Torsion of only spermatic cord in the absence of testis and/or epididymis results in contralateral testicular hypoxia

Abstract

Unilateral spermatic cord torsion in the presence or absence of ipsilateral testis causes hypoxia in the contralateral testis. An experimental study was conducted to find the most important structure that causes contralateral testicular hypoxia following ipsilateral twisting. In five groups each consisting of 10 rats sham operations, epididymoorchiectomy, spermatic cord torsion, spermatic cord torsion following subepididymal orchiectomy or spermatic cord torsion following epididymoorchiectomy were performed. Lactic acid, hypoxanthine and thiobarbituric acid reactive products of lipid peroxidation (TBAR) were determined in the contralateral testis. While lactic acid, hypoxanthine and TBAR values did not differ significantly following sham and epididymoorchiectomy procedures, evaluation of other groups revealed significantly increased values compared with sham and epididymoorchiectomy groups. Since torsion of only spermatic cord and testicular vasculature causes contralateral testicular hypoxia, testis and epididymis do not seem to be mandatory for occurrence of contralateral testicular hypoxia. Testicular artery under distress seems to be the most important structure that results in contralateral testicular hypoxia following torsion.

DNA Flow Cytometry Reveals Depressed Spermatogenetic Activity in the Contralateral Testis within 24 h of Ipsilateral Spermatic Cord Torsion Independently of the Presence of the Testis and Epididymis

“…Furthermore, the contralateral testis deteriorated following torsion of only the spermatic cord in the absence of both testis and epididymis. This has previously been found to elevate the biochemical indicators of tissue hypoxia such as lactic acid, hypoxanthine and thiobarbituric-acid-reactive products of lipid peroxidation [18]. The present study has additionally revealed that spermatogenetic activity has also been depressed in the contralateral testis following torsion of only the spermatic cord.…”

“…This finding suggests the testicular vasculature and spermatic cord under distress to be the most important structures that initiate adverse effects on the contralateral testis. Since the torsion of only the spermatic cord has resulted in elevation of biochemical indicators of tissue hypoxia, the damage seems to be a hypoxic injury [18]. …”

“…Since the contralateral testis may also deteriorate in the absence of the ipsilateral testis during varicocele [5], the ipsilateral testis does not seem to be mandatory for contralateral testicular damage. A recent experimental study further revealed that torsion of only the spermatic cord but not of both testis and epididymis may lead to hypoxia in the contralateral testis [18]. Currently, the roles of both testis and epididymis in contralateral testicular damage encountered following unilateral torsion remain unexplained.…”

The dilemma in the diagnosis of acute scrotum: clinical clues for differentiating between testicular torsion and epididymo-orchitis

“…(20) Several groups have reported decreases in testicular function even after removal of the twisted testes, thus postulating that the ipsilaterally torsed spermatic cord releases substances that act remotely on the contralateral testis. (21) Therefore, further prospective study with long-term clinical follow-up for these patients is mandatory.…”

Effects of Abdominal Location and Epididymal or Vasal Obstructions either Individually or in Association on Ipsilateral and Contralateral Testes

“…It was reported that chemical sympathectomy prior to ipsilateral testicular torsion has prevented the elevation of lactic acid and hypoxanthine levels and spared the histology in the contralateral testes in rats [27, 28]. Since the contralateral testicular deterioration does not mandate the presence of ipsilateral testis and epididymis, and can be detected even following the torsion of only spermatic cord in the absence of ipsilateral testis and epididymis within 24 h of torsion, spermatic cord structures seem to play the most important role in the initiation of reflex and thus contralateral testicular injury [29, 30]. Abdominal location of the testis has also been reported to result in elevated levels of lactic acid and hypoxanthine in both ipsilateral and contralatera testis [3].…”