Hours Of Torsion Research Articles

Proanthocyanidin alleviates testicular torsion/detorsion-induced ischemia/reperfusion injury in rats

Testicular torsion is an urological emergency and can lead to ischemia damage and testicular loss if not diagnosed in time. Proanthocyanidin is reported to have anti-inflammatory and antioxidant properties. The current study aimed to examine the possible effects of proanthocyanidin (P) on the testis in torsion/detorsion (T/D)-induced testicular ischemia/reperfusion (I/R) injury in rats. Forty rats were divided into four groups (n=10 for each): sham-operated (sham), I/R, I/R + P100 (100 mg/kg, 30 min before torsion), and I/R + P200 (200 mg/kg, 30 min before torsion). Testicular T/D was performed on the left testicle by 3 hours of torsion at 720° clockwise, followed by 3 hours of detorsion. In the I/R group, an increase in malondialdehyde (MDA) levels and a decrease in glutathione (GSH), vitamin C (Vit C), glutathione peroxidase (GPx), glucose-6-phosphate dehydrogenase (G6PD) values were determined compared to the sham group (p<0.001). Moreover, an increase in the expression of cleaved caspase-3 and Bcl2-associated X protein (Bax), a decrease in the expression of B-cell lymphoma 2 (Bcl-2) and proliferating cell nuclear antigen (PCNA) were detected in the I/R group (p<0.001). Histopathologically, it was determined that the Johnsen and Cosentino scores of the testicles were irregular in the I/R group (p<0.001). Proanthocyanidin treatment caused a decrease in MDA, cleaved caspase-3 and Bax levels and an increase in GSH, Vit C, GPx, G6PD, Bcl-2 and PCNA values. Additionally, Johnsen and Cosentino rearranged the scores. The present findings revealed the protective and curative effects of proanthocyanidin in organ damage due to testicular torsion/detorsion-induced ischemia/reperfusion with their antioxidative and antiapoptotic properties.

The value of multimodal ultrasonography in the evaluation of late presenting testicular torsion in a rat experimental model.

To evaluate the value of multimodal ultrasonography (US) in a rat experimental torsion model after 6 h of torsion with different degrees. Twenty-one male rats were divided into three groups. Left testes of the rats were twisted around their vascular pedicle 360 degrees in group 1, 720 degrees in group 2, and 1080 degrees in group 3 and intact right testes of the rats were accepted as control group. Grey-scale US, superb microvascular imaging (SMI), colour Doppler ultrasonography (CDUS), strain elastography (SE), and two-dimensional (2-D) shear wave elastography (SWE) examinations were applied 6 h after torsion procedure and testes were removed for pathological evaluation. Short-axis dimensions and volumes of the torsion side were higher than control testes. Lengths of the testes in the 3rd torsion group were smaller than the testes in groups 1 and 2 (P < 0.002). SMI was better than CDUS in recognizing blood flow in testicular tissue. Strain ratios were higher in group 1 and decreased with the increasing torsion degree. Emean and standard deviation (SD) measurements increased in the torsion side. Pathologically the mean testicular damage scores were statistically significant between torsion and control testes in all groups. Our results showed that short-axis and volume measurements, SMI, 2D-SWE, and SE are effective in the evaluation and diagnosis of testicular torsion (TT). Evaluation of affected testis and intact testis with multiparametric US in late presenting TT cases is more reliable than being dependent on a single sonographic modality.

Long-term protective effect of tadalafil on spermatogenesis following testicular ischemia-reperfusion injury in a rat model

Background: Testicular torsion is a urologic emergency that can lead to testicular atrophy and infertility owing to ischemia-reperfusion injury (IRI). The aim of this study was to evaluate the long-term protective effect of tadalafil, a phosphodiesterase-5 inhibitor used to treat erectile dysfunction, on spermatogenesis in a rat testicular model of IRI. Methods: Forty-eight adolescent Sprague–Dawley rats were divided into six groups of 8 each (A–F). Sham operation was performed on group A. Group B underwent surgical 720∘ torsion of the left testis without any medication. Groups C, D, E and F underwent surgical torsion and administration of tadalafil at varying doses (0.3 and 1.0 mg/kg) and durations (single or daily administration for four weeks). After three hours of torsion, detorsion was performed on all groups except group A. Four weeks after the operation, both testes were evaluated for spermatogenesis using the Johnsen scoring system. To evaluate the protective effect of tadalafil against oxidative stress induced by IRI, the malondialdehyde and superoxide dismutase levels of both testes were analyzed four hours after detorsion using the same experimental protocol as for groups A, B, and C. Results: Experimental groups treated with high-dose tadalafil showed higher Johnsen scores for spermatogenesis than the low-dose groups. Groups that received daily tadalafil administration for four weeks showed higher Johnsen scores than those receiving single doses. Furthermore, histopathologic findings and molecular markers related to oxidative stress were markedly improved following tadalafil administration. Conclusions: Tadalafil alleviated the oxidative stress and long-term deterioration of spermatogenesis in a rat testicular model of IRI by restoring the antioxidant status.

Brusatol Over İskemi Reperfüzyonu ile İndüklenmiş Over Dokusu Oksidatif Yaralanmasını Azaltır

Objective: In the scope of this study, it was tried to examine the probable benefits of brusatol against ovarian tissue injury originating from bilateral ovarian torsion/detorsion (T/D). Material and Methods: In this study, experimental animals were randomized to 4 groups. Groups were programmed as sham group I (control), group II (T/D), group III (DMSO+T/D) and group IV (Brusatol+T/D). Group I; the abdomen region was barbered, disinfected, opened by incision and closed respectively, but no T/D model was performed. Group II, as described in group I, after opening and closing abdominal incision, 3 hours of torsion was applied and it was followed by a 3-hour of detorsion. Group III, 1% DMSO was applied intraperitoneally 0,3 ml as every other day for 10 days and the last dose was given 30 minutes prior to detorsion. Group IV; brusatol was administered intraperitoneally 0,5 mg/ml once every 2 days for 10 days and the last dose was applied 30 minutes prior to detorsion. Then, all processes were carried out as described in group II. Following detorsion period, in pursuit of sacrificing the rats, ovarian tissues were removed. Results: Oxidant parameters (MDA, MPO, TOS, OSI) and pro-inflammatory cytokine (TNF-α, IL-1β) levels increased significantly while antioxidant levels (SOD, TAS) reduced in group II and III compared to group I (p<0.05). On the contrary, brusatol application (group IV) reversed all of these values compared to group II and III (p<0.05). Conclusion: As a conclusion, brusatol was evaluated to have protective effects against T/D-induced ovarian injury in rats.

Prevention of the harmful effects of free oxygen radicals by using N-acetylcysteine in testicular torsion

Testicular torsion is a urological emergency both in childhood and in adult life. Many studies on experimental testicular torsion have demonstrated biochemical and pathological ischemia-reperfusion injury and the efficacy of some drugs have been investigated to prevent this damage. N-acetylcysteine (NAC) promotes glutathione synthesis and acts as a glutathione precursor because of the fact that it increases the glutathione-reductase activity by transporting sulfhydryl groups. In this experimental study, the authors aimed to investigate the effectiveness of NAC in preventing ischemia-reperfusion injury following testicular torsion and detorsion. For this experimental study, 36 albino Wistar-male rats were used. The rats were randomly divided into 4 groups: sham (n=8), ischemia-reperfusion(n=8), ischemia-NAC -reperfusion (n=10), and ischemia-NAC-reperfusion-NAC(n=10) groups. Two hours of torsion and 4h of detorsion were created in the left testis. After 4h of detorsion, the rats were sacrificed. Each tissue was divided into two sections for biochemical and pathological examinations. There was a statistically significant difference between the study groups in terms of the total-sulfhydryl level, nitric oxide level, and the malondialdehyde values. Histopathological examination revealed that NAC was effective in preventing reperfusion injury in the testisbut ineffective in preventing the reduction in the spermatid count. The results of this experimental study support that NAC can histopathologically maintain the structure of seminiferous tubules against ischemis reperfusion injury and prevent damage to the germinative cells. However, it was unable to prevent the reduction in spermatid count. There was no significant difference in the prevention of ischemia-reperfusion injury between NAC administration during the first hour of ischemia and NAC administration during reperfusion. Although NAC can prevent tissue damage from ischemia reperfusion injury, it is not effective against the reduction in the spermatid count. N-acetylcysteine may be biochemically effective in preventing ischemia-reperfusion injury after testicular torsion and detorsion. NAC is a readily available and easy to use agent that can be used during testicular ischemia.

Diffusion-Weighted Imaging and Color Doppler Ultrasound in Evaluation of Partial Testicular Torsion in Rat Model.

SummaryBackgroundTo evaluate the utility of histogram analysis of apparent diffusion coefficient (ADC) in the diagnosis of incomplete testicular torsion.Material/MethodsFourteen Wistar albino rats were randomly allocated into two groups. In group 1 (control), left testicles were kept outside for 45 seconds and then replaced, whereas left testicles were twisted by 360° in group 2. Four hours later, DWI was performed. After that, magnetic resonance imaging (MRI) and testicular color Doppler ultrasound (CDU) were performed by two radiologists who looked for the presence or absence of blood flow. ADC measurements were carried out by two radiologists who were blinded to each other’s measurements. After CDU, testes were surgically removed and a pathological examination was performed after four hours of torsion. Comparisons of minimum, mean, and maximum ADC values in testicles were performed with the Wilcoxon test. P value of 0.05 or less was considered as statistically significant. Inter-observer agreement was also analyzed.ResultsIn the torsion group, minimum ADC values for left testicles were significantly lower than for the control group (p<0.05), regardless of the observer. Inter-observer agreement for measurements of ADCmin and ADCmax values was substantial, with an ICC score of 0.751 and 0.774, respectively (95% CI). Inter-observer agreement for the measurement of ADCmean value was excellent, with an ICC score of 0.844 (95% CI). The pathological examination revealed mild interstitial edema and closely packed seminiferous tubules in the left testes, indicating reversible damage in the torsion group.ConclusionsOn the pathological examination, all left testes in the torsion group were recoverable after four hours of torsion. Minimum ADC values can be used as an auxiliary method in the diagnosis of partial testicular torsion. Comparing minimum ADC values between the affected and non-affected testicles can be a useful tool in the early diagnosis of incomplete testicular torsion.

Role of diffusion weighted magnetic resonance imaging in a rat model of testicular torsion

The purpose of this study was to investigate the usefulness of diffusion-weighted imaging (DWI) in the detection of different degrees of testicular torsion (TT) at the 8th hour and testicular salvageability at the 24th hour of torsion. 31 rats were randomly classified into 4 groups. In Group 1 (sham-control group), the left testicle was kept outside and replaced. Left testicles were kept outside and twisted 360° in Group 2, 720° in Group 3 and 1080° in Group 4. Later, DWI was performed at 8th and 24th hours. After DWI, bilateral radical orchiectomy and histopathological examination were performed. Apparent diffusion coefficient (ADC) maps were obtained with b-factors of 0 and 800 s mm-2. Comparisons of ADC values and damage in testicles were performed with Kruskal-Wallis test. Sensitivity of DWI in the diagnosis of TT was 12.5% for 360° torsion, 100% for 720° torsion and 1080° torsion at the 8th hour of torsion. Mean ADC values of the left testicles increased significantly at the 24th hour of torsion in Groups 3 and 4. All testicles in Groups 3 and 4 were observed to be irrecoverable on histopathological examination. Increased ADC values in the affected testicle may represent irreversible tissue damage. So, immediate surgery is not required at this stage, which may reduce morbidity and mortality caused by immediate surgery and anaesthesia. Advances in knowledge: TT can be diagnosed easily by DWI without administrating any contrast material. DWI findings in the affected testicle may represent testicular salvageability.

Role of Strain Elastography in the Evaluation of Testicular Torsion: An Experimental Study.

To evaluate the utility of real-time strain elastography in experimentally induced testicular torsion at different degrees and torsion hours. Thirty-one Wistar albino rats were divided into 4 torsion groups by twisting left testes (group I, sham operated; group II, 360°; group III, 720°; and group IV, 1080°). Elastography was applied at the 8th and 24th hours of torsion. Elasticity patterns (pattern 1, soft testis; pattern 2, moderately soft testis; pattern 3, predominantly hard testis; and pattern 4, almost entirely hard testis) and strain ratios were recorded. Histopathologic evaluation was done at the 24th hour. Interobserver agreement was analyzed. Changes in elastographic patterns and strain ratios among groups II, III, and IV were statistically significant at both hours as determined by both radiologists (P < .01). Elastographic patterns changed from 2 to 3 in groups II and III to 4 in group III between the 8th and 24th hours (P < .05), but in group IV, patterns were reversed, and pattern 1 was observed at both hours. Pathologically severe necrosis (grade 4) was seen in left testes in group IV. In the other groups, pathologic grading in the left testes was as follows: mostly grade 1 in groups I and II and mostly grade 2 in group III. Elastography showed that right testes were affected in group IV, with significant differences in elastographic patterns and strain ratios (P < .01). Interobserver agreement for elastographic patterns in right testes was substantial at the 8th hour (κ = 0.72) and otherwise excellent (κ = 0.81-0.85). Concordance of strain ratios between observers was excellent for right and left testes at the 8th and 24th hours (intraclass correlation coefficients, 0.990 at the 8th hour and 0.987 at the 24th hour). Our results show that real-time strain elastography can be a complementary method in the evaluation of testicular tissue in testicular torsion and can guide surgeons in their surgical approach.

Decompressive fasciotomy in testicular torsion of the spermatic cord in rats

To evaluate the effect of decompression fasciotomy on testes undergoing torsion of the spermatic cord. Spermatic cord torsion was induced in 40 Wistar testes for six and 12 hours. At the time of distortion, decompression fasciotomy was performed on half of the animals. After 42 days, the testicles were examined both macroscopically and microscopically. A non-parametric Mann- Whitney U- test was used for statistical analysis. The results were considered significant at p≤0.05. Testicular weight; volume and degree of histological alterations were evaluated. When the groups without and with fasciotomy were compared, a 12-hour torsion subgroup in the fasciotomy group was noted to present larger volume, heavier weight and superior histological classification when compared with the 12-hour subgroup in the without fasciotomy group. No differences between the two groups after six hours of torsion were found. No significant changes were noticed in the contralateral testis. Testicular fasciotomy (decompression) benefited the macroscopic and histological aspects of the testicles undergoing cord torsion for a 12-hour period. These results demonstrate the role played by compartment syndrome in the pathophysiology of spermatic cord torsion and the need for decompression.

Quantitative Software Analysis of Ultrasonographic Textures in Experimental Testicular Torsion

Ultrasonography (US) has high diagnostic value in testicular torsion but is vulnerable to several potential errors, especially in the early period. Echotexture (ETX) analysis software provides a numerical expression of B-mode images and allows quantitative evaluation of blood flow due to ischemic damage using power Doppler US (PDUS) analysis. Our aim in this study was to determine the diagnostic value and effective parameters of EXT analysis software in the early period of torsion using B-mode and PDUS images. In this study, eight rats were used. Following anesthesia, the right testis was rotated to a 1080-degree counterclockwise position whereas the left testis was left in place to have a control group. B-mode and PDUS images of both sides were recorded with a portable US device immediately (0 hour) and 1 and 2 hours after torsion. The B-mode images were analyzed in terms of gradient, homogeneity, and contrast using the BS200pro software (BAB Digital Imaging System 2007, Ankara, Turkey). Intensity (I)-red and area (A)-red values were measured on PDUS images with the Pixelflux (Version 1.0, Chameleon-Software, Leipzig, Germany). The data were evaluated by the Mann-Whitney U and Wilcoxon tests. Data from B-mode US image EXT analysis showed no significant difference between the right and left testicles in 0 to 2 hours (p > 0.05). The values obtained from PDUS analysis (I-red and A-red) significantly decreased at the testicular torsion side at the end of the second hour (p < 0.05). I-red and A-red values at 0 to 1 hour of torsion indicated similar blood flow alterations (p > 0.05) whereas the flow was significantly lower at 2 hours (p < 0.05). In experimental testicular torsion, ischemic changes can be detected by PDUS power/angio mode using blood flow alterations as early as the second hour. Tissue damage cannot be evaluated within the first 2 hours of torsion with B-mode ETX analysis.

The Predictive Value of Ischemia-modified Albumin in Long-term Results of Ischemia-reperfusion Injury in an Experimental Testicular Torsion Model

To establish the value of ischemia-modified albumin levels in the determination of the long-term results of testicular torsion/detorsion-associated ischemia-reperfusion injury. Eighteen mature male Wistar rats were divided randomly into 3 groups (n = 6 for each group): control, acute torsion/detorsion (T/D) group, and long-term T/D. In the control group, scrotal incision only was performed; in the acute T/D group, after 4 hours of torsion, detorsion was performed and maintained for 2 hours. Blood samples and testicular tissue samples were taken after 2 hours of detorsion. The same T/D procedures were performed in the long-term T/D group. The long-term T/D groups were kept alive for 2 months, and samples were taken at 2 months post procedure. Serum ischemia-modified albumin, serum and tissue malondialdehyde levels, and histopathological damage scores were measured. Serum ischemia-modified albumin levels were significantly higher compared with the control group, in the acute-term T/D (P = .004). This elevation remained pronounced in the long term compared with the control group and acute period (P = .008 and P = .017, respectively). There was a significant negative correlation between serum ischemia-modified albumin levels and histopathological injury score in both the torsioned and contralateral testes (r = -.929, P < .0001 and r = -.560, P = .02, respectively). Ischemia-modified albumin is a valuable parameter in terms of reflecting testis injury in testicular torsion in both the acute period and the long term. It therefore has the potential to be used as data with predictive value regarding patients' fertility capacities.

Honokiol Attenuates Torsion/Detorsion-induced Testicular Injury in Rat Testis by Way of Suppressing Endoplasmic Reticulum Stress-related Apoptosis

To investigate the protective effect of honokiol, a phytochemical used in traditional medicine, on testicular injury after torsion/detorsion (T/D) in a rat model. Testicular torsion is a medical emergency that can cause impairment of semen quality and permanent testicular atrophy or loss. Male Wistar rats were randomized to each time point of each group (n = 6/time point/group). After 2 hours of torsion, the testes were counter-rotated to the natural position. The rats in each group underwent a sham operation, T/D, or T/D with honokiol treatment (5 mg/kg and 10 mg/kg intraperitoneally, immediately before detorsion). Bilateral orchiectomy was performed at 6 and 24 hours and 3 months after detorsion. The testes were examined histologically. Apoptosis and endoplasmic reticulum stress were detected by Western blot. Histologic examination revealed that testicular T/D induced acute injury after 6 and 24 hours, and spermatogenesis was decreased at 3 months of follow-up. At 24 hours after T/D, increases were found in the activation of apoptosis-related molecules [poly (ADP-ribose) polymerase and caspases 3 and 7], and the expression levels of endoplasmic reticulum stress-associated molecules (phosphorylated-eukaryotic translation initiation factor 2 subunit α and CCAAT/enhancer-binding protein homologous protein). These increases were significantly reversed with honokiol treatment. Furthermore, honokiol effectively reversed the inhibition of spermatogenesis in testes treated with T/D for 3 months. The results of our study have shown that the endoplasmic reticulum stress-related apoptotic pathway is involved in testicular injury after testicular T/D. It remains to be determined whether alterations in this pathway would have a protective affect against reperfusion damage.

The role of vascular endothelial growth factor in ischemia-reperfusion injury of testis

OBJECTIVE: Testicular torsion causes ischemia-reperfusion injury of testis and leads to male factor infertility. Its injury initiates a pathophysiologic cascade. In recent studies, protective effect of VEGF has been shown in various forms of ischemia- reperfusion injury. However, no study has investigated the role of VEGF in testicular ischemia-reperfusion injury. The aim of our study was to investigate the time course expression of VEGF, VEGF-receptor (R)1, VEGF-R2, inducible and endothelial nitric oxide synthase (iNOS and eNOS) and to evaluate the effect of VEGF in ischemia-reperfusion injury of testis. DESIGN: Animal study. MATERIALS AND METHODS: Using 8-week-old SD rat, surgery for making unilateral experimental torsion was performed. After 1 hour of torsion, the testis was counter-rotated back to the natural position and reinserted into the scrotum. Bilateral castrations were performed in various time courses after reperfusion. Western bolt analysis and immunohistochemical evaluation were used to determine the activation of VEGF, iNOS, and eNOS. VEGF, VEGF-R1 and -R2 mRNAs were measured by reverse transcription PCR (RT-PCR) and quantitative real-time PCR (QRT-PCR) analysis. RESULTS: In torsion side testis, the expression of VEGF protein and mRNA significantly increased in a time dependent manner since 3 to 120 hour after reperfusion. Although the expression of VEGF-R1 mRNA was increased in a similar way, which of VEGF-R2 mRNA could not be detected. The increase of VEGF protein expression was observed in testicular vascular endothelial cells and seminiferous tubular endothelial cells. Significant activation of iNOS and eNOS were investigated at 12 and 24 hours after reperfusion. CONCLUSIONS: Our study is the first report in the literature to show the time course expression of VEGF in torsion caused ischemia-reperfusion injury testis. Further investigations, such as VEGF infusion study, may lead to a novel approach for the therapy of ischemia-reperfusion injury of the testis.

Ipsilateral testicular necrosis and atrophy after 1,080-degree torsion of the spermatic cord in rats

To assess the incidence of testicular necrosis/atrophy immediately after 1 to 4 hours of 1,080-degree torsion of the spermatic cord, and 60 days after detorsion of the spermatic cord. 42 rats were divided in 7 groups. Except for the control group, surgical torsion of the right spermatic cord was performed in all groups (T0). After 1, 2, or 4 hours of torsion, each group underwent either ipsilateral orchiectomy (groups OT1, OT2, and OT4), or detorsion of the spermatic cord and observation for 60 days (groups DT1, DT2, and DT4), before they were evaluated for the presence of testicular necrosis/atrophy. Only one rat (5.5%) in groups OT1, OT2, and OT4 had testicular necrosis, in comparison with six rats (33.3%) in groups DT1, DT2, and DT4 (p=0.04). The incidence of testicular necrosis/atrophy was not different between subgroups T1, T2, and T4, and the control group (p>0.05). There was, however, a tendency toward greater incidence of necrosis/atrophy in the rats in group DT4. The incidence of testicular necrosis/atrophy immediately after 1 to 4 hours of 1,080-degree torsion of the spermatic cord is 5.5%, in comparison with 33.3% sixty days after detorsion of the spermatic cord.

The Efficacy of Conservative Treatment for Late Term Ovarian Torsion

Recent reports have focused on detorsion after ovarian torsion in the literature. The aim of the study was to investigate late term changes in both ovaries after delayed detorsion following ovarian torsion in rats. Female, prepubertal, Wistar albino rats were divided into four groups (n = 6/group). The left ovaries were used for the study and the right ovaries were kept as the control. The groups were constituted as follows: Group 1: left ovarian fixation, bilateral oophorectomy 48 hours later; Group 2: left ovarian torsion and fixation, bilateral oophorectomy 48 hours later; Group 3: detorsion 48 hours after torsion and bilateral oophorectomy after another 48 hours; Group 4: detorsion 48 hours after torsion and bilateral oophorectomy after 21 days. The total injury score (TIS) was compiled histologically in a double-blind fashion. Congestion, edema, bleeding and polymorphonuclear lymphocyte infiltration were assessed for TIS. The TIS was found to be 8 points in Group 1; 38 in Group 2; 28 in Group 3 and 12 in Group 4, respectively. The TIS was based on results from the left ovaries in Group 1, whereas 31 points were attributable to the left ovaries and 7 to the right ovaries in Group 2. In Groups 3 and 4, TIS points were the same in both study and control ovaries. The difference between the left ovaries of Groups 1 and 2 and the left ovaries of Groups 2 and 4 was statistically significant (p < 0.05). Viable ovarian tissue can be detected even after 48 hours of torsion, which is a relatively long period of ischemia. Tissue injury decreases significantly after detorsion during late recovery. In view of previous case reports in the literature and the present findings, detorsion is recommended in children with ovarian torsion regardless of the ischemic period and/or macroscopic appearance.

Feasibility of Using Near-Infrared Spectroscopy to Diagnose Testicular Torsion: An Experimental Study in Sheep

To assess whether near-infrared spectroscopy can detect testicular hypoxia in a sheep model of testicular torsion within 6 hours of experimental torsion. This was a randomized, controlled, nonblinded study. Trans-scrotal, near-infrared, spectroscopy-derived testicular tissue saturation of oxygen values were obtained from the posterior hemiscrota of 6 anesthetized sheep at baseline and every 15 minutes for 6 hours after either experimental-side, 720-degree, unilateral, medial testicular torsion and orchidopexy or control-side sham procedure with orchidopexy and then for 75 minutes after reduction of torsion and pexy. Color Doppler ultrasonography was performed every 30 minutes to confirm loss of vascular flow on the experimental side, return of flow after torsion reduction, and preserved flow on the control side. Near infrared spectroscopy detected a prompt, sustained reduction in testicular tissue saturation of oxygen after experimental torsion. Further, it documented a rapid return of these values to pretorsion levels after reduction of torsion. Experimental-side testicular tissue saturation of oxygen fell from a median value of 59% (interquartile range [IQR] 57% to 69%) at baseline to 14% (IQR 11% to 29%) at 2.5 hours of torsion, and postreduction values were approximately 70%. Control-side testicular tissue saturation of oxygen values increased from a median value of 67% (IQR 59% to 68%) at baseline to 77% (IQR 77% to 94%) at 2.5 hours and remained at approximately 80% for the entire protocol. The difference in median testicular tissue saturation of oxygen between experimental and control sides, using the Friedman test, was found to be significant (P=.017). This study demonstrates the feasibility, in a sheep model, of using near-infrared spectroscopy for the noninvasive diagnosis of testicular torsion and for quantification of reperfusion after torsion reduction. The applicability of these findings, from an animal model using complete torsion, to the clinical setting remains to be established.

Protective effect of vasoactive intestinal peptide on testicular torsion-detorsion injury: association with heparin-containing mast cells

Objectives To elucidate the action of vasoactive intestinal peptide (VIP) on detorsion injury and the heterogeneity of mast cells in the testes of rats. Methods Prepubertal male Sprague-Dawley rats were used in six groups. Group 1 was the control group (sham operation); group 2 had 2 hours of torsion; group 3, 2 hours of torsion and 1 hour of detorsion after administration of saline; group 4 had 2 hours of torsion and 4 hours of detorsion after administration of saline; group 5, 2 hours of torsion and 1 hour of detorsion after administration of intraperitoneal VIP (25 ng/kg); and group 6, 2 hours of torsion and 4 hours of detorsion after intraperitoneal VIP. The 2 hours of torsion was created by rotating the right testis 720° in a clockwise direction. VIP (25 ng/kg) was injected intraperitoneally 1 minute before the 1 and 4 hours of detorsion. At the end of the experiment, catalase enzyme activity was measured polarographically, and superoxide dismutase, malondialdehyde, and protein were measured spectrophotometrically. Nitric oxide was measured by capillary electrophoresis in the testicular tissue. Routine histologic examination of testicular mast cells was done under light microscopy; the histochemistry was also analyzed. Results Torsion significantly induced oxidative stress, mast cell degranulation, and tissue damage. Detorsion attenuated oxidative stress without any diminution of the histologic damage to the tissue. VIP significantly protected the testicular tissue from detorsion injury. It also inhibited mast cell activity while increasing the heparin content. Conclusions VIP can protect testicular tissue from detorsion injury. Heparin-containing mast cells seem to be important mediator cells for this protection.

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° 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. J Pediatr Surg 36:1050-1053. Copyright © 2001 by W.B. Saunders Company.

New animal model to evaluate testicular blood flow during testicular torsion

Background/Purpose : Unilateral testicular torsion is known to cause infertility because of damage to the contralateral testis. Testicular damage has been attributed to many different mechanisms, one of which is altered contralateral blood flow. In our experiment, in an effort to identify the reason for contralateral testicular injury, the authors developed an accurate method of measuring blood flow in both testes before,, during, and after unilateral torsion. Methods : Four-to 6-week-old piglets weighing 4 to 6 kg were studied. The animals were anesthetized, intubated, ventilated, and catheterized for vascular access. Piglets were assigned randomly to a sham group or a group undergoing 360° or 720° torsion of the left testis (n = 5 per group) for 8 hours, after which it was untwisted. Data were collected at baseline (T = 0), 8 hours of torsion (T = 8), and 1 hour after detorsion (T = 9). Mean arterial blood pressure and heart rate were monitored continuously. Testicular blood flow was determined using radiolabeled microspheres. Blood flow data were evaluated by analysis of variance. Results : In the 360° torsion group, blood flow changes were insignificant during torsion and after detorsion. In the 720° torsion group, blood flow to the twisted testis was reduced significantly, whereas the contralateral testis was unaffected. One hour after detorsion, blood flow to both testes was increased significantly. Conclusions : The authors describe a new animal model to evaluate testicular blood flow during and after testicular torsion. Increased blood flow after detorsion may be the cause of testicular damage in patients with unilateral testicular torsion.

Effect of unilateral testicular torsion on blood flow and histology of contralateral testes

Background/Purpose: Infertility occurs in 25% of patients after unilateral testicular torsion; hence, the authors examined hemodynamic and histological changes in both testes after acute testicular torsion in neonatal piglets.Methods: The animals were anesthetized, intubated, ventilated, catheterized, and assigned randomly to a sham group or one of three experimental groups undergoing 720° torsion of the left testis for 8 hours after which it was untwisted in group I and removed in group II. In group III, both testes were removed. Data were collected at baseline (T = 0), 4 hours (T = 4), and 8 hours of torsion (T = 8) and at the ninth hour of the experiment (T = 9). Testicular blood flow was determined by using radiolabeled microspheres. The testes also were examined blindly with routine and electron microscopy.Results: In group I, testicular blood flow decreased in the affected testis during torsion and increased significantly after detorsion, whereas blood flow to the contralateral testis increased significantly after detorsion. Sham-operated animals showed no histological abnormality in either testis. In all torsion groups, the affected testis showed extensive changes caused by hemorrhagic necrosis. The contralateral testis only showed changes in group I.Conclusion: Unilateral testicular torsion resulted in ipsilateral damage caused by a decrease and subsequent increase in blood flow while in the contralateral testis; damage was the result of a significant increase in blood flow after detorsion.