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Eur J Pediatr Surg 2018; 28(05): 433-438
DOI: 10.1055/s-0037-1603091
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Incidence of Low-Grade Testicular Injury in Orchidectomy Specimens Post-testicular Torsion

Olugbenga Michael Aworanti
1   Department of Paediatric Surgery, Children's University Hospital, Dublin, Ireland
2   Department of Paediatric Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
,
Piotr Hajduk
2   Department of Paediatric Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
,
Deirdre Devaney
3   Department of Histopathology, Children's University Hospital, Dublin, Ireland
,
Feargal Quinn
2   Department of Paediatric Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
,
Sami Awadalla
1   Department of Paediatric Surgery, Children's University Hospital, Dublin, Ireland
› Author Affiliations
Further Information

Publication History

19 February 2017

04 April 2017

Publication Date:
15 May 2017 (online)

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Abstract

Introduction Following detorsion and orchidopexy for testicular torsion, predominantly animal studies have reported a risk of autoimmune and reperfusion injury to the contralateral testis. As a result, when testicular viability is compromised, orchidectomy is readily performed. This practice increases the likelihood of testes with potentially reversible injury being excised. We aim to determine the incidence of such occurrences and review the available evidence for and against early orchidectomy when testicular viability is doubtful.

Materials and Methods Data for a 15-year period from two pediatric institutions on testicular torsion in children younger than 16 years were reviewed. Using a previously published grading system, the orchidectomy specimens in this cohort with early low-grade injury were analyzed. Low-grade injury suggests the possibility of restitutio ad integrum implying restoration of exocrine and endocrine function of the affected testes.

Results Between both institutions, 222 scrotal explorations were performed for testicular torsion; 20 neonatal and 202 outside the neonatal period (age range [median]: 1–28 days [3 days] and 3 months–16 years [13 years], respectively). Of these scrotal explorations, 17 neonatal and 66 nonneonatal orchidectomies were required (85 vs. 33%, respectively; p < 0.0001). From these orchidectomy specimens, 5 (6%) were found to have low-grade injury. The ages of these five children ranged from 9 to 16 years (median 15, mean 13.6 years). Their symptom duration ranged from 8 to 37 hours (median 14, mean 18 hours) and two of these children had a preoperative ultrasound documenting no flow to the testis.

Conclusion The finding of histopathological features that may represent salvageability of a torted testis occurs relatively rarely. Because of this possibility, appropriate intraoperative steps to check for reperfusion must be undertaken prior to orchidectomy. More evidence for the use of antioxidants and tunica albuginea decompression to improve testes salvage rates is required. The potential for exocrine and endocrine function if partial testicular atrophy occurs and the evidence for contralateral autoimmune testicular damage in pre- and postpubertal males require further investigation.

Keywords

testicular torsion - histopathology - sympathetic orchidopathia - reperfusion - injury - orchidectomy
 

  • References

  • 1 Williamson RC, Thomas WE. Sympathetic orchidopathia. Ann R Coll Surg Engl 1984; 66 (04) 264-266
    PubMedGoogle Scholar
  • 2 Mastrogiacomo I, Zanchetta R, Graziotti P, Betterle C, Scrufari P, Lembo A. Immunological and clinical study of patients after spermatic cord torsion. Andrologia 1982; 14 (01) 25-30
    PubMedGoogle Scholar
  • 3 Filho DW, Torres MA, Bordin AL, Crezcynski-Pasa TB, Boveris A. Spermatic cord torsion, reactive oxygen and nitrogen species and ischemia-reperfusion injury. Mol Aspects Med 2004; 25 (1-2): 199-210
    CrossrefPubMedGoogle Scholar
  • 4 Akgür FM, Kilinç K, Aktuğ T. Reperfusion injury after detorsion of unilateral testicular torsion. Urol Res 1993; 21 (06) 395-399
    CrossrefPubMedGoogle Scholar
  • 5 Arda IS, Ozyaylali I. Testicular tissue bleeding as an indicator of gonadal salvageability in testicular torsion surgery. BJU Int 2001; 87 (01) 89-92
    CrossrefPubMedGoogle Scholar
  • 6 Figueroa V, Pippi Salle JL, Braga LH. , et al. Comparative analysis of detorsion alone versus detorsion and tunica albuginea decompression (fasciotomy) with tunica vaginalis flap coverage in the surgical management of prolonged testicular ischemia. J Urol 2012; 188 (4, Suppl): 1417-1422
    CrossrefPubMedGoogle Scholar
  • 7 Chmelnik M, Schenk JP, Hinz U, Holland-Cunz S, Günther P. Testicular torsion: sonomorphological appearance as a predictor for testicular viability and outcome in neonates and children. Pediatr Surg Int 2010; 26 (03) 281-286
    CrossrefPubMedGoogle Scholar
  • 8 Fraser I, Slater N, Tate C, Smart JG. Testicular torsion does not cause autoimmunization in man. Br J Surg 1985; 72 (03) 237-238
    CrossrefPubMedGoogle Scholar
  • 9 Hagen P, Buchholz MM, Eigenmann J, Bandhauer K. Testicular dysplasia causing disturbance of spermiogenesis in patients with unilateral torsion of the testis. Urol Int 1992; 49 (03) 154-157
    CrossrefPubMedGoogle Scholar
  • 10 Hadziselimović F, Snyder H, Duckett J, Howards S. Testicular histology in children with unilateral testicular torsion. J Urol 1986; 136 (1 Pt 2): 208-210
    CrossrefPubMedGoogle Scholar
  • 11 Laor E, Fisch H, Tennenbaum S, Sesterhenn I, Mostofi K, Reid RE. Unilateral testicular torsion: abnormal histological findings in the contralateral testis--cause or effect?. Br J Urol 1990; 65 (05) 520-523
    CrossrefPubMedGoogle Scholar
  • 12 Mikuz G. Testicular torsion: simple grading for histological evaluation of tissue damage. Appl Pathol 1985; 3 (03) 134-139
    PubMedGoogle Scholar
  • 13 Heindel RM, Pakyz RE, Reinking LN, Cosentino MJ. The effect of various degrees of unilateral spermatic cord torsion on fertility in the rat. J Urol 1990; 144 (2 Pt 1): 366-369
    CrossrefPubMedGoogle Scholar
  • 14 Kutikov A, Casale P, White MA. , et al. Testicular compartment syndrome: a new approach to conceptualizing and managing testicular torsion. Urology 2008; 72 (04) 786-789
    CrossrefPubMedGoogle Scholar
  • 15 Arap MA, Vicentini FC, Cocuzza M. , et al. Late hormonal levels, semen parameters, and presence of antisperm antibodies in patients treated for testicular torsion. J Androl 2007; 28 (04) 528-532
    CrossrefPubMedGoogle Scholar
  • 16 Thomas WE, Cooper MJ, Crane GA, Lee G, Williamson RC. Testicular exocrine malfunction after torsion. Lancet 1984; 2 (8416): 1357-1360
    PubMedGoogle Scholar
  • 17 Zanchetta R, Mastrogiacomo I, Graziotti P, Foresta C, Betterle C. Autoantibodies against Leydig cells in patients after spermatic cord torsion. Clin Exp Immunol 1984; 55 (01) 49-57
    PubMedGoogle Scholar
  • 18 Kogan S, Owens G, Tarter T. , et al. Mechanisms of injury in unilateral testis torsion. Eur Urol 1986; 12 (03) 184-186
    CrossrefPubMedGoogle Scholar
  • 19 Kurpisz M, Mazurkiewicz I, Fernandez N. Morphological and immunological observations in experimentally induced torsion of testis in rats. Am J Reprod Immunol Microbiol 1985; 9 (04) 129-135
    CrossrefPubMedGoogle Scholar
  • 20 Harrison RG, Lewis-Jones DI, Moreno de Marval MJ, Connolly RC. Mechanism of damage to the contralateral testis in rats with an ischaemic testis. Lancet 1981; 2 (8249): 723-725
    PubMedGoogle Scholar
  • 21 Merimsky E, Orni-Wasserlauf R, Yust I. Assessment of immunological mechanism in infertility of the rat after experimental testicular torsion. Urol Res 1984; 12 (03) 179-182
    PubMedGoogle Scholar
  • 22 Schanaider A, Aiex CA, Errico G. Immunological effects of acute testicular torsion on the contralateral testis in rats. Eur J Pediatr Surg 2011; 21 (06) 370-374
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Ryan PC, Whelan CA, Fitzpatrick JM. Testicular torsion does not cause autoimmunization in man. Br J Surg 1986; 73 (04) 325-326
    PubMedGoogle Scholar
  • 24 Awojobi OA, Nkposong EO. Seminal fluid changes after testicular torsion. Urology 1986; 27 (02) 109-111
    CrossrefPubMedGoogle Scholar
  • 25 Chakraborty J, Hikim AP, Jhunjhunwala JS. Quantitative evaluation of testicular biopsies from men with unilateral torsion of spermatic cord. Urology 1985; 25 (02) 145-150
    CrossrefPubMedGoogle Scholar
  • 26 Altavilla D, Romeo C, Squadrito F. , et al. Molecular pathways involved in the early and late damage induced by testis ischemia: evidence for a rational pharmacological modulation. Curr Med Chem 2012; 19 (08) 1219-1224
    CrossrefPubMedGoogle Scholar
  • 27 Elshaari FA, Elfagih RI, Sheriff DS, Barassi IF. Testicular torsion-detorsion- histological and biochemical changes in rat testis. J Cytol Histol 2012; 3: 1-6
    PubMedGoogle Scholar
  • 28 Nguyen L, Lievano G, Ghosh L, Radhakrishnan J, Fornell L, John E. Effect of unilateral testicular torsion on blood flow and histology of contralateral testes. J Pediatr Surg 1999; 34 (05) 680-683
    CrossrefPubMedGoogle Scholar
  • 29 Kehinde EO, Mojiminiyi OA, Mahmoud AH, Al-Awadi KA, Al-Hunayan A, Omu AE. The significance of measuring the time course of serum malondialdehyde concentration in patients with torsion of the testis. J Urol 2003; 169 (06) 2177-2180
    CrossrefPubMedGoogle Scholar
  • 30 Savas C, Dindar H, Bilgehan A, Ataoglu O, Yucesan S. Pentoxifylline attenuates reperfusion injury in testicular torsion. Scand J Urol Nephrol 2002; 36 (01) 65-70
    PubMedGoogle Scholar
  • 31 Anim JT, Kehinde EO, Prasad A, Varghese R. Morphological responses of the rabbit testis to ischemic/reperfusion injury due to torsion. Urol Int 2005; 75 (03) 258-263
    CrossrefPubMedGoogle Scholar
  • 32 Okorie CO. Unilateral testicular torsion with necrotic outcome: dilemmas of surgical timing. Urology 2011; 78 (06) 1232-1234
    CrossrefPubMedGoogle Scholar
  • 33 Koşar A, Sarica K, Küpeli B, Alçiğir G, Süzer O, Küpeli S. Testicular torsion: evaluation of contralateral testicular histology. Int Urol Nephrol 1997; 29 (03) 351-356
    CrossrefPubMedGoogle Scholar
  • 34 Madarikan BA. Testicular salvage following spermatic cord torsion. J Pediatr Surg 1987; 22 (03) 231-234
    CrossrefPubMedGoogle Scholar
  • 35 Merimsky E, Rock M, Katz S. Assessment of fertility after testicular torsion: an experimental study. Urol Res 1982; 10 (01) 51-54
    PubMedGoogle Scholar
  • 36 Thomas WE, Anderson JB, Williamson RC. Autoimmunization in testicular torsion. Br J Surg 1985; 72 (08) 672
    CrossrefPubMedGoogle Scholar
  • 37 Puri P, Barton D, O'Donnell B. Prepubertal testicular torsion: subsequent fertility. J Pediatr Surg 1985; 20 (06) 598-601
    CrossrefPubMedGoogle Scholar
  • 38 Anderson JB, Williamson RC. The fate of the human testes following unilateral torsion of the spermatic cord. Br J Urol 1986; 58 (06) 698-704
    CrossrefPubMedGoogle Scholar
  • 39 Anderson JB, Cooper MJ, Thomas WE, Williamson RC. Impaired spermatogenesis in testes at risk of torsion. Br J Surg 1986; 73 (10) 847-849
    CrossrefPubMedGoogle Scholar
  • 40 Dominguez C, Martinez Verduch M, Estornell F, García F, Hernandez M, García-Ibarra F. Histological study in contralateral testis of prepubertal children following unilateral testicular torsion. Eur Urol 1994; 26 (02) 160-163
    CrossrefPubMedGoogle Scholar
  • 41 Akgür FM, Kilinç K, Aktuğ T. Is ipsilateral testis mandatory for the occurrence of contralateral intratesticular biochemical changes indicative of hypoxia after unilateral spermatic cord torsion?. Eur Urol 1995; 28 (02) 143-146
    CrossrefPubMedGoogle Scholar
  • 42 Dokmeci D, Kanter M, Inan M. , et al. Protective effects of ibuprofen on testicular torsion/detorsion-induced ischemia/reperfusion injury in rats. Arch Toxicol 2007; 81 (09) 655-663
    CrossrefPubMedGoogle Scholar
  • 43 Abasiyanik A, Dağdönderen L. Beneficial effects of melatonin compared with allopurinol in experimental testicular torsion. J Pediatr Surg 2004; 39 (08) 1238-1241
    CrossrefPubMedGoogle Scholar
  • 44 Akgür FM, Kilinç K, Aktuğ T, Olguner M. The effect of allopurinol pretreatment before detorting testicular torsion. J Urol 1994; 151 (06) 1715-1717
    CrossrefPubMedGoogle Scholar
  • 45 Yurtçu M, Abasiyanik A, Avunduk MC, Muhtaroğlu S. Effects of melatonin on spermatogenesis and testicular ischemia-reperfusion injury after unilateral testicular torsion-detorsion. J Pediatr Surg 2008; 43 (10) 1873-1878
    CrossrefPubMedGoogle Scholar
  • 46 Kanter M. Protective effects of Ginkgo biloba (EGb 761) on testicular torsion/detorsion-induced ischemia-reperfusion injury in rats. Exp Mol Pathol 2011; 91 (03) 708-713
    CrossrefPubMedGoogle Scholar
  • 47 Ozturk H, Ozturk H, Gideroglu K, Terzi H, Bugdayci G. Montelukast protects against testes ischemia/reperfusion injury in rats. Can Urol Assoc J 2010; 4 (03) 174-179
    CrossrefPubMedGoogle Scholar
  • 48 Ranade AV, Tripathi Y, Rajalakshmi R. , et al. Effect of vitamin E administration on histopathological changes in rat testes following torsion and detorsion. Singapore Med J 2011; 52 (10) 742-746
    PubMedGoogle Scholar
  • 49 Romeo C, Impellizzeri P, Arrigo T. , et al. Late hormonal function after testicular torsion. J Pediatr Surg 2010; 45 (02) 411-413
    CrossrefPubMedGoogle Scholar
  • 50 Schutte B, Becker H, Vydra G. [Exocrine and endocrine testicular function following unilateral torsion–a retrospective clinical study of 36 patients]. Urologe A 1986; 25: 142-146
    PubMedGoogle Scholar
  • 51 Taskinen S, Taskinen M, Rintala R. Testicular torsion: orchiectomy or orchiopexy?. J Pediatr Urol 2008; 4 (03) 210-213
    CrossrefPubMedGoogle Scholar