Testicular Perfusion Research Articles

Does laparoscopic hernia repair affect the vascularity of testis?

Context:Laparoscopic hernia repair, despite its safety and effectivity is related to some drawbacks. Testicular complications are uncommon but serious among them. Testicular atrophy occurs in 0% to 2% of patients after hernioplasty.Aim:In this study, we tried to evaluate the effects of laparoscopic total extraperitoneal (TEP) repair on testicular blood flow in Indian population by comparing the testicular perfusion in preoperative and postoperative status.Settings and Design:A prospective study.Subjects and Methods:A prospective study was conducted among adult male patients having an uncomplicated inguinal hernia. Preoperative and postoperative CDUS evaluation of testicular blood flow was done for each patient.Statistical Analysis Used:Data were analyzed using the SPSS (SPSS, Chicago, IL, USA) software program.Results:The resistive indexes of testicular, capsular, and intratesticular arteries of the operated and nonoperated side were similar preoperatively and did not differ ominously postoperatively.Conclusion:Laparoscopic hernia surgery does not have any significant effect on testicular blood supply and can be advocated safely without any added risk of testicular atrophy.

Testicular ischemia in deficiency of adenosine deaminase 2 (DADA2)

BackgroundDeficiency of adenosine deaminase 2 (DADA2) is a rare autosomal recessive autoinflammatory condition. Recognised features include vasculitis predominantly affecting medium sized vessels, livedoid skin rash, central and peripheral nervous system involvement, variable degrees of immunodeficiency, and marrow failure, amongst other clinical presentations. We present the case of a six year old male with DADA2 who presented with acute testicular ischaemia secondary to vasculitis, the first such description in DADA2.Case presentationA six year old male presented acute right-sided testicular pain. His history included transient infantile neutropenia, resolved hepatosplenomegaly, and longstanding livedo racemosa, leading to screening and confirmation of DADA2 caused by homozygous c.139G > C (p.G47R) mutation of ADA2. As his only clinical feature was that of mild livedo racemosa with normal laboratory parameters at diagnosis, he was being actively monitored prior to starting any treatment. At a routine clinic follow-up a 24 h history of testicular pain was noted on systems review. He was afebrile, and his only physical signs were that of moderate livedo racemosa, and tenderness of the right testicle. Laboratory parameters revealed C-reactive protein (CRP) 8 mg/L (reference range [RR] < 20 mg/L); erythrocyte sedimentation rate (ESR) 28 mm/hr. (RR < 10); and serum amyloid A (SAA)5 mg/L (RR < 10). Ultrasound-scan of the scrotum revealed significantly reduced perfusion of the right testes, without torsion. Surgical scrotal exploration confirmed testicular ischaemia without torsion. Histology demonstrated ischaemic seminiferous tubules with intervening haemorrhage and acute inflammatory cells, consistent with vasculitis of the testis as the cause. He was treated with high dose intravenous methyl-prednisolone followed by a weaning course of oral prednisolone, and subcutaneous adalimumab (anti-tumour necrosis factor alpha, anti-TNFα). Repeat ultrasound-scan 3 weeks later revealed good testicular perfusion, with a small area of focal infarction. At last follow-up (11 months post-event) he remained asymptomatic, on treatment with adalimumab.ConclusionThe phenotype of DADA2 continues to expand, and we add testicular infarction to the features of DADA2. CRP and SAA cannot be relied on as reliable biomarkers to predict tissue ischaemia and hence who to target for anti-TNFα therapy in DADA2, since these remained steadfastly normal before, during, and after testicular infarction in this case.

“My testicles hurt!” Scrotal ultrasonography in the evaluation of adult acute scrotal pain.

Introduction Acute scrotal pain in adult is classified as a medical emergency, necessitating accurate assessment. Common causes include inflammation, trauma and testicular torsion[1]. In cases of testicular torsion, the viability of the testis is dependent on the interval between onset of pain and surgical intervention[2]. A 90% salvage rate is possible for patients who are treated within 4-6 hours, while the salvage rate can drop to 45% with delayed interventions[3]. While clinical and physical examination are essential, B-mode and colour Doppler ultrasound are indispensable because of their moderate-high sensitivity (69-90%) and high specificity (98-100%)[4]. Ultrasound is also cost-effective, swift and non-invasive, leading to timely diagnosis and appropriate treatment plan. Colour Doppler imaging with B-mode ultrasound, allows dynamic assessment of the scrotal structure, reveals testicular perfusion status and possible extent of ischemic injury. Ultrasound strain elastography (SE) shows potential in distinguishing between pathologies and improving clinical diagnosis[3]. Learning Objectives This exhibit aims to: 1. Review the role of ultrasound in diagnosing and distinguishing various acute testicular pathologies. 2. Describe and discuss the sonographic appearances of commonly encountered pathologies utilising various ultrasound imaging techniques (Greyscale, colour Doppler and SE). 3. Evaluate the potentials, pitfalls and limitations of these techniques in diagnosing acute scrotal pain. Imaging Findings In this review, we present a spectrum of cases to demonstrate the sonographic findings of various pathologies commonly encountered in adult acute scrotal pain during the course of our daily practice. The pathologies discussed included testicular torsion, rupture, epididymitis, orchitis and epididymo-orchitis. Both testicular and extra-testicular components are assessed with B-mode and colour Doppler. SE was applied in some cases, and further correlation with other available imaging modalities and/or histopathology were also included wherever available. Insights on recognizing and strategies in overcoming the pitfalls are discussed. Conclusion The ability to identify the sonographic appearances of various scrotal pathologies allows for improving the diagnostic confidence and accuracy. This non-invasive examination of the scrotum improves patient outcomes by decreasing morbidity and avoiding unnecessary and risky surgical exploration.

Study of testicular perfusion after Lichtenstein hernioplasty in uncomplicated inguinal hernia

Background: Inguinal hernia repair is one of the most commonly performed surgical procedures in the world. The aim is to achieve a recurrence free hernia repair with minimum of complications. In mesh inguinal hernia repair testicular cord structures are in direct contact with the mesh. Testicular ischemia usually manifests within 48-72 hours after surgery. Aims of the study was to asses any changes in perfusion of ipsilateral testis after Lichtenstein hernioplasty and establish a baseline testicular perfusion pattern in the study population. This study was conducted in the Department of Surgery for one year at a tertiary care teaching hospital in Delhi.Methods: All consenting adult male patients undergoing Lichtenstein inguinal hernioplasty for unilateral inguinal hernia fulfilling the inclusion and exclusion criteria. A sample size of 50 was included in study.Results: In this study patients were above 18 and below 60 years of age with mean age of 43.58 years. The paired T-test analysis revealed no statistically significant difference between pre and post-operative values of SV, DV, RI, PI and TV.Conclusions: Lichtenstein tension free mesh repair for uncomplicated inguinal hernia does not impair testicular perfusion after the procedure.

Transabdominal preperitoneal hernioplasty for inguinal hernia and male fertility

Objective Inguinal hernia is a common surgical problem. Spermatic cord structures may be injured during open hernia repair, but it is uncommon after laparoscopic repair. Aim The aim was to study transabdominal preperitoneal (TAPP) inguinal hernioplasty and its effect on fertility in male patients. Patients and methods From July 2015 to November 2017, 30 male patients underwent laparoscopic TAPP inguinal hernioplasty and were included in this study. Testicular duplex and semen analysis were done preoperatively and 3 and 6 months postoperatively. Results Preoperative sperm count and motility were within normal ranges. Three months postoperatively, there was a decrease in sperm count in five (16.7%) patients and decreased sperm motility in three (10%) patients. Further three months later, sperm count returned to normal ranges in all patients, and sperm motility returned to normal ranges in two (6.7%) patients but still decreased in one (3.3%) patient. Regarding testicular duplex, arterial flow was normal in all patients preoperatively; 3 months later, there was a decreased arterial flow in two (6.7%) patients; and 6 months postoperatively, testicular arterial flow returned to normal. Conclusion Laparoscopic TAPP hernioplasty is feasible, is easy to learn, and has good results. Postoperatively, there was no significant affection of testicular perfusion or sperm characteristics.

151 Associations of Testicular Size and Arterial Blood Flow with Sexual Development and Semen Characteristics in Dorper Rams Raised in a Subtropical Climate

Spectral Doppler (velocimetric) indices are important indicators of blood perfusion and physiological status of internal organs. Doppler ultrasound is used in andrology to assess the blood flow in the testicular arteries, aiding in the diagnosis of scrotal disorders and abnormal spermatogenesis. It was proposed that blood flow indices measured in the testicular artery, namely, blood flow resistance and pulsatility index, were significant predictors of semen quality in clinically healthy dogs. There is a paucity of studies on the associations of testicular morphology and blood flow dynamics with spermatogenesis in growing rams. Forty-five Dorper rams (24 rams aged 8 to 11 months and 21 rams aged 12 to 24 months) were examined using a portable ultrasound scanner connectecd to a linear-array 7.5-MHz transducer. Measurements of the testes were taken with built-in electronic calipers on images containing the largest cross-sectional area of each testicle in 3 planes (coronal, sagittal, and transverse). Colour and spectral Doppler scans were performed immediately after scrotal ultrasonography to detect the testicular arteries and record the following velocimetric indices: peak systolic velocity (PSV, cm/s), end-diastolic velocity (EDV, cm/s), resistive index (RI = [PSV – EDV)/PSV], and pulsatility index [PI = (SPV – EDV)/mean velocity] of the blood vessels. The length (9.7 ± 0.3 v. 9.0 ± 0.2 cm; mean ± SD) of the testes and scrotal circumference (33.3 ± 0.5 v. 31.8 ± 0.4 cm) were greater (P &lt; 0.05) in sexually mature rams than in peri-pubertal rams. There were no differences (P &gt; 0.05) between the 2 age groups of Dorper rams in mean values for blood flow indices measured in testicular arteries. Semen was collected by ejaculation into the artificial vagina from 38% (8/21) of post-pubertal rams and 21% (5/24) of peri-pubertal animals (Chi-squared test; P &lt; 0.05). Semen volume was negatively correlated with PI of the testicular arteries (r = –0.57, P = 0.04). In summary, the attainment of sexual maturity in Dorper rams maintained in a subtropical climate was associated with significant elongation of testes but not with the changes in testicular volume and blood perfusion. Testicular artery PI was a significant predictor of semen volume in peri-pubertal and sexually mature rams. Based on this and several previous studies, B-mode ultrasonography combined with echotextural analyses of the epididymides and accessory sex glands and serum testosterone measurements provide more useful information on the progression of sexual maturation and present semen quality in rams than the ultrasonographic assessment of testicular dimensions and an array of blood flow indices.

Study of effect of testicular perfusion and fertility in patient operated for inguinal hernia with mesh

Study of effect of testicular perfusion and fertility in patient operated for inguinal hernia with mesh

Bilateral endoscopic totally extraperitoneal (TEP) inguinal hernia repair does not impair male fertility.

Endoscopic totally extraperitoneal (TEP) hernia repair with polypropylene mesh has become a well-established technique. However, since the mesh is placed in close contact with the spermatic cord, mesh-induced inflammation may affect its structures, possibly resulting in impaired fertility. The aim of this observational prospective cohort study was to assess fertility after bilateral endoscopic TEP inguinal hernia repair in male patients. Fifty-seven male patients (22-60years old) with primary, reducible, bilateral inguinal hernias underwent elective bilateral endoscopic TEP hernia repair with use of polypropylene mesh. The primary outcome was testicular perfusion; secondary outcomes were testicular volume, endocrinological status, and semen quality. All patients were assessed preoperatively and 6months postoperatively. Follow-up was completed in 44 patients. No statistically significant differences in measurements of testicular blood flow parameters or testicular volume were found. Postoperative LH levels were significantly higher [preoperative median 4.3IU/L (IQR 3.4-5.3) versus postoperative median 5.0IU/L (IQR 3.6-6.5), p=0.03]. Levels of inhibin B were significantly lower postoperatively [preoperative median 139.0ng/L (IQR 106.5-183.0) versus postoperative median 27.0ng/L (IQR 88.3-170.9), p=0.01]. No significant changes in FSH or testosterone levels were observed. There were no differences in semen quality. Our data suggest that bilateral endoscopic TEP hernia repair with polypropylene mesh does not impair fertility, as no differences in testicular blood flow, testicular volume, or semen quality were observed. Postoperative levels of LH and inhibin B differed significantly from preoperative measurements, yet no clinical relevance could be ascribed to these findings.

Spectrum, Applicability and Diagnostic Capacity of Contrast-Enhanced Ultrasound in Pediatric Patients and Young Adults afterIntravenous Application - A Retrospective Trial.

Purpose: To investigate the spectrum, applicability and diagnostic capacity of intravenous contrast-enhanced ultrasound imaging (CEUS) in a pediatric population. Materials and Methods: From 08/2005 to 11/2015, n = 40 pediatric patients and young adults from 0 - 26 years (Ø 11.4 ± 7.5) and 3.0 - 85.3 kg (Ø 40.8 ± 25.6) with n = 55 investigations received n = 79 IV applications of ultrasound contrast agent (UCA). UCA dose and side effects were documented. Scanned organs were the liver (n = 42), spleen (n = 9), kidney (n = 3), and testis (n = 1). Histology, surgery or reference imaging was compared to CEUS and clinical follow-up. Results: The UCA dose < 20 kg was 0.4 ± 0.3 ml, (0.05 ± 0.02 ml/kg) and > 20 kg was 1.0 ± 0.4 ml (p< 0.0001) (0.02 ± 0.01 ml/kg, p< 0.0001). Adverse effects occurred in 2/79 applications (2.5 %). Agreement CEUS/gold standard resulted in 32/34 investigations. For liver diagnostics (gold standard: MRI, CT, histology, serology), n = 11 malignant and n = 15 benign focal liver lesions were included. The specificity was 100 % (95 % CI: 0.77 - 1.00), the sensitivity was 82 % (95 % CI: 0.48 - 0.98), the positive predictive value was 100 % (95 % CI: 0.69 - 1.00) and the negative predictive value was 88 % (95 % CI: 0.62 - 0.98, p< 0.0001). In n = 2 reference imaging misdiagnosed and CEUS was in accordance with clinical follow-up. All splenic/renal lesions were diagnosed correctly. In n = 1 an insufficient testicular perfusion was ruled out. The observation time was 30.4 ± 30.5 months. Conclusion: CEUS is a well-tolerated and diagnostically equivalent modality in pediatric care, providing fundamental advantages compared to currently approved imaging modalities for these age groups.

Laparoscopic TEP repair of inguinal hernia does not alter testicular perfusion

The effect of laparoscopic TEP repair on testicular perfusion is unclear. The procedure entails dissection of testicular blood vessels off the hernial sac and incorporation of a prosthetic mesh. This carries at minimum, a theoretical risk of compromise in testicular blood supply, which in turn may affect fertility. Our study aims to establish if any alteration in testicular perfusion occurs in very early (24h), early (1week) or late postoperative period (3months) after laparoscopic TEP repair in the Indian population. In our prospective trial, 20 patients underwent unilateral and 8 underwent bilateral laparoscopic TEP hernia repairs using standard technique by experienced surgeons. Flow parameters of testicular, capsular and intratesticular artery were noted using color Doppler ultrasound preoperatively and postoperatively and the postoperative resistive indexes of operated side (n=36) were compared with preoperative values. Additionally, for unilateral repairs, flow parameters on operated side were compared with the non-operated side. No statistically significant difference was noticed in the resistive index of the arteries upon comparing these postoperative with preoperative values. For unilateral repairs, the flow parameters of the operated side were comparable with that of non-operated side (i.e. p>0.05). Laparoscopic TEP performed by experienced surgeons does not alter testicular flow dynamics in early or late postoperative period.

Effects of single-port laparoscopic percutaneous extraperitoneal closure on the orientation of the vas deferens and testicular perfusion and volume: Experience from a single center

To investigate the influence of single-port laparoscopic percutaneous extraperitoneal closure (LPEC) on the orientation of the vas deferens and testicular perfusion and volume in pediatric patients undergoing inguinal hernia repair. A total of 92 consecutively enrolled boys preoperatively diagnosed with a unilateral inguinal hernia underwent single-port LPEC between June 2013 and June 2014. The orientation of the vas deferens and the testicular perfusion and volume of these patients were ultrasonographically assessed preoperatively, one month after surgery and six months after surgery. The surgical procedures were performed successfully without conversion or serious perioperative complications. Ultrasonography showed no angulation or distortion of the vas deferens on the surgical side during a six-month follow-up period. Similarly, there were no perioperative changes in testicular perfusion or volume. Our experience suggests that the single-port LPECtechnique can be safe and effective inpediatric patients with an inguinal hernia and that this technique does not affect the orientation of the vas deferens or testicular perfusion or volume.

Modulation of Thrombosis Significantly Reduces Testicular Damage after Testicular Torsion in Rats: Anti-Thrombotic Treatment and Testicular Torsion

To evaluate the effects of thrombolysis and/or anticoagulation on testicular viability after testicular tortion (TT) was the aim of this study. It has been suggested that alterations of circulation during TT result in thrombus formation that might prevent sufficient perfusion after detorsion. Due to the narrow safety margin of testicular perfusion, even moderate disturbances in blood supply can cause major testicular damage. In 112 rats, the right testicle was torsed for 3 or 6 hours. After detorsion and randomization, they received either enoxaparin, alteplase, both, or placebo, according to their subgroup. Thrombus formation was accessed via D-dimers, pDNA, oxidative testicular damage was evaluated via glutathione peroxidase and malondialdehyde, and cellular damage via inhibin B, testosterone, histological analysis (Johnsen score, Cosetino grading), and TUNEL assay. One hundred and twelve rats were included in the study. The treatment with alteplase or enoxaparin showed significantly less testicular damage and significantly improved Sertoli cell function. Enoxaparin significantly reduced oxidative impairment. The results of the study indicate that TT induces thrombus formation and demonstrate that modulation of thrombosis significantly ameliorates testicular damage in rats. Hence, this treatment option after TT ought to be evaluated in humans.

Testicular perfusion after standing laparoscopic peritoneal flap hernioplasty in stallions

Acquired inguinal herniation is a very common condition in stallions, usually leading to unilateral or bilateral castration to prevent future recurrence. Recently, several surgical techniques such as the standing laparoscopic peritoneal flap hernioplasty (SLPFH) have been developed to avoid herniation recurrence and also preserve the breeding activity of high economic value stallions. However, studies on SLPFH lack more comprehensive and systematic data about reproductive-related adverse effects and outcomes. The aim of this study was to evaluate whether SLPFH of the internal inguinal rings produces changes in the testicular blood flow in a 1-year follow-up. For that purpose, six healthy stallions were used and testicular blood flow was assessed before, 3, 6, and 12 months (T0, T3, T6, and T12) after the procedure. Blood flow was evaluated ultrasonographically, using the pulsed-wave color Doppler mode. Peak systolic velocity, end-diastolic velocity, the time-averaged maximum velocity, and the derived indexes (resistive index) and pulsatility index) of the testicular artery were measured in two localizations: in the spermatic cord and on the caudal epididymal edge of the testicle. On the spermatic cord, the peak systolic velocity of the testicular artery increased significantly at T12. However, on the epididymal edge location of the artery, the pulsatility and resistive indexes were decreased at T12 (P < 0.05). This pattern of blood flow was related to a hyperemic process. Furthermore, SLPFH might have compressed the spermatic cord, causing a slight occlusion of the testicular artery and triggering a compensatory hyperemia to compensate the deficit of blood flow that supplies the testes. The SLPFH of the internal inguinal ring affected the testicular perfusion in stallions in a 1 year follow-up, although there was no effect on sperm production during this time. The spectral Doppler ultrasound is a useful tool to asses the testicular perfusion after reproductive surgical procedure and provides information which anticipates vascular supply compromise of the stallion testicles.

Effects of totally extraperitoneal (TEP) and Lichtenstein hernia repair on testicular blood flow and volume

Laparoscopic totally extraperitoneal hernia repair (TEP) has been compared with the open technique in several studies in terms of technical properties and perioperative outcomes. There are few studies that compare the long-term effects of each technique on testicular structure and function on the side of the hernia repair. The objective of this study is to investigate the effects at 6 months of the TEP and the Lichtenstein technique on testicular volume and arterial flow by the use of Doppler ultrasonography. A total of 148 men with a unilateral hernia were randomized prospectively to undergo TEP or Lichtenstein repair. In both groups, unilateral resistive indices, pulsatile indices of capsular and intratesticular artery flow, and testicular volume (in milliliters) were measured preoperatively and 6 months postoperatively by the use of grayscale and color Doppler ultrasonography (CDUS). The primary outcomes of the study were postoperative findings from history, physical examination, and CDUS measurements at 6 months postoperatively. Demographics, clinical and operative data, CDUS measurements, and recurrence patterns were analyzed. Of 148 procedures, 134 cases consisting of 64 TEP and 70 Lichtenstein repairs were evaluated. Pre- and postoperative CDUS findings, rates of complications, and recurrence in both groups did not show any difference. Operative time was greater with a Lichtenstein repair (36 vs 30 minutes; P = .01). Complications and recurrence rates and effects on testicular perfusion and testicular volume in both laparoscopic and open techniques are similar, whereas the laparoscopic approach has shorter operative time than open hernia repair.

Testicular Infarction Post Inguinal Hernia Repair: Would a laparoscopic approach have helped reduce the risk?

Testicular infarction is a rare consequence of inguinal hernia repairs. Ischaemic orchitis leading to testicular atrophy occurs in 0.2-1.1% of all inguinal hernia repairs. This case report describes a 52 year old male patient who developed testicular infarction three days post-open inguinal hernia mesh repair. Commonly, ischaemic orchitis is caused by damage to the pampiniform plexus which leads to venous congestion and acute thrombosis. The risk factors for developing testicular ischaemia include large or recurrent hernias. It is thought that open approaches have a higher risk of causing ischaemic orchitis compared to the laparoscopic approach due to the need for greater manipulation of the spermatic cord. However, some studies suggest that both approaches do not reduce testicular perfusion post-operatively. Nevertheless, larger studies need to be conducted to evaluate this further and patients should always be informed about this risk regardless of its rarity.

Assessment of testicular perfusion prior to sperm extraction predicts success rate and decreases the number of required biopsies in patients with non-obstructive azoospermia

To assess the role of power and color Doppler ultrasonography (US) in patients with azoospermia prior to testicular sperm extraction. One hundred and thirty consecutive patients with azoospermia were assessed in this prospective study. Based on a semiquantitative method, the results of power Doppler US were graded into three categories: grade 1, no visible vessels; grade 2, between one and three detectable vessels; grade 3, more than three detectable vessels. The location of each visible vessel was also recorded as upper, middle or lower third of the testis. Seventy-four patients with non-obstructive azoospermia (NOA) and 27 with obstructive azoospermia (OA) fulfilled the study criteria. OA patients revealed a significantly higher intratesticular perfusion compared with NOA patients. NOA patients with higher intratesticular perfusion required fewer biopsies for successful sperm retrieval. Moreover, a correlation was noted between the presence of visible vessels in each segment and the probability of successful sperm retrieval during biopsy from the corresponding segment. Our data indicate that a semiquantitative, simplified power Doppler US assessment is capable of localizing areas containing viable sperm with the potential to direct biopsies to specific sites and subsequent decrease in the number of required biopsies.

Improving testicular blood flow with electroacupuncture-like percutaneous nerve stimulation in an experimental rat model of testicular torsion.

The purpose of this study was to determine the blood-flow-enhancing effect of electroacupuncture (EA) in an experimental rat model of testicular torsion. At the first stage, 3D color Doppler ultrasound (3D-CDUS) scans were made to detect baseline perfusion of each testicle in 12 male albino Wistar rats. Then, the left testicles of all rats were twisted 180° clockwise, and 3D-CDUS recordings were repeated. In the next step, 10-Hz EA was applied for 5 min over the T13 and L4 dermatome territories in the study group of six rats. In the control group of six rats, acupuncture needles were inserted in the same manner, but EA was not applied. Baseline, posttorsion, and postintervention (EA and manual needling) 3D-CDUS perfusion recordings were interpreted as volumetric data, and group comparisons were performed. After EA, we observed statistically significant perfusion improvements in both the ipsilateral torsed and contralateral nontorsed testicles. In the control group, testicular perfusion did not show a significant change after manual needling. EA can improve testicular blood flow bilaterally in a rat model of unilateral testicular torsion at 180°.

Can ultrasound help to manage patients with scrotal trauma?

Traumatic injuries to the scrotum are uncommon but, when they do occur, frequently lead to serious complications. Early complications include testicular infarction, necrosis and abscess formation; in the longer-term trauma may result in testicular atrophy and subfertility. Early surgical intervention in patients with testicular rupture can significantly improve the clinical outcome and reduce the need for delayed orchidectomy. However, clinical examination of the scrotum following trauma is difficult and frequently inaccurate; this may result in incorrect triage of patients for surgical exploration. Scrotal ultrasound can reliably assess scrotal injuries and diagnose testicular rupture with a high level of accuracy. Additionally, ultrasound can provide important information regarding testicular perfusion, which can further inform decisions on surgical management. This article reviews the sonographic findings that may be encountered in patients with scrotal trauma, with an emphasis on blunt trauma. It describes the pivotal role that ultrasound can play in the accurate triage of these patients to surgical or conservative management.

Microcirculatory Effects of Selective Endothelin-A Receptor Antagonism in Testicular Torsion

Testicular torsion without timely intervention causes incurable damage to the testis. We examined the causative role of microcirculatory injury in torsion induced testicular damage with particular regard to endothelin-A receptor activation. The microcirculatory consequences of testicular torsion were assessed in the presence or absence of endothelin-A receptor antagonism in rats. Microcirculatory perfusion changes (red blood cell velocity and pulsatile flow pattern alterations) were examined by an orthogonal polarization spectral imaging technique. Microcirculatory inflammatory alterations were assessed byfluorescence intravital video microscopy after 60-minute torsion followed by 240-minute reperfusion. As a specific endothelin-A receptor inhibitor, the antisense homology box derived peptide ETR-p1/fl was applied 10 minutes before reperfusion. Tissue accumulation of leukocytes was estimated by myeloperoxidase activity in tissue biopsies taken at the end of the 4-hour reperfusion period. In further experiments testicular weight as a marker of permanent damage was evaluated 45 days after torsion. The physiological pulsatile flow pattern ceased in the initial phase of reperfusion while leukocyte-endothelial interactions increased throughout the examined reperfusion period. Endothelin-A receptor antagonism caused earlier return of pulsatile flow and recovery of red blood cell velocity, and alleviated microcirculatory inflammatory reactions and atrophy. Results suggest a pathophysiological role of endothelin-A receptor activation in the pathogenesis of testicular torsion. This effect is related to deterioration in testicular perfusion and activation of microcirculatory inflammatory reactions.

Hernioplasty and testicular perfusion

Open and laparoscopic tension-free techniques of hernia repair using synthetic meshes are a well-accepted practice with an excellent patient comfort and a low recurrence rate. It is well known that, direct contact of the mesh to the vessels in the inguinal canal and perimesh fibrosis may have a negative impact on testicular flow. Whether different operative techniques or mesh materials used have an effect on the integrity of the testicle, the influence of the resulting fibrosis on testicular perfusion, and spermatic cord structures is still unclear.Our objective is to review whether there is an association between inguinal hernia and hernia repair techniques, pitfalls of various manipulations and also specific applications on spermatic cord structures and testicular perfusion in view of the literature.Most of the clinical and experimental studies result support the idea that inguinal mesh application for hernioplasty is still a safe procedure in patients. Testicular blood flow may be influenced during open and laparoscopic inguinal hernia surgery. But, so far, there is no evidence for a significant impairment of cord structures after open or laparoscopic hernia repair using tension free techniques. It is clear that fine surgical dissection and reconstruction, doing respect for anatomy and using proper prosthetic material could be obtain the best results. Whether changes in flow parameters remain in the late postoperative period, and whether they have an impact on complications should be evaluated in further clinical and experimental studies.