followed by SOD + catalase were 1.45 +/- 0.17 g. and 9.9 +/- 1.8 x 10(6) sperm/g./d. Neither allopurinol nor verapamil added benefit. No significant rescue was seen in testes undergoing 2 hrs. experimental torsion.

CONCLUSIONS

Treatment with oxygen radical scavengers provides significant rescue of testicular function after acute experimental torsion.

Serum creatine kinase enzyme levels in the early diagnosis of spermatic cord torsion

Delay in the diagnosis of spermatic cord torsion (SCT) is still a significant cause of testicular loss in children. The aim of this experimental study was to assess the diagnostic value of serum creatine kinase (CK) in the early period following SCT. Forty male rats were assigned randomly into five similar groups: group A, control; group B, sham, right testis exposed, manipulated, and blood sampling at 6th h; group C, right SCT, blood sampling at 2nd h; group D, right SCT, blood sampling at 4th h; and group E, right SCT, blood sampling at 6th h. Ck and its isoenzymes were measured in the sera of all animals. All testes were removed and examined histopathologically. Significant increases in serum CK levels compared to control and sham groups were observed at 4 and 6 h following SCT. The major increase in CK was observed in the CK-MM isoenzyme fraction. Histologic pictures showed varying degrees of edema, vascular congestion, and hemorrhage in the testicular tissue, but no necrosis in any of the study groups. These results showed that serum CK levels in rats in the early period following SCT increase significantly before necrosis of testicular tissue. This may be of value as a diagnostic test, to corroborate findings from clinical studies.

Testicular torsion: a follow-up study

Thirty-five patients were examined 6-11 years after operation for torsion of the testis. Loss of testicular tissue was significantly associated with long preoperative duration of symptoms and with low postoperative sperm counts. The sex hormones were normal in the majority of patients but there were significantly higher levels of both FSH and LH in the group of patients with symptoms exceeding 8 hours. There was also a higher prevalence of abnormal semen quality in the same group. Furthermore, FSH and LH levels correlated significantly to the duration of symptoms and correlated inversely to the sperm count and concentration. Measurement of carnitine levels in seminal plasma, as a sign of vas deferens obstruction or dysfunction of epididymis, and of autoantibodies against spermatozoa revealed no significant findings.

Semen quality and endocrine parameters after acute testicular torsion

Of 16 postpubertal patients evaluated following testicular torsion 9 were treated with detorsion and bilateral orchiopexy (detorsion group), and 7 were treated with ipsilateral orchiectomy and contralateral orchiopexy (orchiectomy group). Each patient was evaluated with regard to semen quality, endocrine parameters (follicle-stimulating hormone, luteinizing hormone and testosterone) and the presence or absence of semen antisperm antibodies. These data were compared to similar data from a group of proved fertile semen donors. The semen quality in the detorsion group did not differ significantly from that of controls (p = 0.25) but follicle-stimulating hormone was significantly elevated compared with that of controls before and after stimulation with gonadotropin-releasing hormone. The orchiectomy group, which had been subjected to prolonged torsion (mean 69 hours), demonstrated a significant decrease in semen quality compared with semen quality in controls (p = 0.001), with average sperm density of only 29.0 million per ml. Baseline and post-stimulation levels of follicle-stimulating hormone in the orchiectomy group were also significantly abnormal when compared with those in controls and in the detorsion group. Our study demonstrates that testicular damage (changes in semen quality and/or endocrine parameters) occurs in the ipsilateral and contralateral testis following torsion, regardless of treatment modality. However, with early intervention by detorsion and testicular salvage, subsequent semen quality is likely to remain within normal limits. Late surgical intervention, even with removal of the nonviable testes, may result in significant impairment of semen quality.

Testicular oximetry: a new method for the assessment of tissue perfusion and viability following torsion and detorsion

This study evaluated the use of a polarographic surface PO2 electrode to assess testicular perfusion and viability following torsion and detorsion. Adult male Sprague-Dawley rats were divided into groups and subjected to unilateral testicular torsion and detorsion of varying degrees and durations. Rats subjected to sham torsion or 720 degrees torsion did not show significant decreases in testicular PO2 after 15 minutes, whereas those subjected to 1,080 degrees torsion or spermatic cord ligation uniformly decreased their testicular PO2 to 0 mm Hg within 10 minutes. Testicular PO2 values were similar in rats subjected to 60 minutes of 720 degrees torsion followed by detorsion and those undergoing 15 minutes of 1,080 degrees torsion and detorsion. Rats subjected to breathing 100% oxygen uniformly increased their testicular PO2 to an average of more than twice room-air values. However, rats subjected to 1,080 degrees torsion for 6 hours followed by detorsion did not increase their testicular PO2 when subjected to breathing 100% oxygen, whereas those subjected to 720 degrees torsion for 6 hours followed by detorsion did increase their testicular PO2 when subjected to breathing 100% oxygen. The latter rats did not show microscopic changes associated with acute testicular infarction, whereas the former did.(ABSTRACT TRUNCATED AT 250 WORDS)

The fate of the human testes following unilateral torsion of the spermatic cord

In an attempt to explain the oligozoospermia commonly observed after unilateral testicular torsion, 56 patients with acute torsion were investigated prospectively. Blood was taken pre-operatively for antibody studies and a contralateral testicular biopsy was performed at the time of orchiopexy. At review 3 to 6 months post-operatively, late testicular atrophy was assessed and repeat antibody studies were performed together with a hormone profile and seminal analysis. Although the duration of torsion showed a close correlation with the degree of testicular atrophy (P less than 0.001), no such association could be demonstrated between duration of torsion and subsequent sperm concentration. Twenty of 35 patients had histological evidence of a pre-existing partial maturation arrest in spermatogenesis. Fifteen of 19 with the abnormality were oligozoospermic, while all of those with normal testicular histology had a sperm concentration within the normal range. Anti-sperm antibody formation following torsion was minimal and antitestis antibodies were absent. Testes prone to torsion already show impaired spermatogenesis.

Mechanisms of injury in unilateral testis torsion

We investigated the mechanisms of injury involved in unilateral testis torsion as well as the interventional effects of orchiectomy at 48 h and immunosuppression with corticosteroids in rats. Torsion was associated with abnormal contralateral testis histology and raised antilymphocytes and antisperm antibody titers. Both orchiectomy and steroid administration lessened these findings, suggesting that an immunological process underlies the abnormality seen in this experiment model.

Testicular torsion does not cause autoimmunization in man

Forty-seven patients have been reviewed 2-10 years after torsion of the testicle. Thirty-six (77 per cent) were found to have abnormalities of exocrine or endocrine gonadal function. None showed evidence of testicular autoimmunization using standard assays of sperm agglutination and immobilization by serum or seminal plasma, and the serum mixed agglutination reaction (MAR) test. In addition, 11 cases of acute torsion were followed at intervals for 3-6 months after surgery, but no evidence was observed of the transient development of sperm antibodies. Our findings confirm poor gonadal function after torsion, but do not support the recent suggestion that it is caused by autoimmunization.

Testicular exocrine malfunction after torsion

The exocrine and endocrine functions of the testis were assessed in 67 patients a median of 4.0 years after unilateral torsion (range 3 months-12 years). Of 54 patients who underwent orchidopexy, some atrophy of the affected testis developed in 46; the degree of atrophy was significantly correlated with the duration of torsion (r = -0.56, p less than 0.001). The remaining 13 patients had undergone orchidectomy after a mean duration of torsion of 71 h. Seminal analysis was abnormal in 44 of 51 patients tested (86%), and the low total motile sperm count correlated with the duration of torsion (r = -0.53, p less than 0.001). Sperm counts were much lower in men with torsion for longer than 8 h than those with a shorter period of torsion (median 7.2 X 10(6) v 83.5 X 10(6); p less than 0.00003). Serum levels of luteinising hormone, prolactin, testosterone, and follicle-stimulating hormone were generally within normal limits. An acute ischaemic episode affecting only one testis causes bilateral loss of exocrine function in most patients, while endocrine function is preserved.

Testicular torsion: late results with special regard to fertility and endocrine function

Late results were determined for 42 patients who had undergone detorsion and fixation for unilateral testicular torsion in the prepubertal and pubertal age. Exocrine and endocrine function for the testes was determined in 30 patients who had reached postpuberal age. Patients who underwent detorsion and fixation 8 hours or less after the onset of symptoms had normal-sized testicles and only slight changes in testicular morphology. When treatment was delayed and detorsion was done more than 8 hours later a marked decrease was observed in testicular size. The exocrine function in patients with torsion was reduced. The semen quality, as judged by 2 semen analyses, was normal in 15 patients, doubtful in 3 and pathological in 12. Even when detorsion was done 4 hours or less after the onset of symptoms the exocrine function of the testes was normal in only 50 per cent of the cases. In patients with doubtful and pathological sperm analyses higher follicle-stimulating and luteinizing hormone levels were observed.