Mechanisms of injury in unilateral testis torsion

The protective effects of nitric oxide on the contralateral testis in prepubertal rats with unilateral testicular torsion

OBJECTIVE

To investigate histological changes in the contralateral testis of rats with unilateral testicular torsion and the protective effects of nitric oxide (NO) on possible damage.

MATERIAL AND METHODS

Twenty-eight prepubertal male Sprague-Dawley rats were divided into four equal groups. Group 1 underwent a sham operation of the right testis under general anaesthesia. Group 2 underwent a similar operation but the right testis was rotated 720 degrees clockwise for 6 h, maintained by fixing the testis to the scrotum, and saline infused during the procedure. Group 3 underwent similar torsion but L-arginine methyl ester (a precursor of NO) was infused during the procedure. In Group 4, NG-nitro-L-arginine-methyl ester, a NO synthase inhibitor, was infused separately during the administration of L-arginine methyl ester and torsion. All the left (untwisted) testes were removed from rats 21 days after surgery and evaluated histologically, assessing seminiferous tubule diameter, loss of sperm and spermatids, loss of germ cell layers, disarray of germ cell layers, rupture of tubules, Leydig cell proliferation and reaction in the ruptured tubules, and oedema.

RESULTS

There was a significant difference in the indicators of histological damage between groups 2 and 4 and groups 1 and 3, except for the Leydig cell reaction in the ruptured tubules and oedema. The damage was significantly less in group 3 than in groups 2 and 4.

CONCLUSION

These results suggest that long-term histopathological changes in the contralateral testes are important after unilateral testicular torsion and that NO has a protective effect on the contralateral testis.

Pediatric testicular problems

Testicular problems in children may be both congenital and acquired. These problems are often difficult to diagnose and carry significant sequelae if untreated. Early surgical consultation is often needed for correction of the problem. This article reviews the pathophysiology of the most common pediatric testicular abnormalities with emphasis on the diagnostic modalities employed and current treatment alternatives.

Late gonadal function and autoimmunization in familial testicular torsion

Testicular torsion, one of the most common pediatric urological emergencies, is rarely familial. This study deals with the sixth recorded family with familial testicular torsion and the effects on the spermatogenesis and the appearance of testicular autoantibodies in three affected subjects (two brothers, aged 18 and 15 years, and their father, aged 48 years). The father and one of the brothers, who had peripubertal unilateral testicular torsion, presented normal fertility and oligozoospermia, respectively. The other brother, who had a history of bilateral testicular torsion, did not present pubertal development until he was 18 years old and he needed substitutive testosterone therapy. Sperm autoantibody titer increased only in the two cases with unilateral torsion and remained unmodified at a 5-year follow-up. The results indicate that testicular torsion can cause variable degrees of spermatogenesis impairment and induce development of autoantibodies against spermatozoa and gonadal antigens. The persistence of fertility in the father and the progressive spermatogenesis recovery in one of the affected sons suggest that the damaging effects of these autoantibodies deserve further investigation.

Contralateral testicular blood flow in unilateral testicular torsion measured by the 133Xe clearance technique

Contralateral testicular blood flow was measured by the intratesticular injection of 133Xe in 9 controls (Group 1) and in 34 adult male albino rats with experimentally induced left testicular torsion. In Group 2 (n = 9) testicular torsion was maintained for 3 h; in Group 3 (n = 7) torsion was maintained for 9 h and in Group 4 (n = 10) for 15 days. In Group 5 (n = 16) torsion was maintained for 9 h in 8 rats and the sera were given to 8 normal animals. In Groups 3, 4 and 5 there was a significant increase in contralateral testicular blood flow on the fifteenth day. This increase may be the cause of contralateral testicular damage in prolonged unilateral testicular torsion.

Diagnosis and management of testicular torsion: pitfalls and perils

When a patient presents with acute scrotal pain and physical findings do not permit confident exclusion of testicular torsion, the initial step in management is immediate consultation with a urologist, pediatric surgeon, or general surgeon. Scrotal imaging is fallible and takes time that may be critical to salvage of the testis. Manual detorsion may be indicated when specialty support is not immediately available, but even if this technique is apparently successful, the patient should be transferred to specialty care without delay.