Figure - available from: The Journal of International Medical Research
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(a) Age distribution of children with testicular torsion <360°. (b) A blood flow signal is visible in the affected testis, but is reduced compared with the healthy side. (c) The blood flow signal in the testis is normal, but the testis is in a transverse position.
Source publication
Objective:
This study aimed to summarize clinical manifestations, and physical examination, laboratory examination, and ultrasound results of children with testicular torsion <360°.
Methods:
We performed a retrospective study of children who were diagnosed with testicular torsion <360° between October 2007 and October 2017.
Results:
There were...
Citations
... Testicular volumes (pre-op and post-op).degree of testicular torsion is 360 0[22]. Guo et al documented that testicular torsion of less than 360 degrees mainly develops in children aged 2-3 years[23]. However, Sharp et al reported that the testis typically twists more than 360 0 ...
Background: Testicular torsion is a urological emergency necessitating emergent intervention. It occurs when the testis twists
around its spermatic cord leading to impaired blood supply and may result in testicular atrophy (loss).
Materials and Methods: This was a prospective study of children aged 15 years and below who were managed for unilateral
testicular torsion between January 2016 and December 2020 at the pediatric surgery unit of Enugu State University Teaching Hospital
(ESUTH) Enugu, Nigeria. A total of 82 cases of unilateral testicular torsion were managed during the study period. The mean age of the
patients was 11 years with a range of 1 month to 15 years. On presentation with clinical features of testicular torsion, the patients were
clinically evaluated and an ultrasound to evaluate the volumes of both testes was performed. Bilateral orchidopexy was done and at
least 6 months post orchidopexy, a repeat ultrasound was again performed to assess for any change in testicular volume relative to the
contralateral testis.
Results: Testicular pain was a consistent symptom in all the patients and 360 degrees of testicular torsion was the most common
extent of the twist. All the patients had bilateral orchidopexy. About 20% of the patients had a signifi cant reduction in testicular volume.
Surgical site infection was the most common post-operative complication and none of the patients expired.
Conclusion: Although detorsion and orchidopexy corrects and stabilizes the torsed testis, this study has shown that about one-fi fth
of the patients may come down with testicular atrophy despite the orchidopexy.
Background. Acute testicular torsion is a urological emergency in adolescent boys and young men characterized by twisting of the spermatic cord, along with its vessels, around a vertical or horizontal axis. The occurrence of this condition leads to testicular ischemia, and timely diagnosis and appropriate treatment are critical to prevent loss of the organ. Aim: to investigate the histopathological changes and immunohistochemical characteristics of testicles in children with acute torsion within 6.1 to 12 hours from the onset of clinical symptoms. Materials and methods. A histological, histochemical, and immunohistochemical study of testicular tissue biopsies taken during detorsion and orchiopexy surgery within 6.1 to 12 hours from the onset of clinical symptoms of acute unilateral torsion in 7 patients was conducted. Results. According to our data, with each hour of the disease in the period from 6.1 to 12 hours after acute torsion of the testicle, negative dynamics of changes in the morphological structures of the affected genital gonad were observed. If at the limit of 6-7 hours from the onset of the disease, we observed reversible damage to testicular tissues in almost 100% of cases, then in patients with 12-hour torsion, irreversible focal changes in the testicle were diagnosed in almost 28,6% of cases. Morphological signs of loss of viability were focal death of incretory (steroidogenesis) and excretory (spermatogenesis) cells of the testis, severe damage to the spermatogenic epithelium of the seminiferous tubules. Morphologically, large hemorrhages and diffuse blood penetration of the interstitium, thrombi, single leukocytes were observed, pyknosis of the nuclei of the spermatogenic epithelium and desquamation of cells were determined, and deformed seminiferous tubules with their partial or complete devastation were diagnosed. In some histological slides, Leydig cells were absent or shadow cells were diagnosed, especially around devastated and necrotic tubules. However, a small number of cells of the spermatogenic epithelium in the seminiferous tubules were characterized by a PAS-positive reaction to glycogen and glycoproteins, which meant their functional preservation. Conclusion. It was established that progressive morphological changes in the gonad develop with increasing time of acute complete testicular torsion. In patients with 12-hour torsion, irreversible focal changes in the testicle were diagnosed in almost 28,6% of cases, characterized by focal death of incretory (steroidogenesis) and excretory (spermatogenesis) cells of the testicle, damage to cells of the spermatogenic epithelium. With the aim of unifying and systematizing pathological changes in the testicle by its torsion depending on the time since the onset of the disease, we propose to disintegrate testicular ischemia as compensated (the first 6 hours from the onset of the disease), subcompensated ischemia (6.1-12 hours from the onset of the disease) and critical ischemia (12.1-24 hours or more from the onset of the disease).
The aim: To determine the morphological and immunohistochemical changes in the testes 2-6 hours after the onset of clinical symptoms of acute unilateral testicular torsion. Materials and methods: A morphological and immunohistochemical study was conducted on biopsy samples of testicular tissues taken 2-6 hours after the onset of clinical symptoms of acute unilateral testicular torsion during detorsion and orchiopexy surgery in 27 adolescent patients. Results: In cases of incomplete torsion (180-360°) and a disease duration of up to 2 hours, the seminiferous tubules maintained their normal structure. The convoluted seminiferous tubules showed minor damage during 4 hours of ischemia caused by testicular torsion of 360-450°, which was characterized by mild damage. Glycogen and neutral glycoproteins were preserved in the cytoplasm of spermatogonia, primary spermatocytes, and Sertoli cells, indicating that their intracellular metabolism was relatively preserved. The ischemia that lasted for 4 hours with testicular torsion of 450-720° was characterized by a moderate degree of gonadal damage. However, there was pronounced expression of vimentin and calretinin, and the presence of glycogen and neutral glycoproteins indicated functional activity of the gonads. A six-hour ischemia period with a 360-450° testicular torsion demonstrated 100% gonadal viability, with 50% of the seminiferous tubules preserved and 35% with minor damage. Severe damage to the spermatogenic epithelium was observed in 15% of seminiferous tubules, characterized by dystrophy of spermatogenic epithelial cells with signs of karyopyknosis, karyorrhexis, vacuolization, hyperchromasia of cytoplasmic organelles, shedding of individual cells into the lumen of tubules, and focal necrosis. Conclusions: 1. The degree of torsion and duration of symptoms are prognostic factors for testicular salvage in torsion episodes. Ischemia lasting up to 6 hours is characterized by a moderate degree of gonadal damage, and detorsion of the testicle performed within 6 hours from the onset of pathology allows for preservation of the testicle in 100% of cases. 2. Histological examination of the susceptibility of different cell types to ischemia reveals that Sertoli cells and spermatogonia are the most resistant, while spermatocytes and spermatids are more susceptible and prone to degeneration.
The diagnostic significance of the color Doppler study of testicular blood flow in testicular torsion has been studied for about 40 years, however, the prognostic value of the results obtained is ambiguous, as are the actual imaging capabilities of the technique. Our own experience of 110 observations of testicular torsion in children older than the neonatal period allows us to draw statistically reliable conclusions. Made on equipment premium-class research made it possible to evaluate how visualization intratesticular vascular pattern, and whirpool-sign and submit the primitive model of the actual inversion, explaining the impossibility of rendering whirpool-sign with the greatest tight inversion. The dynamics of testicular blood flow was studied immediately after successful and unsuccessful manual detorsion and in the long term after operative detorsion and orchopexy. The publication contains a brief analysis of the literature and is extensively illustrated.
