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INTRODUCTION@#Doppler scrotal ultrasonography (US) is the modality of choice in diagnosing testicular torsion. We aimed to evaluate the performance of scrotal US in diagnosing testicular torsion over the past 18 years in our institution and determine the factors contributing to the length of wait times for it.@*METHODS@#A retrospective review was conducted of boys who presented with acute scrotal pain from 2014 to 2015. US reports, operative findings, final diagnosis and key time points of the patients' journey (time to emergency department consultation, time to admission, time to US and time to operating theatre [OT]) were collected. US performance results were compared with those observed in a historical cohort from 1998 to 2004. Wait times were compared between operated and non-operated patients.@*RESULTS@#Data from 519 boys with a mean age of 9.15 years was collected. Of these, 438 (84.4%) boys had undergone initial scrotal US; of these scrotal US cases, 28 were surgically explored, with 23 confirmed to have torsion. Another five cases were explored without prior US, and all were confirmed to have torsion. Performance analysis of US showed a sensitivity of 100% and a specificity of 98.8%. There was no significant difference between wait times of operated and non-operated patients. Time to US (P < 0.0001, r = 0.96) and time to OT (P < 0.0001, r = 0.64) correlated significantly with the total time from presentation to surgery.@*CONCLUSION@#There has been an improvement in the diagnostic performance of scrotal US for testicular torsion over the past 18 years. Quality improvement programmes targeted at reducing wait times for patients presenting with acute scrotum should target time to US and time to OT.
Subject(s)
Male , Child , Humans , Female , Scrotum/surgery , Spermatic Cord Torsion/surgery , Acute Pain/diagnostic imaging , Ultrasonography , Retrospective StudiesABSTRACT
A male neonate born at gestational age of 40 weeks was found to have an enlarged and darkened right hemiscrotum after birth. Left testicle was descended and normal. No clinical signs of distress were evident. A color Doppler ultrasound showed an absence of testicular blood flow, consistent with perinatal testicular torsion. The patient underwent a bilateral scrotal exploration through an inguinal incision and a necrotic right testicle was found. A right orchiectomy and left orchiopexy were performed. Perinatal testicular torsion is a rare but severe condition. A high clinical suspicion is required since most of perinatal testicular torsion are intrauterine and can often be asymptomatic, only with localized findings of the affected testis. The management of perinatal testicular torsion is still controversial; however, the most consensual approach is a prompt testicle exploration with orchiectomy of the necrotic testicle and contralateral orchiopexy
Recém-nascido do sexo masculino com idade gestacional de 40 semanas, com edema e escurecimento cutâneo do hemiescroto direito constatados após o nascimento. O testículo esquerdo era palpável na bolsa escrotal e não apresentava alterações. A ecografia escrotal com Doppler revelou ausência de fluxo vascular no testículo direito, achado compatível com torção testicular perinatal. O doente foi submetido a exploração escrotal bilateral através de abordagem por via inguinal, tendo sido confirmada a necrose do testículo direito. Foi realizada orquidectomia direita e orquidopexia esquerda. A torção testicular perinatal corresponde a uma patologia rara, mas com possíveis consequências graves. O seu diagnóstico requer elevada suspeição clínica, uma vez que a maioria dos casos ocorre no período pré-natal, podendo ser assintomáticos após o nascimento e manifestar-se com alterações localizadas ao testículo afetado. A abordagem da torção testicular perinatal é ainda controversa, sendo mais consensual uma exploração escrotal célere com orquidectomia do testículo necrosado e orquidopexia contralateral
Subject(s)
Humans , Male , Spermatic Cord Torsion/surgery , Infant, Newborn , Orchiectomy , OrchiopexyABSTRACT
【Objective】 To report a case of testicular infarction due to polyarteritis nodosa (PAN), and to discuss its clinical diagnosis and treatment based on relevant literatures at home and abroad, so as to have a better understanding of this rare disease. 【Methods】 Clinical data of a case complaining of scrotal pain who was initially diagnosed as testicular torsion and later confirmed to be testicular infarction due to PAN were retrospectively analyzed, and relevant literatures were reviewed. 【Results】 With glucocorticoid, vasodilator and antioxidant treatment, the patient’s testicular blood flow was improved. 【Conclusion】 Testicular infarction due to PAN is a rare disease which is difficult to diagnose timely. The diagnosis depends on biopsy and the standards formulated by American College of Rheumatology (ACR). Good prognosis can be achieved with timely diagnosis and correct treatment.
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RESUMEN El síndrome de escroto agudo es una urgencia quirúrgica, que si no se hace una evolución adecuada y existen demoras en el diagnostico puede el paciente tener daños irreversibles en la viabilidad testicular. Se presenta la Guía de Práctica Clínica sobre el síndrome de escroto agudo con el objetivo de hacer una actualización sobre el tema y proporcionar un instrumento asistencial y docente en los servicios de cirugía pediátrica del país. Varias enfermedades pueden ser la causa de aparición del síndrome de escroto agudo, entre ellas, la torsión testicular, la torsión de hidátides testiculares y la orquiepididimitis. El síntoma fundamental es el dolor testicular y requiere generalmente tratamiento quirúrgico. El tratamiento oportuno de estos pacientes evita complicaciones como la necesidad de orquiectomia, la esterilidad y reincorpora más rápidamente al paciente a su actividad social.
ABSTRACT Acute scrotum syndrome is a surgical emergency, which if an adequate evolution is not made and there are delays in the diagnosis, the patient can have irreversible damage in the testicular viability. The Clinical Practice Guidelines on acute scrotum syndrome is presented with the aim of updating the subject and providing a care and teaching instrument in the pediatric surgery services of the country. Several diseases can be the cause of the onset of acute scrotum syndrome, including testicular torsion, testicular hydatid torsion, and orchiepididymitis. The fundamental symptom is testicular pain and usually requires surgical treatment. The timely treatment of these patients avoids complications such as the need for orchiectomy, sterility, and that way the patient is more quickly reincorporated into his social activity.
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Objective:To investigate the correlation between hematological parameters and testicular viability, and to identify potential indicators of intraoperative testicular viability or postoperative testicular atrophy.Methods:Clinical data of 173 children with testicular torsion treated by emergency operation in the Department of Urology, Beijing Children′s Hospital, Capital Medical University from January 2006 to January 2020 were retrospectively analyzed.According to the surgical methods, 90 and 83 cases were included in the orchiectomy group and orchiopexy group, respectively.The duration of onset, spermatic cord torsion degree and hematological parameters of the 2 groups were compared by the independent-samples t test, χ2 test and Mann- Whitney U test.Risk factors for testicular resection were analyzed by multivariate Logistic regression.In addition, 30 children in the orchiopexy group were followed up for bilateral scrotal ultrasound at 6 months postoperatively.They were sub-grouped into testicular atrophy group (13 cases, 43.3%) and non-atrophy group (17 cases). Differences between 2 subgroups were compared by the independent-samples t test and Mann- Whitney U test.Receiver operating characteristic (ROC) curves were plotted to analyze the prognostic potentials of indexes with significant differences in children with the duration of onset of >6-<51 h. Results:Duration of onset (9.3 h vs.51.0 h)( Z=-8.293, P<0.001), spermatic cord torsion degree (360.0° vs. 540.0°)( Z=-5.267, P<0.001), mean platelet volume (MPV) (9.8 fL vs.10.1 fL)( Z=-2.018, P=0.044) and age (147.5 months vs. 143.0 months)( Z=-2.165, P=0.030) were significantly different between the orchiopexy group and the orchiectomy group.The multivariate Logistic regression analysis suggested that the duration of onset ( OR=1.033, P<0.001), spermatic cord torsion degree ( OR=1.004, P<0.001) and MPV ( OR=1.662, P=0.044) were positively correlated with testicular resection.For patients with the duration of onset of >6-<51 h, the area under the curve (AUC) of duration of onset, spermatic cord torsion degree and MPV was 0.753, 0.755 and 0.629, respectively.MPV was significantly different in the postoperative testicular atrophy group and the non-atrophy group [(10.2±0.5) fL vs.(9.8±0.5) fL]( t=2.426, P=0.022). The ROC curve analysis showed that the cut-off value of MPV for predicting testicular atrophy was 9.9 fL, and its sensitivity and specificity were 83.3% and 70.6%, respectively, the AUC was 0.752. Conclusions:The duration of onset, spermatic cord torsion degree and MPV can be used as predictors of intraoperative testicular viability, which are helpful for clinicians to predict and judge the testicular necrosis caused by testicular torsion before operation.In addition, 43.3% of children with testicular torsion eventually developed testicular atrophy after orchiopexy, and only MPV may be used as a predictor of postoperative testicular atrophy.
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Objective:To investigate the feasibility of shear wave elastography (SWE) to evaluate the protective effect of testicular compartment decompression on spermatogenesis after testicular torsion reduction.Methods:Thirty-two rabbits were randomly divided into 4 groups: control group (S group), testicular torsion simple reduction group (I group), and testicular torsion reduction+ compartment decompression group (T group: T1 group, T2 group), 8 rabbits per group. After the complete testicular torsion model was established in the I and T groups, the I group was simply reperfused, and the T group was reperfused before decompression of the compartment. Rabbits in each group were kept for 30 days after successful modeling. Each group of rabbits underwent testicular fascia intracompartment pressure measurement and SWE examination before operation, after successful complete torsion modeling, after reperfusion and 30 days later. After the experiment, the surgical side testicles were taken for pathological examination.Results:After testicular torsion, the pressure of testicular fascia and the average Young′s modulus (Emean) of testicular tissue in each experimental group increased (all P<0.05), and further increased with the extension of torsion time (all P<0.05). After reperfusion, the testicular fascial compartment pressure and testicular tissue Emean value in group I further increased (all P<0.05), while the testicular fascial compartment pressure and testicular tissue Emean value in group T decreased (all P<0.05). Thirty days later, testicular fascial compartment pressure and testicular tissue Emean value in group I were higher than those in group T (all P<0.05), while Johnsen′s score of testicular tissue was lower than that in group T ( P<0.05), and testicular tissue apoptosis index and malondialdehyde content were higher than those in group T Group T (all P<0.05). Conclusions:Decompression of the testicular compartment has a protective effect on spermatogenesis after testicular torsion reduction. SWE can indirectly evaluate the severity of testicular compartment syndrome after testicular torsion and reduction, and the protective effect of compartment decompression on spermatogenesis.
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This study aimed to review and compare the characteristics and treatment outcomes of cryptorchid testicular torsion in pre- and postpubertal children. We reviewed the clinical data of 22 patients with testicular torsion complicated by cryptorchidism who were treated between January 2010 and December 2019. Patients were categorized into prepubertal (1 month to 9 years; n = 12) and postpubertal groups (10-16 years; n = 10). The age at presentation, clinical presentations, physical examination, and operation outcomes were assessed. The common clinical presentations in both groups were inguinal pain and a tender inguinal mass. Patients in the prepubertal group were significantly more likely to present with restlessness (33.3%) than those in the postpubertal group (0%; P = 0.044). After detorsion, testicular blood flow recovered during surgery in 25.0% of the prepubertal and 80.0% of the postpubertal patients (P = 0.010). Orchiectomy was required in 50.0% of the prepubertal and 20.0% of the postpubertal patients (P = 0.145). Of the 22 patients with follow-up data, the rates of testicular salvage were significantly different, at 16.7% in the prepubertal patients and 60.0% in the postpubertal patients (P = 0.035). Cryptorchid testicular torsion has various manifestations. Although an empty hemiscrotum and a painful groin mass were common in both groups, restlessness was more prevalent in the prepubertal patients during early testicular torsion onset than that in the postpubertal patients. Notably, the testicular salvage rate was significantly lower in the prepubertal patients than that in the postpubertal patients.
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This study aimed to establish nomograms to preoperatively predict the possibility of testicular salvage (TS) in patients with testicular torsion. The clinical data of 204 patients with testicular torsion diagnosed at Xijing Hospital and Tangdu Hospital (Xi'an, China) between August 2008 and November 2019 were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to determine the independent predictors of TS. Based on multivariate regression coefficients, nomograms to predict possibility of TS were established. The predictive ability of the nomograms was internally validated by receiver operating characteristic (ROC) curves and calibration plots. The duration of symptoms ranged from 2 h to 1 month, with a median of 3.5 days. Thirty (14.7%) patients underwent surgical reduction and contralateral orchiopexy, while the remaining 174 (85.3%) underwent orchiectomy and contralateral orchiopexy. Finally, long symptom duration was an independent risk predictor for TS, while visible intratesticular blood flow and homogeneous testicular echotexture under color Doppler ultrasound were independent protective predictors. Internal validation showed that the nomograms, which were established by integrating these three predictive factors, had good discrimination ability in predicting the possibility of TS (areas under the ROC curves were 0.851 and 0.828, respectively). The calibration plots showed good agreement between the nomogram-predicted possibility of TS and the actual situation. In conclusion, this brief preoperative prediction tool will help clinicians to quickly determine the urgency of surgical exploration.
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Objective Testicular torsion (TT) is an emergency with an incidence of 1:1,500 in patients < 18 years old. Irreversible changes in the testicular parenchyma may happen. The Testicular Workup for Ischemia and Suspected Torsion (TWIST) questionnaire evaluates signs and symptoms to determine the risk of TT and improve the time of management. The aim of the present study was to compare the intraoperative findings of patients with TT with the result of the preoperative TWIST questionnaire. Methods A cohort of 33 pediatric patients that consulted to the emergency room was evaluated. The TWIST questionnaire was applied in the first approach. Imaging studies, time to the operating room (OR) and intraoperative findings were evaluated. Theoretical and real findings were compared. Results The median age was 13 years old (interquartile range [IQR] 1015 years old). Edema and scrotal inflammation was the most frequent finding (42.4%), followed by testicular induration (21.2%), nausea and vomiting (15.2%), and horizontal testicle and absence of cremasteric reflex (9.1%). The TWIST stratification was 3% high-risk, 18.2% intermediate-risk and 78.8% low-risk. Testicular Doppler ultrasound was performed in 93.9% of the patients: vascular congestion was found in 21.9%. A total of 30.3% of the kids were taken to surgery after 163 minutes (±116.5). Intraoperative diagnosis of TT was confirmed in the high-risk patient, in 33.3% of the intermediate-risk, and in 50% of the low-risk. The receiver operating characteristic (ROC) curve showed an accuracy of 60% (p = 0.602). Conclusions The TWIST questionnaire in the first approach allows to take the high-risk patients im
Objetivo La torsión testicular (TT) es una emergencia con incidencia de 1:1.500 en pacientes menores de 18 años. Pueden ocurrir cambios irreversibles en el parénquima testicular. El cuestionario TWIST evalúa signos y síntomas para determinar el riesgo de TT y mejorar los tiempos de atención. El objetivo de este estudio fue comparar los hallazgos intraoperatorios de los pacientes con el resultado del TWIST preoperatorio. Métodos Se evaluó una cohorte de 33 pacientes pediátricos que consultaron al Departamento de Emergencias. Se aplicó el cuestionario TWIST en la primera aproximación. Estudios imagenológicos, tiempo de entrada a salas de cirugía y hallazgos intraoperatorios también fueron evaluados. Se compararon los hallazgos teóricos y reales. Resultados La mediana de edad fue de 13 años (rango intercuartil [RIQ]: 1015). Edema e inflamación escrotal fueron los hallazgos principales, (42,4%) seguidos de induración testicular (21,2%), náusea y vómito (15,2%), y testículo horizontal y ausencia del reflejo cremastérico (9,1%). Estratificación TWIST: 3% alto riesgo, 18,2% intermedio, y 78,8% bajo. Se realizó Doppler testicular en 93,9% de los pacientes: se encontró congestión vascular en 21,9%. Se operaron 30,3% de niños tras 163 minutos (± 116,5). En el intraoperatorio se confirmó TT en el paciente de alto riesgo, en 33,3% de intermedio, y en 50% de bajo riesgo. La curva de característica operativa del receptor (COR) evidencia una exactitud de 60% (p = 0.602). Conclusiones El cuestionario TWIST en la primera aproximación es útil para operar inmediatamente pacientes de alto riesgo. Sin embargo, no ofrece un alto nivel de confianza para el diagnóstico de TT en pacientes de intermedio y bajo riesgo.
Subject(s)
Humans , Male , Child , Adolescent , Spermatic Cord Torsion , Surveys and Questionnaires , Emergencies , Testis , ROC Curve , Ultrasonography, Doppler , Parenchymal TissueABSTRACT
@#Introduction: Testicular torsion is a urological emergency causing spermatic cord twisting. Delayed management can cause poor outcome, i.e. orchiectomy. Here, we investigated several prognostic factors, including age, onset, clinical symptoms, leukocyte count, for testicular torsion outcomes (orchiectomy vs. orchiopexy) in children in Indonesia. Methods: A retrospective review of 23 patients with testicular torsion who underwent scrotal exploration from July 2013 to November 2018 at our institution was done. Results: The age at testicular torsion diagnosis was 12.8 (interquartile range, 4.6-15.1) years. Only fever showed strong significant prognostic factor for orchiectomy (OR=20; 95% CI=1.6 – 248; p=0.017), while other factors were not, with p-value of 0.54, 1.0, 1.0, 0.19, 1.0, 0.62, 0.62, 0.58, and 0.62, for age, onset, scrotal pain, abdominal pain, hyperemia, edema, nausea, vomitus and white blood cells count, respectively. Furthermore, logistic regression test also revealed that fever is a strong prognostic factor for orchiectomy (OR=22.6; 95% Cl=1.3 – 394.2; p=0.033). Conclusion: The patient with testicular torsion with fever tends to undergo orchiectomy. Further multicenter studies with a larger sample size are necessary to confirm our findings.
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Objective@#To investigate the correlation between testicular torsion in adolescence and seasonal temperature changes.@*Methods@#The clinical data of 28 children with testicular torsion diagnosed surgically at Wuhan Children′s Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from June 2009 to December 2017 were retrospectively analyzed.Seasons and temperatures at the onset of the disease in the area were recorded based on hospital information and China Meteorological Science Data Sharing Service Network.According to the seasons of onset, 28 children were divided into spring group, summer group, autumn group and winter group.@*Results@#The average age of 28 cases was 13.0 years (10.4-17.0 years). The duration of the disease was 1-4 days [(1.0±0.4) days]. Testicular torsion was found in 17 cases (60.7%) on the right side and 11 cases (39.3%) on the left side.Six patients (21.4%) underwent testicular reduction and bilateral testicular fixation, 22 patients (78.6%) underwent torsional orchiectomy plus contralateral testicular fixation.Testicular torsion was observed in 16 patients (57.1%) during the 3 months from December to February when the median temperature of onset was 1.3 ℃ (-2.1-5.6 ℃). Testicular torsion was observed in 6 patients (21.4%) during the 3 months of spring (March to May) when the median temperature was 9.4 ℃ (6.5-12.1 ℃). During the 3 months of summer (June to August), testicular torsion was observed in 2 patients (7.1%) when the median temperature was 21.8 ℃ (19.0-26.5 ℃). Testicular torsion was observed in 4 patients (14.4%) during the 3 months of autumn (September to November) when the median temperature was 11.1 ℃ (8.0-13.2 ℃). The incidence of testicular torsion in different seasons was significantly different (χ2=3.270, P=0.011). Pearson correlation analysis showed that the incidence of testicular torsion in adolescence was significantly negatively correlated with the season (winter) (r=-1.000, P=0.026).@*Conclusions@#Testicular torsion in children tends to be seasonal, and acute testicular torsion is more likely to occur in cold seasons.
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Objective@#To investigate the effects of melatonin on the oxidative stress and signaling pathways of apoptosis-related genes following testicular torsion/detorsion in male rats.@*METHODS@#Twenty-four healthy male Sprague-Dawley rats were randomly divided into a control, a torsion and a melatonin group of equal number. The torsion model was made in the animals of the latter two groups by 720° torsion of the left testis for 2 hours. The rats of the torsion and melatonin groups received intraperitoneal injection of isotonic saline and melatonin (17 mg/kg) respectively at 15 minutes prior to detorsion. At 24 hours after modeling, testis tissues were collected from the rats for detection of the apoptosis of the germ cells by flow cytometry (FCM), analysis of the expressions of Fas, Fas ligand (FasL) and Bax mRNA by quantitative real-time PCR (qRT-PCR), measurement of the cytochrome C content released from the mitochondrion by Western blot, and determination of the total antioxidant capacity (T-AOC) and the levels of myeloperoxidase (MPO) and malodialdehyde (MDA) by spectrophotometry.@*RESULTS@#Compared with the torsion group, the rats treated with melatonin showed significantly increased normal testicular cells (［77.81 ± 6.52］% vs ［88.61 ± 7.93］%, P < 0.05), decreased early apoptotic germ cells (［16.74 ± 3.16］% vs ［6.97 ± 1.65］%, P < 0.05), down-regulated expressions of Fas (［4.52 ± 0.29］ vs ［2.66 ± 0.37］, P < 0.01), FasL (［2.82 ± 0.30］ vs ［1.73 ± 0.18］, P < 0.01) and Bax mRNA (［2.39 ± 0.18］ vs ［1.50 ± 0.14］, P < 0.01), reduced levels of cytochrome C (［1.40 ± 0.38］ vs ［0.67 ± 0.30］, P < 0.01), MPO (［0.52 ± 0.15］ vs ［0.19 ± 0.10］ U/g prot, P < 0.01) and MDA ［6.37 ± 1.73］ vs ［3.98 ± 0.90］ nmol/mg prot, P < 0.01) and elevated T-AOC (［0.76 ± 0.25］ vs ［1.55 ± 0.32］ U/mg prot, P < 0.01).@*CONCLUSIONS@#Melatonin has a significant protective effect on spermatogenesis after testicular torsion by regulating the expressions of apoptosis-related genes and increasing T-AOC in the testis tissue.
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Objective To investigate the correlation between testicular torsion in adolescence and seasonal temperature changes.Methods The clinical data of 28 children with testicular torsion diagnosed surgically at Wuhan Children's Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from June 2009 to December 2017 were retrospectively analyzed.Seasons and temperatures at the onset of the disease in the area were recorded based on hospital information and China Meteorological Science Data Sharing Service Network.According to the seasons of onset,28 children were divided into spring group,summer group,autumn group and winter group.Results The average age of 28 cases was 13.0 years (10.4-17.0 years).The duration of the disease was 1-4 days [(1.0 ± 0.4) days].Testicular torsion was found in 17 cases (60.7％) on the right side and 11 cases (39.3％) on the left side.Six patients (21.4％) underwent testicular reduction and bilateral testicular fixation,22 patients (78.6％) underwent torsional orchiectomy plus contralateral testicular fixation.Testicular torsion was observed in 16 patients (57.1％) during the 3 months from December to February when the median temperature of onset was 1.3 ℃ (-2.1-5.6 ℃).Testicular torsion was observed in 6 patients (21.4％) during the 3 months of spring (March to May) when the median temperature was 9.4 ℃ (6.5-12.1 ℃).During the 3 months of summer (June to August),testicular torsion was observed in 2 patients (7.1％) when the median temperature was 21.8 ℃ (19.0-26.5 ℃).Testicular torsion was observed in 4 patients (14.4％) during the 3 months of autumn (September to November) when the median temperature was 11.1 ℃ (8.0-13.2 ℃).The incidence of testicular torsion in different seasons was significantly different (x2 =3.270,P =0.011).Pearson correlation analysis showed that the incidence of testicular torsion in adolescence was significantly negatively correlated with the season (winter) (r =-1.000,P =0.026).Conclusions Testicular torsion in children tends to be seasonal,and acute testicular torsion is more likely to occur in cold seasons.
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OBJECTIVE@#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.@*METHODS@#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.@*RESULTS@#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 ( < 0.05).@*CONCLUSIONS@#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.
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Humans , Male , Diagnostic Errors , Incidence , Retrospective Studies , Spermatic Cord Torsion , TestisABSTRACT
Objective: The detailed knowledge about protective effects of capsaicin (cap)and involved mechanisms against testicular torsion (TT)is still not available completely. Methods: Male Wistar rats were assigned into four major cohorts: (i)sham, (ii)TT, (iii)three subgroups subjected to TT and different doses of cap (100, 500, and 1000 µg/mL), and (iv)three subgroups of healthy animals subjected to various concentrations of cap. The animals were decapitated at 24 h after reperfusion, and the evaluation of protein expression was performed by Western blotting assay. At 72 h after reperfusion, apoptotic cell death and tissue injury were evaluated by TUNEL nuclear and H&E staining, respectively. Results: The results showed that cap administration following TT significantly increased the expression of tuberous sclerosis proteins 1 and 2 (Tsc1/Tsc2)in a dose-dependent manner (P < 0.05). Cap decreased cell apoptosis at highest dose. Likewise, cap contributed to the preservation of tubular morphology and decreased tissue injury at the highest tested concentration (1000 µg/mL). Conclusion: Collectively, our findings demonstrate the validity of cap as a therapeutic agent against TT through targeting Tsc1/Tsc2 in a dose-dependent manner.
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Acute scrotal conditions form a significant proportion of cases in surgical ward. They contribute to significant morbidity in younger age group and mortality in older age group. In this study we have attempted to study the causes, aetiology, prevalence and management of acute scrotal conditions. The prevalence in descending order was Acute epididymo orchitis, Pyocele, Hematocele, Fournier’s gangrene, Acute filarial scrotum, Testicular torsion, Scrotal abscess, Mumps orchitis, scrotal trauma. Of these Epididymo orchitis, mumps orchitis and Filarial scrotum were treated conservatively with antibiotics, rest and scrotal support. Fournier’s gangrene, Scrotal abscess and scrotal trauma with wound debridement and reconstruction. Pyocele and hematocele by incision and evacuation of pus and blood respectively. Testicular torsion is treated by surgical de rotation and B/L orchidopexy. Orchidectomy was done if warranted in hematocele, pyocele, and testicular torsion.
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Objective To discuss the MRI features of testicular torsion,and to improve the clinical and imaging understanding. Methods 8 cases of testicular torsion confirmed by surgery and pathology were included in this study,the MRI signs and clinical data were compared and analyzed.2 underwent MRI conventional scan,6 underwent both MRI conventional and enhanced scan.Results The median age of testicular torsion male patients was 16.7 years,attack time 4.0-24.0 h.In MRI,there were 6 cases(75.0%)with testis and epididymis volume augmented,2 cases(25.0%)with increase of testicular signal strength in T1WI sequence,4 cases(50.0%) with decrease of testicular signal strength in T2WI sequence,8 cases(100.0%)with tortuosity,enlargement,nodules of spermatic cord,6 cases(75.0%)with decreased enhancement in testis and epididymis.Conclusion Tortuosity,enlargement of spermatic cord and decreased enhancement in testis and epididymis are the MRI features of testicular torsion.
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Objective To investigate the clinical characteristics and choices of management of neonatal testicular torsion (NTF).Methods Between January 2013 and December 2015,the clinical data of 7 cases of neonatal testicular torsion who were confirmed by surgery and pathological examination in the department of pediatric surgery of our hospital was retrospectively reviewed.Of the 7 NTTs (4 in right,2 in left and 1 in both sides),the median age and onset time of NNTs was 3 d (1-21 d) and 1 d (1-21 d),respectively.The presentation of NTTs included swelling of scrotum,scrotal mass and discoloration of scrotum.Features of ultrasonography included enlargement of testicular volume,echo heterogenicity or enhancement of testis,and decreased or disappeared testicular blood flow.Results All NTTs were performed by surgery and confirmed by pathological examination.In the operation,5 patients with extravaginal torsion (1 bilateral) and 2 with intravaginal torsion were detected.The degree of twisted testis was from 270° to 720°(average 438.8°) and resection rate for necrosis testis was 87.5％ (7/8).The median time of follow-up was 12 months (3-36 months),and none of testis underwent re-torsion and the findings of testicular ultrasonography was not abnormal.Conclusions The presentation of neonatal testicular torsion is non-specific.Once the scrotum shows discoloration,swelling,or enlargement of testis,testicular torsion is suspected.Urgent surgical exploration is recommended in order to make an effort to save the testis.
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This study was conducted to investigate the protective effects of sildenafil citrate on testicular injury after testis torsion/detorsion (T/D) in rats. Forty adult male Wistar rats were randomly allocated into four equal groups of ten rats each. Group 1 (Sham-operated); Group 2 (torsion for 2 hours and detorsion for 2 hours); Group 3, (torsion for 2 hours, sildenafil injection and detorsion for 2 hours), and Group 4 (sildenafil injection, torsion for 2 hours and detorsion for 2 hours).The levels of lipid peroxidation (P<0.001) and nitric oxide (P < 0.01) were significantly increased in in the testis of group 2 rats. Testicular reduced glutathione and serum inhibin B levels were decreased significantly (P<0.001) after T/D. Administration of sildenafil either before or after torsion prevented the increase in lipid peroxidation and nitric oxide, and alleviated glutathione and inhibin B levels. Sildenafil also prevented ischemia/reperfusion cellular damage and histological alterations in testicular tissue. These results suggest that treatment with sildenafil citrate 2 hours before or after torsion could induce protective effects against ischemia/reperfusion injury.
ABSTRACT
<p><b>Objective</b>To analyze the high-frequency ultrasound image features of acute scrotum in children and explore the value of high-frequency ultrasonography in the diagnosis and differential diagnosis of the disease.</p><p><b>METHODS</b>This retrospective study included 256 children aged 2 days to 14 years undergoing color Doppler ultrasonography at 2 hours to 3 days after onset of acute scrotum. We analyzed the morphology, internal echo and blood supply of the testis in comparison with the clinical and pathological results.</p><p><b>RESULTS</b>Among the 256 cases, acute testicular torsion was found in 23, of which 16 were treated by complete resection the necrotic testis and the other 7 by surgical reduction of testicular torsion. Ultrasonographically, the involved testes presented different degrees of increase or decrease in volume, with uneven internal echoes, irregular hypoechoic flakes, and testicular hydrocele. Color Doppler flow imaging (CDFI) showed significant blood flow signals around the diseased testes but none within them. Acute testicular appendix torsion was found in 116 cases, in which ultrasonography manifested nodules with round or oval abnormal echoes between the upper pole of the testis and caput epididymidis, first hypoechoic and then gradually increased, heterogeneous internally. CDFI revealed enlarged epididymides and enriched testicular blood flow but no blood flow signals in the nodules. The 103 cases of acute epididymitis were ultrasonographically characterized by varied degrees of swelling of the involved epididymis with uneven internal echoes and rich blood flow signals on CDFI. Six of the cases were diagnosed as acute orchitis, with the ultrasonographic features of testicular swelling and low but uniform internal echoes, with rich blood flow signals on CDFI. Incarcerated inguinal hernia was confirmed in 15 cases, in which ultrasonography revealed intrusion of the hernia into the obviously enlarged scrotal sac with the mesentery and intestine in it, and blood flow visible on CDFI. Acute scrotal wall hematoma and edema was found in 8 cases, with the ultrasonographic characteristics of scrotal wall thickening, with visible blood flow signals on CDFI.</p><p><b>CONCLUSIONS</b>High-frequency ultrasonography has a high sensitivity and specificity for acute scrotum in children, which can be applied as the first-choice clinical imaging modality and provide reliable evidence for the diagnosis and differential diagnosis of the disease.</p>