OBJECTIVE: To investigate the differences between high-frequency ultrasound-guided manual detorsion combined with surgery (MD+S) and surgery alone in the treatment of testicular torsion, and to provide some new evidence for the timely diagnosis and treatment of the disease. METHODS: We retrospectively analyzed the clinical data on 134 cases of unilateral testicular torsion within 48 hours treated in our hospital by MD+S or by surgery alone from January 2015 to May 2022. We statistically analyzed the age distribution, and duration and degrees of testicular torsion, followed by comparison between the two groups. RESULTS: In the 134 cases, the median age of onset was 15 (13－19) years old, the median onset-to-visit time was 15 (8－25) hours, and the median degree of torsion was 360° (180°－1080°). Of the total number of patients, 21 underwent testicular excision and the other 113 were treated with the testis preserved, with no statistically significant difference in age distribution between the two groups (P>0.05), and a higher rate of testis resection in those with longer duration and greater angle of torsion (P<0.05). Totally, 33 of the patients were assigned to the MD+S group and 101 to the surgery alone group. According to the actual clinical conditions and excluding those with torsion time longer than 24 hours and torsion angle greater than 720 °, 28 of the patients underwent ultrasound-guided MD+S (with 1 case of testis resection, 3.6%), and 68 received surgery alone (with 7 cases of testis resection, 10.3%). The rate of testis resection was higher in the surgery alone than that in the MD+S group, but with no statistically significant difference between the two groups (P>0.05), which was considered to be related to the small sample size in this study. CONCLUSION The popularization of testicular torsion knowledge can shorten the onset-to-visit time, and reasonable manual detorsion before emergency surgery can reduce the rate of testis resection.
Humans ; Male ; Spermatic Cord Torsion/therapy* ; Retrospective Studies ; Adolescent ; Young Adult ; Ultrasonography ; Testis/surgery* ; Adult

Scrotal pain is a common complaint in a urological practice. Its diagnosis can prove challenging in both acute and chronic forms and requires a thorough and complete history and physical examination. This article discusses the evaluation and management of several entities of scrotal pain, including testicular torsion, epididymitis, postvasectomy pain, varicocele, and chronic orchialgia.
Diagnosis, Differential ; Epididymitis/*diagnosis/drug therapy ; Humans ; Male ; Pain/*diagnosis ; *Pain Management ; Pain, Postoperative ; Physical Examination ; *Scrotum ; Spermatic Cord Torsion/*diagnosis/surgery ; Testis/physiopathology ; Varicocele/*diagnosis/physiopathology/therapy ; Vasectomy

OBJECTIVETo investigate the protective effect of Danxuetong injection (DXT, a combination of Danshen and Xueshuantong injections) against testicular ischemia-reperfusion injury following testis torsion/detorsion in rats.

METHODSThirty-two 4-week-old healthy male SD rats were randomly divided into four groups of equal number: sham operation, normal saline, single DXT injection, and successive DXT injection. The rat models of testicular ischemia-reperfusion injury were established by 2-hour 720-degree torsion/detorsion of the unilateral testis. At 6 weeks after modeling, the rats were killed and their testes were harvested for measure- ment of testicular coefficients, sperm counts, sperm motility, and the levels of total anti-oxidative capacity (T-AOC) , superoxide dismutase (SOD) , nitric oxide synthase (NOS) , and malondialdehyde ( MDA) in the testis tissue.

RESULTSCompared with the rats of the normal saline group, those of the single DXT injection and successive DXT injection groups showed significant increases in the testicular coefficient (0.11 ± 0.03 vs 0.35 ± 0.04 and 0.40 ± 0.06, P < 0.05), sperm count ([0.46 ± 0.10] vs [1.44 ± 0.50] and [3.00 ± 1.28] x10(9)/ml, P < 0.05), sperm motility ([13.63 ± 14.04] vs [39.63 ± 5.04] and [76.31 ± 3.67]%, P < 0.05), the activity of SOD (72.76 ± 5.58 vs 116.25 ± 8.83 and 133.20 ± 13.84, P < 0.05), and the level of T-AOC (5.58 ± 1.07 vs 13.34 ± 5.81 and 19.21 ± 5.69, P < 0.05), but a remarkable decrease in the content of MDA (42.38 ± 8.94 vs 20.94 ± 5.65 and 15.02 ± 1.03, P < 0. 05) in the injured testes.

CONCLUSIONDXT can effectively rid the testis tissue of oxygen free radicals, improve sperm count and motility by antioxidation, and protect the testis tissue of prepubertal rats against testicular ischemia-reperfusion injury after testis torsion/detorsion. It also has a protective effect on the contralateral testis, and successive injection has a better effect than single injection of DXT.

Animals ; Antioxidants ; therapeutic use ; Drug Therapy, Combination ; methods ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Male ; Malondialdehyde ; metabolism ; Nitric Oxide Synthase ; metabolism ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; prevention & control ; Spermatic Cord Torsion ; complications ; therapy ; Superoxide Dismutase ; metabolism ; Testis ; blood supply ; metabolism

Phosphodiesterase type 5 (PDE5) inhibitors are the most classic first-line medicine for male erectile dysfunction. Recent researches have demonstrated that PDE5 inhibitors can also be employed in the treatment of lower urinary tract symptoms, renal ischemia/reperfusion injury and testicular torsion. This article updates the application of PDE5 inhibitors in these fields and their relevant mechanisms.
Humans ; Lower Urinary Tract Symptoms ; drug therapy ; Male ; Phosphodiesterase 5 Inhibitors ; therapeutic use ; Reperfusion Injury ; drug therapy ; Spermatic Cord Torsion ; drug therapy ; Treatment Outcome

OBJECTIVETo investigate the protective effect of grape seed proanthocyanidin (GSP) on spermatogenesis following testicular torsion/detorsion in mice.

METHODSTwenty-four healthy male Kunming mice, aged 8 weeks and weighing 25 - 27 g, were randomly divided into a control, a torsion and a treatment group, each containing 8 animals. The unilateral testicular torsion/detorsion model was established in the treatment and torsion groups. Thirty minutes before detorsion, the animals of the treatment group were injected intraperitoneally with 50 mg/kg GSP, and those of the torsion group with normal saline at the same dose, both for 3 days postoperatively. On the 4th day after surgery, ipsilateral orchiectomy were performed to detect histopathological changes, the levels of superoxide dismutase (SOD) and malondialdehyde (MDA), and the apoptotic index (AI) of germ cells in all the mice.

RESULTSCompared with the torsion group, the treated mice showed significantly increased Johnsen score (5.00 +/- 1.85 vs 7.38 +/- 0.92, P < 0.05), seminiferous tubule diameter ([176.50 +/- 1.60]microm vs [178.75 +/- 1.58] microm, P > 0.05), spermatogenic cell layers (3.75 +/- 1.03 vs 5.75 +/- 0.71, P < 0.05) and SOD activity ([29.04 +/- 4.46] U/mg prot vs [52.67 +/- 3.57] U/mg prot, P < 0.05), but remarkably reduced level of MDA ([4.63 +/- 0.05] nmol/mg prot vs [2.91 +/- 0.04] nmol/mg prot, P < 0.05) and AI of germ cells ([40.50 +/- 1.60]% vs [16.25 +/- 1.67] %, P < 0.05).

CONCLUSIONGrape seed proanthocyanidin has a protective effect against spermatogenic injury in mice, the mechanisms of which may be related to its actions of scavenging oxygen free radicals, inhibiting lipid peroxidation and improving the antioxidant ability of the body.

Animals ; Grape Seed Extract ; pharmacology ; therapeutic use ; Male ; Malondialdehyde ; metabolism ; Mice ; Mice, Inbred Strains ; Proanthocyanidins ; pharmacology ; therapeutic use ; Spermatic Cord Torsion ; drug therapy ; metabolism ; Spermatogenesis ; drug effects ; Superoxide Dismutase ; metabolism ; Vitis

OBJECTIVETo investigate the different effects of Shengmai injection on testicular injury after testis torsion/detorsion in rats of different ages.

METHODSSixteen healthy male SD rats aged 3, 6 and 12 weeks were equally randomized into an experimental group (testicular torsion/detorsion plus Shengmai injection) and a control group (testicular torsion/detorsion plus saline). The rat models of testicular torsion were killed 24 h after surgery for the measurement of total antioxidant capacity (T-AOC), superoxide dismutase (SOD) activity and malondialdehyde (MDA) content in the testis.

RESULTSCompared with the controls, the 3- and 6-week-old rats of the experimental group showed no significant changes in T-AOC, SOD activity and MDA content (P > 0.05), while the 12-week-old experimental rats exhibited a remarkable increase in SOD and T-AOC and an obvious decrease in MDA content (P < 0.05).

CONCLUSIONShengmai injection has a protective effect against acute ischemia-reperfusion testicular injury after torsion/detorsion in rats, but the effect varies with the age, more obvious in older ones.

Animals ; Drug Combinations ; Drugs, Chinese Herbal ; therapeutic use ; Male ; Malondialdehyde ; metabolism ; Phytotherapy ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; prevention & control ; Spermatic Cord Torsion ; drug therapy ; metabolism ; Superoxide Dismutase ; metabolism ; Testis ; drug effects ; injuries ; metabolism

OBJECTIVETo investigate the differential diagnosis and treatment of acute scrotum.

METHODSWe retrospectively analyzed the clinical characteristics of 316 cases of acute scrotum and reviewed the related literature.

RESULTSAmong the total number, there were 117 cases of acute epididymitis (37.0%), 76 acute orchitis (24.1%), 39 acute periorchitis (12.3%), 23 acute scrotal infection (7.3%), 21 testicular trauma (6.6%), 17 idiopathic scrotal edema (5.4%), 16 testicular torsion (5.1%), and 7 scrotal gangrene (2.2%). Eighty-one of them underwent surgery and 235 received conservative treatment, of whom 1 with scrotal gangrene died of toxic shock for refusing surgical drainage. Those with testicular torsion all showed positive results in Prehn's test and responded well to surgery.

CONCLUSIONAcute scrotum is detrimental to male health, for which early diagnosis and prompt treatment are essential.

Acute Disease ; Adolescent ; Adult ; Age Distribution ; Child ; Child, Preschool ; Epididymitis ; diagnosis ; therapy ; Humans ; Infant ; Male ; Middle Aged ; Orchitis ; diagnosis ; therapy ; Retrospective Studies ; Scrotum ; pathology ; Spermatic Cord Torsion ; diagnosis ; therapy ; Young Adult

OBJECTIVETo investigate the protective effect of verapamil and hypothermia on the spermatogenesis of rats after testicular torsion.

METHODSSixty healthy pubertal male Sprague-Dawley rats were equally divided into 5 groups: A (testis torsion), B (testis torsion + verapamil), C (testis torsion + hypothermia), D (testis torsion + verapamil + hypothermia) and E (control). After treatment, the left testis was removed for the observation of the histological changes under the microscope and measurement of the percentage of apoptotic cells by flow cytometry.

RESULTSHE staining showed disordered arrangement, reduced layers and decreased number of spermatogenic cells, apoptotic bodies, necrosis and partial invasion of inflammatory cells in all the groups but E, most obvious in Group A. The apoptosis rates of germ cells in Groups A, B, C, D and E were (32.11 +/- 2.20)%, (20.18 +/- 1.50)%, (20.02 +/- 1.90)%, (13.75 +/- 1.40)% and (8.56 +/- 0.90)%, respectively, and the Makler scores in the 5 groups were (14.47 +/- 1.35), (15.45 +/- 0.75), (15.48 +/- 0.75), (16.22 +/- 0.72) and (19.60 +/- 0.56), respectively, both with statistically significant differences (P < 0.01).

CONCLUSIONThe increased apoptosis of germ cells after testicular torsion-and-reposition may reduce the spermatogenesis of the testis. Either verapamil or local hypothermia can enhance testicular resistance against injuries, and the combination of the two can more efficiently prevent the germ cells from apoptosis.

Animals ; Apoptosis ; Hypothermia, Induced ; Male ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; physiopathology ; therapy ; Spermatic Cord Torsion ; physiopathology ; therapy ; Spermatogenesis ; Verapamil ; therapeutic use

OBJECTIVETo investigate the protective effect of astragalus on testis tissues following unilateral testicular torsion/detorsion.

METHODSThirty healthy adult Wistar rats were equally randomized into Group A (sham-operation control), B (torsion/detorsion) and C (torsion/detorsion plus intraperitoneal injection of astragalus). The testicular torsion/detorsion model was established by the Turner method. All the rats were fed under the same condition for 7 days and sacrificed, and the torsional testes were harvested for the detection of germ cell apoptosis, glutathione activity and the level of malonic diethylaldehyde (MDA).

RESULTSThe apoptosis indexes (AI) of spermatogenic cells in the torsional testes were (5.82 +/- 1.21), (36.18 +/- 8.40) and (20.39 +/- 3.57) in Group A, B and C, significantly higher in Group B and C than in A (P < 0.05) and in Group B than in C (P < 0.05). Significant differences were observed in glutathione activity in the ipsilateral testes among Group A (48.03 +/- 2.01), B (30.93 +/- 1.25), C (38.44 +/- 1.06) U/mg (P< 0.05), as well as in the level of MDA, (1.43 +/- 0.17), (3.98 +/- 0.36), (2.57 +/- 0.53) nmol/ml, among the three groups (P < 0.05).

CONCLUSIONAstragalus could significantly reduce the apoptosis of spermatogenic cells, decrease the level of lipid peroxidation and protect glutathione activity in the torsional testis.

Animals ; Apoptosis ; Astragalus Plant ; Disease Models, Animal ; Lipid Peroxidation ; Male ; Phytotherapy ; Rats ; Rats, Wistar ; Spermatic Cord Torsion ; drug therapy

OBJECTIVETo investigate the protective effect of pentoxifylline on spermatogenesis following testicular torsion/detorsion in rats.

METHODSHealthy male Sprague-Dawley rats (n = 24) were divided into three groups randomly, each comprising 8 rats. In Group I, rats underwent a sham operation. In Group II and III, animals were submitted to unilateral 720 degrees testicular torsion, then detorsion in two hours. Infusion of isotonic saline and pentoxifylline into tail vein was initiated 15 minutes prior to relief of torsion in Group II and III respectively. Twenty four hours later, testes were examined for evidence of germ cell apoptosis by the flow cytometry and the level of total antioxidant capability (T-AOC) and malondialdehyde (MDA) by spectrophotometry.

RESULTSCompared with that of group II, the number of apoptotic germ cell and the level of MDA decreased remarkably in Group III, but T-AOC increased significantly (P <0.01).

CONCLUSIONPentoxifylline provided significant rescue of testicular function after acute experimental torsion.

Animals ; Apoptosis ; drug effects ; Flow Cytometry ; Germ Cells ; drug effects ; pathology ; Male ; Malondialdehyde ; metabolism ; Pentoxifylline ; pharmacology ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Spermatic Cord Torsion ; drug therapy ; metabolism ; pathology ; Spermatogenesis ; drug effects ; Vasodilator Agents ; pharmacology