Torsion Repair Research Articles

Surgical Repair of Right Medial Lung Lobe Torsion after Chronic Diaphragmatic Herniorrhaphy in a Dog

Surgical Repair of Right Medial Lung Lobe Torsion after Chronic Diaphragmatic Herniorrhaphy in a Dog

Quadratus lumborum block in pediatric patients - a case series

Introduction. The quadratus lumborum block (QLB) was the first interfascial plane block introduced to the Leskovac General Hospital thanks to the Kybele Inc. international teaching program in April 2017. Outlines of cases. During the period from April 2017 to December 2019, 22 pediatric patients underwent various surgical procedures and had the QLB type 1 block as a part of a multimodal perioperative pain management plan. Unilateral QLB was provided for unilateral inguinal hernia repair, orchidopexy, testicular torsion repair, and open appendectomy. Bilateral QLB was provided for laparoscopic appendectomy and cholecystectomy. Decreased use of fentanyl and sevoflurane was noticed in the cases when QLB was performed preoperatively. All the patients had well controlled pain. Conclusion. QLB is a simple and safe technique. Clear sonographic landmarks allow it to be easily performed. QLB has great potential to improve and facilitate postoperative pain management.

Using two “V” shaped flaps in penile torsion treatment

Introduction: Penile torsion is a congenital malformation that causes a rotational deformity of the penile shaft. Several techniques have been considered for penile torsion repair. In this study, we described our experience using two separate “V” dartos flaps, which leads to a more satisfying result. Patient and methods: Two young men with severe penile torsion aged 24 and 28 years old were candidates for surgery. During our novel method for penile torsion repair, we degloved the penis and dissected the dartos fascia from the penis shaft, then cut it distally from the sub-coronal region with a longitudinal cut to make two dartos flaps in a “V” shape. With these two flaps, we corrected penile torsion in a more satisfying way without crossing the urethra. Results: Penile torsion and concurrent chordee were completely corrected after surgery. Urine culture was sterile and uroflowmetry indicated a maximal urinary flow of 12 ml/s 3 months after the operation. Both patients were satisfied with ejaculation and their follow-up indicated complete resolution of penile torsion. Conclusions: Penile torsion is a challenging congenital anomaly. We used a two “V” shaped flap passage method to complete penile rotation and chordee correction without performing any plication techniques. Our penile torsion correction procedure resulted in the successful repair of torsion and excellent outcomes. Level of evidence: Not applicable for this multicenter audit.

Role of p97/Valosin-containing protein (VCP) and Jab1/CSN5 in testicular ischaemia-reperfusion injury.

The most significant complication of testicular ischaemia is loss of the testis, which may lead to infertility. Testicular ischaemia damages protein degradation pathways which, together with the overproduction of damaged proteins and consequent upregulation of ubiquitin-conjugated protein aggregates. Despite recent advances, the factors leading to impairment of spermatogenesis owing to testicular ischaemia remain poorly understood. This study was undertaken to gain insight into the cellular and molecular mechanism underlying torsion induced germ cell apoptosis. Male rats were subjected to 2 h torsion, and testes were examined at 2, 4, 12 and 24 h after torsion repair (reperfusion). Ischaemia-reperfusion (IR) of the testes resulted in apoptosis which was revealed by the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate (dUTP) nick end labeling (TUNEL) technique. At 12 h after torsion repair germ cell loss reached peak, then decreased at 24 h repair. Western blotting showed that apoptotic proteins (active caspase 3, caspase 9 and Bax) gradually was upregulated at 12 h reperfusion, however anti-apoptotic protein (Bcl2) was downregulated in the relevant IR treatment. Furthermore, Jab1/CSN5 expression was gradually upregulated and p97/VCP expression was downregulated in IR injury according to western blotting and immunohistochemistry. To test further whether polyubiquitination was also involved in IR injury, the expression of polyubiquitinated proteins was examined, which showed that polyubiquitinated proteins were significantly increased in IR injury. These finding suggest that p97/VCP and Jab1/CSN5 provide a novel signaling pathway for testicular ischaemia and may play an important role in IR injury induced cell death in rat testis.

Correlation of severity of penile torsion with type of hypospadias & ventral penile curvature and their management

ObjectiveThis study was carried out to evaluate the correlation between the severity of penile torsion on the one hand and the degree of ventral penile curvature and the type of hypospadias on the other. We also assessed the effectiveness of correction of chordee and torsion by penile degloving and mobilization of the urethral plate and the corpus spongiosum. Patients and methodsThis prospective study included 116 patients with hypospadias and penile torsion out of a total of 376 primary hypospadias cases seen between January 2006 and June 2013. The patients’ age ranged from 8 months to 26 years with a mean age of 8.37 and a median age of 6.4 years. Prior to surgery the type of hypospadias as per location of the meatus, the presence or absence of chordee, the size of the dorsal hood and deviation of the median raphe on the dorsal hood were noted. The torque of the penile shaft (torsion) toward either side of the midline and ventral curvature was measured using a sterile small protractor around the penile shaft. The techniques used for the correction of penile torsion and chordee were penile degloving and mobilization of the corpus spongiosum with the urethral plate and the urethra. ResultsThe abnormal penile rotation ranged from 15° to 110° (average 51.98°). In 70.69% of the patients the torque was on the left side, while it was on the right in 29.31%. 11.2% of the patients had a severe torque, while it was moderate in 37.94% and mild in 50.86% of the cases. The mean torque was 62.38°±23.03° in patients with distal penile (80 cases), 38.04°±18.50° in patients with mid penile (24 cases) and 18.25°±3.33° in patients with proximal penile hypospadias (12 cases) (P value=0.001). Ventral curvature was seen in 71 cases. Mean ventral curvature was 38°±18.55°, 44.28°±21.11° and 73.58°±32.96° in patients with distal penile, mid penile and proximal hypospadias, respectively (P value=0.001). The procedures of choice for the repair of penile torsion were penile degloving in 11% of the cases, mobilization of the urethral plate and the corpus spongiosum in 28% of the cases, mobilization of the proximal urethra in 40% of the cases and mobilization of the urethral plate into the glans in 21% of the cases. Chordee could be corrected using penile degloving and mobilization of the urethra/urethral plate in all cases. ConclusionsPenile torque is more common and severe in distal hypospadias, while ventral curvature is seen more often in proximal hypospadias. The degree of torsion is inversely proportional to the severity of ventral curvature. Techniques for the repair of penile torque and ventral curvature include penile degloving and mobilization of the urethral plate with the corpus spongiosum and the urethra.

Penile torsion repair in children following a ladder step: Simpler steps are usually sufficient

ObjectiveTo evaluate the correction of different degrees of penile torsion following a ladder step so that simpler steps are used whenever possible. This can avoid the morbidity and complications of complex procedures. Patients and methodsCases of congenital and acquired penile torsion were repaired on a ladder step basis irrespective of the degree of torsion, starting with degloving and skin realignment, then a dorsal dartos flap and finally corporopexy. The torsion is checked with artificial erection after each step, and if corrected completely then the next step(s) is omitted. ResultsTwenty-five cases of penile torsion (30–180°) were repaired over a 4-year period. Three cases were corrected by degloving only, 12 by degloving and skin realignment, five by a dartos flap and four required a corporopexy. Postoperative complications included five cases of penile edema, one case of hematoma and one case of dorsal skin gangrene. Residual torsion of <15° occurred in three cases. No cases required redo surgery. ConclusionA ladder step approach is a good option for penile torsion repair, starting with simpler techniques until complete correction is achieved. There is no need to plan a complex procedure in advance.

Tunica Albuginea Decompression Fails to Alter the Injury of Prolonged Arterial Occlusion During Testicular Torsion

The correlation between intratesticular pressure during torsion/detorsion and subsequent testicular function and viability has been reported in several recent studies. We assessed the impact of tunica albuginea incision with tunica vaginalis flap coverage on intratesticular pressure and future histopathological parameters in a rat testicular torsion model. A total of 21 rats were divided into 3 groups. Group 1 consisted of 7 controls undergoing a sham operation, group 2 consisted of 7 animals undergoing torsion-detorsion, and group 3 consisted of 7 animals undergoing testicular torsion-detorsion followed by tunica albuginea incision and tunica vaginalis flap coverage. Torsion was created by 720-degree counterclockwise rotation of the left testis for 2 hours. By using a compartment monitor, the intratesticular pressure of the torsed testes was measured before torsion (pre-torsion), immediately before torsion repair (pre-detorsion), 5 minutes after detorsion (post-detorsion), and after tunical incision and tunica vaginalis flap application. The correlations between intratesticular pressure values and testicular weight, modified Johnsen score and mean seminiferous tubule diameter were evaluated 4 weeks postoperatively. Median pre-detorsion intratesticular pressure was significantly decreased after detorsion in group 2 (21 vs 7 mm Hg, p <0.001) and group 3 (23 vs 7 mm Hg, p = 0.001). In addition, median intratesticular pressure after tunica albuginea incision and tunica vaginalis flap coverage in group 3 was significantly less compared to median post-detorsion intratesticular pressure in group 2 (5 vs 7 mm Hg, p = 0.025). Overall no significant difference was detected between groups 2 and 3 regarding median modified Johnsen score, mean seminiferous tubule diameter or median testicular weight. The significant reduction of intratesticular pressure in group 3 did not correlate with testicular weight (r = 0.500, p = 0.391), modified Johnsen score (r = -0.205, p = 0.741) or mean seminiferous tubule diameter (r = -0.200, p = 0.747). Tunica albuginea decompression with tunica vaginalis flap coverage is an effective technique for decreasing intratesticular pressure in torsed testes. However, this technique failed to alter the injury of prolonged arterial occlusion in testicular torsion.

Ventrocaudal cystorrhaphy without urethral sphincterotomy in two broodmares

SummaryTwo broodmares were diagnosed with rupture of the urinary bladder. One mare revealed abnormalities post partum and the other associated with ante partum uterine torsion. The clinical symptoms included mild abdominal pain, anorexia, decreased urinary volume and increased peritoneal fluid. In one mare, based on the creatinine level of the peritoneal fluid and serum biochemical abnormalities, uroperitoneum was diagnosed. In the other mare, the bladder rupture was found during the celiotomy for surgical repair of uterine torsion that was diagnosed upon rectal examination. Surgery was performed without a urethral sphincterotomy. The vaginal floor was incised in a standing position and the bladder was diverted into the vagina in order to suture the tears located in the ventrocaudal aspect of the bladder. Both mares survived after treatment for uraemia. Bladder rupture, although uncommon, may affect peripartum mares. Approach to the ruptured bladder without urethral sphincterotomy in a standing position should be considered as a choice for surgical repair.

Intratesticular pressure after testicular torsion as a predictor of subsequent spermatogenesis: a rat model

To assess the correlation between intratesticular pressure (ITP) after testicular torsion and subsequent testicular function using a rat model and to show that ITP at surgery is a useful predictor of future spermatogenesis. Fourteen rats were divided into a torsion group (n= 7) and a control group with sham operation (n= 7). Torsion was created by 720° rotation of the left testis in a counter-clockwise direction. Using a handheld compartment monitor, the ITP of the torsed testes was measured three times: before torsion (pre-torsion), just before torsion repair (pre-detorsion) and 5 min after torsion repair (post-detorsion). We evaluated the correlation between ITP and testicular weight, epididymal sperm count or pathological findings, such as the seminiferous tubule diameter (STD) and the modified Johnsen's score, 4 weeks after surgery. Mean (se) pre-torsion, pre-detorsion and post-detorsion ITP values in the torsion group were 5.9 (2.5), 19.7 (10.7) and 8.2 (4.8) cm H(2) O, respectively. The ITP in torsed testes significantly increased after torsion (P < 0.01) and decreased after detorsion (P < 0.01). Strong correlations were observed between the reduction of ITP after detorsion and testicular weight (r= 0.87, P < 0.05), epididymal sperm count (r= 0.94, P < 0.05), STD (r= 0.87, P < 0.05) or the Johnsen's score (r= 0.99, P < 0.001). A smaller reduction in ITP after detorsion can be a risk factor for subsequent disturbance of spermatogenesis, suggesting that ITP can be an index for determining whether the affected testis should be removed after testicular torsion.

254 INCREASED INTRATESTICULAR PRESSURE AFTER TESTICULAR TORSION AS A NEW PREDICTOR OF SUBSEQUENT SPERMATOGENESIS -AN ANIMAL STUDY

You have accessJournal of UrologyPediatrics: Basic Research1 Apr 2011254 INCREASED INTRATESTICULAR PRESSURE AFTER TESTICULAR TORSION AS A NEW PREDICTOR OF SUBSEQUENT SPERMATOGENESIS -AN ANIMAL STUDY Yoshinobu Moritoki, Yoshiyuki Kojima, Kentaro Mizuno, Hideyuki Kamisawa, Yutaro Hayashi, and Kenjiro Kohri Yoshinobu MoritokiYoshinobu Moritoki Nagoya, Japan More articles by this author , Yoshiyuki KojimaYoshiyuki Kojima Nagoya, Japan More articles by this author , Kentaro MizunoKentaro Mizuno Nagoya, Japan More articles by this author , Hideyuki KamisawaHideyuki Kamisawa Nagoya, Japan More articles by this author , Yutaro HayashiYutaro Hayashi Nagoya, Japan More articles by this author , and Kenjiro KohriKenjiro Kohri Nagoya, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.345AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ischemic damage from testicular torsion is mainly related to the duration of the torsion; however, some torsed testes cannot be salvaged despite prompt diagnosis and intervention. Pathologically, the veins, not the arteries, are initially occluded, leading to hemorrhagic infarction, then arterial flow is gradually lost, and finally the testes become ischemic. We speculated that intratesticular pressure (ITP) rises after torsion and that a decrease in ITP after torsion repair suggests that the infarction is incomplete, i.e., ITP is a predictor of subsequent dysfunction of the affected testis and infertility. In this study, we examined the correlation between ITP after testicular torsion and subsequent testicular function or spermatogenesis using a rat model. METHODS Fourteen prepubertal Sprague-Dawley rats (6E weeks old) were divided into a control group (n = 7) with a sham operation and a torsion group (n = 7). Torsion was created by 720-degree rotation of the left testis in a counter-clockwise direction, and after 2 hours, the torsion was repaired by counter-rotating the testis to the natural position. The testis was then fixed in the scrotum with a 5–0 Vicryl suture. We measured ITP of the left testis using a handheld compartment monitor 3 times, before torsion (pre-torsion), just before detorsion (pre-detorsion), and 5 minutes after detorsion (post-detorsion). Mature rats were sacrificed 28 days after surgery and both testes were removed. We evaluated the correlation between ITP and testicular weight, seminiferous tubule diameter (STD), and the Johnsen's score (JS). RESULTS The pre-torsion, pre-detorsion, and post-detorsion ITP in the torsion group was 5.9 ± 2.5, 19.7 ± 10.7, and 8.2 ± 4.8 cm H2O, respectively. The ITP in torsed testes significantly increased after torsion (p < 0.01) and decreased after detorsion (p < 0.01). Strong correlations were observed between the reduction in ITP after detorsion and testicular weight (r = 0.87, p < 0.05), STD (r = 0.87, p < 0.05), and the JS (r = 0.99, p < 0.001). CONCLUSIONS Less reduction in ITP after detorsion can be a risk factor for subsequent disturbance of spermatogenesis, suggesting that ITP can be an index to determine the necessity for removal of the affected testis after testicular torsion. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e102 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yoshinobu Moritoki Nagoya, Japan More articles by this author Yoshiyuki Kojima Nagoya, Japan More articles by this author Kentaro Mizuno Nagoya, Japan More articles by this author Hideyuki Kamisawa Nagoya, Japan More articles by this author Yutaro Hayashi Nagoya, Japan More articles by this author Kenjiro Kohri Nagoya, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Modern Technique for Penile Torsion Repair

Penile torsion is a congenital malformation that results in a rotational defect of the penile shaft. Various techniques have been described for correcting penile torsion, although there is no consensus on the best repair. We describe our experience using a dorsal dartos flap to correct penile torsion. We retrospectively reviewed the records of all 25 patients who underwent repair of significant penile torsion using a dorsal dartos flap at our institution between 2004 and 2007. A total of 17 repairs were performed in association with chordee repair, 7 with hypospadias and 1 with bilateral inguinal hernias. Patient age at the time of repair ranged from 6 to 19 months (mean 9). Of the patients 15 had torsion of at least 90 degrees, 8 had torsion of 60 to 90 degrees and 2 had torsion that was not recorded in degrees. Mean followup was 4 months (range 1.5 to 19). Of the cases 16 demonstrated complete resolution of penile torsion, 7 had residual torsion less than 10 degrees and 2 had documented improvement that was not reported in degrees. No patient has undergone further repair for torsion. Penile torsion is a challenging congenital anomaly. The dorsal dartos flap is familiar to pediatric urologists and can be varied for use in repair of penile torsion. The procedure results in successful repair of the torsion, has few complications and can easily be performed concurrently in the setting of other operative repairs. This approach provides excellent short-term results.

Twist and Shout: A Clinical and Experimental Review of Testicular Torsion

Riyad T. Ellati, Parviz K. Kavoussi, Terry T. Turner, Jeffrey J. Lysiak From the Department of Urology, University of Virginia Health System, USA Purpose: This review addresses different aspects of testicular torsion from the clinical perspective as well as the basic cellular and molecular events responsible for the post-torsion testicular changes and pathology, including tissue ischemia-reperfusion injury. Materials and Methods: A review of all published literature on testicular torsion was performed by use of two search engines. Results: Testicular torsion, or more correctly termed torsion of the spermatic cord, is a surgical emergency in order to salvage the testis. Its incidence is approximately 1 in 4,000 per annum. Testicular torsion must be treated promptly to avoid loss of the ipsilateral testis; however, even with torsion repair and gross testicular salvage, significant injury may still occur. Conclusions: The cellular and molecular mechanisms leading to ischemiareperfusion injury are incompletely understood, and adjuncts to surgical treatment have received little attention. Understanding the cellular and molecular effects is important because 25% of males with a history of torsion may experience adult infertility. This review emphasizes current knowledge of basic science results and clinical outcomes of testicular torsion. (Korean J Urol 2009;50:1159-1167) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Curcumin attenuates ischemia–reperfusion injury in rat testis

To evaluate the effect of curcumin, a potent antioxidant, on testicular ischemia-reperfusion injury caused by overgeneration of reactive oxygen species (ROS) after testicular torsion-detorsion. Controlled experimental study using rats. Research laboratory. Sixty adult male Sprague-Dawley rats. Rats in the control group underwent a sham operation of the left testis. In the torsion-detorsion group, the left testis was rotated 720 degrees for 2 hours. Rats in treatment group received the same surgical procedure as the torsion-detorsion group, but curcumin was administered IV at repair of testicular torsion. Testicular activity of xanthine oxidase, which catalyzes production of ROS; malondialdehyde level (an indicator of ROS content); protein expression level of heme oxygenase-1, which catalyzes antioxidant generation; and spermatogenesis. Unilateral testicular torsion-detorsion caused significant increases in xanthine oxidase activity, malondialdehyde level, and heme oxygenase-1 protein expression level and caused a significant decrease in testicular spermatogenesis in ipsilateral testes. The rats treated with curcumin had significant decreases in xanthine oxidase activity and malondialdehyde level and had significant increases in heme oxygenase-1 protein expression level and testicular spermatogenesis in ipsilateral testes, compared with the torsion-detorsion group. The curcumin exerts a protective effect on testicular ischemia-reperfusion injury.

Antiapoptotic effects of dehydroepiandrosterone on testicular torsion/detorsion in rats

In the present study, we aimed to evaluate the effects of dehydroepiandrosterone (DHEA) on apoptosis of testicular germ cells after repair of testicular torsion in rats. Twenty-four adult male Sprague-Dawley rats were randomly divided into four groups, with six rats in each group: sham operation, torsion/detorsion (T/D), T/D + vehicle, and T/D + DHEA. Three hours before detorsion, 50 mg kg(-1) DHEA was given intraperitoneally to T/D + DHEA group. In all groups, bilateral orchiectomies were performed and both testicles were histologically examined, with apoptosis detected using the in situ DNA fragmentation [terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling (TUNEL)] system, with morphological damage detected using a four-level grading scale in each specimen. The testes of the sham group showed a normal histology. In T/D and T/D + vehicle groups, apoptotic spermatogonia and spermatocyte number were significantly higher than in the sham group (P < 0.01 for all). The T/D + DHEA group showed a reduction in apoptotic spermatocyte and spermatogonia number in seminiferous epithelia compared with T/D group (P < 0.01 for both). Apoptotic cell number of contralateral testes did not reveal any significant differences among these groups (P > 0.05). Specimens from T/D and T/D + vehicle had a significantly greater histological injury than sham and T/D + DHEA groups in the ipsilateral testes (P < 0.01 for both). Therefore, the results suggest that DHEA may be a protective agent for preventing apoptosis caused by testicular torsion.

Role of UCH-L1/ubiquitin in acute testicular ischemia–reperfusion injury

The most significant complication of testicular torsion is loss of the testis, which may lead to impaired fertility. Molecular mechanisms how spermatogenesis impairs owing to testicular torsion remain unknown. This investigation, by using mouse model of testicular torsion, was undertaken to gain insight into the cellular and molecular mechanism underlying torsion-induced germ cell loss. Male mice were subjected to 2h ischemia-inducing torsion, and testes were examined at 24, 48, and 72h after the repair of torsion (reperfusion). Ischemia–reperfusion (IR) of the testes resulted in germ cell, mostly in spermatogonia, apoptosis, which was revealed by the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate (dUTP) nick end labeling (TUNEL) technique. At 24h after torsion repair germ cell apoptosis reached peak, then decreased until 72h repair. Western blots showed that apoptotic proteins (p53, Caspase-3 and -9) gradually were upregulated at 48h reperfusion, however, anti-apoptotic proteins (Bcl-2 and BDNF) were downregulated in the relevant IR treatment. IR injury induced CHOP protein appearance with maximum expression at 24h of reperfusion. Furthermore, the germ cell apoptosis triggered downregulation of ubiquitin carboxyl-terminal hydrolase-L1 (UCH-L1) at both mRNA and protein levels. To test further whether ubiquitination was involved in IR stress, both mono- and poly-ubiquitin levels in IR stress condition were examined, which showed that both mono- and poly-ubiquitin expression significantly impaired. These results provide evidences of UCH-L1/ubiquitination signaling to the testis IR injury in vivo.

Beneficial Effect of Taurine on Testicular Ischemia-Reperfusion Injury in Rats

To evaluate the effect of taurine, a potent antioxidant, on testicular ischemia-reperfusion injury due to excess reactive oxygen species produced by neutrophils after testicular torsion-detorsion. A total of 60 adult male Sprague-Dawley rats were randomly divided into three groups, each containing 20 rats. The control group underwent a sham operation of the left testis. In the torsion-detorsion group, the left testis was rotated 720 degrees counterclockwise for 2 hours. The treatment group underwent the same surgical procedure as the torsion-detorsion group, but taurine was administered intravenously at repair of the testicular torsion. One half of the rats in each group underwent orchiectomy 4 hours after detorsion for measurement of myeloperoxidase activity, an indicator of neutrophil accumulation in the testis, and for evaluation of tissue malondialdehyde, an indicator of intratesticular reactive oxygen species content. The remainder were killed at orchiectomy 3 months after detorsion for analysis of testicular spermatogenesis. Unilateral testicular torsion-detorsion caused a significant increase in myeloperoxidase activity and the malondialdehyde level and a significant decrease in testicular spermatogenesis in the ipsilateral testes. The decrease in ipsilateral testicular spermatogenesis involved a reduction in testicular weight, mean seminiferous tubular diameter, number of germ cell layers, and mean testicular biopsy score. The rats treated with taurine had a significant decrease in myeloperoxidase activity and malondialdehyde level and a significant increase in testicular spermatogenesis in the ipsilateral testes compared with the torsion-detorsion group. The results of our study have shown that the administration of taurine exerts a beneficial effect on testicular ischemia-reperfusion injury. This effect might be partly the result of a reduction in reactive oxygen species generation by diminishing neutrophil recruitment to the testis.

In Vivo Detection of Apoptotic Cells in the Testis Using Fluorescence Labeled Annexin V in a Mouse Model of Testicular Torsion

It is well established that experimental testicular torsion induces germ cell specific apoptosis. Annexin V (BD Pharmingentrade mark) binds phosphatidylserine that becomes exposed on the cell membrane in apoptotic cells. In vivo detection of apoptotic cells with fluorescently labeled annexin V is an emerging technique that we evaluated for detecting apoptotic germ cells in a mouse model of testicular torsion. Annexin V labeled with an indocyanine fluorophore (bisfunctional succinimidyl ester of cyanine 5.5) (Amersham, Little Chalfont, United Kingdom) was injected intravenously in mice 18 hours after the repair of unilateral 720-degree testicular torsion for 2 hours. Serial fluorescence images were obtained 21, 24, 28 and 42 hours after torsion repair. Relative fluorophore localization was visualized in vivo using an optical small animal imaging system mounted with a filter in near infrared light. Average fluorescence intensity in torsed and sham testes was quantified in images of testes in situ exposed through an abdominal incision and in ex vivo testes. A significant increase in fluorescence intensity was found in images of torsed vs sham operated testes. This was seen in ex vivo, exposed and in vivo testes (215%, 250% and 161%, respectively, p <0.05). Bisfunctional succinimidyl ester of cyanine 5.5 conjugated to dehydrogenase, a protein with a size similar to that of annexin V, was used to assess for capillary leakage. It was also more localized to the torsed testis relative to its contralateral sham control whether exposed or ex vivo (174% and 176%, respectively). To our knowledge this study demonstrates for the first time the possibility of in vivo near infrared fluorescence imaging of apoptotic germ cells after testicular torsion in mice. It shows important confounding factors that must be considered as this new imaging technique is developed for detecting apoptotic cells in vivo in testes or in any other organ.

Testicular Torsion Alters the Presence of Specific Proteins in the Mouse Testis as Well as the Phosphorylation Status of Specific Proteins

Testicular torsion followed by torsion repair induces an ischemia-reperfusion injury to the testis that can render the testis aspermatogenic. Previous results have demonstrated this loss of spermatogenesis to be the result of germ cell apoptosis induced by oxidative stress. The present work reports protein changes occurring in the mouse testis 24 hours after repair of a testicular torsion known to induce germ cell apoptosis and severe seminiferous impairment. Total proteins were extracted from sham-operated testes and testes having had 2-hour 720 degrees torsion 24 hours previously. Testicular proteins were separated by 2-dimensional electrophoresis and the resulting gel images were analyzed with image analysis software. Of the over 1100 proteins detected on the average gel, over 700 were consistently appearing in multiple gels, and those protein spot intensities were averaged within sham and torsion groups and compared between the 2 groups. Twenty-three proteins were consistently increased after torsion repair and 48 were decreased. Six proteins, 3 of which increased and 3 of which decreased after torsion repair, were identified by mass spectrometry. The 3 proteins that increased after torsion repair, beta2-tubulin and 2 isoforms of serum albumin, as well as the 3 proteins that decreased after torsion repair, vimentin, phosphoglycerate kinase, and t-complex protein 1beta, were for the most part associated with various aspects of cell stress responses. The number of proteins phosphorylated on tyrosine residues exceeded the number of proteins phosphorylated on serine/threonine residues, but among 6 stress-related proteins specifically examined for phosphorylation in sham testes and those examined after torsion repair, increases in threonine phosphorylation of c-Jun NH2 terminal kinase and activating transcription factor 2 were the most prominent. Knowing these proteins and the pathways to which they point will aid in the search for new therapies of oxidative stress in the testis.

Penile torsion repair by suturing tunica albuginea to the pubic periosteum

Purpose The aim of the study was to evaluate the effectiveness of a new technique to repair penile torsion in children. Methods Eighteen boys with penile torsion were evaluated in our department from 1989 to 2003. Eleven had associated hypospadias, 4 had chordee without hypospadias, and 3 had torsion only. The direction of rotation was counterclockwise in 16 cases and clockwise in 2 cases. Torsion was repaired in 6 patients by degloving the penis and reattaching the dartos and the skin (comparative group). In 11 patients (1 with prior repair), the torsion was corrected by suturing the lateral edge of the corpus cavernosum to the pubic periosteum (study group). Two patients were not treated. Result Follow-up ranges from 6 months to 7 years. All of the 11 cases in the study group had satisfactory correction of the penile torsion. All of the urethroplasties for hypospadias were successful. In the comparative group, none of 6 patients had satisfactory correction of the rotation. Conclusion The technique of degloving the penis and reattaching the skin cannot reliably correct penile torsion in our experience. Lateral suturing of tunica albuginea to the pubic periosteum to repair penile torsion appears to be a better technique.

THE FAILED COMPLETE REPAIR OF BLADDER EXSTROPHY: INSIGHTS AND OUTCOMES

We describe the complications of complete repair and their management. A total of 19 patients were referred after failed complete repair. Total dehiscence occurred in 6 males, major bladder prolapse in 3, minor prolapse in 3, pubic separation in 1, impassable stricture in 1, and total hemiglans and corporal loss in 2. Overall, partial glans loss was seen in 7 patients, urethral loss in 5 and penile skin loss in 3. One female had complete dehiscence and 1 had major prolapse, both losing the urethrovaginal septum. One female had an impassable stricture. Six males with dehiscence underwent re-closure with osteotomy. Urethral replacement was performed with full thickness skin graft (FTSG) in 3 and with buccal mucosa in 3. Five patients underwent a modified Cantwell-Ransley (C-R) epispadias repair after placement of skin expanders, and 1 awaits repair. The 3 patients with major prolapse underwent re-closure with osteotomy. A urethral buccal graft was used in 1 patient, FTSG was used in 2 at a later operation and all 3 underwent C-R epispadias repair. Of the 3 patients with minor prolapse 2 underwent re-closure with osteotomy using urethral buccal graft or FTSG followed later with a C-R repair. The final patient with minor prolapse underwent re-closure with osteotomy and C-R repair after testosterone stimulation. One patient with pubic separation and urethral and skin loss underwent re-closure with osteotomy, C-R repair after skin expanders and later bladder neck repair. In 1 case a ureteral graft replaced a posterior urethral stricture. Of the 2 patients with hemiglans and corporal loss 1 underwent penile torsion repair and later hypospadias repair, while the other is being observed. Two females underwent re-closure with osteotomy and urethral replacement with tubularized bladder. The case of stricture was managed endoscopically. Complications of complete repair are similar to those of other repairs but more serious if soft tissue loss occurs. Because of these increased risks, this procedure and its formidable complications are best managed by experienced exstrophy surgeons.