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OBJECTIVE: The current study aimed to explore the potential protective effect of Passiflora Incarnata L., (PI) in treating IR injury after testicular torsion in rats. MATERIALS AND METHODS: This research investigated the impact of PI on IR damage in male Wistar albino rats. Animals were divided to three groups: group 1 (sham), group 2 (IR), and group 3 (IR+PI). RESULTS: The malondialdehyde (MDA), myeloperoxidase (MPO) and glutathione (GSH) levels did not significantly differ across the groups (p = 0.830, p = 0.153 and p=0.140, respectively). However, Group 3 demonstrated a superior total antioxidant status (TAS) value compared to Group 2 (p = 0.020). Concurrently, Group 3 presented a significantly diminished mean total oxidant status (TOS) relative to Group 2 (p = 0.009). Furthermore, Group 3 showed a markedly improved Johnsen score relative to Group 2 (p < 0.01). IR caused cell degeneration, apoptosis, and fibrosis in testicular tissues. PI treatment, however, mitigated these effects, preserved seminiferous tubule integrity and promoted regular spermatogenesis. Furthermore, it reduced expression of tumor necrosis factor-alpha (TNF-α), Bax, and Annexin V, signifying diminished inflammation and apoptosis, thereby supporting cell survival (p < 0.01, p < 0.01, p < 0.01, respectively). CONCLUSIONS: This study revealed that PI significantly reduces oxidative stress and testicular damage, potentially benefiting therapies for IR injuries.
OBJETIVO: Explorar el posible efecto protector de Passiflora incarnata L. (PI) en el tratamiento de la lesión por isquemia-reperfusión (IR) después de una torsión testicular en ratas. MÉTODO: Se estudió el impacto de Passiflora incarnata en el daño por IR en ratas Wistar albinas machos. Los animales se dividieron tres grupos: 1 (simulado), 2 (IR) y 3 (IR+PI). RESULTADOS: Los niveles de malondialdehyde (MDA), myeloperoxidase (MPO) y glutathione (GSH) no difirieron significativamente entre los grupos (p = 0.830, p = 0.153 y p = 0.140, respectivamente). Sin embargo, el grupo 3 tuvo un valor de estado antioxidante total (TAS) superior en comparación con el grupo 2 (p = 0.020). Al mismo tiempo, el grupo 3 presentó un estado oxidante total (TOS) medio significativamente disminuido en comparación con el grupo 2 (p = 0.009). El grupo 3 mostró una mejora notable en la puntuación de Johnsen en comparación con el grupo 2 (p < 0.01). La IR causó degeneración celular, apoptosis y fibrosis en los tejidos testiculares. El tratamiento con PI mitigó estos efectos, preservó la integridad de los túbulos seminíferos y promovió la espermatogénesis regular. Además, redujo la expresión de factor de necrosis tumoral alfa, Bax y anexina V, lo que significa una disminución de la inflamación y de la apoptosis, respaldando así la supervivencia celular (p < 0.01, p < 0.01 y p < 0.01, respectivamente). CONCLUSIONES: Este estudio reveló que PI reduce significativamente el estrés oxidativo y el daño testicular, beneficiando potencialmente las terapias para lesiones por IR.
Assuntos
Modelos Animais de Doenças , Passiflora , Ratos Wistar , Traumatismo por Reperfusão , Torção do Cordão Espermático , Animais , Masculino , Torção do Cordão Espermático/complicações , Torção do Cordão Espermático/tratamento farmacológico , Traumatismo por Reperfusão/prevenção & controle , Ratos , Passiflora/química , Extratos Vegetais/uso terapêutico , Extratos Vegetais/farmacologia , Antioxidantes/farmacologia , Antioxidantes/uso terapêutico , Apoptose/efeitos dos fármacos , Fitoterapia , Malondialdeído/análise , Malondialdeído/metabolismo , Testículo/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Glutationa/metabolismo , Peroxidase/metabolismo , Peroxidase/análise , Fator de Necrose Tumoral alfa/análise , Fator de Necrose Tumoral alfa/metabolismo , Espermatogênese/efeitos dos fármacosRESUMO
BACKGROUND: Testicular torsion is a condition in which a testis rotates around its longitudinal axis and twists the spermatic cord. This in turn results in a significant decrease in blood flow and perfusion of testicular tissue. During Testicular torsion, the testicular tissue is affected by ischemia, heat stress, hypoxia, and oxidative and nitrosative stress. The testicular torsion should be considered an emergency condition and surgical intervention (testicular detorsion ) as the sole treatment option in viable cases involves counter-rotation on twisted testes associated, when possible, to orchipexy, in order to avoid recurrence. Possible testicular detorsion side-effects occur due to reperfusion and endothelial cells injury, microcirculation disturbances, and intense germ cells loss. OBJECTIVES: To discuss testicular torsion surgery-based methods, different time frames for testicular torsion induction, and the associated pathophysiology by emphasizing cellular and molecular events as well as different therapeutic agent applications for testicular torsion. MATERIALS AND METHODS: We reviewed all original research and epidemiological papers related to testicular torsion condition. RESULTS: Testicular torsion causes germ cell necrosis, arrested spermatogenesis, and diminished testosterone levels, with consequent infertility. Among different involved pathophysiological impacts, testicular torsion/detorsion-induced ischemia seems to play the key role by leading the tissue toward other series of events in testis. Numerous studies have used adjuvant antioxidants, calcium channel blockers, anti-inflammatory agents, or vasodilating agents in order to decrease these effects. DISCUSSION AND CONCLUSION: To the best of our knowledge, no previously conducted study examined therapeutical agents' beneficial effects post clinical I/R condition in humans. Different agents targeting different pathophysiological conditions were used to ameliorate the ischemia/reperfusion-induced condition in animal models, however, none of the administrated agents were tested in human cases. Although considering testicular detorsion surgery is still the golden method to reverse the testicular torsion condition and the surgical approach is undeniable, the evaluated agents with beneficial effects, need to be investigated furthermore in clinical conditions. Thus, furthermore clinical studies and case reports are required to approve the animal models proposed agents' beneficial impacts.
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Traumatismo por Reperfusão , Torção do Cordão Espermático , Ratos , Masculino , Animais , Humanos , Torção do Cordão Espermático/complicações , Células Endoteliais , Ratos Sprague-Dawley , Traumatismo por Reperfusão/tratamento farmacológico , TestículoRESUMO
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
Assuntos
Humanos , Masculino , Torção do Cordão Espermático/cirurgia , Recém-Nascido , Orquiectomia , OrquidopexiaRESUMO
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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PURPOSE: The TWIST (Testicular Work-up for Ischemia and Suspected Torsion) score was developed to allow for expedited diagnosis of testicular torsion (TT) in children based on clinical variables: edema (2 points), hard mass (2), absent cremasteric reflex (1), high-riding testis (1) and nausea/vomiting (1). We sought to validate the TWIST Score applied by non-expert physicians for the diagnosis of testicular torsion in an adult population. METHODS: We prospectively analyzed all consecutive males presenting to a tertiary hospital with acute scrotum. Patients with previous scrotal pathology or trauma were excluded. Physical examination was performed by a general surgeon and variables of TWIST were recorded. All patients underwent Scrotal Doppler Ultrasound. Measures of accuracy of the TWIST score and ROC curves were generated to evaluate its performance in diagnosing TT in adults. RESULTS: Of 68 patients, 34 had TT (50%). Median age was 24.9 years. According to the original cutoffs of TWIST, 23 patients had a score ≤ 2 among which none had TT. Fifteen patients had a score of 3-4, among which seven had TT. Thirty patients had a score ≥ 5, among which 27 had TT. All 18 patients with a score of 6 or greater had TT (100% PPV). ROC curve revealed an AUC of 0.95. CONCLUSION: The TWIST Score is valid for the diagnosis of Testicular Torsion in adults, presenting a PPV of 90% for a cutoff of 5 points and 100% for six points. In all patients with a score of 2 or less, the disease could be safely excluded (100% NPV).
Assuntos
Exame Físico , Torção do Cordão Espermático/diagnóstico , Adulto , Humanos , Masculino , Estudos Prospectivos , Adulto JovemRESUMO
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.
Assuntos
Humanos , Masculino , Criança , Adolescente , Torção do Cordão Espermático , Inquéritos e Questionários , Emergências , Testículo , Curva ROC , Ultrassonografia Doppler , Tecido ParenquimatosoAssuntos
Criptorquidismo/complicações , Torção do Cordão Espermático/diagnóstico , Criptorquidismo/cirurgia , Humanos , Lactente , Masculino , Orquiectomia/métodos , Orquidopexia/métodos , Torção do Cordão Espermático/etiologia , Torção do Cordão Espermático/cirurgia , Testículo/patologia , Testículo/cirurgia , Ultrassonografia DopplerRESUMO
INTRODUCTION: Ongoing controversy surrounds the role of atmospheric temperature in the incidence of intravaginal testicular torsion (iTT). This debate may be attributed to inadequate research methodology. As environmental risk factors have been successfully investigated with distributed lag non-linear model regression (DLNM), we applied this methodology to investigate the association between daily mean atmospheric temperatures (Tmean) and daily incidences of intravaginal testicular torsion (iTT) in our region. STUDY DESIGN: We analyzed time series consisting of the daily incidences of surgically confirmed iTT according to Tmean, in a circumscribed region in central Brazil from 2012 to 2015, with non-parametric tests, unadjusted and seasonally and long-term trend adjusted time series regression, as well as with DLNM. RESULTS: We recovered 218 cases of iTT in 1125 days of study. Most patients were teenagers (median 15.8 years, interquartile range 14.1-18.5 years). Within the 188 days with events, a single event was recorded on 161 days, two events were recorded on 24 days, and three events were recorded on 3 days. Tmean was lower in days with iTT compared with days without iTT (median 21.4 °C vs. 20.9 °C, p = 0.0002). We found decreasing magnitude and uncertainty of the direction of the effect of Tmean as a risk factor for iTT as the time series regression model was adjusted for seasonal and long-term trends. DLNM indicated a more complex exposure-response relation, with a proportional increase in risk when Tmean fell below 19.4 °C at the day of exposure (for 18.0 °C, RR 4.35) and a protective effect, for similar temperatures, after 1-2 and 7-12 days of exposure (RR 0.44 and 0.78, respectively). DISCUSSION: The association between lower Tmean and higher incidences of iTT at first observed with conventional non-parametric tests and unadjusted time series regression disappeared with adjusted time series regression models, reproducing the conflicting results of the literature. In contrast, DLNM revealed both a proportional effect of Tmean with decreasing temperatures and a delayed decrease in risk, suggesting a harvesting effect, seen when the pool of susceptible patients is depleted at exposure leading to a subsequent decrease in the incidence of the disease. CONCLUSION: According to DLMN, exposures to lower Tmean were associated with immediate greater risk and delayed reduction in risk for iTT. This pattern, indicating a harvesting effect, strongly argues that low temperatures do constitute a risk factor for iTT.
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Meio Ambiente , Torção do Cordão Espermático/diagnóstico , Torção do Cordão Espermático/epidemiologia , Temperatura , Adolescente , Adulto , Brasil/epidemiologia , Ritmo Circadiano/fisiologia , Estudos de Coortes , Humanos , Incidência , Modelos Lineares , Masculino , Estudos Retrospectivos , Medição de Risco , Torção do Cordão Espermático/cirurgia , Fatores de Tempo , Adulto JovemRESUMO
We identified factors associated with delay in presentation and misdiagnosis of testicular torsion. Compared with acute cases, delayed presentations were more likely to report isolated abdominal pain, developmental disorders, and history of recent genital trauma. Failure to perform a genitourinary examination or scrotal imaging was associated with misdiagnosis.
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Diagnóstico Tardio , Erros de Diagnóstico , Torção do Cordão Espermático/complicações , Torção do Cordão Espermático/diagnóstico , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Humanos , Lactente , Masculino , Estudos Retrospectivos , Fatores de Risco , Torção do Cordão Espermático/terapiaRESUMO
BACKGROUND: The acute scrotum is an emergency. Testicular torsion represents approximately 25% of the causes. The annual incidence of testicular torsion is approximately 1/4,000 persons under 25 years, with highest prevalence between 12 and 18 years old. It usually occurs without apparent cause, but it has been associated with anatomical, traumatic, and environmental factors, among others. CLINICAL CASE: A male 15 year-old male, with no history of importance, was seen in the Emergency Department, presenting with a sudden and continuous pain in the left testicle. It was accompanied by a pain that radiated to the abdomen and left inguinal area, with nausea and vomiting of more than 12h onset. Doppler ultrasound showed changes suggestive of testicular torsion. Surgery was performed that showed findings of a necrotic left testicle with rotation of the spermatic cord of 360°. A left orchiectomy was performed. CONCLUSIONS: Testicular torsion should always be considered one of the leading causes of acute scrotal pain. Delays in diagnosis should be avoided as this is directly related to the percentage of testicular salvage or loss.
Assuntos
Torção do Cordão Espermático/cirurgia , Adolescente , Criança , Emergências , Humanos , Masculino , Orquiectomia , Torção do Cordão Espermático/diagnóstico por imagem , Torção do Cordão Espermático/epidemiologia , Ultrassonografia DopplerRESUMO
Orchiopexy is performed as part of cryptorchidism and testicular torsion treatment. The inflammation caused by the needle and suture penetration has been suggested to be one of the possible causes of subfertility after parenchymal transfixation of the testicles. The purpose of the present study was to investigate testicular alterations after parenchymal transfixation sutures at different ages in rats. Prepubertal, pubertal, and adult rats were submitted to parenchymal suturing (without tying the knots, thus avoiding local ischemic injury) of the right testicle, which was maintained for 4 hours. All animals were subjected to euthanasia on completion of 14 weeks of life. The right testicles were studied as the sutured testicles, whereas the left organs were studied as contralateral. One age-matched control group of rats that was not submitted to any procedure was used for comparison. During euthanasia, sperm were collected from the tail of the epididymal and evaluated for concentration, motility, and viability. Samples from testicular tissue were collected for morphologic analysis. Sperm analysis indicated that only the adult operated animals presented reductions in motility (38.2% of adult vs. 54.1% of control; P = 0.02) and viability (16.6% of adult vs. 24.6% of control; P = 0.003). Several morphologic alterations were noted both in sutured and in contralateral testes at all ages. For instance, the seminiferous epithelium volumetric density of right testicles was reduced from 50.4% in controls to 32.3% in prepubertal operated animals, 45.3% in pubertal operated animals, and 39.4% in adult operated animals (P < 0.05). The seminiferous epithelium volumetric density was also reduced to 39.9% and 39.0% in contralateral testicles of animals operated before and after puberty, respectively (P < 0.05). The animals operated on before puberty and in adulthood showed more testicular morphologic alterations, as seminiferous tubule volumetric density, seminiferous tubule length, and tubular diameter were reduced only in prepubertal and/or adult operated animals. Testicular transfixation in rats led to important morphologic modifications in the ipsilateral and contralateral organs. These alterations were observed regardless of the age when surgery was performed, but they were milder in animals operated on during puberty. Orchiopexy techniques that do not involve the application of testicular transfixation sutures should be recommended.
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Orquidopexia/efeitos adversos , Túbulos Seminíferos/patologia , Maturidade Sexual , Espermatozoides/fisiologia , Fatores Etários , Animais , Sobrevivência Celular , Infertilidade Masculina/etiologia , Infertilidade Masculina/patologia , Masculino , Orquidopexia/métodos , Ratos , Ratos Wistar , Epitélio Seminífero/patologia , Contagem de Espermatozoides , Motilidade dos Espermatozoides , Técnicas de Sutura/efeitos adversos , Testículo/patologiaRESUMO
Los apéndices testiculares y epididimarios son remanescentes embriológicos del conducto paramesonéfrico y del conducto mesonéfrico, respectivamente. Estos apéndices pueden sufrir torsión causando un cuadro conocido como escroto agudo. El presente trabajo tuvo como objetivo determinar las variaciones de los apéndices testicular y epididimario, registrando su forma y tamaño. Se utilizaron 30 cadáveres de indivíduos adultos, Brasileños, con edades comprendidas entre 18 y 70 años, fijados en formaldehído 40%, facilitados por el Laboratorio de Anatomía Descriptiva y Topográfica de la Universidad Federal de Alagoas (UFAL), Maceió, Brasil. A través de disección se identificó la presencia de los respectivos apéndices, los que fueron medidos con un caliper manual (MetricaR), registrando su longitud y anchura. Los apéndices testiculares fueron observados en 41 testículos (68,3%) y los apéndices epididimarios en 15 casos (25%). El promedio de la longitud fue de 4,9 mm (DE=1,7) para el apéndice testicular y de 5,2 mm (DE=2,4) para el epididimario. Con respecto a la anchura de los apéndices, el promedio registrado fue de 3,2 mm (DE=1,7) para el testicular y de 2,6 mm (DE=0,9) para el epididimario. Los datos obtenidos puede ser utlizados como soporte morfológico a la clínica urológica y cirugía testicular.
Testicular and epididymal appendages are embryologic remnants of the mesonephric duct and paramesonephric, respectively. These appendices are subject to a torsion causing condition known as acute scrotal syndrome. This study aimed to determine the variations of testicular and epididymal appendices, registering its presence and size. We studied 30 cadavers of adult individuals, Brazilians, aged 18 and 70, fixed in formaldehyde 40%, provided by the Laboratory of Descriptive and Topographic Anatomy of the Federal University of Alagoas (UFAL), Maceió, Brazil. By dissecting these, the presence of the respective appendixes were identified, which were measured with a manual caliper (Metrica), recording its length and width. The testicular appendices were observed in 41 testes (68.3%) and epididymal appendices in 15 cases (25%). The average length was 4.9 mm (SD=1.7) for the appendix testis and epididymis to 5.2 mm (SD=2.4). With respect to the width of the appendices, the average recorded were 3.2 mm (SD=1.7) and 2.6 mm (SD=0.9) for testicular and epididymal, respectively. The data obtained can be used as morphological support in urological clinical and testicular surgery.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Testículo/anatomia & histologia , Epididimo/anatomia & histologia , Variação Anatômica , Torção do Cordão Espermático/etiologia , CadáverRESUMO
Introducción: la torsión testicular perinatal es definida como la torsión del testículo en período prenatal, o dentro de los primeros 28 días de vida. Objetivo: evaluar los datos obtenidos de las historias clínicas, y proponer principios de tratamientos clínicos y quirúrgicos. Métodos: fueron revisadas retrospectivamente las historias clínicas de los recién nacidos operados con diagnóstico de torsión testicular en el servicio de cirugía pediátrica del Hospital Pediátrico William Soler, entre enero de 2000 y diciembre de 2009. Resultados: 18 pacientes fueron elegibles para el estudio, 17 tenían torsión unilateral con testículo aumentado de tamaño duro e indoloro (94 por ciento), 55 por ciento tenían hidrocele contralateral, 16 pacientes nacieron a término, con más de 3 100 g de peso (88 por ciento), y la torsión extravaginal y la afectación del testículo izquierdo se observó en 13 (72 por ciento). Un caso fue bilateral asincrónico (6 por ciento), pues el testículo izquierdo estaba torcido en la región inguinal, isquémico, pero no necrótico, y fue preservado. Dos casos (12 por ciento) tenían torsión de tipo intravaginal, y uno de ellos se presentó, clínicamente, como escroto agudo. Se diagnosticó la afección en edades de 0 a 7 días en el 72 por ciento de los casos. Se realizó orquiectomía sin exploración contralateral a 16 pacientes (88 por ciento). La evolución fue satisfactoria en 17 (94 por ciento). Conclusiones: la torsión testicular perinatal representa el 3,4 por ciento de las afecciones quirúrgicas neonatales, y puede afectar un testículo no descendido. Se sugiere protocolizar el uso del ultrasonido doppler preoperatorio, y la exploración y fijación del testículo contralateral
Introduction: the perinatal testicular torsion is defined as a twist of testicle in prenatal period or within the first 28 days of life. Objective: to assess the data obtained from the medical records and to propose the principles of clinical and surgical treatments. Methods: retrospectively the medical records of newborn operated on diagnosed with testicular torsion were reviewed admitted in the pediatric surgery service of the William Soler Teaching Children Hospital from January, 2000 to December, 2009. Results: eighteen patients were eligible for study, 17 had a unilateral torsion with a testicle of increase size, hard and painless (94 percent), the 55 percent had contralateral hydrocele, 16 patients born at term weighing more than 3 100 g (88 percent), the extravaginal torsion and left testicle involvement was observed in 13 (72 percent). A case had bilateral asynchronism (6 percent), since the left testicle was twisted in the inguinal region with ischemia but not necrosis and could be preserved. Two cases (12 percent) had torsion of intravaginal type and one of them was clinically presented as acute scrotum. The affection was diagnosed in ages from 0 to 7 days in the 72 percent of cases. An orchiectomy was performed without contralateral exploration in 16 patients (88 percent). Evolution was satisfactory in 17 cases (94 percent). Conclusions: the perinatal testicular torsion accounts for the 3,4 percent of neonatal surgical affections and may to involve a und-descent testicle. Authors suggest making a protocol of preoperative Doppler ultrasound and the exploration and fixation of contralateral testicle
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Objetivo: analizar los pacientes tratados por escroto agudo en el Hospital Provincial Pediátrico Docente Eliseo Noel Caamaño, de Matanzas. Pacientes y métodos: entre enero del 2000 al 2010, ingresaron 96 pacientes con escroto agudo, de los cuales 54 fueron diagnosticados de torsión testicular, 26 de torsión de hidátide de Morgagni, 13 de orquiepididimitis aguda asociadas a trauma o no, y 3 de edema escrotal. Resultados: la mayor incidencia fue en la primera década de la vida. En el estudio analizado la torsión testicular fue la primera causa, seguida de la torsión de la hidátide. Conclusiones: los pacientes portadores de estas dos causas de escroto agudo deben ser sometidos a tratamiento quirúrgico lo más urgente posible.
Objective: Analyzing the patients treated for acute scrotum at the Teaching Pediatric Provincial Hospital Eliseo Noel Caamaño, of Matanzas. Patients: From January 2000 to 2010, 96 patients entered the hospital with acute scrotum; 54 of them were diagnosed as testicular torsion, 26 as torsion of Morgagni hydatid, 13 as acute orchiepidydimitis associated to trauma or not, and 3 of scrotal edema. Results: The higher incidence was in the first decade of life. In the analyzed study the testicular torsion was the first cause, followed by the hydatid torsion. Conclusions: the patients who have these two causes of acute scrotum should be objects of surgical treatment as urgent as possible.
RESUMO
OBJECTIVES: This study was designed to investigate prevention of contralateral testicular injury with sildenafil citrate after unilateral testicular torsion/detorsion. METHODS: Thirty-seven adult male rats were divided into four groups: sham operated (group 1, n = 7), torsion/detorsion + saline (group 2, n = 10), torsion/detorsion + 0.7 mg of sildenafil citrate (group 3, n = 10) and torsion/detorsion + 1.4 mg of sildenafil citrate (group 4, n = 10). Unilateral testicular torsion was created by rotating the right testis 720º in a clockwise direction for 2 h in other groups, except for group 1, which was served as sham group. After torsion (2 h) and detorsion (2 h) periods, rats were killed. RESULTS: The level of reduced glutathion (GSH) (p<0.05) and the activities of catalase (p<0.01) and glutathione peroxidase (p<0.05) in the contralateral testis from group 2 were significantly lower and nitric oxide (NO) (p<0.05) level in the contralateral testis were significantly higher than those of group 1. Administration of low-dose sildenafil citrate (group 3) prevented the increases in malondialdehyde and NO levels and decreases in glutathione peroxidase activities and GSH values induced by testicular torsion. However, administration of high-dose sildenafil citrate (group 4) had no effect on these testicular parameters (p>0.05). Histopathological changes were detected in groups 2, 3 and 4. CONCLUSION: These results suggest that biochemically and histologically torsion/detorsion injury occurs in the contralateral testis following 2-h torsion and 2-h detorsion and that administration of low-dose sildenafil citrate before detorsion prevents ischemia/reperfusion cellular damage in testicular tissue.