PURPOSE: This review addresses different aspects of testicular torsion from the clinical perspective as well as the basic cellular and molecular events responsible for the post-torsion testicular changes and pathology, including tissue ischemia-reperfusion injury. MATERIALS AND METHODS: A review of all published literature on testicular torsion was performed by use of two search engines. RESULTS: Testicular torsion, or more correctly termed torsion of the spermatic cord, is a surgical emergency in order to salvage the testis. Its incidence is approximately 1 in 4,000 per annum. Testicular torsion must be treated promptly to avoid loss of the ipsilateral testis; however, even with torsion repair and gross testicular salvage, significant injury may still occur. CONCLUSIONS: The cellular and molecular mechanisms leading to ischemia-reperfusion injury are incompletely understood, and adjuncts to surgical treatment have received little attention. Understanding the cellular and molecular effects is important because 25% of males with a history of torsion may experience adult infertility. This review emphasizes current knowledge of basic science results and clinical outcomes of testicular torsion.
Adult ; Apoptosis ; Emergencies ; Humans ; Incidence ; Infertility ; Ischemia ; Male ; Reperfusion ; Reperfusion Injury ; Spermatic Cord ; Spermatic Cord Torsion ; Testis

The epididymis is divided into caput, corpus and cauda regions, organized into intraregional segments separated by connective tissue septa (CTS). In the adult rat and mouse these segments are highly differentiated. Regulation of these segments is by endocrine, lumicrine and paracrine factors, the relative importance of which remains under investigation. Here, the ability of the CTS to limit signaling in the interstitial compartment is reviewed as is the effect of 15 days of unilateral efferent duct ligation (EDL) on ipsilateral segmental transcriptional profiles. Inter-segmental microperifusions of epidermal growth factor (EGF), vascular endothelial growth factor (VEGFA) and fibroblast growth factor 2 (FGF2) increased phosphorylation of mitogen activated protein kinase (MAPK) in segments 1 and 2 of the rat epididymis and the effects of all factors were limited by the CTS separating the segments. Microarray analysis of segmental gene expression determined the effect of 15 days of unilateral EDL on the transcriptome-wide gene expression of rat segments 1-4. Over 11,000 genes were expressed in each of the four segments and over 2000 transcripts in segment 1 responded to deprivation of testicular lumicrine factors. Segments 1 and 2 of control tissues were the most transcriptionally different and EDL had its greatest effects there. In the absence of lumicrine factors, all four segments regressed to a transcriptionally undifferentiated state, consistent with the less differentiated histology. Deprivation of lumicrine factors could stimulate an individual gene's expression in some segments yet suppress it in others. Such results reveal a higher complexity of the regulation of rat epididymal segments than that is generally appreciated.
Animals ; Ejaculatory Ducts ; physiology ; Epididymis ; drug effects ; physiology ; Gene Expression Regulation ; drug effects ; Growth Substances ; pharmacology ; Male ; Mice ; Rats ; Reverse Transcriptase Polymerase Chain Reaction ; Signal Transduction

As part of our efforts to identify novel contraceptive targets in the epididymis we performed transcriptional profiling on each of the 10 and 19 segments of the mouse and rat epididymidis, respectively, using Affymetrix whole genome microarrays. A total of 17 096 and 16 360 probe sets representing transcripts were identified as being expressed in the segmented mouse and rat epididymal transcriptomes, respectively. Comparison of the expressed murine transcripts against a mouse transcriptional profiling database derived from 22 other mouse tissues identified 77 transcripts that were expressed uniquely in the epididymis. The expression of these genes was further evaluated by reverse transcription polymerase chain reaction (RT-PCR) analysis of RNA from 21 mouse tissues. RT-PCR analysis confirmed epididymis-specific expression of Defensin Beta 13 and identified two additional genes with expression restricted only to the epididymis and testis. Comparison of the 16 360 expressed transcripts in the rat epididymis with data of 21 other tissues from a rat transcriptional profiling database identified 110 transcripts specific for the epididymis. Sixty-two of these transcripts were further investigated by qPCR analysis. Only Defensin 22 (E3 epididymal protein) was shown to be completely specific for the epididymis. In addition, 14 transcripts showed more than 100-fold selective expression in the epididymis. The products of these genes might play important roles in epididymal and/or sperm function and further investigation and validation as contraceptive targets are warranted. The results of the studies described in this report are available at the Mammalian Reproductive Genetics (MRG) Database (http://mrg.genetics.washington.edu/).
Animals ; Epididymis ; physiology ; Gene Expression Profiling ; methods ; Male ; Mice ; Organ Specificity ; RNA ; genetics ; isolation & purification ; Rats ; Reverse Transcriptase Polymerase Chain Reaction ; Transcription, Genetic