Neovascularisation of the testes by experimental omentotesticulopexy

Abstract

With the currently used surgical procedures, surgical correction of extreme forms of high undescended testes is associated with an atrophy rate of 10% to 30%. In this experimental study in two groups of Sprague-Dawley rats of pubescent age, we examined whether fixation (pexy) of an omental flap on the testis (omentotesticulopexy = OMTX) permits preservation of the viability of the parenchyma. A left-sided OMTX was performed in group 1 with the animals under general anaesthesia. An omental flap was prepared. The tunica albuginea of the testis planned for OMTX was pierced with a needle (26 x 23 G) within an area with a diameter of 1 cm; a puncture distance of 2 mm was used. The omental flap was then fixed using absorbable monofilament 6-0 interrupted sutures. Six weeks later the spermatic vessel was transected at this site. The right testis was left untouched throughout the procedure; it remained in situ. In group 2 only the spermatic vessel on the left side was severed. The right testis was not manipulated and remained in situ. After a total of 10 weeks both testes were removed from all rats and fixed in formalin. Standardised haematoxylin and eosin staining was performed and histological sections were obtained. The size of the testicles, Leydig-cell count, viability, and calcified areas within the tissue were determined for all testicles. Student's t-test was used for statistical evaluation. The study showed that OMTX leads to neovascularisation in the area of fixation and that viability can be preserved within this area.

Testicular histology after intestinal pedicle flap (cecum) apposition in rats

“…The fixation of the intestinal flap seems better when sutured around the terminal portion of the testicular vessels. This has already been mentioned in a publication where omentum was used as a neovascularization inductor [15][16][17] .…”

“…The mobilization of a flap, with a long pedicle, to the scrotum can be very important in high position testicle surgical procedure. Some authors used bladder 14 and omentum [15][16][17] in their experiments. However, we should remember that orchidopexies in human beings have been increasingly indicated for very young boys, about nine months old 18 .…”

“…More recently, in the literature, efforts were observed to promote testicular revascularization by using omentum, bladder flaps or fasciovascular flaps sutured to the gonads in experimental models. These procedures have indicated a new way for reducing the rates of postoperative testicular atrophy [13][14][15] . The experiment results showed us, that it was easily possible to use an intestinal flap with its pedicle, without damage to the gross anatomy of the donor organ.…”

The effects of local and sustained release of fibroblast growth factor on testicular blood flow and morphology in spermatic artery— and vein-ligated rats

“…33 Moreover, experimental studies showed that division of spermatic vessels may result in testicular atrophy and severe damage to the germinal epithelium with spermatogenetic arrest and interstitial cell dysfunction. [12][13][14] Often testicular injury is much greater histologically than one would expect from gross examination of the testis. [12][13][14] An alternative to the Fowler-Stephens procedure is microvascular autotransplantation of the testes.…”

“…4,5,7,10,11 However, unacceptable testicular atrophy rates up to 30% to 50% have been reported after the Fowler-Stephens procedure. [2][3][4][5]7,[10][11][12][13][14] Recent advances in understanding of the biological process of neovascularization and the discovery of angiogeneic cytokines has enabled therapeutic angiogenesis. 15 Therapeutic angiogenesis is defined as induction and stimulation of neovascularization by local delivery systems containing angiogeneic growth factors in conditions of hypovascularity.…”