Prenatal ultrasound diagnosis of fetal testicular torsion: a case report / 中华围产医学杂志

This article reported a case of fetal testicular torsion diagnosed by prenatal ultrasound. Ultrasound examination at 38 weeks of gestation showed a slightly enhanced echo in the left testicle of the fetus and fluid accumulation within the testicular sheath cavity and between the sheath and fascia, presenting a 'double-ring' sign. An emergency cesarean section was performed considering the risk of acute fetal testicular torsion. Postnatal ultrasound images revealed abnormalities in the left testicle of the neonate and peripheral effusion with a 'double-ring' echo. The patient was considered to have congenital testicular torsion (with a high possibility of extravaginal type) and received an emergency treatment of left testicular torsion reduction combined with testicular fixation surgery and right testicular fixation surgery. Six months after surgery, reexamination by ultrasound showed the testicles of the newborn were normal.

Effect and necessity of early surgical management of neonatal testicular torsion: an analysis of 11 cases / 中华围产医学杂志

Objective:To investigate the clinical features of neonatal testicular torsion and to evaluate the effect and necessity of early intervention.Methods:A retrospective analysis was performed on 11 neonates admitted to the Second Hospital of Shandong University with neonatal testicular torsion from June 2017 to June 2022. Clinical data of these cases including clinical manifestations, ultrasonography findings, surgical management and outcomes were reviewed and analyzed with descriptive statistical methods.Results:The median age of the 11 patients on admission was 2.6 d (1-5 d). The median time from finding abnormal scrotum to admission was 12 h (1-120 h). Various degrees of scrotal swelling or scleroma were found in the patients. Among them, seven patients presented with acute inflammatory signs of cyano sis or skin redness, and testis-like tissue induration could be touched. Ultrasound scan showed abnormal blood flow in the affected testicle in all cases. Emergency scrotal exploration under general anesthesia was performed successfully in all cases and ten of them underwent orchiectomy of the affected testicle plus contralateral orchiopexy. The rest one who was admitted within 1 h after birth only underwent orchiopexy of the affected testicle as the parents refused contralateral testicular exploration. During the operation, 12 twisted testis were observed, including seven with extravaginal torsion, three with intravaginal torsion and two adhering to the surrounding tissue without normal testicular tissue or distinguishable torsion direction or degree. In this study, ten patients had unilateral testicular torsion, which affected the left side in seven cases and the right side in three cases, and one had bilateral testicular torsion, which was diagnosed as left testicle torsion before surgery. During scrotal exploration, the left testicle of this bilateral case was resected due to necrosis, while the right testicle twisted about 180 degrees with good blood flow and was subjected to orchidopexy after reduction. In one case, the unaffected testicle was unfixed and dysplastic during contralateral exploration, which was also subjected to orchidopexy. In the 12 testis with torsion, one testicle of the patient admitted within 1 h after birth and the right testicle of the bilateral case were preserved with a salvage rate of 2/12. Pathological examination showed necrosis in the ten excised testis, and fibrosis and calcification foci in two of them. None of the patients had any perioperative complications and the scrotal incision healed well in all neonates. The patients were followed up for 6-12 months with regular ultrasound. The two preserved testis and the contralateral testis subjected to orchidopexy were located in the scrotum with good blood supply, and no torsion, atrophy or other abnormalities occurred.Conclusions:Neonatal testicular torsion is rarely seen in clinical practice and has no specific manifestations. It has a high excision rate due to testicular necrosis. Early diagnosis and bilateral scrotal exploration are crucial to the prognosis and the keys to save the affected testis and avoid anorchidism.

Spermatic cord torsion: a retrospective analysis

ABSTRACT Objective To evaluate the time interval and possible delay in transportation to referral units for the treatment of testicular torsion. Methods We retrospectively analyzed all cases of spermatic cord torsion surgically treated at a university hospital between January 2018 to December 2021. We evaluated the time intervals, including pain onset until the first presentation (D1), interhospital transference time (D2), pain onset until urological evaluation in a tertiary service (D3), urological evaluation until surgery (D4), and time from pain onset to surgical treatment (D5). We analyzed demographic and surgical data, orchiectomy rates, and time intervals (D1-D5). Torsions presented to the first medical presentation within 6h were considered early for testicular preservation. Results Of the 116 medical records evaluated, 87 had complete data for the time interval analysis (D1 to D5) and were considered the total sample. Thirty-three had D1 ≤6h, 53 had D1 ≤24h (includes patients in the D1 ≤6h subgroup), and 34 had D1 >24h. The median time intervals of the total samples and subgroups D1 ≤6h, D1 ≤24h, and D1 >24h were D1 = 16h 42min, 2h 43min, 4h 14min and 72h, D2 = 4h 41min, 3h 39min, 3h 44min and 9h 59min; D3 = 24h, 6h 40min, 7h and 96h; D4 = 2h 20min, 1h 43min, 1h 52min and 3h 44min; D5 = 24h 42min, 8h 03min, 9h 26min and 99h 10min, respectively. Orchiectomy rates of the total sample, subgroups D1 ≤6h, D1 ≤24h, and D1 >24h were 56.32%, 24.24% (p<0.01), 32.08% (p<0.01), and 91.18% (p<0.01), respectively. Conclusion Late arrival at the emergency department or a long interhospital transference time determined a large number of patients who underwent orchiectomy. Thus, public health measures and preventive strategies can be developed based on the data from this study aiming to reduce this avoidable outcome.

Testicular decompression and tunica vaginalis flap in human acute testicular torsion: modified step-by-step technique description and preliminary outcomes

ABSTRACT Objective To report the effects of a tunica vagina flap on testicular compartment syndrome. Methods This single-arm clinical trial was conducted from September 2020 to October 2021. Consecutive patients with suspected testicular torsion within 24 hours of pain onset were included. Patients with past testicular torsion, bilateral torsion, or previous atrophy were excluded. The tunica vaginalis was opened, and the intratesticular pressure was measured before testicular retrieval from the scrotum and detorsion (P1), after detorsion (P2), and after transverse incision (P3). A tunica vaginalis flap was performed and a new intratesticular pressure was recorded (P4). The contralateral testicular pressure was recorded before fixation (Pc). The minimum follow-up period was 6 months. Results Fifteen patients were recruited from September 2020 to October 2021. Nine patients completed the follow-up. The median age (range) was 15 years (9-19). The mean P1, P2, P3, P4, and Pc (range) were 43, 60, 23, 20, and 14mmHg, respectively. The atrophy rate was 66.3% and the viability was 88.9%. No major complications were observed. Conclusion The modified tunica vaginalis flap in acute testicular torsion decreased intratesticular pressure. Furthermore, normal testicular pressure can improve testicular preservation. It can also decrease testicular pressure to normal levels and preserve the testicular parenchyma.

Testicular volume and Tanner stage: determinant factors for testicular torsion

ABSTRACT Objective To assess testicular volumes and sexual maturation in patients with testicular torsion. Methods A retrospective analysis of consecutively treated patients with testicular torsion between 2016 and 2018. Age, pubic hair staging (Tanner), and by ultrasonography, volume of the unaffected testis (in cubic centimeters) were evaluated either immediately before surgery or at the first postoperative visit. Patients with previous testicular disease, such as cryptorchidism, or with no records of testicular volume were excluded. The analysis included descriptive statistics and Bayesian regression. Results We treated 149 patients during the study period, and 141 (94.6%, median age 17.3 years) met the inclusion criteria. Median testicular volume was 13.0cm3 (interquartile range of 10.5-15.2), with similar right and left volumes (12.9cm3versus 13.3cm3; p=0.94). Sixty-five (46.1%) patients were Tanner stage IV, 17 (12.1%) stage III, and 59 (41.8%) stage V. Conclusion In this study, we were able to estimate volumes of testicular torsion, which aggregated around late puberty values (13.0cm3 for the whole dataset, 12.2cm3 for patients <25 years), suggesting that testicular hypermobility, due to congenital anatomical abnormalities, remains quiescent until the organ reaches a critical volume, after which torsion becomes possible. These findings provide a tentative explanation for the disease's age distribution.

Spermatic vein thrombosis. first clinical case reported in colombia

ABSTRACT Introduction: Spermatic vein thrombosis (SVT) is a very rare event with no specific epidemiological data. Its presentation is predominantly on the left, and in most cases, its cause is unknown. Its diagnosis is usually made by exclusion when studying acute scrotum pain. The following is the first case of SVT reported in Colombia and one of the few cases of right laterality in the world. Case presentation. A 21-year-old male patient consulted the emergency department of a tertiary care institution in Bogotá, Colombia, due to pain in the right inguinoscrotal region for a week that progressively increased in intensity and was accompanied by unquantified fever, without other associated symptoms. The patient reported only a medical history of a mild cranioencephalic trauma without sequelae at the age of 20 years. A testicular Doppler ultrasound was performed, revealing right spermatic cord thrombosis. He started antibiotic therapy, low molecular weight heparins and coumarin, which resulted in an adequate response and resolution of the condition. Conclusion: SVT poses a diagnostic challenge that requires a high clinical suspicion, which is achieved by having knowledge of this condition and establishing it as a differential diagnosis of acute scrotum pain. Once suspected, Doppler ultrasound becomes a useful tool for diagnosis because, in addition to being cost-efficient, it allows the initiation of a timely, safe and effective conservative treatment, thus avoiding unfavorable outcomes for the patient.

RESUMEN Introducción. La trombosis de la vena espermática (TVE) es una entidad muy poco frecuente de la cual no se tienen datos epidemiológicos específicos. Su presentación es de predominio izquierdo, en la mayoría de los casos su causa es desconocida y su diagnóstico suele realizarse por exclusión en el estudio del escroto agudo. A continuación, se presenta el primer caso documentado de TVE en Colombia y uno de los pocos de lateralidad derecha en el mundo. Presentación del caso. Hombre de 21 años quien consultó al servicio de urgencias de una institución de tercer nivel de atención de Bogotá, Colombia, por un cuadro clínico de una semana de evolución consistente en dolor en región inguinoescrotal derecha que aumentó progresivamente de intensidad y estuvo acompañado de un pico febril no cuantificado; el paciente indicó como único antecedente médico un trauma craneoencefálico leve sin secuelas a los 20 años. Se realizó estudio con ecografía Doppler testicular en donde se observó trombosis del cordón espermático derecho. Se inició manejó con antibioticoterapia, heparinas de bajo peso molecular y cumarínicos, con lo cual se obtuvo una adecuada respuesta y la resolución del cuadro. Conclusión. La TVE representa un reto diagnóstico, por lo que se requiere de una alta sospecha clínica, la cual se genera teniendo conocimiento de la entidad e incluyéndola en el diagnóstico diferencial del escroto agudo. La ecografía Doppler es una herramienta fundamental para diagnosticar TVE, además permite iniciar un tratamiento conservador oportuno, seguro y eficaz que evite desenlaces desfavorables para el paciente, lo que resulta ser costo-efectivo.

Testicular torsion: a modified surgical technique for immediate intravaginal testicular prosthesis implant

ABSTRACT Purpose: The aim of this paper is to propose a modified surgical technique for immediate intravaginal prosthesis implantation in patients undergoing orchiectomy due to testicular torsion, and to evaluate the wound healing process and patient's satisfaction. Material and methods: We prospectively analyzed 137 patients with testicular torsion admitted to our facility between April 2018 and May 2020. Twenty-five patients who underwent orchiectomy were included in this study. Fifteen had a testicular prosthesis implanted at the same time as orchiectomy using a modified intravaginal technique (summary figure) and 10 received implants 6 to 12 months after orchiectomy. Wound healing was evaluated at a minimum of four checkpoints (on days 15, 45, 90 and 180 after surgery). At the end of the study, a questionnaire was administered to measure patients' satisfaction rate. Student's t test was used for comparison of quantitative data between negative vs. positive cultures (p <0.05). The chi-square test was used to verify associations between categorical variables and immediate vs. late prosthesis implantation (p <0.05). Results: Patient's ages ranged from 13 to 23 years (mean 16.44 years). Overall time lapse from symptoms to orchiectomy ranged from 10 hours to 25 days (mean 7.92 days). Only one extrusion occurred and it happened in the late implant group. All wounds were healed in 72%, 88%, 95.8% and 100% of the cases on the 15th, 45th, 90th and 180th days after implant, respectively. At the end of the study, all patients stated they would recommend it to a friend or relative. The only patient that had prothesis extrusion asked to have it implanted again. Conclusion: There was no prosthesis extrusion using the modified intravaginal surgical technique for immediate testicular prosthesis implantation, which proved to be an easily performed and safe procedure that can avoid further reconstructive surgery in patients whose testicle was removed due to testicular torsion.

Testicular torsion and climate changes in macroregions of São Paulo, Brazil / Torção testicular e diferenças climáticas nas macrorregiões do estado de São Paulo, Brasil

ABSTRACT Objective: To analyze the association between climate changes in the macroregions in the state of São Paulo and testicular torsion treated cases. Methods: The cases were selected in the Brazilian Public Health Data System Database from January 2008 to November 2016. All surgical procedure records were identified by the Hospital Admission Authorization document. Two codes were selected to process the search: testicular torsion (surgical cure code) and acute scrotum (exploratory scrototomy code). The macroregions were grouped in five areas linked to climate characteristics by International Köppen Climate Classification. Results: A total of 2,351 cases of testicular torsion were registered in the period. For the areas B, C and E (testicular torsion n=2,130) there were statistical differences found in association of testicular torsion cases and decreased temperature (p=0.019, p=0.001 and p=0.006, respectively), however, in analyses for the areas A and D statistical differences were not observed (p=0.066 and p=0.494). Conclusion: Decrease in temperature was associated with testicular torsion in three macroregions of São Paulo. The findings support the theory of cold weather like a trigger in occurrence of testicular torsion in a tropical climate region.

RESUMO Objetivo: Analisar a associação entre mudanças climáticas nas macrorregiões do estado de São Paulo e os casos tratados com torção testicular registrados. Métodos: Os casos foram selecionados no Banco de Dados do Sistema de Dados de Saúde Pública do Brasil de janeiro de 2008 a novembro de 2016. Todos os registros de procedimentos cirúrgicos foram identificados pelo documento de Autorização de Internação Hospitalar. Dois códigos foram selecionados para processar a busca: torção testicular (código de cura cirúrgica) e escroto agudo (código de escrototomia exploratória). As macrorregiões foram agrupadas em cinco áreas ligadas às características climáticas pela Classificação Internacional de Clima Köppen. Resultados: Foram registrados 2.351 casos de torção testicular no período. Para as áreas B, C e E (torção testicular n=2.130), foram encontradas diferenças estatísticas na associação dos casos de torção testicular e diminuição da temperatura (p=0,019, p=0,001 e p=0,006, respectivamente), mas nas análises das áreas A e D não foram observadas diferenças estatísticas (p=0,066 e p=0,494). Conclusão: A diminuição da temperatura foi associada à torção testicular em três macrorregiões de São Paulo. Os resultados apoiam a teoria do clima frio como um gatilho para ocorrência de torção testicular em uma região de clima tropical.

Presentation delay, misdiagnosis, inter-hospital transfer times and surgical outcomes in testicular torsion: analysis of statewide case series from central Brazil

ABSTRACT Purpose To estimate statewide presentation delay, misdiagnosis rate, inter-hospital transfer times and testicular salvage for testicular torsion patients treated in our state's public health system. Patients and Methods Case series of consecutive testicular torsion patients treated in our state's public health system between 2012-2018. Predictors included presentation delay (time from symptoms to first medical assessment), facilitie's level-of-care (primary, secondary, tertiary), first diagnosis (torsion, epididymitis, other), Doppler-enhanced ultrasound request (Doppler-US) and inter-hospital transfer times, with surgical organ salvage as the main response. We used Bayesian regression to estimate the effect of first examining facilitie's level-of-care, first diagnosis, and Doppler-US on transfer time. Results 505 patients were included, most (298, 59%) with presentation delay >6 hours. Misdiagnosis at first examining facility raised transfer time from median 2.8 to 23.4 (epididymitis) and 37.9 hours (other) and lowered testicular salvage rates from 60.3% (torsion) to 10.7% (epididymitis) and 18.3% (other). Doppler-US had negligible effects on transfer time once controlling for misdiagnosis in the regression model. Although organ salvage in patients presenting before 6 hours at the tertiary facility was high (94.6%, and about 20% lower for those presenting at lower levels-of-care), the overall salvage rate was more modest (46%). Conclusion Our low overall testicular salvage rates originated from a large proportion of late presentations combined with long transfer times caused by frequent misdiagnoses. Our results indicate that efforts to improve salvage rates should aim at enhancing population-wide disease awareness and continuously updating physicians working at primary and secondary levels-of-care about scrotal emergencies.

Microsurgical subinguinal varicocelectomy with spermatic cord double traction and vein stripping / 亚洲男科学杂志(英文版)

We retrospectively reviewed data for 286 patients with varicocele who underwent microsurgical subinguinal varicocelectomy from March 2015 to May 2017 in Shanghai General Hospital (Shanghai, China). In this surgical approach, the testis was delivered, and the gubernacular and external cremasteric veins were stripped. In addition, the spermatic cord was delivered downward with continuous double traction away from the external ring. The remaining procedure was similar to the conventional approach. We followed patients for at least 3 months and evaluated postoperative semen parameters, pain symptoms, and complications. We excluded data for 32 men due to inadequate follow-up (<3 months). Of the remaining 254 patients, 73 had oligoasthenospermia, 121 had nonobstructive azoospermia, and 60 had symptomatic varicoceles. Total progressive sperm counts increased in the oligoasthenospermic patients from a median preoperative value of 9.15 × 106 ml-1 to 25.33 × 106 ml-1 (n= 34), and 35.6% (26/73) initially oligoasthenospermic men contributed to unassisted pregnancies. Sperm returned to the ejaculate in 12.4% (15/121) azoospermia patients. In patients with scrotal pain (n = 60), 43 (71.7%) reported complete resolution of pain, 16 (26.7%) reported partial resolution, and 1 (1.7%) reported no change. No patients experienced varicocele recurrence. This double-traction strategy avoids opening the external oblique aponeurosis, and results in less damage and faster recovery. In addition, the stripping strategy eliminates potential damage to the testis caused by the varicose veins. Our results showed that microsurgical subinguinal varicocelectomy using spermatic cord double traction in conjunction with testicular delivery for vein stripping is a safe and effective approach for varicocele repair.

A case report of spermatic neuroblastoma / 中华泌尿外科杂志

The purpose of this study is to study the clinical characteristics of spermatic cord tumor.The clinical data of a case of varicocele in our hospital were analyzed retrospectively.In this case,the patients with varicocele had a good recovery after operation.Varicocele is a rare case.The best mode of treatment is surgical resection and follow-up after operation.

Microsurgical subinguinal varicocelectomy with spermatic cord double traction and vein stripping / 亚洲男科学杂志(英文版)

We retrospectively reviewed data for 286 patients with varicocele who underwent microsurgical subinguinal varicocelectomy from March 2015 to May 2017 in Shanghai General Hospital (Shanghai, China). In this surgical approach, the testis was delivered, and the gubernacular and external cremasteric veins were stripped. In addition, the spermatic cord was delivered downward with continuous double traction away from the external ring. The remaining procedure was similar to the conventional approach. We followed patients for at least 3 months and evaluated postoperative semen parameters, pain symptoms, and complications. We excluded data for 32 men due to inadequate follow-up (<3 months). Of the remaining 254 patients, 73 had oligoasthenospermia, 121 had nonobstructive azoospermia, and 60 had symptomatic varicoceles. Total progressive sperm counts increased in the oligoasthenospermic patients from a median preoperative value of 9.15 × 106 ml-1 to 25.33 × 106 ml-1 (n= 34), and 35.6% (26/73) initially oligoasthenospermic men contributed to unassisted pregnancies. Sperm returned to the ejaculate in 12.4% (15/121) azoospermia patients. In patients with scrotal pain (n = 60), 43 (71.7%) reported complete resolution of pain, 16 (26.7%) reported partial resolution, and 1 (1.7%) reported no change. No patients experienced varicocele recurrence. This double-traction strategy avoids opening the external oblique aponeurosis, and results in less damage and faster recovery. In addition, the stripping strategy eliminates potential damage to the testis caused by the varicose veins. Our results showed that microsurgical subinguinal varicocelectomy using spermatic cord double traction in conjunction with testicular delivery for vein stripping is a safe and effective approach for varicocele repair.

Papel da ultrassonografia no diagnóstico da torção do cordão espermático / Ultrasonography role in the diagnosis of spermatic cord torsion

Introdução: Escroto agudo é uma síndrome clínica caracterizada por aumento do volume escrotal, associada à dor, sudorese, febre, náuseas e vômitos. Entre suas causas, destaca-se a torção de cordão espermático, que corresponde a rotação testicular sob seu eixo vascular, comprometendo a irrigação tecidual. Trata-se de uma emergência urológica cujo tratamento é cirúrgico. Objetivo: Relatar um caso e revisar a literatura acerca desta patologia. Materiais e Métodos: Revisão do prontuário e revisão da literatura. Resultados: Homem de 14 anos com dor intermitente no testículo esquerdo há duas semanas. A ultrassonografia diagnosticou torção testicular e do cordão espermático à esquerda. O paciente realizou orquiectomia tendo alta no dia seguinte. Conclusão: Os relatos de casos relacionados à torção de cordão espermático têm sua importância baseados na necessidade do aprendizado e no reconhecimento rápido dessa condição pelo profissional médico, visando o manejo adequado e de prontidão dos pacientes acometidos pela condição.

Introduction: Acute scrotum is a clinical syndrome characterized by increased scrotal volume, which is associated with pain, sweating, fever, nausea, and vomiting. Among its causes, the spermatic cord torsion is easy noticed and corresponds to the testicular rotation under its vascular axis, compromising tissue irrigation. It is a urological emergency, and its treatment is surgical. Objective: Report a case and review the literature about this disease. Materials and Methods: Medical record review and literature review. Case Results: A 14-year-old man with pain in his left testicle for two weeks underwent an ultrasound scan that detected testicular and spermatic cord torsion. A left orchiectomy was performed and the man was discharged the next day. Conclusion: Case reports related to twisting of the spermatic cord have its importance based on the need for learning and rapid recognition of this condition by the medical professional, aiming at an adequate and ready management of the patients affected by the condition.

Remote ischemic conditioning protects against testicular ischemia∕reperfusion injury in rats

Abstract Purpose To evaluate the effect of remote ischemic conditioning associated to N-acetylcysteine (NAC) on testicular ischemia∕reperfusion (I∕R) injury in rats. Methods Twenty-five adult male Wistar rats were randomly distributed into five experimental groups (n=5), as follows: Sham, I∕R, Perconditioning (PER), NAC and PER+NAC. Two-hour ischemia was induced by rotating the left testis 720° to clockwise direction, followed by 4 hours of reperfusion. Perconditioning was performed by three I/R cycles of 10 min each on the left limb, 30 min before reperfusion. N-acetylcysteine (150 mg∕kg) was administered 30 min before reperfusion. Results Statistical differences were observed in MDA levels between I/R group with all groups (p<0.01), in addition there was statistical difference between PER and Sham, and PER+ NAC groups (p<0.05) in plasma. Conclusions The protective effect of perconditioning isolated in the reduction of lipid peroxidation related to oxidative stress was demonstrated. However, when Perconditioning was associated with NAC, there was no protective effect against testicular injury of ischemia and reperfusion.

Torsión de cordón espermático: análisis de situación en un período de 4 años en la Clínica Quirúrgica Pediátrica del Centro Hospitalario Pereira Rossell, Montevideo, Uruguay / Torsion of spermatic cord: situation analysis over a period of 4 years in Pediatric Surgical Clinic of the Pereira Rossell Hospital Center, Montevideo, Uruguay / Torção do cordão espermático: análise da situação ao longo de um período de 4 anos em Clinica Cirúrgica Pediátrica do Centro Hospitalar Pereira Rossell, Montevideo, Uruguai

Introducción: El sindrome escrotal agudo es una causa frecuente de consulta en la urgencia pediátrica y el diagnóstico de su etiología puede ser realmente un desafío para el pediatra y el cirujano. Existen múltiples etiologías posibles, siendo la torsión de cordón espermático la más importante, porque el retraso en su diagnóstico y tratamiento conlleva una alta incidencia de necrosis gonadal. Esta patología debe considerarse una emergencia quirúrgica. El objetivo de este artículo es conocer la situación de la torsión de cordón espermático en nuestro medio ya que existe un único estudio sobre esta patología realizado hace más de 30 años. Material y método: Se realizó un estudio observacional descriptivo y retrospectivo. Se identificaron todas las escrototomías realizadas con planteo clínico de síndrome escrotal agudo con la sospecha de una torsión de cordón espermático, en el período comprendido entre el 1.º de enero de 2015 y el 31 de diciembre de 2018. Se analizó la edad de los pacientes, patología diagnosticada en el intraoperatorio, lado afectado, sentido de la rotación y procedimiento realizado. Resultados: En el período comprendido entre el 1.º de enero de 2015 y el 31 de diciembre de 2018 se intervinieron quirúrgicamente 68 pacientes con diagnóstico de sindrome escrotal agudo. Del total, 49 pacientes (72 %) presentaron una torsión de cordón espermático, y a 16 (32,6 %) se les realizó orquiectomía. A todos se les realizó pexia testicular contralateral en el mismo acto quirúrgico. Conclusiones: En el período analizado fueron intervenidos 49 pacientes con torsión de cordón espermático. En 16 casos se realizó orquiectomía. Se identificó una leve predominancia del lado derecho, y el sentido de la rotación fue principalmente interno, si bien existe un importante subregistro de dicho dato en las descripciones operatorias. En el 72 % de los pacientes en quienes se decidió conservar la gónada, el cirujano describe una importante isquemia testicular, por lo que resulta fundamental realizar, para un futuro artículo, el seguimiento de estos pacientes para conocer su evolución.

Introduction: Acute scrotal syndrome is a frequent cause of consultation in the pediatric emergency and the diagnosis of its etiology can really be a challenge for the pediatrician and the surgeon. There are multiple possible etiologies, with torsion of the spermatic cord being the most important due to the high incidence of gonadal necrosis that the delay in diagnosis and treatment entails. This pathology should be considered a surgical emergency. The objective of this article is to know the situation of spermatic cord torsion in our environment since there is only one study done on this pathology more than 30 years ago. Material and method: A descriptive and retrospective observational study was carried out. All scrototomies performed with a clinical approach to acute scrotal syndrome were identified with the suspicion of spermatic cord torsion in the period between January 1, 2015 and December 31, 2018. The patients' age, pathology was analyzed. Diagnosed intraoperatively, affected side, direction of rotation and procedure performed. Results: In the period between January 1, 2015 and December 31, 2018, 68 patients were diagnosed with a diagnosis of acute scrotal syndrome. Of the total, 49 patients (72 %) had spermatic cord torsion, and 16 (32.6 %) had orchiectomy. All of them underwent contralateral testicular pexia in the same surgical act. Conclusions: In the analyzed period, 49 patients with spermatic cord torsion were operated. In 16 cases orchiectomy was performed. A slight predominance of the right side was identified, and the direction of rotation was mainly internal, although there is an important underreporting of this data in the operative descriptions. In 72 % of the patients in whom it was decided to preserve the gonad, the surgeon describes an important testicular ischemia, so it is essential for a future article to monitor these patients to know their evolution.

Introdução: A síndrome escrotal aguda é uma causa freqüente de consulta na emergência pediátrica e o diagnóstico de sua etiologia pode realmente ser um desafio para o pediatra e o cirurgião. Existem múltiplas etiologias possíveis, sendo a torção do cordão espermático a mais importante devido à alta incidência de necrose gonadal que o atraso no diagnóstico e tratamento acarreta. Essa patologia deve ser considerada uma emergência cirúrgica. O objetivo deste artigo é conhecer a situação de torção do cordão espermático em nosso ambiente, uma vez que existe apenas um estudo sobre essa patologia há mais de 30 anos. Material e método: Foi realizado um estudo observacional descritivo e retrospectivo. Todas as escrototomias realizadas com abordagem clínica da síndrome escrotal aguda foram identificadas com suspeita de torção espermática no período de 1 de janeiro de 2015 a 31 de dezembro de 2018. A idade dos pacientes foi analisada. diagnosticado no intraoperatório, lado afetado, direção da rotação e procedimento realizado. Resultados: No período de 1 de janeiro de 2015 a 31 de dezembro de 2018, 68 pacientes foram diagnosticados com diagnóstico de síndrome escrotal aguda. Do total, 49 pacientes (72 %) apresentaram torção espermática e 16 (32,6 %) tiveram orquiectomia. Todos foram submetidos a pexia testicular contralateral no mesmo ato cirúrgico. Conclusões: No período analisado, foram operados 49 pacientes com torção espermática. Em 16 casos, foi realizada orquiectomia. Foi identificada uma ligeira predominância do lado direito, e o sentido de rotação era principalmente interno, embora exista uma importante subnotificação desses dados nas descrições operatórias. Em 72 % dos pacientes nos quais foi decidido preservar a gônada, o cirurgião descreve uma importante isquemia testicular, por isso é essencial que um artigo futuro monitore esses pacientes para conhecer sua evolução.

The protective effect of Ganoderma lucidum on testicular torsion/detorsion-induced ischemia-reperfusion (I/R) injury

Abstract Purpose To investigate the protective effect of Ganoderma lucidum on testicular torsion/detorsion (T/D)-induced ischemia-reperfusion (I/R) injury. Methods Thirty male Wistar albino rats were randomly categorized into 3 groups: Group 1: sham, Group 2 ( T/D): 2,5 hours of ischemia and 7 days of reperfusion, Group 3 (T/D+ G. lucidum ): 2,5 hours of ischemia and 7 days of reperfusion and 7 days of 20 mg/kg via gastric gavage G. lucidum polysaccharides per day. Biochemical assays of Malondialdehyde (MDA), superoxide dismutase (SOD), Catalase (CAT), Glutathione (GSH) levels , histopathology and expression levels of VEGF and Bcl-2 with immunohistochemical methods were examined in testicular tissue. Results G. lucidum treatment was found to have prevented the T/D-induced I/R injury by decreasing MDA levels of the testis. SOD, CAT and GSH activities were decreased in group 2, while they were increased in group 3 (p<0.001) and significant improvement in the tube diameter was observed in group 3. Bcl-2-positive germinal cells were lowered in group 3 compared to the group 2. VEGF expression showed an increase in group 2, whereas it decreased in group 3. Conclusion The antioxidant G. lucidum is thought to induce angiogenesis by reducing the apoptotic effect in testicular torsion-detorsion.

Liposarcoma del cordón espermático simulando una hernia inguinal incarcerada / Liposarcoma of the spermatic cord mimicking an incarcerated inguinal hernia

INTRODUCCIÓN: Los tumores paratesticulares representan del 7%-10% de las masas intraescrotales. Los sarcomas abarcan el 90% de las lesiones malignas del cordón espermático y de éstas, aproximadamente, el 3%-7% son liposarcomas. CASO CLÍNICO: Presentamos el caso de un varón de 45 años, que consultó en urgencias por una masa inguinoescrotal derecha no reductible, diagnosticándose de hernia inguinal incarcerada. Se realizó cirugía urgente evidenciando una gran tumoración de aspecto lipomatoso, dependiente de cordón espermático. Se realizó orquiectomía y hernioplastía inguinal. La anatomía patológica, reveló un liposarcoma bien diferenciado de cordón espermático. Posteriormente, se realizó estudio de extensión, sin afectación a distancia y no precisó tratamiento adyuvante. Actualmente, tras dos años de seguimiento no ha presentado recidiva. DISCUSIÓN: Sólo alrededor de 200 casos han sido comunicados previamente en la literatura y sólo 61 de éstos se presentaron simulando una hernia inguinal incarcerada. Debido a la baja incidencia de esta patología es difícil de conocer la historia natural y llegar a conclusiones sobre los resultados del tratamiento, el cual hasta el momento sigue siendo la orquiectomía radical, con escisión amplia de los tejidos locales. El papel de la radio y quimioterapia aun es controvertido. CONCLUSIONES: Los sarcomas del cordón espermático son neoplasias raras con alta tasa de recurrencia local. Su manejo inicial es quirúrgico. Se requiere de un alto índice de sospecha clínica para el diagnóstico ya que las implicaciones oncológicas varían en función del tratamiento que, en ocasiones, es llevado a cabo por cirujanos generales al simular una hernia inguinal.

INTRODUCTION: Paratesticular tumors represent 7%-10% of intraescrotal masses. Sarcomas account for 90% of malignant lesions of the spermatic cord and of these approximately 3%-7% are liposarcomas. CLINICAL CASE: This is the case of a 45 year old male who consulted in the emergency department for a non-reducible right inguino-scrotal mass and was diagnosed with an incarcerated inguinal hernia. Emergency surgery was performed which revealed a large lipomatous tumor, originating from the spermatic cord. Orchiectomy and hernioplasty were performed. Histopathology revealed a well-differentiated liposarcoma of the spermatic cord. Later extension study was conducted, without distant affectation, and did not require adjuvant treatment. Today, after two years of monitoring has been no recurrence. DISCUSSION: Only about 200 cases have been previously reported in the literature and only 61 of these were presented mimicking an incarcerated inguinal hernia. Due to the low incidence of this disease it is difficult to know the natural history and draw conclusions on the results of treatment, which so far remains the radical orchiectomy with wide local excision of the tissue. The role of radiotherapy and chemotherapy is still controversial

Validation of targeted microsurgical spermatic cord denervation: comparison of outcomes to traditional complete microsurgical spermatic cord denervation / 亚洲男科学杂志(英文版)

The aim of this study was to validate the effectiveness of targeted microsurgical spermatic cord denervation (MSCD) of the trifecta nerve complex in comparison to traditional full MSCD with complete skeletonization of the spermatic cord in men with chronic orchialgia. Retrospective chart review was performed by a single fellowship-trained microsurgeon between 2011 and 2016. Patients had follow-ups at 6 weeks, 6 months, and 1 year postoperatively. Thirty-nine men with chronic orchialgia underwent full MSCD between 2011 and 2013. In July 2013, after the publication of an anatomic study with identification of Wallerian degeneration of the trifecta nerve complex in men with chronic orchialgia, the technique was changed to targeted MSCD. From July 2013 to March 2016, 43 men underwent targeted MSCD. When comparing the full MSCD group to the targeted MSCD group, there was no significant difference in resolution of pain (66.7% vs 69.8%, P = 0.88), no difference in partial relief of pain (17.9% vs 23.3%, P = 0.55), and no difference in failure to respond rates (15.4% vs 7.0%, P = 0.22) between the two groups. There was no difference in mean change of visual analog pain scale scores between the two groups (P = 0.27). Targeted MSCD had a shorter operative time (53 min vs 21 min, P = 0.0001). Targeted MSCD offers patients comparable outcomes to traditional full MSCD, with a shorter operative time, a less technically challenging surgery, and potentially less risk to cord structures which should be preserved.

Torsion of testes in newborn:a study of 12 cases / 中国新生儿科杂志

Objective To study the clinical features, diagnosis and treatment of torsion of testes in newborn. Method Neonates who were diagnosed with neonatal testicular torsion and admitted to Shenzhen Children's Hospital from March 2008 to July 2018 were studied. The clinical data such as days in age, time of onset, clinical manifestations, time of ultrasound examination, characteristics of ultrasound examination, surgery time, surgical types, postoperative conditions, pathological findings, and follow-up results were retrospectively analyzed. Result A total of 12 infants with torsion of testes were enrolled. The average onset time was 2.9 d, ranged from 1～10 d. The time of onset was within 24 h after birth in six infants. The median duration from onset to seeing a doctor was 3.5 d, ranged from 2 h to 28 d. First manifestations being reported grammer were scrotal swelling or mass, including 7 cases on the left side and 5 cases on the right side. Among them, 9 cases were associated with redness or cyanosis of the scrotum. Ultrasound was characterized by the disappearance or significant reduction of testicular parenchymal blood flow signal, and the sensitivity of ultrasound was 100％. The average time from admission to operation was (2.1±1.1) h. All the 12 infants had orchiectomy,after necrosis of unilateral testicle was confirmed. Eight of them underwent contralateral test icular fixation. The average operation time was 46 min. There was no wound bleeding or infection postoperatively, and the average hospital stay was 6.4 d. The pathological features were blurred residual contour of the seminiferous tubule (9 cases) or the disappearance of the seminiferous tubule structure (3 cases). After 3 to 24 months of follow-up, no contralateral testicular torsion or atrophy was found. Conclusion The rate of testicular necrosis in children with torsion of testes is high. The newborn with scrotal swelling should be diagnosed promptly with color Doppler ultrasound. If necessary, surgical exploration should be performed in time.

Microsurgical Denervation of Spermatic Cord for Chronic Idiopathic Orchialgia: Long-Term Results from an Institutional Experience

PURPOSE: Chronic testicular pain remains an important challenge for urologists. At present there are many treatment modalities available for chronic orchialgia. Some patients remain in pain despite a conservative treatment. Microsurgical denervation of spermatic cord appears to be successful in relieving pain in patients who fail conservative management. We assessed the long-term efficacy, complications and patient perceptions of microsurgical denervation of the spermatic cord in the treatment of chronic orchialgia. MATERIALS AND METHODS: A prospective study was conducted from January 2007 to January 2016 which included men with testicular pain of >3 months duration, failure of conservative management, persistent of pain for >3 months after treating the underlying cause. Total 48 patients with 62 testicular units (14 bilateral) showed the response to spermatic cord block and underwent Microsurgical Denervation of Spermatic Cord. RESULTS: Out of 62 testicular units (14 bilateral) which were operated, complete 2 years follow-up data were available for 38 testicular units. Out of these 38 units, 31 units (81.57%) had complete pain relief, 4 units (10.52%) had partial pain, and 3 units (7.89%) were non-responders. Complications were superficial wound infection in 3 units (4.83%), hydrocele in 2 units (3.22%), subcutaneous seroma in 2 units (3.22%), and an incisional hematoma in 1unit (1.61%) out of 62 operated testicular units. CONCLUSIONS: Idiopathic chronic orchialgia remains a difficult condition to manage. If surgery is considered, microsurgical denervation of spermatic cord should be considered as a first surgical approach to get rid of pain and sparing the testicle.