The continuing conundrum of testicular torsion

Williamson, R. C. N.

doi:10.1002/bjs.1800720702

Cited by 69 publications

(38 citation statements)

References 40 publications

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“…Intrascrotal torsions are common in transpubertal and postpubertal age due to the increase in testicular mass [7][8][9]. Vigorous exercise, local trauma, a powerful cremasteric reflex and sexual excitement are possible precipitating factors of TT [2,10].…”

Section: Resultsmentioning

confidence: 99%

The Etiology of Acute Scrotal Swelling on Surgical Exploration among Children and Adolescents in Jahra

Grover¹,

Adib²,

Joseph³

et al. 1998

Med Princ Pract

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Objective: To describe the clinical presentation as well as the outcome of surgically explored acute scrotal swellings among children and adolescents recorded at the Al-Jahra Hospital, Kuwait during the period 1985–1995. Methods: Hospital records of 120 cases were reviewed. Results: Seventeen percent of the cases were found to be testicular torsions (TT) and 40% torsions of testicular appendages (TAT). Other etiologies included traumatic swelling (15%), idiopathic edema (13%), epididymo-orchitis (10%), hydroele (4%) and others (2%). Ages of patients ranged from 6 months to 18 years, averaging 9.3 years (SD = 2.9) for TAT cases and 10.1 years (SD = 6.4) for TT cases. Swelling and pain were located on the left side for 65% of the torsion cases. Direct trauma was reported in 22% of the torsion cases. In 90% of TT cases, orchidopexy was performed with success. Subsequent testicular atrophy occurred in only 1 patient who had symptoms for more than 48 h prior to surgery. Orchidectomy was directly performed on necrosed testes in a patient with signs lasting more than 48 h, and another patient with signs lasting 4 days. Conclusions: Primary health care physicians in Jahra district should continue to educate parents and adolescents to recognize the gravity of scrotal pain, and the importance of early response as a way of avoiding testicular necrosis.

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Section: Resultsmentioning

confidence: 99%

The Etiology of Acute Scrotal Swelling on Surgical Exploration among Children and Adolescents in Jahra

Grover¹,

Adib²,

Joseph³

et al. 1998

Med Princ Pract

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“…Testicular torsion is a surgical emergency in humans [26] that requires surgical intervention to allow reperfusion of the affected testis. The extent of testicular damage with subsequent necrosis after spermatic cord torsion is related to the duration and severity of the torsion.…”

Section: Discussionmentioning

confidence: 99%

Effects of Early Phase of Preconditioning on Rat Testicular Ischemia

Ceylan

Yüncü²,

Armutçu³

et al. 2005

Urol Int

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Introduction: Brief episodes of ischemia followed by periods of reperfusion generate a powerful protective mechanism in cell, tissue or organ, which increase the resistance to further ischemic damage. This is known as ischemic preconditioning, and has not been investigated in testis. The present experiments were undertaken to determine whether early phase of ischemic preconditioning is evident in rat testis. Materials and Methods: Surgery was conducted under thiopental (60 mg/kg, intraperitoneal) anesthesia in male Wistar rats. Surgical procedures were performed through a midline incision. Group 1 was designed as a sham group. In group 2, which served as the ischemia group, the animals were subjected to unilateral testicular torsion by rotating the left testis 720° in a clockwise direction. Then, this testis was maintained in the torsion position by fixing with a silk suture to the scrotal wall for 90 min. In groups 3 and 4, 5 or 10 min ischemia followed by 10 min reperfusion was introduced, respectively, to induce single cycle ischemic preconditioning. In group 5, which served as the multiple cycle preconditioning group, 3 cycles of 10 min ischemia and 10 min reperfusion were applied prior to 90 min ischemia. Both ipsilateral and contralateral testes were removed from the rats at the end of the experimental periods, and tissue malondialdehyde (MDA), nitric oxide (NO) levels, xanthine oxidase (XO), myeloperoxidase (MPO) and superoxide dismutase (SOD) activities were measured. Both testes were also evaluated histologically, assessing interstitial edema, congestion, hemorrhages, rupture of tubules and Leydig cell proliferation. Results: 90 min ischemia produced a marked increase in MDA level in left testis. However, all ischemic preconditioning protocols used in this study did not show any significant modification in MDA, NO levels or XO, MPO and SOD activities. Histological grading scale was also similar in ischemia and preconditioning groups. Conclusion: These results suggest that there are no protective effects with ischemic preconditioning in rat testis as showed by biochemical analysis and histological examinations.

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“…Testicular torsion is a pathological condition that renders the testis ischemic, and surgical intervention is usually required for reperfusion of the testis [1] . However, even after reperfusion, testicular atrophy is common [2] . It has been shown that ischemia/reperfusion injury of the rat testis results in a permanent loss of spermatogenesis despite return of blood flow [3] and continued presence of functional Leydig cells [4] and Sertoli cells [5] .…”

Section: Introductionmentioning

confidence: 99%

Salutary Effects of N-Acetylcysteine on Apoptotic Damage in a Rat Model of Testicular Torsion

Payabvash¹,

Salmasi²,

Kiumehr³

et al. 2007

Urol Int

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Introduction: Numerous studies performed in recent years have shown protective effects of N-acetylcysteine (NAC) on cardiac and renal tissue damage following ischemia/reperfusion injury. We assessed the effectiveness of systemic administration of NAC, at a therapeutic dose, in a rat model of a 1-hour 720-degree testicular torsion/detorsion. Materials and Methods: Sprague-Dawley rats were divided into five groups, 14 animals in each: group 1 animals underwent sham operation as the control group; group 2 rats underwent torsion/detorsion and received saline injection, and the animals in groups 3, 4, and 5 received intraperitoneal injections of 150 mg/kg NAC 30 min before torsion, after torsion, and after detorsion, respectively. Markers of oxidative stress as well as germ cell apoptosis indices were assessed 4 and 24 h after detorsion, respectively. Results: The apoptosis indices were significantly higher in group 2 as compared with the control group. Four hours after detorsion, the testicular level of lipid peroxidation was significantly increased, and antioxidant enzyme activities were significantly decreased in group 2 as compared with the controls. Administration of NAC either 30 min before or after torsion (groups 3 and 4) significantly improved the germ cell apoptosis indices and oxidant/antioxidant balance. Administration of NAC after detorsion had no significant effect on biochemical markers or germ cell apoptosis. Conclusion: Administration of NAC prior to torsion or detorsion, but not after detorsion, induces protective effects against ischemia/reperfusion injury in a rat model of testicular torsion.

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The continuing conundrum of testicular torsion

Cited by 69 publications

References 40 publications

The Etiology of Acute Scrotal Swelling on Surgical Exploration among Children and Adolescents in Jahra

The Etiology of Acute Scrotal Swelling on Surgical Exploration among Children and Adolescents in Jahra

Effects of Early Phase of Preconditioning on Rat Testicular Ischemia

Salutary Effects of N-Acetylcysteine on Apoptotic Damage in a Rat Model of Testicular Torsion

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