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Oxidative stress triggered by testicular torsion and detorsion in young males could negatively impact future fertility. Using a rat animal model for testicular IRI (tIRI), we aim to study the induction of autophagy (ATG) during testicular ischemia and tIRI and the role of oxidative-stress-induced c-Jun N-terminal Kinase (JNK) as a cytoprotective mechanism. Sixty male Sprague-Dawley rats were divided into five groups: sham, ischemia only, ischemia+SP600125 (a JNK inhibitor), tIRI only, and tIRI+SP600125. The tIRI rats underwent an ischemic injury for 1 h followed by 4 h of reperfusion, while ischemic rats were subjected to 1 h of ischemia only without reperfusion. Testicular-ischemia-induced Beclin 1 and LC3B expression was associated with decreased p62/SQSTM1 expression, increased ATP and alkaline phosphatase (AP) activity, and slightly impaired spermatogenesis. SP600125 treatment improved p62 expression and reduced the levels of Beclin 1 and LC3B but did not affect ATP or AP levels. The tIRI-induced apoptosis lowered the expression of the three ATG proteins and AP activity, activated caspase 3, and caused spermatogenic arrest. SP600125-inhibited JNK during tIRI restored sham levels to all investigated parameters. This study emphasizes the regulatory role of JNK in balancing autophagy and apoptosis during testicular oxidative injuries. [ABSTRACT FROM AUTHOR]

INTRODUCTION: We aimed to investigate the surgical outcomes following inguinal and subinguinal urologic procedures under deep intravenous sedation (DIVS) with multimodal local anesthesia (LA). METHODS: We conducted a retrospective cohort study from September 2022 to December 2023 including adult patients deemed eligible for day surgery (American Society of Anesthesiologist score 1-3) undergoing radical orchiectomy (RO), microscopic varico- score 1-3) undergoing radical orchiectomy (RO), microscopic varico-celectomy (MV), or microscopic denervation of the spermatic cord (MDSC). All procedures were performed at a single urologic ambulatory surgical center and outpatient clinic, and by a single surgeon (PP). Procedures were performed through a subinguinal or inguinal approach with DIVS and adjunctive multimodal LA. We evaluated intraoperative complications and relevant surgical outcomes and parameters. RESULTS: A total of 103 patients were included in the analysis with a mean age ± standard deviation of 37.3±9.6. This included 25 patients who underwent RO, 54 patients who underwent MV, and 24 patients who underwent MDSC. All procedures were completed successfully without intraoperative complications. Oncologic outcomes were preserved, fertility outcomes improved, and pain scores reduced similarly to the expected rates in the literature. CONCLUSIONS: Our preliminary results demonstrate the safety, effectiveness, and feasibility of performing inguinal and subinguinal urologic procedures under DIVS with LA. These findings suggest that this technique preserves high-quality care while avoiding the unnecessary risks of general or spinal anesthesia, representing an opportunity to transfer these cases outside of hospitals' operating rooms into outpatient ambulatory centers. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A 17‐year‐old patient with acute testicular pain had no blood flow observed on scrotal ultrasound Doppler on either side, suggestive of bilateral torsion. The patient underwent immediate scrotal surgical exploration, and a numerical anomaly was observed during surgery—there were two testicles on each side, and all four exhibited torsion. After detorsion, circulation was recovered, and three of four testicles were kept. One dystrophic testis was removed. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the protective efficacy of remifentanil against testicular ischemia-reperfusion injury.The study included 24 male rats. The rats were randomized into three groups: Group 1 was the control group. Group 2 was subjected to a testicular torsion/detorsion model. Group 3 underwent similar procedures and additionally received remifentanil (0.6 μg/kg/min) intravenously for the first 20 min of reperfusion. Blood samples were taken for biochemical analyses, and orchiectomy was performed for histopathologic examination.Biochemical analysis of blood samples showed a significant increase in antioxidant enzyme activity, including superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in Group 3 compared to Group 2 (p:0.004 and p:0.002, respectively). There was a dramatic decrease in the levels of proinflammatory cytokines, including interleukin-1 beta (IL-1 Beta), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) in Group 3 compared to Group 2 (p:0.001, p:0.046, and p:0.004, respectively). Similarly, malondialdehyde (MDA) levels decreased in Group 3 compared to Group 2 (p:0.004). Histopathologic examination of Group 3 rats showed positive changes in inflammation, hemorrhage, edema, and congestion levels compared to Group 2 (p<0.001). Similarly, there was a positive effect on the Johnsen and Cosentino score in Group 3 compared to Group 2 (p:0.001 and p<0.001, respectively).In our study, it has been documented that remifentanil protects against testicular ischemia-reperfusion injury. [ABSTRACT FROM AUTHOR]

Background: Snodgrass explained TIP (tubularized incised plate) for hypospadias repair in 1994 as a method to improve and widen mobilization of the urethral plate while performing Thiersch-Duplay urethroplasty. Since its introduction, various studies have reported describing the success of modified procedures for repairing distal hypospadias lesions. Aim: The present study aimed to assess the complications associated with Snodgrass urethroplasty (tubularized incised plate urethroplasty) in subjects presenting to the outpatient department. Methods: The study included 50 male subjects with fresh cases of anterior, middle, and distal hypospadias. All the subjects underwent the Snodgrass procedure for hypospadias management. Intraoperative and postoperative data were gathered and analyzed statistically. Results: No complication was encountered in 2% (n=1) subjects. Torsion and testicular ascent were seen in 2% (n=1) study subjects each. Urethral stricture and penile skin necrosis were seen in 6% (n=3) of subjects each. Meatal stenosis, urethrocutaneous fistula, and wound infection were seen in 10% (n=5) of study subjects each. Wound dehiscence was seen in 4% (n=2) of study subjects. Postoperative edema was seen in 30% (n=15) study subjects. Peri-catheter leak was recorded in 18% (n=9) of study subjects. Conclusions: The present study concludes that a properly nourished patient with good personal hygiene, optimum operative time with less intraoperative bleeding, adequate tissue for covering the neo urethra, and adequate mobilization of the graft are the bare necessities of a good surgical outcome. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study aimed to evaluate the approaches of pediatric surgeons and pediatric urologists in Türkiye regarding the diagnosis and treatment of testicular torsion (TT) and their adherence to the European Association of Urology (EAU) pediatric urology guideline. METHODS: A survey consisting of 19 questions, accompanied by an annotation describing the objective of the study, was emailed to pediatric surgeons and pediatric urologists in June and July 2023. RESULTS: Of the 95 respondents, 62.1% had over 10 years of experience, and 48.4% treated more than five cases of TT annually. Of the participants, 87.4% stated that scrotal Doppler ultrasonography (US) was always used, and 12.6% stated that US was used in cases of doubtful diagnosis. Concerning treatment, 14.7% reported performing manual detorsion, 70.5% never did, and 14.7% did so only if the operating room was unavailable soon. A total of 92.6% of participants opted for emergency surgery. Among participants who perform manual detorsion, 71.4% perform surgery within 24 hours after successful manual detorsion. Regarding fixation of the contralateral testicle, 14.7% never performed it, and 27.4% did so only when they performed an orchiectomy on the torsion testicle. CONCLUSION: While most participants follow EAU pediatric urology guidelines by performing emergency surgery, the rate of manual detorsion is low. Few participants stated that emergency surgery may not be performed after manual detorsion. While all of the participants performed fixation of the torsion testicle in accordance with the guidelines, the same adherence was not observed in the contralateral testicle. [ABSTRACT FROM AUTHOR]

Testicular torsion is a common disorder in males and results in blockage of testicular circulation with subsequent damage of testicular germ cells. The current work aimed to compare the therapeutic effect of platelet-rich plasma (PRP) and injectable platelet-rich fibrin (i-PRF) on torsion/detorsion (T/D) injury in rats. Forty mature male Wister rats were arranged into 4 groups; (1) Control, (2) T/D, (3) T/D + PRP, and (4) T/D+ i-PRF. The right testis was twisting 1080° clockwise for 3 h in groups 2, 3 and 4, then 10 μl of PRP or i-PRF was injected intra-testicular 3 h after detorsion in groups 3 and 4, respectively. After 30 days postoperatively, the semen quality and hormonal assay were improved in PRP and i-PRF-treated groups with superiority of i-PRF (P < 0.001). High significance of Catalase, Glutathione Peroxidase (GPx), Superoxide Dismutase, Interleukin-1β (IL-1β), Caspase-3 and Tumor necrosis factor-α (TNF-α) was reported in treated rats with PRP and i-PRF (P < 0.001) with superiority to i-PRF-treated rats (P < 0.001). Testicular histoarchitectures were improved in PRP and i-PRF-treated rats with superiority of i-PRF-treated rats. It was concluded that PRP and i-PRF have regenerative efficacy on testicular damage after induced T/D injury with a superior efficacy of i-PRF. [ABSTRACT FROM AUTHOR]

Introduction: Recognizing testicular torsion is extremely important in patients presenting to the emergency department (ED) with acute scrotal pain. Traditional manual detorsion techniques are frequently employed by emergency physicians but are not always successful. Delays in detorsion increase the risk of testicular infarction and infertility, and the need for orchiectomy. Novel techniques such as the testicular traction technique have been described as a potential solution for difficult-todetorse testicles. Case Report: Our case report describes a 20-year-old male with no significant past medical history who presented to a rural ED with acute, atraumatic testicular pain secondary to testicular torsion with an intact cremasteric reflex. After confirming the diagnosis using Doppler ultrasound, manual detorsion using the traditional “open book” technique was attempted and unsuccessful. The patient was subsequently successfully detorsed using the novel testicular traction technique. Conclusion: The testicular traction technique is a safe, rapid, and effective primary or adjunctive technique in manual testicular detorsion. Given the time-sensitive nature of testicular torsions, adjunctive techniques play a crucial role in managing challenging detorsions, particularly in resource-limited rural settings with limited access to urologic services. Although it is commonly thought that the cremasteric reflex is absent in testicular torsions, it may be present in rare circumstances, and its presence should not be an absolute in ruling out torsion. [ABSTRACT FROM AUTHOR]

Testicular torsion, as one of the medical emergencies, needs prompt diagnostic and treatment measures. This cross-sectional study aimed to assess the clinical and paraclinical findings and the treatment measures performed in the community of hospitalized patients who underwent surgery in Shahid Beheshti Hospital of Babol from 2012 to 2021 with the initial diagnosis of testicular torsion. The research sample was selected via the convenience sampling method. The necessary information was collected from patients' medical records in the form of a checklist. Thereafter, the data were analyzed in SPSS software (version 22) using descriptive and graphical indicators, as well as Chi-square and Fisher's exact tests at a significance level of 0.05. The findings demonstrated that 197 patients with a mean age of 18.91 years were included in the study. The majority of them (n=121; 61.42%) had torsion on the right side. More than 98% of patients experienced pain, while most of them did not have fever (n=160; 81.22%) and vomiting (n=153; 77.66%). In 148 (75.13%) patients, the final diagnosis was testicular torsion, and in 101 (68.24%) patients, the testicle was preserved. Moreover, the result of the surgery had a significant relationship with the degree of rotation and the duration of the onset of symptoms until hospitalization and from hospitalization to surgery (P>0.001, 0.001 and 0.026, respectively). It can be concluded that an understanding of clinical characteristics of testicular torsion cases and as a result, informing the treatment staff involved in the treatment process, reduce the duration of delay in surgery and leads to more appropriate clinical treatment and improved results in testicular torsion patients. [ABSTRACT FROM AUTHOR]

Introduction: Dirofilarial infestation has been reported as an extremely rare cause of pediatric acute scrotum. We aimed to evaluate clinical, radiological, and intraoperative findings of children who underwent surgical management for acute scrotum due to dirofilariasis in an endemic country. Materials and Methods: A retrospective study of patient records of children who underwent surgery for acute scrotum due to dirofilariasis between 2018 and 2022. Results: There were eight emergency presentations for acute scrotum due to dirofilariasis. Three presentations (37.5%) were not associated with scrotal pain. The median age at presentation was 59 (range: 19-100) months. Four patients (67.7%) underwent emergency scrotal exploration at the first presentation and another one during the second presentation. Recurrent episodes were seen in two patients who were initially managed nonsurgically with antibiotics alone. Ultrasonography was performed in all six patients and revealed a parasitic nodule in three (50%). Conclusions: Dirofilariasis causing acute scrotum may cause significant diagnostic dilemma for clinicians. It may resemble idiopathic scrotal edema since it predominantly affects boys under 6 years of age and is painless in a significant proportion. However, left unoperated, it appears to have a high recurrence rate. [ABSTRACT FROM AUTHOR]

Accumulation of reactive oxygen species during testicular torsion causes oxidative stress, which in turn causes ischemia-reperfusion (I/R) injury to the testis. In testicular torsion/detorsion (T/D) in male mice, the purpose of this study was to investigate the influence of Mito-TEMPO (MT) on I/R injury. Forty-two male mice were divided into seven groups, including a control group and six treatment groups (360° T/D, 720° T/D, 360° T/D + 0.70 mg/kg MT, 360° T/D + 1 mg/kg MT, 720° T/D + 0.70 mg/kg MT and 720° T/D + 1 mg/kg MT). After inducing testicular torsion, oxidative enzymes, and testicular histopathology were evaluated. The results showed that 720° T/D resulted in increased testicular malondialdehyde levels and histological damage, along with reduced activities of catalase, superoxide dismutase, and glutathione peroxidase. Treatment with MT reduced tissue malondialdehyde levels and increased the activities of catalase, superoxide dismutase, and glutathione peroxidase. These findings suggest that MT administration protects against acute testicular T/D injury in mice. [ABSTRACT FROM AUTHOR]

Objective: Ovarian torsion (OT) represents a severe gynecological emergency in female pediatric patients, necessitating immediate surgical intervention to prevent ovarian ischemia and preserve fertility. Prompt diagnosis is, therefore, paramount. This retrospective study set out to assess the utility of combined clinical, ultrasound, and laboratory features in diagnosing OT. Methods: The authors included 326 female pediatric patients aged under 14 years who underwent surgical confirmation of OT over a five-year period. Logistic regression analysis was employed to pinpoint factors linked with OT, and the authors compared clinical presentation, laboratory results, and ultrasound characteristics between patients with OT (OT group) and without OT (N-OT group). The authors conducted receiver operating characteristic (ROC) curve analysis to gauge the predictive capacity of the combined features. Results: Among 326, OTwas confirmed in 24.23 % (79 cases) of the patients. The OT group had a higher incidence of prenatal ovarian masses than the N-OT (22 cases versus 7 cases) (p < 0.0001). Similarly, the authors observed significant differences in the presence of lower abdominal pain, suspected torsion on transabdominal ultrasound, and a high neutrophil-lymphocyte ratio (NLR > 3) between the OT and non-OT groups (p > 0.05). Furthermore, when these parameters were combined, the resulting area under the curve (AUC) was 0.868, demonstrating their potential utility in OT diagnosis. Conclusion: This study demonstrates a prediction model integrating clinical, laboratory, and ultrasound findings that can support the preoperative diagnosis of ovarian torsion, thereby enhancing diagnostic precision and improving patient management. Future prospective studies should concentrate on developing clinical predictive models for OT in pediatric patients. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Pediatric testicular torsion (TT) is a urologic emergency that may result in testicular loss if left untreated. Testicular salvage is dependent on prompt intervention, and thus delays in diagnosis and management may threaten testicular viability. Knowledge of real-world Canadian practice patterns for pediatric TT will allow optimization of practices based on resource availability and geographic limitations to improve care. METHODS: An electronic survey on pediatric TT management was distributed to Canadian urologists. Descriptive statistics were performed on respondent demographic factors, hospital policies and barriers to care, surgical approaches, and transfer practices. Respondent practice patterns were analyzed based on geographic location and training. RESULTS: Thirty-four urologists responded, with most respondents operating a community practice. Ultrasonography (US) was frequently used to support TT diagnosis. Despite this, poor US access was often cited as a barrier to care, with particular impact on rural urologists. Neonatal patients and <10 years old were commonly transferred to a pediatric hospital for definitive management due to surgeon discomfort and hospital policies. Reported transport methods commonly included use of the patient's own vehicle or ambulance based on availability and timing. CONCLUSIONS: Neonatal patients and patients under 10 years old are most commonly reported to be transferred to pediatric hospitals for TT management. Patients located in rural locations and at centers with limited US access may be at risk for delayed diagnosis and treatment. Pathways for prompt management of suspected TT may better serve these younger pediatric patients. [ABSTRACT FROM AUTHOR]

Key Clinical Message: The incidence of undescended testicles torsion in a 7‐year‐old is rare, making it a clinically unusual occurrence. Emphasizing the importance of thorough urogenital assessments in children, particularly in underserved communities, is critical to prevent serious complications like testicular gangrene. [ABSTRACT FROM AUTHOR]

Testicular torsion carries the ominous prospect of inducing acute scrotal distress and the perilous consequence of testicular atrophy, necessitating immediate surgical intervention to reinstate vital testicular perfusion, notwithstanding the paradoxical detrimental impact of reperfusion. Although no drugs have secured approval for this urgent circumstance, antioxidants emerge as promising candidates. This study aspires to illustrate the influence of eprosartan, an AT1R antagonist, on testicular torsion in rats. Wistar albino rats were meticulously separated into five groups, (n = 6): sham group, eprosartan group, testicular torsion-detorsion (T/D) group, and two groups of T/D treated with two oral doses of eprosartan (30 or 60 mg/kg). Serum testosterone, sperm analysis and histopathological examination were done to evaluate spermatogenesis. Oxidative stress markers were assessed. Bax, BCL-2, SIRT1, Nrf2, HO-1 besides cleaved caspase-3 testicular contents were estimated using ELISA or qRT-PCR. As autophagy markers, SQSTM-1/p62, Beclin-1, mTOR and AMPK were investigated. Our findings highlight that eprosartan effectively improved serum testosterone levels, testicular weight, and sperm count/motility/viability, while mitigating histological irregularities and sperm abnormalities induced by T/D. This recovery in testicular function was underpinned by the activation of the cytoprotective SIRT1/Nrf2/HO-1 axis, which curtailed testicular oxidative stress, indicated by lowering the MDA content and increasing GSH content. In terms of apoptosis, eprosartan effectively countered apoptotic processes by decreasing cleaved caspase-3 content, suppressing Bax and stimulating Bcl-2 gene expression. Simultaneously, it reactivated impaired autophagy by increasing Beclin-1 expression, decreasing the expression of SQSTM-1/p62 and modulate the phosphorylation of AMPK and mTOR proteins. Eprosartan hold promise for managing testicular dysfunction arising from testicular torsion exerting antioxidant, pro-autophagic and anti-apoptotic effect via the activation of SIRT1/Nrf2/HO-1 as well as Beclin-1/AMPK/mTOR pathways. [ABSTRACT FROM AUTHOR]

Testicular torsion is a critical urologic condition for which testicular detorsion surgery is considered irreplaceable as well as the golden method of reversal. However, the surgical treatment is equivalent to a blood reperfusion process, and no specific drugs are available to treat blood reperfusion injuries. Salidroside (SAL) is one of the main effective substances in rhodiola, which has been shown to have antioxidant and antiapoptosis activities. This study was designed to determine whether SAL exerted a protective effect on testicular ischemia-reperfusion (I/R) injury. In this study, the I/R injury model of the testes and reoxygenation (OGD/R) model were used for verification, and SAL was administered at doses of 100 mg/kg and 0.05 mmol/L, respectively. After the experiments, the testicular tissue and TM4 Sertoli cells were collected for histopathologic and biochemical analyses. The results revealed that SAL improves the structure of testicular tissue and regulates the oxidation-antioxidation system. To further understand the molecular mechanisms of SAL in treating testicular I/R injuries, transcriptomics and metabonomics analyses were integrated. The results show that the Nfr2/HO-1/GPX4/ferroptosis signaling pathway is enriched significantly, indicating that it may be the main regulatory pathway for SAL in the treatment of testicular I/R injuries. Thereafter, transfection with Nrf2 plasmid-liposome was used to reverse verify that the Nfr2/HO-1/GPX4/ferroptosis signaling pathway was the main pathway for SAL anti-testicular I/R injury treatment. Thus, it is suggested that SAL can protect against testicular I/R injuries by regulating the Nfr2/HO-1/GPX4 signaling pathway to inhibit ferroptosis and that SAL may be a potential drug for the treatment of testicular I/R injuries. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of this study was to evaluate the amount of sensitivity and specificity of the slit-light (SL) method in the diagnosis of ocular cyclotorsion. MATERIALS AND METHODS: One hundred and twenty eyes of 60 individuals (10-60 years old), with mean visual acuity of 0.08 ± 0.14 LogMAR, were divided into two groups (normal and torsion groups). Individuals without ocular motility disorder were selected as normal and patients with extraocular motility disorders and oblique muscle dysfunctions as the torsion group. The sensitivity and specificity of SL in the diagnosis of ocular torsion were measured by masked investigators and compared to fundus photography (FP). Inter- and intraobserver variability of these techniques was also determined. RESULTS: The amounts of sensitivity and specificity of SL, measured by the first examiner, were 60% and 92% for intorsion and 50% and 96% for extorsion assessment, respectively. These amounts were 53% and 95% for intorsion, and 54% and 97% for extorsion by the second examiner. The contingency coefficient between the two examiners was 68.6% for SL. This amount was 61% between FP and SL for the first examiner and 63% for the second. The contingency coefficient for the repeatability of SL was 72.2% for the first examiner and 75.7% for the second. This amount was 71.2% between the two examiners. CONCLUSION: SL can be considered a useful method for the diagnosis of cyclotorsion. [ABSTRACT FROM AUTHOR]

Introduction: acute surgical scrotum is one of the most frequent emergencies in pediatric age. Objective: to describe epidemiological, clinical and surgical aspects of children with acute scrotum. Methods: a descriptive and cross-sectional investigation was carried out in the Pediatric Surgery Service belonging to the "José Luis Miranda" University Pediatric Hospital of Villa Clara. The population was made up of a total of 117 children with a diagnosis of acute scrotum during the period from 2017 to 2021. Documentary analysis of medical records was used in data collection and descriptive and inferential statistics in the analysis. Results: the age group 10 to 18 years (52.99%) and those from the Municipality of Santa Clara (58.12%) prevailed. The most frequent clinical manifestations were pain (97.44%) and flushing (99.15%). Hydatid torsion (54.55%) and testicular torsion (58.82%) predominated in the adolescent and the evolution time ranged from six to 24 hours. 75.21% were diagnosed by the clinical method and treated with scrototomy and excision of the hydatid. Conclusions: currently the management of acute scrotal syndrome is a challenge. It is a pediatric emergency that requires timely medical action to avoid complications. [ABSTRACT FROM AUTHOR]

Introduction: Testicular torsion (TT) is a rare but urgent condition; it leads to severe pain and swelling that must be diagnosed and treated immediately, where there is an expectant period of 6-8 h. It is an important prognostic factor in the arrival time to the emergency department. Raising awareness about TT is essential to ensure early diagnosis and timely treatment, which can prevent irreversible damage and loss of fertility. Aim: Our study aimed to measure the awareness, knowledge, and attitude toward testicular torsion (TT) among the general population in Saudi Arabia. Subject and Methods: This is a cross-sectional study conducted among the general population living in Saudi Arabia. A self-administered questionnaire was distributed among the population using an online survey. The questionnaire includes socio-demographic characteristics (i.e., age, gender, region, etc.), a questionnaire to assess the knowledge of testicular torsion, and questionnaires to assess the prevalence, management, and attitude toward testicular torsion. Results: Of the 473 participants, 56% were males, and 61% were aged between 18 to 30 years old. Unfortunately, One quarter of our population has a good knowledge level about testicular torsion. The overall mean knowledge about Testicular Torsion score was below average (3 out of 8 points). Factors associated with increased knowledge include younger age, male gender, living in the Central Region, working in the medical field, having heard of testicular torsion, and having a personal or family history of testicular torsion. Conclusion: In conclusion, there was a lack of testicular torsion knowledge among the general population. Further studies and social campaigns should be done to encourage the general population's understanding and increase their knowledge level. [ABSTRACT FROM AUTHOR]

Testicular torsion is a severe urological emergency caused by the twisting of the spermatic cord. The nationwide incidence of testicular torsion in Japan has not been previously reported. Accordingly, we aimed to estimate the nationwide incidence of testicular torsion using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) and examine the orchiectomy rate. This cross-sectional study was based on data from the NDB. We extracted data of patients aged < 21 years with documented testicular torsion and relevant treatment from January 2018 to December 2020. Testicular torsion was identified based on the Japanese standardized disease codes. The national incidence rate between 2018 and 2020 was calculated and assessed according to age and region of origin. Orchiectomy rates were evaluated according to age. The nationwide incidence rates of testicular torsion were 14.46, 15.09, and 15.88 per 100,000 males aged < 21 years in 2018, 2019, and 2020, respectively. The orchiectomy rate was 7.1%. Testicular torsion was most frequently observed during winter. A similar trend was observed nationwide. To the best of our knowledge, this study is the first to report the nationwide incidence of testicular torsion in Japan. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this study was to examine changes in testicular stiffness at various intervals after the induction of testicular torsion, as well as to assess the predictive value of testicular stiffness for testicular spermatogenesis after torsion. Methods: Sixty healthy male rabbits were randomly assigned to one of three groups: complete testicular torsion, incomplete testicular torsion, or control. All rabbits underwent preoperative and postoperative scrotal ultrasonography, including shear wave elastography (SWE), at predetermined intervals. Changes in SWE values were analyzed and compared using repeatedmeasures analysis of variance. To assess the diagnostic performance of SWE in determining the degree of spermatogenic function impairment, the areas under the receiver operating characteristic curves (AUCs) were calculated. Results: SWE measurements in both central and peripheral zones of the testicular parenchyma affected by torsion demonstrated significant negative correlations with spermatogenesis, with coefficients of r=-0.759 (P<0.001) and r=-0.696 (P<0.001), respectively. The AUCs of SWE measurements in the central or peripheral zones of the torsed testicular parenchyma were 0.886 (sensitivity, 83.3%; specificity, 100%) and 0.824 (sensitivity, 83.3%; specificity, 73.3%) for distinguishing between hypospermatogenesis and spermatogenic arrest, respectively (P=0.451, DeLong test). Conclusion: Variations in the stiffness of both central and peripheral regions of the testicular parenchyma correlate with the extent and duration of torsion, exhibiting a specific pattern. The "stiff ring sign" is the characteristic SWE finding associated with testicular torsion. SWE appears to aid in the non-invasive determination of the extent of spermatogenic damage in torsed testes. [ABSTRACT FROM AUTHOR]

Background: Any delay in diagnosis, surgical intervention, or referral might irreparably damage the testicles since testicular torsion is an emergency vascular accident brought on by the spermatic cord spinning, which blocks the blood supply to the testis. Objectives: To assess parents’ knowledge and attitudes towards testicular torsion. To assess the relationship between the level of parents’ knowledge and their demographic characteristics. To assess the relationship between the level of parents’ attitudes and their demographic characteristics. Methodology: A descriptive (cross-sectional) study was carried out during a period starting from February to April 2023. A probability simple–random sample including (106) participants including the teaching staff, employees, and married students participated in the study. Data were analyzed through the use of the statistical package of Social Sciences (SPSS) version 26. Results: Overall, all assessment of the knowledge of respondents towards TT was fair, and overall, all assessment of the attitudes of respondents towards TT was good. Conclusion: Parents’ knowledge toward TT was fair regarding identifying the condition but it was very poor regarding identifying the time frame in which TT must be managed and the age group most affected by TT. Parents’ attitudes towards TT were very good, especially regarding the belief that it is an urgent condition. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Key Clinical Message: Symmetrical peripheral gangrene (SPG) is very rare condition associated with symmetrical ischemia and gangrene affecting two or more distal extremities. It is almost always associated with septicemia and has a high mortality rate. The rarity of this condition and lack of prospective trials makes its recognition and management difficult. Care providers should maintain a high index of suspicion for SPG in patients with sepsis who develop cyanosis and ischemia of extremities. Doing early culture and sensitivity studies is key in guiding apropriate antibiotic treatment. Symmetrical peripheral gangrene (SPG) is very rare condition associated with symmetrical ischemia and gangrene affecting two or more distal extremities. It can occur at any age and may affect either sex. It is almost always associated with septicemia and has a high mortality rate (up to 35%). The rarity of this condition and lack of prospective trials makes its recognition and management difficulty. Only a few case reports have been in literature since its discovery in 1981. A 14 year old boy was referred to our tertiary facility due to postoperative wound sepsis. He had undergone right scrotal exploration and orchidectomy due to right testicular torsion. His initial symptoms were abrupt onset of scrotal pain and swelling which he developed while playing. Physical examination findings on admission were severe pallor of mucous membranes, fever and diaphoresis and mild respiratory distress. He also had a gangrenous perineal area involving the penis and cyanosed tips of fingers and toes bilaterally. He had a normal ankle branchial index of 0.9. His preliminary laboratory investigations revealed a marked neutrophilia, anemia, thrombocytopenia, and elevated D‐Dimers. Initial resuscitative interventions included oxygen therapy, blood transfusion with whole blood and platelets, empirical antibiotics, analgesics, and surgical debridement of the perineal in theater. A diagnosis of severe sepsis complicated with disseminated intravascular coagulation (DIC) was made. The cyanosis on extremities spread proximally during the patient's course of treatment to full blown gangrene. At the time when clinical and biochemical remission of the infection was attained, the gangrene had demarcated at below elbow in both upper limbs and below knees in both lower limbs. An arterial angiogram was done and revealed normal flow in all proximal and distal branches of the aorta with no occlusion. A multidisciplinary agreement to conduct quadrilateral amputations plus penile amputation was made between urologists, vascular and orthopedic surgeons. The exact pathogenesis of how SPG occurs is not well understood. The underlying mechanism includes a low flow state with DIC. Ischemic changes usually begin in the peripheries and extend proximally. Ischemic changes are not preceded by peripheral vascular occlusive disease. SPG should be suspected when a patient present with marked coldness, pain in the distal extremities, cyanosis, and pallor. Early recognition helps to arrest the progression of ischemic changes before overt gangrene occur and improves the qaulity of life. [ABSTRACT FROM AUTHOR]

Testicular and scrotal abnormalities can occur in children, adolescents, and adults. The lesions, often accompanied by pain and swelling/enlargement of the scrotum, can cause anxiety in patients and their parents. Regardless of age, proper diagnosis is based on adequate anamnesis and physical examination. Color Doppler ultrasound is the first-line test in the differential process of testicular and scrotal diseases. Testicular and scrotal lesions require differentiation for benign and malignant processes as well as therapeutic management, including urgent surgical intervention. The aim of this paper is to present the most common causes of testicular and scrotal abnormalities in pediatric and adult patients and to outline the symptoms and diagnostic and therapeutic management. [ABSTRACT FROM AUTHOR]

Nocardiosis is a rare infection of the lung, brain and skin and can be a localized or disseminated infection. Here, we report a case of a 56-year-old male patient who presented with a right testicular torsion for which right orchiectomy was done in the hospital. In the post-operative period, patient developed increased respiratory insufficiency and was intubated. Chest X-ray revealed bilateral fluffy opacities most likely due to infective etiology. Endotracheal tube aspirate sample was sent for Gram staining and culture, organism present showed characteristics like Nocardia. MALDI-TOF identified organism as Nocardia otitidiscaviarum. The patient was treated with cotrimoxazole and ceftriaxone. His clinical condition improved. We report this case because Nocardia otitidiscaviarum is a rare cause of pulmonary nocardiosis and although there is high mortality reported in nocardiosis, early diagnosis because of the availability of advanced diagnostic technology and prompt treatment can help save the patient. [ABSTRACT FROM AUTHOR]

Background: Scrotal pain is a common problem which requires timely diagnosis and treatment. Pain and swelling may prevent clinician a complete examination by the clinician. Conditions like testicular torsion needs timely management to prevent testicular loss. Methods: This is a prospective study done in medical college hospital. All patients aged above 18 years and with complaint of acute scrotal pain of less than a week duration was included in this study. Results: The results were analyzed to know the age distribution, causes of testicular pain and diagnostic methods. Conclusion: Acute scrotal pain and swellings are common in younger and middle age (in this study 55% are in 18-40 years age group) individuals with variable symptomatology. The commonest cause for acute scrotum in our study is epididymo-orchitis (53.6%) followed by Fournier's gangrene (17.2%). Ultrasound scan of the scrotum is very much helpful and supportive in the diagnosis of testicular torsion, varicocele, pyocele and testicular abscess. [ABSTRACT FROM AUTHOR]

Backgrounds/Aims: Ischemic reperfusion (I-R) injury is greatly influenced by the testicular torsion/detorsion process (TDP). In this instance, the anti-inflammatory properties of plateletrich plasma (PRP) combined with tadalafil (Td) significantly promote tissue healing in the I-R injury model. Methods: Five groups of rats were created: the control group, the I-R group not receiving any therapy, the I-R group receiving a single dosage of Td (0.25 mg/kg, I.P.), the I-R group receiving a single dose of PRP (80 l, intratesticular), and the I-R group receiving both Td and PRP. Sperm morphology, motility, and histology were assessed. The levels of TNF-, BAX, antioxidant status, and testosterone were measured. Additionally, E-selectin expression was done. Results: PRP reduced oxidative stress, inflammation, and apoptosis while also boosting testosterone levels, which alleviated I-R injury. Otherwise, PRP reduces E-selectin expression, which modifies the pathways that control endothelial function. Td also partially demonstrated its testicular-protective activity at the same time. Conclusion: PRP's proven anti-inflammatory, antioxidant, and antiapoptotic potentials make it a natural treatment for testicular harm caused by tadalafil. For the first time, it was demonstrated that PRP therapy restored the functionality of the vascular endothelium, specifically the control of E-selectin expression. Combining Td and PRP therapy may be a promising strategy for improving response to PDE5 inhibitors. [ABSTRACT FROM AUTHOR]

A rat testis model was used to assess effects of polyethylene glycol (PEG) clotrimazole microparticles on ischemia-reperfusion injury. Forty-eight healthy male Wistar rats were included and randomized into six investigational groups (n = 8): Group SHAM: Merely laparotomy was implemented. Group ISCHEMIA: Merely a 3-hour interval ischemia was done. Group I/R: A 3-hour interval ischemia, three-hour reperfusion for left testis, and one-week reperfusion for right testis were done and 20 µL normal saline was administered intraperitoneally (IP) 30 min before termination of ischemia. Group I/R/PEG: The same as group I/R as well as 20 µL PEG (IP) 30 min before termination of ischemia. Group I/R/CLTMZLMP: The same as group I/R and 20 µl (10 mg/kg) of clotrimazole microparticles (IP) 30 min before termination of ischemia. Group I/R/PEGCLTMZLMP: The same as group I/R and 20 µL PEG-based clotrimazole microparticles (IP) 30 min before termination of ischemia. Evaluations were based on analyses of biochemical assays. PEG-based clotrimazole microparticles improved enhanced antioxidant activity (p < 0.05). PEG-based clotrimazole microparticles could be helpful in minimizing ischemia-reperfusion injury in testicular tissue exposed to ischemia [ABSTRACT FROM AUTHOR]

Adama Ouattara,1 Abdoul-Karim Paré,1 Delphine Yé,1 Mamadou Z Traoré,1 Mohamed Simporé,1 Mickael Rouamba,1 F Aristide Kaboré,2 Timothée Kambou1 1Division of Urology, Souro Sanou University Teaching Hospital, Bobo-Dioulasso, Burkina Faso; 2Division of Urology, Yalgado Ouedraogo University Teaching Hospital, Ouagadougou, Burkina FasoCorrespondence: Adama Ouattara, Division of Urology, P.O Box 1465, Bobo-Dioulasso, Burkina-Faso, Email adamsouat1@hotmail.comIntroduction: Spermatic cord torsion (SCT) is a rare urological emergency that can jeopardize the fertility of the patient. Our study aimed to investigate the epidemiological, diagnostic and therapeutic aspects of SCT in Souro Sanou University Teaching Hospital.Materials and Methods: This was a descriptive cross-sectional study with retrospective data collection from January 1, 2017, to December 31, 2021, in the emergency surgical and urology division of Souro Sanou University Hospital.Results: The annual frequency of SCT was 4.4 patients/year. The mean age of the patients was 17.82 ± 6.74 years. Painful swelling of the hemi-scrotum was the main presenting symptom. The torsion involved the left spermatic cord in 50% of cases and both spermatic cords in 5% of cases. The mean time of symptoms before presentation was 78.8 hours ± 153 hours. Only 27.3% of patients presented before the 6th hour after the onset of pain. The average time from presentation to surgical intervention was 5.6 hours ± 5 hours. Orchiectomy was performed in 11 patients (47.8%). The average hospital stay was 3.1 ± 1.4 days.Conclusion: SCT is a rare urological emergency. The prognosis depends on the duration and degree of torsion. A high orchidectomy rate can be observed with a delay in presentation.Keywords: spermatic cord torsion, emergency, orchiectomy

Aim: To classify (etiologically) and to evaluate various scrotal pathologies using ultrasonography and describe the role of High resolution ultrasound and colour doppler in their diagnosis and differentiation. Methods: A prospective study was conducted in the Department of Radiology. The 100 patients with clinical features of scrotal diseases were include in this study. All the patients included in the study underwent scrotal ultrasonography using 7.0-12.0 MHZ high frequency linear array transducer coupled with Colour Doppler in Esaote My Lab 40 and Phillips affinti 70G equipments. Results: The patients most commonly involved were those belonging to the age group of 30 to 40 years (38%). The least number of patients belonged to the age group of 0-10 years (4%). On USG, the total number of lesions detected were 120. The most common cause of scrotal pathologies was hydrocele (n=31, 25.83%) followed by epididymal cyst (n= 20, 16.67%), epididymo-orchitis (n =16, 13.33%), epididymitis (n = 9; 7.5%), funiculitis (n=8, 6.67%), varicocele (n = 7, 5.83%), pyocele (n= 6, 5%), testicular torsion (n=5, 4.17%), testicular abscess (n = 5, 4.17%), inguino-scrotal hernia (n = 4, 3.33%), testicular microlithiasis (n= 3, 2.5%), testicular tumour (n=3, 2.5%) and tubercular epididymo-orchitis (n=3, 2.5%). The number of scrotal lesions seen on the left side were 45(37.5%), on the right side were 35 (29.17%) and in bilateral locations were 20(16.67%). Associated symptoms included swelling, pain, fever and infertility. Almost all the scrotal pathologies were associated with scrotal swelling (n=97, 97%) except in 3 cases. Epididymal cysts were seen in 20 patients, Acute epididymo-orchitis(n=16) was most commonly seen on the left side. Hydrocele (n=31) was the most common scrotal pathology detected in this study. Varicocele 7 patients was most commonly seen on the left side. Testicular torsion was detected in 5 (n = 5) patients. 3 (n=3, 60%) patients had right testicular torsion. Conclusion: High frequency ultrasonography with Color Doppler study serves as an excellent diagnostic imaging modality in the evaluation of scrotal diseases. It is the investigation of choice since it is highly sensitive, easy to perform, widely available, repeatable and involves no risk of ionizing radiation. Periodic follow-up USG scans are recommended for patients with inflammatory scrotal lesions to monitor response to treatment and to reveal the development of complications. [ABSTRACT FROM AUTHOR]

Background: Accessory splenic tissue is a commonly encountered phenomenon in medical literature. Typically, these accessory spleens are found in close proximity to the main spleen, either in the hilum or within the surrounding ligaments. Nevertheless, it is noteworthy that they can also be located in unusual sites such as the jejunum wall, mesentery, pelvis, and, exceptionally rarely, the scrotum. The first documented case of accessory splenic tissue in the scrotum was reported by Sneath in 1913 and is associated with a rare congenital anomaly called splenogonadal fusion. This report describes an infant who presented with a scrotal mass noted by his mother and after examination, investigations, and surgical exploration, it was revealed to be splenogonadal fusion. Case description: An 8-month-old Caucasian male patient presented with a mass in the left testicle and bluish discoloration of the scrotum, which had been incidentally noticed in the previous 2 months. The general physical examination was unremarkable. Other than a palpable scrotal mass that was related to the upper pole of the testis, the rest of examination was unremarkable. Imaging revealed that this mass originated from the tail of the epididymis without infiltrating the testis and tumor markers were normal. On inguinal exploration, a reddish brown 2 × 2 cm mass was found attached to the upper pole and was completely excised without causing any harm to the testis, vessels, or epididymis. Histopathological evaluation confirmed the presence of intratesticular ectopic splenic tissue. Conclusion: Although uncommon, splenogonadal fusion can be included in the differential diagnosis of a testicular swelling. Accurate diagnosis allows for appropriate treatment planning which helps to avoid unnecessary radical orchiectomy, which can have a significant impact on the patient's reproductive and psychological wellbeing. [ABSTRACT FROM AUTHOR]

Introduction: Testicular torsion refers to the torsion of the spermatic cord structures and subsequent loss of the blood supply to the ipsilateral testicle. This is a surgical emergency; early diagnosis and treatment are vital to save the testicle and preserving future fertility.1 The rate of testicular viability decreases significantly after 6 hours from onset of symptoms.2 Testicular torsion is primarily a disease of adolescents and neonates. It is the most common cause of testicular loss in these age groups. However, torsion may occasionally occur in men 40-50 years old.3 Aim of the study is to know the clinical presentation, management of diagnosed cases of testicular torsion. Methodology: An prospective observational study done in 13 cases diagnosed to have Testicular Torsion from January 2023 to August 2023 in the Department of General Surgery, Sri Venkateswara Medical College, Tirupati. History, clinical examination findings, investigations, management and complications were noted in the proforma and the results were analyzed for the study purpose. Results: In the present study majority of the cases were in the age group of 31-40 years. All cases had scrotal pain and cases with delayed presentation had fever and swelling. Only 2 cases presented before a day and 54% cases presented between 1- 3 days and 31% of cases presented more than 3 days. Conclusion: Testicular torsion is a acute surgical emergency and needs immediate intervention to prevent loss of testis and fertility. So all acute scrotal conditions should be considered as torsion and should be evaluated by USG Doppler to rule out torsion. Orchidopexy of the contra lateral testis is needed to prevent torsion in the contra lateral side. [ABSTRACT FROM AUTHOR]

The main functions of the testis, steroidogenesis and spermatogenesis, depend on the endocrine axis and systemic and local tolerance mechanisms. Infectious or non-infectious diseases may disturb testicular immune regulation causing infertility. Literature has illustrated that bacterial and viral infections lead to autoimmune infertility: either sperm antibodies or autoimmune epidydimoorchitis. However, little is known about the association between non-infectious testicular pathologic diseases and autoimmunity. Here we review the novel aspect of varicocele and testicular cord torsion pathology linked to inflammation and discuss how immune factors could contribute to or modulate autoimmunity in ipsi- and contralateral testis. [ABSTRACT FROM AUTHOR]

Neonatal testicular torsion (NTT) is a rare but significant condition occurring within the first 30-day postbirth, leading to vascular compromise and potential testicular loss. This paper presents a case of NTT detected incidentally in a neonate with bilateral hydrocele, emphasizing the challenge of early diagnosis and management complexities. The infant underwent surgical intervention involving detorsion and bilateral orchiopexy but eventually required right orchiectomy due to necrosis. The paper highlights the prevalence of NTT in conjunction with hydrocele and stresses the importance of parent education and vigilant follow-up. Various diagnostic methods, primarily ultrasonography, and a range of management strategies are discussed, considering factors such as salvage potential, risk to the contralateral testicle, and surgical intervention's risks and benefits. The paper argues for individualized management, taking into account specific neonate conditions and parental preferences, underlining the essential role of informed and empathetic consultation. The case reinforces the urgent need for increased awareness, early detection, and carefully considered therapeutic approaches to prevent devastating outcomes like infertility and the necessity for lifelong hormone supplementation. [ABSTRACT FROM AUTHOR]

Background: Any delay in diagnosis, surgical intervention, or referral might irreparably damage the testicles since testicular torsion is an emergency vascular accident brought on by the spermatic cord spinning, which blocks the blood supply to the testis. Objectives: To assess parents' knowledge and attitudes towards testicular torsion. To assess the relationship between the level of parents' knowledge and their demographic characteristics. To assess the relationship between the level of parents' attitudes and their demographic characteristics. Methodology: A descriptive (cross-sectional) study was carried out during a period starting from February to April 2023. A probability simple--random sample including (106) participants including the teaching staff, employees, and married students participated in the study. Data were analyzed through the use of the statistical package of Social Sciences (SPSS) version 26. Results: Overall, all assessment of the knowledge of respondents towards TT was fair, and overall, all assessment of the attitudes of respondents towards TT was good. Conclusion: Parents' knowledge toward TT was fair regarding identifying the condition but it was very poor regarding identifying the time frame in which TT must be managed and the age group most affected by TT. Parents' attitudes towards TT were very good, especially regarding the belief that it is an urgent condition. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Does the provision of an educational animation, developed with young people, about testicular health and fertility impact the knowledge of these topics among adolescents? SUMMARY ANSWER The development and provision of education on testicular health and fertility were welcomed by adolescents and associated with a significant increase in knowledge. WHAT IS KNOWN ALREADY Young people may know less than they should about testicular health and male fertility topics. Lack of knowledge can have implications for health including late medical help-seeking for signs and symptoms of scrotal disorders, such as torsion, for which late presentation frequently results in testicular damage. STUDY DESIGN, SIZE, DURATION A mixed methods experimental pre- and post-design was used with embedded qualitative data collection. High school students completed a pre-animation questionnaire, watched four animations on testicular health and fertility, and completed a post-animation questionnaire. Data were collected during Personal Social and Health Education lessons across a 2-week period. PARTICIPANTS/MATERIALS, SETTING, METHODS Four animations on testicular health and fertility, informed by andrologists, academics, designers, boys, and young men, were developed. Eligible participants were boys and girls in the UK school years 8 and 9 (age 13–14 years). Participants completed a Time 1 (T1) survey (fertility knowledge, demographics) prior to watching the animations and a Time 2 (T2) survey (fertility knowledge, perceptions of the animations) immediately after the animations. Perceptions were rated on 10-point response scales (higher scores better). Participants additionally expressed in their own words positive and negative aspects of the animations. ANOVA was used to examine the effects of the animations using a 2 (time: T1, T2)×2 (gender: male, female) design on topic knowledge, perceived importance, usefulness, and style of the animations according to gender. Regression analysis examined the associations between gender, disability, class year, and knowledge at T2 while controlling for knowledge at T1. Qualitative data on perceptions of the animations were analyzed using inductive thematic analysis. MAIN RESULTS AND THE ROLE OF CHANCE Results showed that the animations significantly increased testicular health and fertility-related knowledge from T1 (x̄ =41.84 ± 24.72) to T2 (x̄ =79.15, ±15.04). Boys had significantly higher levels of knowledge compared to girls at T1 (x̄ =44.74, SD = 25.16 versus x̄ =37.79 ± 23.49, respectively) and T2 (x̄ =80.07, SD = 15.68 versus x̄ =77.89 ± 14.30, respectively) but knowledge gain from T1 to T2 was not significantly different according to gender (P  = 0.11) as shown by non-significant gender×time interaction. There were no significant gender differences in the perceived usefulness and importance of the animations or liking of the style of the animations, with both genders considering the animations as useful, important, and likable. Regression analysis showed only knowledge at T1 to be significantly associated with knowledge at T2. Qualitative data showed three main themes: accessibility of important and useful information; information engagement and help-seeking behaviour; and inclusivity of information. LIMITATIONS, REASONS FOR CAUTION This was a pre- and post-study with a sample of young people from a selected educational institution without a control group. Only short-term effects of the animations were recorded. WIDER IMPLICATIONS OF THE FINDINGS Adolescents are interested in and learn from the provision of engaging fertility-related information. Boys and men should be considered as being a relevant target population for fertility education, not just girls and women. STUDY FUNDING/COMPETING INTEREST(S) This research was carried out in partnership with the British Fertility Society, was financially supported by an Economic and Social Research Council Impact Acceleration Award (520792) and commercial sponsorship from iMediCare Ltd, Bayer AG, Merck Group, Cryos International given to the British Fertility Society, and a financial contribution from Orchid Cancer Appeal. The authors are fully responsible for the content of the animations and this manuscript, and the views and opinions described in the publication reflect solely those of the authors. J.B. reports a grant from Merck Serono Ltd outside the submitted work. C.H. G.G. A.D. E.B. U.G. M.L, B.W. and M.H. declare no conflict of interest. K.M. reports honoraria from Bayer and Merck. A.P. reports paid consultancy for Cryos International, Cytoswim Ltd, Exceed Health, and Merck Serono in the last 2 years, but all monies have been paid to the University of Sheffield. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

Introduction: Several acute scrotal conditions can present in similar way, testicular torsion is by far the most significant. Other conditions that presents in similar way to testicular torsion include, torsion of appendix testis, epididymo-orchitis, trauma to testis, haematocele, strangulated inguinal hernia, Henoch-Schonlein purpura etc. A variety of investigations have been described in the management of acute scrotal conditions. But ultimately for acute scrotum scrotal exploration remains as gold standard approach. Aim: To study clinical presentation, differential diagnosis and management of acute scrotum. Methodology: Prospective study, in Department of general surgery, Government General Hospital, Kadapa from 22nd December 2018 to 21st December 2020 in 100 cases. Results: In present study most common condition is epididymo-orchitis with 35 cases (35%) followed by fournier's gangrene30(30%), Pyocele16(16%), haematoma 10(10%), torsion 8(8%) and scrotal wall abscess 1(1%). Symptom wise pain and swelling were the presenting complaints in all the patients involved in the study. Conclusion: Torsion is common in younger age group. Epididymo-orchitis is common in young and middle age groups where as fournier's gangrene was common in elderly age groups. USG colour Doppler should be done in all cases except in clinically obvious cases of Fournier's gangrene. Conservative management is the main stay of treatment in the case of epididymo-orchitis. Thorough debridement followed later by graft cover or secondary suturing is effective treatment in case of fournier's gangrene. [ABSTRACT FROM AUTHOR]

Background: To diagnose testicular torsion promptly and accurately when diagnosis of testicular torsion is difficult by color Doppler ultrasonography owing to testicular blood flow, we assess the helpfulness of physical findings to aid diagnosis of testicular torsion in cases with preserved testicular blood flow. Methods: We retrospectively collected data of 45 patients below 18 years of age with suspected diagnosis of testicular torsion and underwent surgery. The clinical data of testicular torsion with normal testicular blood flow were compared to testicular torsion with normal testicular blood flow or no-testicular torsion for accurate diagnosis of testicular torsion. Results: Testicular torsion was diagnosed in 34 of the 45 patients, and normal testicular blood flow was detected in six of the 34 patients. In testicular torsion with normal flow, duration of symptoms was significantly shorter, and the degree of torsion was significantly more mild than decreased blood flow. All testicular torsion with normal testicular flow had abnormal testicular findings. Duration of symptoms in patients with testicular torsion with normal flow was also significantly shorter than non-testicular torsion. Conclusions: If testicular blood flow is detected, the presence of abnormal testicular findings and short duration of symptom are highly suspicious for testicular torsion. [ABSTRACT FROM AUTHOR]

Background/aim: To investigate the effects of acetylsalicylic acid (ASA) and the use of ultrasound elastography on testicular torsion. Materials and methods: Herein, 6 equal groups of rats were formed (n: 48): control group, sham group, torsion/detorsion (T/D)-1 h group, T/D-1 h + ASA group, T/D-8 h group, and T/D-8 h + ASA group. Testicular torsion was created by rotating the left testis 720° clockwise. At 30 min before torsion, 100 mg/kg of ASA was injected intraperitoneally. Elastography was performed at 8 and 24 h. After orchiectomy, specimens were collected for histopathological evaluation. Results: When comparing the left testicular volume (LV) parameters obtained from the elastography applied at 8 h, significant differences were observed between the following group pairs: the sham and T/D-8 h groups, T/D-1 h and T/D-8 h groups, and T/D-1 h + ASA and T/D-8 h groups (p = 0.004, p = 0.023, and p = 0.026, respectively). The mean LVS (velocity) (stiffness assessment) of the groups was similar at 8 h. When comparing the LV parameters at 24 h, significant differences were found between the T/D-1 h and T/D-8 h groups and between the T/D-8 h and T/D-8 h + ASA groups (p = 0.008 and p = 0.004, respectively). For the LVS mean values at 24 h, significant differences were found between the control and sham groups, sham and T/D-1 h groups, sham and T/D-8 h groups, and sham and T/D-8 h + ASA groups (p = 0.009, p = 0.021, p = 0.027, and p = 0.009, respectively). Histopathological evaluation showed a decrease in the morphological grades and an increase in the mean testicular injury scores in the T/D-1 h + ASA group compared to the T/D-1 h group. The T/D-8 h + ASA group had a higher morphological grade than the T/D-8 h group, whereas their mean testicular injury scores were similar. Conclusion: ASA treatment for testicular torsion was shown to be ineffective. Elastography can be a complementary method to Doppler ultrasonography in the diagnosis of testicular torsion and can guide surgeons in their approach to surgery. [ABSTRACT FROM AUTHOR]

Testicular torsion is a urological emergency. However, surgical detorsion of the torsed spermatic cord can cause testicular reperfusion injury. Although remote ischemic preconditioning (RIPC) has been convincingly shown to protect organs against ischemia/reperfusion (I/R) injury, little is known regarding the effect of RIPC on testicular torsion/detorsion-induced reperfusion injury. Therefore, we aimed to evaluate the effect of RIPC on testes after testicular I/R injury in a rat model in vivo. Male Sprague–Dawley rats were randomly classified into 4 groups: sham-operated (sham), testicular I/R (TI/R), or remote liver (RIPC liver) and limb (RIPC limb) ischemic preconditioning groups. Testis I/R was induced by 3 h of right spermatic cord torsion (720° clockwise), and reperfusion was allowed for 3 hours. In the RIPC group, four cycles of 5 min of ischemia and 5 min of reperfusion were completed 30 min prior to testicular torsion. The ERK1/2 inhibitor U0126 was administered intravenously at the beginning of reperfusion (1 mg/kg). The testes were taken for the oxidative stress evaluations, histology, apoptosis, immunohistochemical and western blotting analysis. Remote liver and limb ischemic preconditioning attenuated ipsilateral and contralateral testicular damage after testicular I/R injury. For example. RIPC reduced testicular swelling and oxidative stress, lessened structural damage, and inhibited the testicular inflammatory response and apoptosis. Furthermore, RIPC treatment enhanced testicular ERK1/2 phosphorylation postI/R. Inhibition of ERK1/2 activity using U0126 eliminated the protection offered by RIPC. Our data demonstrate for the first time that RIPC protects testes against testicular I/R injury via activation of the ERK1/2 signaling pathway. [ABSTRACT FROM AUTHOR]

Objectives: Testicular torsion is a critical medical condition necessitating prompt diagnosis and intervention. This study aimed to explore the potential safeguarding effect of carvacrol against histological damage and oxidative stress resulting from torsion/detorsion (T/D) in rat testes. Materials and Methods: A total of 32 adult male rats were randomly divided into four groups. The sham group did not undergo any intervention. The second group received an intraperitoneal injection of 75 mg/kg carvacrol half an hour before detorsion application. The third group was administered 80 mg/kg carvacrol intraperitoneally without detorsion. The fourth group (control) experienced (T/D) through the administration of saline. Following a 5-hour reperfusion period, the left testis was excised for histological slide preparation. Blood serum was used to measure antioxidant enzyme levels. Data analysis was performed using the SPSS version 19 software and analysis of variance tests. Results: Significant histological alterations were observed between the sham and other three groups. The levels of superoxide dismutase (SOD), glutathione peroxidase (GPx), and testosterone significantly decreased in all treatment groups compared to the control group (P < 0.05). Conversely, malondialdehyde (MDA) levels increased in the torsion control group in contrast to the sham group (P < 0.05). Carvacrol administration mitigated MDA levels in the treatment groups. Also, there were significant differences in tissue parameters between the sham and the other groups (P < 0.05). Conclusions: According to the results of this study, carvacrol possesses the potential to mitigate testicular tissue damage, enhance testicular function, and ameliorate oxidative stress consequential to testicular rotation. [ABSTRACT FROM AUTHOR]

The issue of objective assessment of a patient's condition with testicular torsion, who has been admitted to an urgent clinic, is becoming increasingly relevant. The aim of the study is to assess the degree and dynamics of psychological condition of pediatric patients with testicular torsion and psychological correction of identified disorders. Materials and methods. The study of psychological state included 27 children aged 11-16 years, who underwent surgery for testicular torsion and had psycho-neurological disorders related to the pathology and possible consequences. The psychological state of the children was evaluated by analyzing the data obtained during the questionnaire. The questionnaire was administered after the patient's discharge from the hospital and one month after the operation, during the psychological correction of the identified disorders. The questionnaire diagnoses the formed pattern of attitudes towards the disease itself, its treatment, doctors and medical staff, family and close people, the environment, work (education), loneliness and the future, as well as towards vital functions such as well-being, mood, sleep and appetite. The questionnaire, modified into a personal survey based on the Bekhterev Institute, consists of 7 sections and 7 statements that reflect the patient's opinion regarding testicular pathology. Results. After analyzing the data obtained from the questionnaire, four types of attitudes were identified in the group of children studied. Anxious: This type of attitude was observed in 10 participants, representing 37.05 % of the group (n = 10). Obsessive-phobic: This type of attitude was found in 9 participants, representing 33.33 % of the group (n = 9). Neurasthenic: A total of 4 participants exhibited this type of attitude, representing 14.81 % of the group (n = 4). Melancholic: This type of attitude was observed in 4 participants, also representing 14.81 % of the group (n = 4). The basis of postoperative treatment and rehabilitation of children with testicular pathology should be rational psychotherapy aimed at explaining the peculiarities of the postoperative period, removing obsessive doubts about one's own inadequacy, and improving medical-social adaptation. After surgery, in the first month of postoperative period, along with psychological correction, neurotic changes in mental state disappear in all children. Conclusions 1. The impact of testicular torsion on the psychological state of pediatric patients is significant, which should become an important factor in choosing the treatment strategy. 2. The psychological state of a child with testicular torsion significantly influences the course of the postoperative period and the recovery process. 3. Timely and effective surgical intervention for testicular pathology in children not only eliminates a range of possible complications but also mitigates the impact of the pathology on the patient's psychological state. 4. Multidisciplinary assistance in the case of testicular torsion should adhere to all the principles of a patient-centered model and focus on the patient's individual needs, the specifics of clinical approaches, and risk factors. This approach also involves considering life circumstances, involving the patient in clinical decision-making, providing objective information to the patient and their family about available therapeutic options, and ensuring medical and rehabilitation support. [ABSTRACT FROM AUTHOR]