Treatment Of Testicular Torsion Research Articles

Clinical and hematological analysis of testicular torsion in children.

Analyze the clinical manifestations, laboratory tests, and imaging data of testicular torsion to provide clinical insights for timely and accurate diagnosis and treatment of testicular torsion. A retrospective analysis was conducted on the clinical data of 67 pediatric patients suspected of testicular torsion, admitted and subjected to surgical exploration from June 2018 to June 2023. Based on whether the torsed testicle was excised during surgery, the patients were divided into orchiectomy group (40 cases) and orchidopexy group (27 cases). Combining clinical symptoms, signs, ultrasound examinations, and laboratory tests, the study aimed to summarize the influencing factors on the onset, diagnosis, and treatment of testicular torsion. The clinical manifestations of all 67 pediatric patients were generally typical. Color Doppler Flow Imaging (CDFI) and surgical exploration were performed for all cases, and the results were consistent. Testicular color doppler ultrasound suggested reduced or absent blood flow, leading to surgical treatment in all cases. All patients had unilateral testicular torsion, with 46 cases (68.66%) on the left side and 21 cases (31.34%) on the right side. Intrafunicular torsion occurred in 60 cases (89.55%), while extrafunicular torsion occurred in 7 cases (10.45%). The onset distribution was as follows: 20 cases in spring, 16 cases in summer, 16 cases in autumn, and 15 cases in winter. Univariate analysis indicated significant statistical differences in age, degree of testicular torsion, duration of symptoms, NEUT, NLR, and occurrence of tunica fluid between the two groups of patients. Multivariate logistic regression analysis showed that the duration of symptoms and the occurrence of hydrocele were independent risk factors for determining testicular viability. Testicular torsion is more common in children and adolescents, with clinical manifestations including scrotal pain, scrotal redness and swelling, abdominal pain, nausea, and vomiting. In the early stages of testicular torsion, inflammatory markers in the blood increase, and preoperative ultrasound indicates hydrocele. This suggests that the testicle is in an early twisted state, with good viability and potential for preservation.

The management of testicular torsion: A survey of Turkish pediatric surgeons and pediatric urologists.

This study aimed to evaluate the approaches of pediatric surgeons and pediatric urologists in Türkiye regarding the diagnosis and treatment of testicular torsion (TT) and their adherence to the European Association of Urology (EAU) pediatric urology guideline. A survey consisting of 19 questions, accompanied by an annotation describing the objective of the study, was emailed to pediatric surgeons and pediatric urologists in June and July 2023. Of the 95 respondents, 62.1% had over 10 years of experience, and 48.4% treated more than five cases of TT annually. Of the participants, 87.4% stated that scrotal Doppler ultrasonography (US) was always used, and 12.6% stated that US was used in cases of doubtful diagnosis. Concerning treatment, 14.7% reported performing manual detorsion, 70.5% never did, and 14.7% did so only if the operating room was unavailable soon. A total of 92.6% of participants opted for emergency surgery. Among participants who perform manual detorsion, 71.4% perform surgery within 24 hours after successful manual detorsion. Regarding fixation of the contralateral testicle, 14.7% never performed it, and 27.4% did so only when they performed an orchiectomy on the torsion testicle. While most participants follow EAU pediatric urology guidelines by performing emergency surgery, the rate of manual detorsion is low. Few participants stated that emergency surgery may not be performed after manual detorsion. While all of the participants performed fixation of the torsion testicle in accordance with the guidelines, the same adherence was not observed in the contralateral testicle.

Analysis of factors associated with delayed diagnosis and treatment of testicular torsion in 1005 cases from Chongqing city, China: a cross-sectional study

This study aimed to investigate the clinical and social factors of delayed treatment for testicular torsion (TT) and to explore the risk factors of testicular excision in China. The clinical data of 1005 patients with TT who were admitted to 48 medical institutions in Chongqing city (China) from January 2012 to December 2021 were retrospectively analyzed. It was revealed that the misdiagnosis rates of non-senior (junior and middle) grade doctors and senior doctors were 25.1% and 9.6%, respectively. The proportion of TT patients who received timely treatment (within 6 h after onset of symptoms) was 23.8%. The results of the multivariable logistic regression analysis indicated that absent cremasteric reflex was a protective factor for delayed surgery of more than 6 h from onset of symptoms to surgery. Misdiagnosis, consultation with a non-urologist as the first consultant doctor, absence blood flow in color Doppler ultrasound, negative high-riding testis findings, the presence of fever, and non-manual detorsion were identified as risk factors associated with delayed surgery (more than 6 h from the onset of symptoms) for TT. Furthermore, misdiagnosis, non-urologist first-consultant doctor, absent blood flow in DUS, non-manual detorsion, fever, degree of cord twisting > 180, and the initial diagnosis in tertiary hospitals were risk factors for orchidectomy. Having TT on the right side, and the presence of nausea and vomiting were identified as protective factors for orchidectomy. Technical training in the diagnosis and treatment of TT should be extended to primary hospitals and doctors to significantly improve their accuracy in managing this condition.

Patient Query in Adolescent Testicular Torsion Cases: "Was it Necessary to Mention My Scrotal Pain?"

Objective This study investigates the reasons for the failure to diagnose testicular torsion (TT) in different healthcare facilities (HCFs) and by various physicians. Method We retrospectively analyzed all male patients who underwent TT surgery within the adolescent age group between 2015 and 2023. Healthy adolescent patients who initially presented or were referred to an HCF and were subsequently diagnosed at our hospital for TT surgery were analyzed, focusing on why they were not diagnosed earlier. Results A total of 11 patients aged 10 to 17 who were surgically confirmed to have TT at our hospital between 2015 and 2023 were analyzed retrospectively. These patients had been admitted to various public and private HCFs due to the sudden onset of symptoms such as abdominal pain, vomiting, fainting, sweating, and walking difficulties during and after working hours. Four patients had previously been admitted to one HCF, while seven had been admitted two to six times to an HCF. All patients were healthy, and all but one had received age-appropriate education. However, only two of them had reported experiencing scrotal pain. Laboratory tests and/or radiological examinations were conducted on eight patients, and nine patients received medical treatment and/or prescriptions. None of the patients were initially diagnosed with acute scrotum. Conclusion Despite having unrestricted and free access to well-equipped HCFs, the early diagnosis and treatment of TT are not ensured. Factors contributing to this delay include patients' concealment of, or failure to fully disclose, scrotal complaints, as well as physicians' incomplete history taking and genital examinations. The physician's male gender was not found to contribute to an earlier diagnosis of TT. A mandatory genital examination should be included in the emergency assessment protocol for male patients.

Typical errors in the diagnosis and treatment of testicular torsion in adults. Clinical observation

Testicular torsion refers to diseases of the acute scrotum group and requires early diagnosis and emergency surgical care. Despite the characteristic clinical signs, sometimes there are difficulties in diagnosis, which leads to delayed treatment and irreversible damage to the testicle.The article describes a clinical case of testicular torsion in a young patient with errors in diagnosis, which led to the removal of the testicle. As a result of a diagnostic error – an incorrect collected anamnesis and not timely execution of ultrasound dopplerography, conservative treatment for epididymoorchitis was carried out. The given example illustrates the importance of a thorough study of the anamnesis of the disease – the onset and nature of pain, nausea, as well as local symptoms that are not characteristic of other acute testicular diseases. In addition, if a testicular torsion is suspected, it is necessary to perform urgent, sometimes repeated ultrasound dopplerography of the scrotum organs, which is of irreplaceable value for solving the issue of emergency surgical treatment. At the slightest suspicion of testicular torsion, in particular the presence of several characteristic symptoms and ultrasound data, you need to resort to emergency surgery.

The diagnosis and treatment of testicular torsion in children with non-scrotal initial symptoms.

To explore the clinical characteristics of testicular torsion in children with non-scrotal initial symptoms who were misdiagnosed. A retrospective analysis of 73 cases children with testicular torsion and non-scrotal symptoms who were admitted to our department from October 2013 to December 2021 was performed. Patients were divided into misdiagnosis (27 cases) and clear diagnosis at first visit (46 cases) groups. Clinical data, including age at surgery, clinical presentation, physical examination, number of visits (≥2 times), affected side, time from initial symptoms to surgery, and surgical outcomes, were collected. The TWIST (Testicular Workup for Ischemia and Suspected Torsion) score was calculated and analyzed. Statistically significant differences between the misdiagnosis and clear diagnosis groups were seen in the time from initial symptoms to surgery, the number of visits, the degree of testicular torsion, and the rate of orchiectomy (P < 0.05). There were no statistically significant differences (P > 0.05) in age, affected side, TWIST score, guardian, direction of testicular torsion, intra-vaginal or extra-vaginal torsion, and Arda classification. Postoperative follow-up was 6-40 months. Of the 36 patients who required an orchiopexy, 1 had testicular atrophy at six months and 2 were lost to follow-up. The contralateral testis of the 37 children who underwent orchiectomies developed normally without torsion. The clinical manifestations of testicular torsion in children are diverse and can easily lead to misdiagnosis. Guardians should be aware of this pathology and seek timely medical attention. When the initial diagnosis and treatment of testicular torsion is difficult, the TWIST score during the physical examination may be useful, especially for patients with intermediate-to-high risk scores. Color Doppler ultrasound can assist in making the diagnosis, but when testicular torsion is highly suspected, routine ultrasound is not necessary as it may lead to delayed surgical treatment.

Real-world management of testicular torsion: Level of adherence to the EAU Pediatric Urology guidelines

BackgroundTesticular torsion is the most frequent cause of irreversible ischemia to the testis. Despite guidelines being available, challenges remain in both diagnosis and management of the disease. ObjectiveThis study aims to determine the adherence of urologists and residents in urology to the European Association of Urology (EAU) Pediatric Guideline on Testicular torsion. Study designBoth Dutch and European urologists, and residents in urology filled in a survey on testicular torsion. Information on demographics, diagnostics, and treatment modalities was retrieved from the questionnaire based on the EAU Guideline on Paediatric Urology. ResultsA total of 303 responders participated, of which 214 (71%) were from The Netherlands. Most (61%) responders treated three or more cases of testicular torsion in 2020. Ultrasound was used by 64%, followed by an attempt of manual detorsion by 38% (Summary Fig.). Importantly, 23% preferred not to perform emergency surgery after successful manual detorsion. A Winkelmann procedure was performed by 23%, without fixation of the test is using suture material. A large group of responders (30%) only fixed the contralateral testis by a proven testicular torsion. DiscussionA feasible adherence to the EAU Guideline on Paediatric Urology in treating testicular torsion was reported using this survey, although not all recommendations are implemented as proposed. The fact that outcomes of the different diagnostic and treatment modalities are lacking might be a limitation in interpreting the results of this survey. ConclusionMajority of the responders followed the EAU Guideline on Paediatric Urology in the diagnosis and treatment of testicular torsion. Ultrasound might contribute to diagnosing testicular torsion as long as this does not cause any delay for surgical exploration. Surprisingly, many urologists do not perform a surgical fixation of the testis after detorsion. Since a wide range of techniques and materials is used in case of surgical fixation, the guideline may provide in preferences for a unified policy among urologists. [Display omitted]

Chlorogenic acid ameliorates torsion/detorsion-induced testicular injury via decreasing endoplasmic reticulum stress

Testicular torsion (TT) is an urological emergency situation especially in adolescents and young men. The main pathophysiology of testicular torsion/detorsion (T/D) is ischemia-reperfusion (I/R) injury. I/R induces the production of reactive oxygen species (ROS) thought to play a critical role in tissue injury. Increasing evidence suggests that ER stress may play an important role in I/R-induced cell death. During ischemia, oxygen and glucose deprivation also causes abnormalities in protein folding processes. Antioxidants suppress oxidative stress directly as well as ER stress and thus gain importance in the treatment of pathologies associated with oxidative stress and ER stress, such as I/R damage. Chlorogenic acid (CGA) which is formed by the esterification of caffeic and quinic acids and is one of the most abundant phenolic acids in nature. There is also a growing body of studies reporting protective effects of CGA against I/R injury in different tissues, including intestinal, heart and brain. To investigate the effects of CGA on oxidative stress and ER stress in an experimental testicular I/R injury model. Rats were divided into three groups: control, T/D, and T/D+CGA. In the T/D+CGA group, 100mg/kg CGA was given intraperitoneally 30min before detorsion. While tissue malondialdehyde (MDA) levels were determined manually using a colorimetric method, tissue superoxide dismutase (SOD), 78-kDa glucose regulatory protein (GRP78), activating transcription factor 6 (ATF6) and C/EBP homologous protein (CHOP) levels were determined enzyme-linked immunosorbent assay (ELISA) kits. Johnsen's testicle scoring system was used for histological evaluation. In T/D group, tissue MDA, GRP78, ATF6 and CHOP levels were significantly higher than control group (p<0.05). These increases were significantly reversed with CGA pre-treatment (p<0.05). The histopathological Johnsen score was significantly lower in the T/D group compared to the control group, but the level of histopathological Johnsen score was significantly restored by CGA pre-treatment (p<0.05). The relationship between I/R injury and ER stress has been emphasized frequently in recent years. This study in which the effects of CGA on TT were examined for the first time, showed that CGA can inhibit I/R-induced testicular damage. These results may provide a new insight into CGA and may form the first clinical theoretical basis for the possible use of CGA in the treatment of TT in the future. However, the real function of CGA in TT patients needs further investigation.

Testicular torsion in adults: which news?

We read with pleasure the article written by Dang et al.1 and the authors should be noted for the large case series reported. Testicular torsion is one of the causes of acute scrotum, in all age groups. Even in adults, testicular torsion is difficult to diagnose, so it is necessary to perform a surgical exploration. Some diseases such as testicular cancer must be considered when treating a patient with testicular torsion. Radiological investigations sometimes help us in the diagnosis, but surgery is always necessary to exclude testicular damage. A long-term follow-up is always necessary to evaluate testicular function and viability. It is clear that organizing a multicenter study, even if retrospectively, is always difficult and complex. The data reported are interesting, especially on some clinical aspects, thus highlighting how the diagnosis and treatment of testicular torsion are also in adults sometimes difficult and not always correct. The clinical approach is similar to what is done in the pediatric age, but some differences are evident. For example, the time of onset and the time used for the diagnosis seem to be reduced compared to the pediatric age, perhaps because the adult goes alone to the hospital and knows how to evaluate their symptoms. In spite of this, the absolute percentage of torsions (50%), if corrected excluding 30% of procedures without cause and 10% associated with tumor, is clearly higher than that in the previous age (pediatric and adolescent age). Interesting is also the side localization, which confirms a predisposition for the right side. Based on the study results, if we must analyze and find some uncertain aspects, we can highlight that some data which currently seem to be fundamental in pediatric age for the therapeutic approach, are not reported. In fact, metachronous torsions are not described, and therefore, the simultaneous treatment of the contralateral side is not suggested.2 Moreover, although they reported ultrasound and Doppler data, they do not report data concerning the ultrasound appearance of the testicular parenchyma, so we cannot have data to correlate with testicular viability at the time of surgery and during follow-up. Also inherent to follow-up, the authors reported a follow-up of 30 days, and this may be incorrect on the assessment of testicular viability. How many testes have become atrophic some months after surgery? The long-term outcome is therefore crucial because the ultrasonographic appearance, vitality at surgery, and long-term testicular quality are key elements in predicting any problems with fertility or gonadal function. Very interesting are the data regarding the presence of testicular cancer since it is practically nonexistent in pediatric age.3 These data are important, especially for those surgeons that work with adolescents and young adults. If we have to find some limits, we can specify that the surgical approach is always secondary to the experience of the surgeon who may or may not use ultrasound and other diagnostic methods. In this case, in a multicenter study without having decided beforehand the criteria to treat acute scrotum, what tests to do and when to perform a surgical approach, data collected can be difficult to interpret. However, in the conclusions that are to be shared, surgical exploration should always be performed in case of doubt; and although the percentage of operations without diagnosis may be high, it is correct not to waste time waiting for radiological investigations that may not help in the clinical decision. In our opinion, it remains fundamental that future research should be based on long-term follow-up of these patients, with clinical and radiological controls to be defined, certainly for many months, perhaps adding laboratory tests and analysis of seminal fluid in those patients seeking paternity. Many experiences in fact report that in the long term, testicles left in place after torsion, have altered function. It is therefore essential that research proposes new diagnostic and therapeutic treatments after surgical procedures to ensure better testicular vascularization and vitality of the testis.4 COMPETING INTERESTS Both authors declare no competing interests.

123 Supporting A Learning System in Paediatric Emergency Pathways; Using Organisational Comparisons, Serious Incidents and Near Miss Events To Improve The Diagnosis And Treatment Of Testicular Torsion

Abstract Introduction Scrotal pain is a common presentation to the emergency department requiring prompt investigation and management to identify testicular torsion. Using national data we aim to identify key suboptimal areas in the acute diagnosis and management of testicular torsion with a view to improving outcomes. Method A freedom of information request was made to all Trusts in England that manage testicular torsion. Serious Incidents (SI's) were analysed to see if those with Paediatric Emergency Departments fared better than those without. In addition, a qualitative thematic analysis of the NHS England Strategic Executive Information System database from 2007-2019 was undertaken, identifying common themes associated with orchidectomies and ‘near miss’ events in children. Results 304 serious incidents were returned with 62 Orchidectomies and 242 Near Miss Events. Misdiagnosis of symptomatic testicle was not significant when comparing ED to specialists (OR = 1.46, p = 0.3842). Atypical presentation resulting in orchidectomy was significant when comparing ED to specialists (OR = 6, p = 0.0355). Near miss events are due to a variety of factors. There was no statistical significance in incidents when comparing ED's caring for all ages with Paediatric EDs U = 807.5, z = -1.124, p = 0.261. Conclusions There's a need for education in ED about atypical presentation of testicular torsion and examination of scrotum in cases of lower abdominal pain. It's also vital that specialist teams are cognisant of the standard operating procedures relevant to scrotal pain. Finally, there should be a drive for annual audit in Urology and ED units with regards to testicular torsion as SI's may be under-reported.

Ultrasound evaluation of long-term outcome in boys operated on due to testicular torsion.

We aimed at verifying the usefulness of spectral Doppler ultrasonography in determining development of the testis after torsion in boys.The study involved 28 patients and 30 control cases divided into 3 developmental groups: pre-pubertal, early pubertal, and pubertal. It presented surgical management in testicular torsion (TT), volume, and echogenicity of testes, as well as peak-systolic velocity (PSV), end-diastolic velocity (EDV), and vascular resistance index (RI) in the capsular and intra-testicular arteries, regarding developmental groups, detorsed testes, uninvolved ones, and testes in the control group.Orchiectomy was performed in 13 boys with complete TT, in 11 lasting for over 24 hours, and in 2 lasting for 9 and 10 hours, respectively. Orchiectomy mainly involved patients aged up to 6 years, who at the time of the follow-up ultrasound belonged to the pre-pubertal group.There is no clear correlation between the type of testicular torsion, its duration, and the echogenicity of the testis. Testicular torsion has a negative effect on the volume of detorsed testis with compensatory hypertrophy of the uninvolved testis. The study represents a new approach to the issue of long-term gonadal blood supply abnormalities after treatment of testicular torsion in childhood.

“Study of Etiology of Acute Scrotum and Its Management”

Introduction: Acute Scrotum is an emergency with vast number of differential diagnoses with potential to have short and long term complications. Low salvage rates are often secondary to misdiagnosis and delayed presentation. Late presentation remains the greatest cause of orchiectomy.Many studies had been conducted, on whether every patient of acute scrotum should be explored or not on solely clinical grounds.&#x0D; Objective: The purpose of this study was to study the etiology, age incidence, the differential diagnosis and complications in patients with acute scrotum.&#x0D; Methods: The present prospective observational study was carried out at a tertiary care centre from August 2015 to November 2017 amongst 102 patients diagnosed and admitted for acute scrotum. &#x0D; Results: Out of 102 patients acute scrotum majority 74 (72.54%) had epididymitis and/or orchitis, 6 (5.88%) testicular torsion, 20(18.6%) pyocoele. In final diagnosis, we got 20 patients of pyocoele but only 17 patients were diagnosed clinically, while 3 patients were earlier diagnosed as epididymo-orchitis. Out of 6 patients of testicular torsion, in 3 patients we were able to save testis and bilateral orchiopexy was done. Out of 20 patients of pyocoele, 3 patients were complication of epididymo-orchitis and 2 of testicular torsion. In 8 patients with gangrenous testis orchiectomy was performed.&#x0D; Conclusion: Overlap exists between testicular torsion and other conditions of acute scrotum in the younger population. The clinical manifestations, physical examination findings, and laboratory test results are helpful in distinguishing the etiology; however, ultrasonography and color Doppler help in the diagnosis and immediate treatment for testicular torsion.

Clinical Characteristics of Testicular Torsion and Identification of Predictors of Testicular Salvage in Children: A Retrospective Study in a Single Institution

Purpose: Testicular torsion (TT) is a serious surgical emergency. Prompt diagnosis and treatment of TT are essential to improve the incidence of salvaged testes. The aim of this study was to evaluate the historical features, physical examination findings, laboratory tests, and ultrasound examinations in children with TT, as well as to identify the predictors of testicular salvage in children. Materials and Methods: We retrospectively reviewed the records of 136 males who presented with TT to our institution. Clinical findings, physical examinations, laboratory data, color Doppler ultrasound findings, operating results, and the results of follow-up were collected and analyzed. Patients with neonatal torsion, negative scrotal exploration, or testicular appendix torsion were excluded. A multivariable logistic regression model was used to identify predictors of testicular salvage. Receiver operator characteristics analyses were performed to determine the probability of a non-salvageable torsed testis based on time and degree of twisting. Results: A total of 136 children with TT were identified. Patients were aged from 1 to 16 years, with a mean age of 9.7 years (median, 12; range, 1–16 years). The peak incidences of TT were found between ages of 12 and 14 years. Acute TT is significantly more common in the winter. Testicular salvage occurred in 49 (36%) cases. Of the 49 cases of testicular salvage, 5 patients developed subsequent testicular atrophy. Cutoff values of 13.5 h and 530 degrees of torsion would provide sensitivities of 96 and 61%, with specificity of 80 and 70%, respectively. Multivariate analysis showed that time to surgery and degree of testicular twist were correlated with the risk of a non-salvageable testis. Conclusions: Testicular salvage can be predicted by the duration of symptoms along with degree of twisting. Early scrotal exploration based on careful physical examination decreases the risk of misdiagnosis of spermatic cord torsion. A certain percentage of children with TT presenting with lower abdominal pain should have their testicles checked to make sure that they do not have torsion, especially those visitors in cold season.

Evaluation of parental sociocultural background and education level in response to pediatric testis torsion

Acute scrotal pain (ASP) remains one of the most common male urologic emergencies in the pediatric age group. The most concerning outcome of testicular torsion (TT) is the need for orchiectomy, which has a negative impact on the child's development in general and on sexual development and psychology in particular. Time is the most important factor in the treatment of TT. Parental awareness of ASP indicating the possibility of TT is a significant factor in children's hospital admission time. Sociocultural background may be an indicator in parental awareness. This study sought to determine if parental sociocultural and education level is associated with delayed treatment for TT. This retrospective study evaluated data for patients with scrotal or abdominal pain and TT at two hospitals in Konya, Turkey from 2012 to 2020. Study participants were the parents of the patients treated for TT. Participants were contacted by telephone and asked about their educational background. The study population was divided into 2 groups based on parent characteristics. Group 1 parents had an education level less than high school, had no health insurance, were in need of state aid, and had a low sociocultural background. Group 2 parents had an education level of at least high school or higher and had health insurance. Symptom duration (time between symptom onset and hospital admission) and surgical procedures for the patients were compared between the 2 parent groups. Of the 140 patients who received a diagnosis of TT, 77 were in Group 1 and 63 in Group 2. Mean patient age was 12.7±2.7 (5-16) years Median symptom duration was 7 (1-120) hours. Symptom duration was higher in Group 1, but no statistically significant differences were noted between groups (Group 1 duration was 8h vs. Group 2 duration of 6h; p=0.331). Orchiectomy was performed for 62 (44.3%) patients and testicular-sparing surgery for 78 (55.7%). Orchiectomy rates between groups were statistically significant and higher in Group 1 with 41 (53.2%) versus 21 (33.3%) in Group 2. Factors such as low sociocultural family background and low parental education level increase the risk of orchiectomy for their children. Awareness of the symptoms of TT may minimize the possibility of testicular loss.

Does Elastography Have a Place in Evaluating Tissue Stiffness in Testicular Torsion?

Background: One of the most important urologic emergencies is testicular torsion in children. Elastography is as an objective method in diagnosis and treatment of testicular torsion, with grayscale and colored images. Our study presents an original framework, which may guide certain research and practices in this field. Objectives: The aim of this study was to evaluate the effectiveness of ultrasound (US)-elastography for the diagnostic performance of testicular torsion. Materials and Methods: In this experimental study, 16 male white New Zealand rabbits of the same weight and age were selected and divided into two groups. In group I, the right testicle was fixed, and in group II, the right testicle underwent 720° torsion in a counterclockwise direction and fixed. Following 1 and 2 hours of ischemia, measurements of the right and left testicles were performed simultaneously. The left testicle was measured again after 24 hours in order to better observe the changes that right testicular ischemia might have had on the left testicle. Results: A statistically significant increase was detected in the elastography values of the right testicle at 1, 2, and 24 hours (P &lt; 0.05). Elastography values were significantly increased in the left testicle after 24 hours (P &lt; 0.05). The elastographic measurement values of the testicular tissue increased significantly with the increase in the duration of ischemia. Conclusion: With the width of its imaging window and healthy evaluation opportunity, elastography is a method in determining tissue stiffness of unilateral and contralateral testicular structures. In this study, the efficacy of elastography was evaluated. As a future research, further studies are needed to evaluate the elastography values in epididmo-orchitis and other causes of acute scrotum.

Acute Testicular Torsion Management

Testicular torsion is a common cause of acute scrotal pain and requires timely diagnosis and treatment to prevent testicular loss. Several factors must be taken into consideration when determining the appropriate treatment algorithm for patients. The definitive treatment is surgical exploration with orchiectomy or orchiopexy of the affected testicle and contralateral orchiopexy. The use of manual detorsion depends on the ability to proceed with immediate surgical exploration and should not delay definitive treatment. Recent developments in the understanding of ischemia-reperfusion injury in testicular torsion have led to the potential for nonsurgical adjuvants in the treatment of testicular torsion, although none are currently being used in practice. The treatment of neonatal torsion remains controversial and practice patterns vary greatly. Medicolegal concerns also play a role in the treatment decisions in both neonatal and nonneonatal testicular torsion. This review contains 6 figures, 5 tables, and 54 references. Key Words: compartment syndrome, detorsion, infertility, ischemia-reperfusion injury, orchiopexy, surgical exploration, testicular prosthesis, testicular torsion

Clinical features of testicular torsion and its misdiagnosis:analysis of 274 cases

To summarize the clinical characteristics of testicular torsion and explore the relationship between its incidence and temperature, the value of supplementary examinations, and the factors causing misdiagnosis and testicular lesions. We retrospectively analyzed the clinical data of the patients with testicular torsion diagnosed in 9 hospitals in Hunan Province from May 1, 2009 to November 1, 2018. The temperature at onset and WBC value after onset were analyzed. The misdiagnosis rate and testicular lesion rate in the first-visit hospitals were compared between the large general hospitals and local hospitals. The factors that affected the diagnosis and treatment of testicular torsion were analyzed. A total of 274 cases were included in this study, and misdiagnoses occurred in 151 cases (61.9%). The initial diagnosis was made in large general hospitals in 59 cases; misdiagnosis occurred in 30.5% of the cases and the rate of testicular lesions was 57.6%. Of the 215 cases first diagnosed in local hospitals, only 82 cases were diagnosed correctly, and the misdiagnosis rate was as high as 61.9%; the rate of testicular lesion was 85.6% in these cases. There were significant differences in the misdiagnosis rate and testicular lesion rate between the two groups (P &lt; 0.05). The first-visit misdiagnosis rate of testicular torsion is much lower and the probability of testicle preservation is significantly higher in large general hospitals than in the local hospitals, suggesting the importance of health education for testicular torsion, enhancing the awareness of this condition and training of the surgeons in primary hospitals.

The protective effect of low-energy shock wave on testicular ischemia-reperfusion injury is mediated by the PI3K/AKT/NRF2 pathway

AimsTesticular ischemia-reperfusion (IR) injury is the primary pathophysiological consequence of testicular torsion. Low-energy shock wave (LESW) is an effective treatment for certain diseases. The present study investigated whether LESW could improve on testicular IR injury in rats and examined the involved mechanism. Main methodsTesticular reperfusion was induced in rats after 1-h ischemia. The first LESW treatment was performed 30 min prior to testicular reperfusion, and then every other day for another 3 applications. LY294002 was applied to investigate the involved mechanism. Testicular morphological changes and malonaldehyde (MDA) level were respectively assessed by hematoxylin-eosin staining. Western blot and thiobarbituric acid method. Western blot, real-time quantitative PCR and immunohistochemistry were performed to assess the apoptosis, the activation of phosphatidylinositol-4,5-bisphosphate 3-kinase/protein kinase B (PI3K/AKT) pathway the nuclear factor erythroid 2-related factor 2 (NRF2) and vascular endothelial growth factor A (VEGF-A) level in the testis of rats. Key findingsLESW improved testicular IR injury in rats. Moreover, LESW upregulated the phosphorylation levels of AKT and glycogen synthase kinase 3β (GSK-3β). Also, it upregulated the levels of nuclear NRF2, heme oxygenase 1 (HO-1) and NAD(P)H quinone dehydrogenase 1 (NQO-1) in these rats. Nevertheless, LY294002 blocked these protective effects. LESW also upregulated VEGF-A level in rats with testicular IR injury. SignificanceThis study demonstrated that LESW could ameliorate testicular IR injury in rats, which might be attributed to the activation of PI3K/AKT/NRF2 pathway. These findings suggested the potential of LESW in the treatment of testicular torsion.

Diagnosis and treatment of testicular torsion: a clinical analysis of 95 cases

Objective To analyze the clinical features, diagnosis and treatment of testicular torsion. Methods The clinical data of 95 patients with testicular torsion admitted from March 2001 to April 2017 were analyzed retrospectively. Results The age of patients ranged from 13 to 42 years (mean 19.6 years). Among 95 patients, 91 cases had essential clinical symptoms of scrotal pain; 1 case reported the right testicular enlargement without pain, and 3 cases presented with left inguinal mass. Color Doppler flow imaging (CDFI) was performed in 91 patients, reduction or loss of blood flow signals were detected in 88 cases, and normal blood flow signals were presented in 3 cases. The diagnosis of testicular torsion was confirmed by CDFI in 91 cases before surgery, and 4 cases were diagnosed by medical history and physical examination. The duration from onset to surgery was 10 h in 60 cases. All the patients received operation, 92 cases were diagnosed as testicular torsion in scrotum and 3 cases as cryptorchidism torsion after surgery. Among 92 cases of testicular torsion in scrotum, twisted testicles were removed in 41 cases and the testicles were retained in 51 cases; while testicles were removed in 1 case of cryptorchidism torsion, and the testicles were fixed in the scrotum in other 2 cases of cryptorchidism. Sixty eight patients were postoperatively followed-up for 1 month to 15 years, the retained necrotic testis atrophy occurred in 1 case, and the testicular size was normal in other 67 cases. In the 68 cases, there was no testicular discomfort and no testicular torsion after operation. Conclusions CDFI is valuable in preoperative diagnosis of testicular tortion. Once the diagnosis is made, it should be operated as soon as possible to retain the testicular function, and the affected testicle should be retained with caution for cryptorchidism torsion. Key words: Spermatic cord torsion; Cryptorchidism; Ultrasonography, Doppler, color; Diagnosis; Treatment

TESTICULAR TORSION IN THE INGUINAL CANAL IN CHILDREN

There was performed analysis of diagnostic methods and modes of surgical treatment of testicular torsion in the inguinal canal, a comparison with similar indices in the torsion of a scrotally located gonad. The anatomical premises and features of a testicle in the inguinal canal associated with atypical anatomy are discussed. The results of the study indicate to a greater severity of testicular ischemia and, accordingly, the frequency of unsatisfactory results, despite a somewhat lower degree of torsion, which is explained by the compression of the gonad in the inguinal canal. Difficulties and peculiarities of clinical diagnostics, other differential-diagnostic set are shown. Difficulties and peculiarities of ultrasonic and Doppler diagnostics, typical ultrasonic symptoms of testicular torsion in the inguinal canal, their diagnostic value are demonstrated. The modalities of surgical treatment of this pathology are considered. Several different variants of surgical tactics are presented in various clinical and anatomical conditions. The research materials confirm the legitimacy and the possibility of using each of them. The total loss of the gonad in the torsion in the inguinal canal amounts of 8 (66.7%) of the cases out of 12, which is significantly higher than when the testicle is turned in conditions of a typical anatomy. However, the results of the study confirm that with the timely treatment, clinical and radiation diagnosis, taking into account the features of the shape of the torsion and emergency intervention that takes into account the specific clinical situation, despite the difficulties, the result of treatment can be positive.