Testicular Necrosis Research Articles

A Case of Torsion of the Undescended Testis

This article presents the case of a 14-year-old male who experienced acute torsion of an undescended testis located in the right inguinal canal. The patient presented with severe right inguinal pain. Imaging studies, including CT and MRI, revealed the underlying pathology. Intraoperative findings confirmed testicular necrosis, necessitating an orchiectomy. This report aims to highlight the clinical presentation, radiological findings, and surgical management of this condition, supplemented with relevant images.

Synergistic Effects of Vitamin D and Exercise on Diabetes-induced Gonadotoxicity in Male Wistar Rats: Role of Xanthine Oxidase/Uric Acid and Nrf2/NfkB Signaling.

Type 2 Diabetes mellitus (T2DM) is one of the oldest known chronic diseases, characterized by elevated fasting blood sugar (FBS). T2DM is a metabolic disorder that can distort the activities of multiple physiological systems, including the reproductive system. Although different drugs have been designed for managing this disorder, these drugs have been reported to have negative side effects. Hence, this study was designed to explore the possible synergistic effect of vitamin D and exercise on T2DM-induced testicular dysfunction. Thirty-six male Wistar rats were randomized into six (6) groups: control, diabetes untreated, diabetes treated with 1000 IU/kg of vitamin D, diabetes treated with 5 min/day of physical exercise, diabetes treated with vitamin D and exercise, diabetes treated with 180 mg/kg of metformin. T2DM induction led to a significant increase in FBS, lactate, and lactate dehydrogenase, and was reversed by vitamin D supplementation and exercise. Also, vitamin D and exercise synergistically blunted T2DM-induced oxido-inflammatory response evidenced by a significant decrease in testicular malondialdehyde, interleukin 1β, interleukin 6, and tumor necrosis factor alpha, and an increase in superoxide dismutase, catalase, glutathione peroxidase, and interleukin 10. These events were associated with a decrease in T2DM-induced increase in XO, UA, and Nf-κb and an increase in T2DM-induced decrease in Nrf2. Also, vitamin D and EX reversed the observed impairment in sperm quality and testicular histology following T2DM-induction. This study revealed the synergistic effect of vitamin D and exercise on T2DM-induced testicular dysfunction.

Pathomorphological and immunohistochemical characteristics of the testicle in children with critical ischemia during acute torsion

Background. The occurrence of acute torsion of the testicle in children leads to ischemia of the testicle, and in the absence of timely medical assistance - to the loss of the organ. The period from 12 hours to 24 hours from the onset of the disease leaves only a 20% chance of saving the genital gonad. There are still no exact signs of viability of the affected gonad in case of critical ischemia of the testicle due to its torsion. Therefore, the study of the dynamics of changes in morphological structures in the course of acute testicular torsion, morphological and functional disorders resulting from torsion, is of great practical interest, because there is no consensus on the nature and degree of these changes in the affected gonad. Objective: study of the nature and severity of pathomorphological changes and immunohistochemical features of the acute torsion testicle in children within 12.1-24 hours or more from the onset of the disease. Methods. A histological, histochemical, and immunohistochemical study of testicular tissue biopsies taken during the operation of detorsion and orchiopexy, and orchidectomy within 12.1–24 hours or more from the onset of clinical symptoms of acute unilateral torsion in 16 patients was conducted. Results. The morphological study of the gonads showed that the duration of acute torsion of 12.1–24 hours or more is characterized by severe pathological changes found in the testicles. After 18 hours of acute ischemia, tubules were visualized in many fields of view in the form of shadows with the impossibility of identifying the structures due to hemorrhagic or ischemic infarcts. Immunohistochemical typing demonstrated the absence of expression of vimentin and calretinin, which indicated the death of sustentocytes (Sertoli cells) and Leydig cells. With a duration of acute torsion of 12.1-18 hours, a histochemical study of glycogen in the cytoplasm of spermatogonia, spermatocytes, and sustentocytes using the PAS-reaction showed that some cells of the spermatogenic epithelium were characterized by irreversible changes preceding necrosis, although giant multinucleated spermatids with relatively preserved glycogen, which meant there was a minimal chance for saving the gonad. Conclusion. Total duration of symptoms and degree of male gonadal torsion are the main prognostic factors for testicular preservation or necrosis in episodes of torsion. The duration of an acute torsion of 12.1-18 hours, according to morphological research, leaves in 42,9% of cases the presence of a minimal chance of saving the genital gonad. After 18 hours from the onset of acute complete testicular torsion in children, the operation of choice is orchidectomy.

Exteriorised testicular necrosis following treated severe orchi-epididymitis

Clinical representation of testicular necrosis presented as a defined cutaneous extraposition necrosis as well, no pus or mucus composed structure detected on the necrotic tissue on the left scrotum area in a patient treated for a left Orchi-epididymitis a month earlier. The aspect was dry rough surface slightly pain inducing when mobilized. This is a rare complication of Orchi-epididymitis with an incidence of 1-2% of all epididymitis cases in the emergency department [1,2].

Early testicular necrosis complicating the torsion of sperma cord: A case report with literature review

Spermatic cord torsion is a surgical emergency that requires rapid diagnosis and treatment to avoid orchiectomy. Imaging should not delay surgical intervention. The degree of torsion, in addition to the exact duration, is a significant factor in determining testicular viability. However, there is limited data on the impact of the degree of torsion on testicular viability. We present a case study of a young adolescent patient who experienced early testicular necrosis resulting from torsion of the spermatic cord and underwent a right orchiectomy. Our aim is to demonstrate the impact of the degree of torsion on testicular outcomes and to review relevant literature.

Long time follow-up for patients with testicular torsion: new findings.

Testicular torsion is the major urologic emergency. If not treated promptly, this condition can result in testicular necrosis or long-term functional impairment. At present, there are few paper about long time follow-up of these patients. The primary objective of our study is to report the long-term clinical-instrumental data (mean follow-up 12 years) of patients treated for testicular torsion. We considered patients treated for testicular torsion during the period between 1997 and 2017. Inclusion and exclusion criteria were created. Patients were contacted by phone between December 2021 and January 2022. Each patient underwent clinical and ultrasonographic evaluation, and in addition, some subjects were offered additional tests (hormonal assays and semen analysis). During the study period, 22 patients were treated for testicular torsion. From the ultrasonographic study, it was found that the volume of the affected testis is reduced and it is associated with microcalcifications and heterogeneous echogenicity. Morphovolumetric recovery seems to be more related to age of onset than to the degree of torsion. Based on our results we can state that affected testes, if preserved, grow less and have altered ultrasonographic morphology. Clinically, the age of onset of torsion seems more important than the degree of torsion.

Nursing of a patient undergoing orchidectomy for testicular necrosis caused by injection of calcium chloride

Nursing of a patient undergoing orchidectomy for testicular necrosis caused by injection of calcium chloride

Can we preserve the necrotic testis caused by incarcerated inguinal hernia in infants under 3months?

This study aims to investigate whether necrotic testis resulting from incarcerated inguinal hernias can be preserved in infants under 3months old. A retrospective analysis was conducted on data collected from infants under 3months old who had necrotic testis caused by incarcerated inguinal hernias between 2016 and 2020. They were divided into two groups: the orchiectomy group and the testicular preservation group. The control group consisted of normal male children of the same age. Data regarding bilateral testicular volume, dihydrotestosterone, inhibin B, and antisperm antibodies were collected. The study included 42 cases, with 18 patients being followed up for 6-54months after the operation. In the testicular preservation group, 2 children did not experience testicular atrophy. There was no significant difference in the volume of the contralateral testes between the testicular preservation group and the control group; however, both groups had smaller testicular volumes compared to the orchiectomy group. There was no significant difference in the levels of inhibin B between the testicular preservation group and the orchiectomy group, although both were lower than the control group. Furthermore, no significant difference was observed in the levels of dihydrotestosterone and the positivity rate of antisperm antibodies among the three groups. Preserving the necrotic testis may allow it to survive without impacting the contralateral testis. Therefore, a more conservative approach should be considered for orchiectomy when dealing with testicular necrosis caused by incarcerated inguinal hernias in infants.

Ameliorative Role of Grape Seed Extract (Vitis Vinifera) on Gemcitabine- Induced Testicular Damage in Rabbits

Spermatogenesis is a highly conserved and regulated process and it is sensitive to fluctuations in the physical and chemical environment. Gemcitabine is a novel antimetabolic anticancer drug used frequently in the treatment of many cancers. Gemcitabine may disrupt spermatogenesis by targeting various testicular cell types. Grape seed extract is a natural product, recently identified as one of the most powerful antioxidants. In addition, it has been reported to exert anticarcinogenic effects. This current work aimed to study the effect of gemcitabine on the testicular tissue of local adult rabbits and to evaluate the possible protective role of Grape seed extract. A experimental study was performed on twenty seven adult male local rabbits, were divided into three groups, nine rabbit in each group as following: group (A): animals of control group received normal saline injection, group (B): animals of treated group received therapeutic dose of gemcitabine alone in a dose of 25 mg/kg body weight intraperitoneally once per week for six successive weeks and group (C): served as protective group and was concomitantly treated with grape seeds extract by oral gavages in a dose of 250 mg/kg body weight and gemcitabine in a dose of 25 mg/kg body weight intraperitoneally once per week for six successive weeks. The results of the present investigation showed that gemcitabine toxicity produced significant structural changes in the testis of group B, gemcitabine treated group, in the form of multiple distortion of the seminiferous tubules, with cellular disorganization, testicular tubular cell degeneration, necrosis, tubular atrophy, desquamation and sloughing of the seminiferous epithelium which was accumulated in the centre of the seminiferous tubules in the form of degenerated tissue. Many seminiferous tubules showed widely spaced spermatogenic cells. Karyopyknosis, disappearance of interstitial cells of Leydig and necrotic Sertoli cells, progressive tubular and interstitial testicular damage together with spermatogenic arrest was an initial necrotic change induced by gemcitabine exposure. Disorganization of spermatogenic cells, an interruption in spermatogenesis process and the seminiferous tubules are devoid of sperms was also showed in this study. Sections from the testes of animals received therapeutic dose of gemcitabine and treated by grape seed extract, group (C) were showing partial preservation of the normal structure of the seminiferous tubules. Most of them more or less resembled the normal structure. It could be concluded that gemcitabine caused marked alterations in the structure of the seminiferous tubules of the rabbit testis that may be minimized by administration of grape seed extract. Our findings simply revealed that grape seeds extract treatment significantly inhibits testicular cell apoptosis, which suggests that apoptosis may be one of the underlying mechanisms by which grape seeds extract protects against gemcitabine induced defective spermatogenesis.

Pathological, biochemical and hormonal changes associated with prolonged administration of methanol extract of <i>Garcinia kola</i> seed in adult male Wistar rats.

Garcinia kola (GK) seed is believed to possess aphrodisiac properties hence its traditional use to manage erectile dysfunctions in man. However, there has been conflicting reports of its long-term effects on the male reproductive organs. In this study, the effect of varying doses of methanol extract of GK on testicular function and structure in Wistar rats was evaluated. Forty adult male rats (350-360g) were randomly divided into 4 groups. Groups 1, 2 and 3 received oral doses of 600mg/kg, 400mg/kg and 100mg/kg of the extract daily, respectively for 70 days while group 4 (control group) received normal saline (0.9% NaCl). Blood samples were collected fortnightly from each rat for serum chemistry and testosterone analysis. At termination, the testes, epididymides and livers were harvested, weighed and fixed in 10% neutral buffered formalin and processed for histopathology. The results were presented as mean ± standard error of mean (SEM) and analyzed using one way analysis of variance (ANOVA) at P< 0.05. Dose-related pathological changes were observed in the testes and epididymides. Testicular weight decreased significantly (p<0.05) in 400mg/kg and 600mg/kg groups compared to the control group. There was testicular necrosis associated with distortion of the seminiferous tubular wall and reduced seminiferous tubular diameter. Seminiferous tubules had reduced germinal epithelial thickness along with an absence of viable spermatids and spermatozoa. Serum testosterone levels decreased progressively (p < 0.01) in groups 1 and 2 while those of groups 3 and 4 remain unchanged. The results established that ingestion of methanol extracts of GK seed at the dose of 400mg/kg and 600mg/kg produced significant gonadal pathology in adult male Wistar rats despite the absence of remarkable hepatic biochemical and structural changes.

Potential role of inducible nitric oxide synthase (iNOS) activity in testicular dysfunction following co-administration of alcohol and combination antiretroviral therapy (cART) in diabetic rats: an immunohistochemistry study

Diabetes, alcohol abuse, and combination antiretroviral therapy (cART) use have been reported to cause multi-organ complications via induction of oxidative stress and inflammation. Moreover, these are the most common factors implicated in male reproductive dysfunctions. This study evaluated testicular oxidative stress, inflammation, apoptosis, and germ cell proliferation in diabetic rats receiving alcohol or cART and their combination. Thirty adult male Sprague Dawley rats were divided into five groups, each consisting of six rats; control, diabetic only (DM), diabetic treated with alcohol (DM + A), diabetic treated with cART (DM + cART), and diabetic treated with both alcohol and cART (DM + A + cART). After 90 days of treatment, the rats were terminated, and the testes were extracted and processed for immunohistochemistry analysis for oxidative stress, inflammatory cytokines, apoptosis, and cell proliferation marker. In comparison to the control, oxidative stress markers, inducible nitric oxide synthase (iNOS), malondialdehyde (MDA), and 8-hydroxydeoxyguanosine (8-OHDG) increased significantly in all treated groups. Expression of testicular proinflammatory cytokines, interleukin-1β, and tumor necrosis factor-α was upregulated in all treated groups, but interleukin-6 was upregulated in DM, DM + cART, and DM + A + cART treated groups and was downregulated in the DM + A treated group. All treated animal groups showed an upregulation of apoptotic marker (caspase 3) and a downregulation of proliferation marker (Ki-67). However, Ki-67 staining intensity significantly increased in treated animals compared to the control. These findings suggest that diabetes, alcohol abuse, cART use, and their combination via iNOS activity upregulation can induce inflammation and oxidative stress in testicular tissue, stimulating germ cell apoptosis and proliferation inhibition leading to failure of spermatogenesis.

Severe acute epididymo-orchitis complicated with testicular necrosis

Severe acute epididymo-orchitis complicated with testicular necrosis

Dose-dependent effects of taurine against testicular damage in a streptozotocin-induced type 1 diabetes mellitus rat model.

Testicular dysfunction has been associated with chronic hyperglycemia in diabetes mellitus patients. We investigated taurine's possible mechanisms and protective effects against testicular damage using a rat model of streptozotocin-induced diabetes. Wistar rats (N = 56) were divided into seven equal groups. Untreated control rats received saline, and treated control rats received taurine 50mg/kg orally. To induce diabetes, rats received a single dose of streptozotocin. Metformin-treated diabetic rats received metformin at a dose of 300mg/kg. Taurine-treated groups received 10, 25, or 50mg/kg. All treatments were provided orally once a day for 9weeks following the streptozotocin injection. Levels of blood glucose, serum insulin, cholesterol, testicular tumour necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), interleukin-1beta (IL-1β), malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione (GSH), and catalase (CAT) were examined. Sperm count, progressive sperm motility, and sperm abnormalities were examined. Body and relative reproductive gland weights were assessed. Histopathological examinations of the testes and epididymis were performed. Metformin as well as taurine (in a dose-dependent manner) resulted in significant improvements in body and relative reproductive gland weights, blood glucose, serum cholesterol, and insulin levels, as well as cytokine and oxidative parameters. These findings were associated with significant improvement in sperm count, progressive sperm motility, sperm abnormalities, and histopathological lesions in the testes and epididymis. Taurine can potentially improve hyperglycemia, hypercholesterolemia, and testicular damage associated with diabetes mellitus, possibly by controlling inflammation and oxidative stress.

A Case about Testicular Necrosis after Resection: Objective Negligence and Its Evaluation Method in Medical Criminal Law

A Case about Testicular Necrosis after Resection: Objective Negligence and Its Evaluation Method in Medical Criminal Law

A Case about Testicular Necrosis after Resection: The Court’s Myth of the Medical Evidence through Testimony

A Case about Testicular Necrosis after Resection: The Court’s Myth of the Medical Evidence through Testimony

Echis ocellatus Venom-Induced Reproductive Pathologies in Rat Model; Roles of Oxidative Stress and Pro-Inflammatory Cytokines.

This study reported reproductive pathologies associated with Echis ocellatus venom in animal model. Twenty male Wistar rats with body weight between 180 and 220 g were selected randomly into two groups (n = 10). Rats in group 1 served as the control while rats in group 2 were envenomed with a single intraperitoneal injection of 0.055 mg/kg−1 (LD6.25) of E. ocellatus venom on the first day and a repeated dose on the twenty fifth day. Both control and envenomed rats were monitored for fifty consecutive days. The venom caused a significant (p < 0.05) reduction in sperm motility, count, and volume, with increased sperm anomalies in envenomed rats compared to the control. Likewise, serum concentrations of male reproductive hormones were significantly (p < 0.05) higher in envenomed rats. Increased levels of malondialdehyde were accompanied by a significant (p < 0.05) decrease in reduced glutathione and catalase activity in the epididymis and testis tissues of envenomed rats. The venom enhanced the release of epididymal and testicular tumor necrosis factor-alpha and interleukin1-beta compared to the control. Furthermore, severe pathological defects were noticed in tissues of the testis and epididymis of envenomed rats. This study demonstrated that E. ocellatus venom toxins can induce reproductive dysfunction in male victims of snake envenoming.

Management of Incarcerated Inguinal Hernia in Children at the University Hospital of Antananarivo - Joseph Ravoahangy Andrianavalona

Inguinal hernia is one of the most common surgical pathologies in children. The main risk is the evolution towards strangulation especially before the age of one year. Our study reports our experience on the management of strangulated hernias in children at the University Hospital Center of Antananarivo - Joseph Ravoahangy Andrianavalona (CHUA - JRA). This is a 12-month retrospective study. The parameters studied are the age of onset of strangulation, gender, the side concerned, clinical manifestations, therapeutic methods, outcomes. Of 74 cases collected, 96% were male. The right side predominated with 71.62% of cases. More than 70% of the cases were less than a year old, of which 50% were less than 3 months old. Besides the signs of strangulation, 10 cases presented an evident occlusive syndrome and 5 cases had come with a deterioration of the general state. Among 56 cases of initial reduction, 49 cases were reduced and their surgical treatment was postponed from 2 to 7 days. Cases with evident signs of complications, reduction failure, and cases of ovarian hernias had emergency surgery. Two cases of immediate post-operative death, 6 cases of testicular necrosis and two cases of recurrence over a three-month follow-up were deplored in patients operated on immediately. In case of strangulated hernia, delayed surgery after an immediate reduction offers a better prognosis. The main factor limiting this method is the late consultation responsible for advanced visceral complications.

Parenchymal echotexture changes as a predictor of viability in testicular torsion.

Preoperative test that can predict the salvageability of the torsed testis may add essential information to the surgeon managing testicular torsion (TT), this can assist with patients' and parents' expectations, particularly with nonviable testes. We aimed to examine if parenchymal echotexture changes in preoperative ultrasound can predict irreversible hemorrhagic necrosis. Preoperative ultrasound studies of 154 patients with TT were reviewed by 3 raters (2 radiologists and 1 urologist). The raters were asked to categorize the affected testicular parenchymal echotexture into one of the following categories: (1) normal (identical to the contra-lateral testis), (2) homogenous hypoechoic, or (3) focal heterogeneous echotexture. Testis non-viability was defined macroscopically during surgical exploration and correlated with the US results. Sensitivity, specificity, and positive and negative predicting values of the proposed diagnostic test were calculated. Cohen's kappa coefficient was used to determine inter-rater agreement. A total of 54/154 patients had a nonviable testis. Mean of 59.5% cases was classified as category 1, 27.3% cases as category 2, and 13.2% cases as category 3. Testicular necrosis was 12%, 34%, and 92% in each category, respectively. Category 3 classified non-viability with a mean specificity of 99.3% and with a high inter-rater agreement level (Cohen's kappa coefficient of 0.830). Mean positive predictive value of 97% and mean negative predictive value of 74.3%. The mean sensitivity of this test however was low 39.7%. Ultrasound finding of focal parenchymal echotexture heterogeneous changes is highly specific although not sensitive, for nonviable testis. The presence of this finding reassures non-viability in over 99%.

Laparoscopic –Assisted Orchidopaxy in Non-Palpable Testes in Adult Population

ABSTRACT:&#x0D; &#x0D; Objectives: To present our experience of managing impalpable undescended testes in post-pubertal patients with intention of testicular preservation using laparoscopic assisted orchidopaxy. &#x0D; &#x0D; Study Design: Descriptive Case series.&#x0D; &#x0D; Place &amp;&#x0D; Duration of&#x0D; Study: Department of Urology, Jinnah Postgraduate Medical Center (JPMC) Karachi, between Jan 2015 to Dec 2020 with minimal 6 months follow-up.&#x0D; &#x0D; Methodology: We included all patients with clinically impalpable testes with aged 12 and above. All patients had ultrasound abdomen performed as initial screening test followed by laparoscopic assessment and definite procedure. Patients with normal or hypo-plastic testes were underwent single staged orchidopaxy, while patients with testicular atrophy were planned for orchiectomy. Intraoperative testicular biopsy and Semen analysis were not routinely performed in our study.&#x0D; &#x0D; Results: Total 36 patients with 41 impalpable testes underwent laparoscopic localization and management. Mean age of patients was 20.75+ 5.98 years. 50% of testes were on the right side, 36.1% on left sided while 3.88% were bilateral. 5 (12.1%) patients had clinical inguinal hernia.. Diagnostic yield of ultrasound was (75.6%) and 100 % in laparoscopy. 33 testis were true intra-abdominal while 4 were inguinal and 4 were vanishing testes Normal looking testes were observed in 24 testes (64.86%) followed by hypoplastic in 11(29.72%) while 2 testes (5.40%) were atrophic. Two intra-operative complications included urinary bladder injury and vas deferens injury in one patient each. Postoperatively testicular ischemic necrosis in one (2.4%) and wound infection in 2 (4.8%) patients were noted. Late follow up revealed one port site hernia (2.4%) and one testicular atrophy (2.4%). Success rate of orchidopaxy in our study was 94.6%.&#x0D; &#x0D; Conclusions: Laparoscopic has been proved as excellent diagnostic and therapeutic tool for the management of intra- abdominal undescended testes in adolescent and post-pubertal patients.&#x0D; &#x0D; &#x0D; Key words: Impalpable testes, Laparoscopic-assisted orchidopaxy, Adolescent, Adult

Testicular appendage torsion resulting in testicular ischemia and necrosis in a child

Torsion of intrascrotal appendages is the most common cause of acute scrotum in children, comprising 40 %–60% of the underlying cause of this entity. Torsion of the testicular appendages can be managed conservatively because it spontaneously necroses, disappears, and does not cause testicular dysfunction without blocking testicular blood flow. Our patient had a relatively large torsed testicular appendage, and we performed conservative treatment because there was no spermatic cord torsion. Clear blood flow to the testis was confirmed by ultrasonography examination, but the testicular blood flow was blocked and, as a result, there was testicular necrosis. The aim of this case report is to warn that testicular necrosis can occur even in torsed testicular appendage, which presents conventional ultrasonic findings and can rule out torsion of the spermatic cord. • Torsion of intrascrotal appendages is the most common cause of acute scrotum in children, and it generally can be managed conservatively because it does not cause testicular dysfunction without blocking the testicular blood flow. • Our case of torsed testicular appendage resulted in necrosis despite maintenance of spermatic cord blood flow on ultrasonography examination. • This is the first case report showing that a torsed appendage may have blocked testicular blood flow and caused testicular necrosis.