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Background: Torsion of the spermatic cord is a hazardous and common urologic issue. The current work evaluates the possible protective effect of pregabalin (PGB) and xanthenone (XAN) in testicular ischemia/reperfusion injury induced by testicular torsion/detorsion in rats. Materials and methods: Seven groups of adult male Wistar albino rats were allocated randomly into seven groups, namely, sham control, torsion/detorsion (T/D), PGB 50 mg/kg, PGB 100 mg/kg, XAN 1 mg/kg, XAN 2 mg/kg, and PGB 50 mg/kg plus XAN 1 mg/kg groups. Serum cholesterol and testosterone levels were determined. Also, the levels of malondialdehyde (MDA), reduced glutathione (GSH), nitric oxide (NO), superoxide dismutase (SOD), tumor necrosis factor‐α (TNF‐α), nuclear factor kappa B (NF‐қB), angiotensin (Ang) II, Ang‐(1–7), and angiotensin‐converting enzyme2 (ACE2) were assessed in testicular tissue. Immunohistochemical analysis of heme oxygenase‐1 (HO‐1) and caspase‐3 was performed. Finally, the histopathological examination of the testicular tissues was performed. Results: The PGB 50 mg/kg, PGB 100 mg/kg, XAN 1 mg/kg, XAN 2 mg/kg, and PGB 50 mg/kg plus XAN 1 mg/kg groups showed a significant decrease in serum cholesterol, MDA, NO, TNF‐α, NF‐қB, and Ang‐II levels coupled with a significant increase in both testosterone and ACE2 expression. Furthermore, all test groups showed a significant improvement in the histopathological picture with a reduction in caspase‐3 and an increase in HO‐1 immunoexpression in testicular tissue. Conclusion: PGB and XAN may have promising effects on preventing testicular T/D injury through antioxidant, anti‐inflammatory, and antiapoptotic actions. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this scoping review was to identify the topics of research and the types of studies published by the French Association of Urologists in Training (AFUF) since it was created, 35 years ago and to perform a bibliometric analysis. Methods: A scoping review on PubMed, Google scholar, Excerpta Medica database (EMBASE) was conducted from 1989 until the 31st of December 2023. The PRISMA extended guidelines for scoping reviews were followed. Articles were independently screened and analyzed by two reviewers. The theme type, primary results, language of publication, number of male and female authors and number of citations from each included article were extracted. Results: A total of 32 articles were included among which 17 surveys and 11 cohort studies. There was a median percentage of 20% women among authors. Fifteen articles (47%) were published in French and 17 articles in English. The median number of citations was 4.5. The topics covered were urologist in training's surgical education, well-being, professional practice, and urologic emergencies: renal trauma and spermatic cord torsion. The creation of large national databases enabled the generation of multiple studies focusing on previously under-represented topics. Conclusion: Over the 35 years since it was created, The AFUF has had an interesting and prolific scientific output. It has shown its concerns for urologists in training. [ABSTRACT FROM AUTHOR]

Background and objective: This study aimed to assess the protective ability of edaravone on testicular torsion–detorsion injury in rats. Methods: Eighteen adult male Sprague–Dawley rats were randomly divided into three groups: Sham group (control, n = 6); testicular torsion/detorsion (T/D group, n = 6) and T/D+edaravone (T/D+E group, n = 6). The spermatic cords of rats of the T/D group and the T/D+E group were rotated 720° in a clockwise direction and maintained for 120 min in this torsion position. Around 90 min after the torsion, edaravone at a dose of 10 mg/kg dissolved in saline was administered IP to the T/D+E group. The testicle was counter‐rotated to its normal position to allow reperfusion for 4 h. Left testes of each animal were excised 240 min after beginning of reperfusion. Oxidative stress markers (TAS, TOS, SOD, and MDA) and apoptotic pathways (Caspase 3, Caspase 8, Caspase 9, Bcl‐2, and Bax,) were assessed by ELISA methods. Also, testicles were subjected to the histopathologic and ultrasound examinations. Results: Ultrasound imaging showed that edaravone reduced the surface area and increased vascularization in testicles with T/D (p < 0.0001, p < 0.05, respectively). Edaravone pretreatment markedly decreased the levels of MDA, TOS, Bcl‐2, Bax, Caspase 3, Caspase 8, and Caspase 9 (p < 0.0001). Also, it increased significantly TAS levels (p < 0.0001) and reduced insignificantly SOD activity. Histopathologic examinations demonstrated that edaravone significantly attenuated the histological damage caused by T/D in testicles. Conclusion: Taken together, the findings indicate that pretreatment of edaravone has protective effect against testicular T/D injury. [ABSTRACT FROM AUTHOR]

Background Objectives Materials and methods Results Discussion and conclusion Testicular torsion is a common urological emergency in children and teenagers that, in most cases, requires surgical exploration and detorsion. However, even after a successful intervention, a high number of patients still develop irreversible damage.To investigate whether the administration of phosphodiesterase inhibitors (PDE) in animal models of testicular torsion can reduce damages caused by the ischemia–reperfusion syndrome.A systematic search of the Medline, Web of Science, Embase, and Ovid databases for studies up to December 2023 was performed using PRISMA guidelines. A detailed search was conducted using the following key terms: “testicles,” “ischemia,” “reperfusion,” and “phosphodiesterase inhibitors.” There was no restriction regarding language or year of publication. We investigated spermatogenesis by the Johnsen's biopsy score (JTBS) and histological damage by the Cosentino's biopsy score (CBS). Malondialdehyde (MDA), nitric oxide (NO), superoxide dismutase (SOD), and glutathione peroxidase (GPx) testicular levels were also analyzed.Initially, 296 articles were identified. However, only 20 studies met the inclusion criteria. PDE inhibitors improved JTBS (MD = 2.53, CI = 1.94 to 3.13), CBS (MD = −1.11, CI = −1.25 to −0.97) and SOD (SMD = 3.27, CI = 1.59 to 4.95) outcomes. PDE did not improve MDA (SMD = −0.93, CI = −2.19 to 0.34), NO (SMD = −0.54, CI = −1.56 to 0.48), and GPx (SMD = 0.77, CI = −0.38 to 1.92) outcomes. A higher dose of PDE inhibitors only improved CBS outcome.This review indicates that the administration of PDE inhibitors in rats ameliorated the outcomes, representing a promising complementary strategy for spermatogenesis recovery following testicular torsion. Our review suggests that JTBS and CBS could be translated into future human studies, validating and extending these findings within the context of human physiopathology, while providing applicability of interventions in real clinical practice. [ABSTRACT FROM AUTHOR]

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]

Testicular ischemia requires timely diagnosis and definitive management to avoid serious consequences such as orchiectomy. It is almost always caused by testicular torsion; however, there are other causes to be aware of. A 32-year-old man developed testicular ischemia following a laparoscopic robotic-assisted inguinal hernia repair with preperitoneal mesh. The ischemia progressed to a fully infarcted testicle with no evidence of torsion on subsequent surgical exploration. He ultimately did require an orchiectomy. While extremely rare, testicular ischemia or infarct must be considered in patients presenting with testicular pain shortly after inguinal hernia repair. Emergent surgical evaluation and loosening of the hernia mesh may be required to salvage the testicle. [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 Objectives Materials and Methods Results Discussion and Conclusion Testicular torsion/detorsion can cause testis loss and infertility. Aloperine is a major active alkaloid extracted from Sophora alopecuroides Linn. It has been shown to have organ‐protective effects. However, the effects of aloperine on the testis and its underlying mechanisms remain unclear.This study investigated the effect of aloperine on testicular torsion/detorsion injury in rats.Male Sprague‐Dawley rats were randomized to the sham‐operated (sham), testicular I/R (TI/R), or aloperine preconditioning (ALOPre) or postconditioning (ALOPost) groups. All rats except for the sham‐operated rats were subjected to 3 h of right spermatic cord torsion (720°, clockwise), followed by 3 h of detorsion. Aloperine (10 mg/kg) was intravenously administered before testicular torsion (ALOPre) or at the onset of testicular detorsion (ALOPost). The therapeutic efficacy of aloperine was evaluated by histological analysis, oxidative stress evaluation, inflammatory response examination, apoptosis analysis, protein analysis, and immunohistological assessment.Compared with TI/R, aloperine protected both the ipsilateral and contralateral testes against unilateral testicular I/R, as evidenced by a reduced testicular weight to body weight (TW/BW) ratio (ALOPre: p = 0.0037; ALOPost: p = 0.0021) and volume (ALOPre: p = 0.0020; ALOPost: p = 0.0009), less structural damage with better Johnsen (ALOPre: p = 0.0013; ALOPost: p = 0.0021), and Cosentino scores (ALOPre: p < 0.0001; ALOPost: p < 0.0001), increased mean seminiferous tubule diameter and mean seminiferous tubule epithelial height, decreased testicular apoptosis, and less oxidative stress and inflammatory response. In addition, aloperine significantly stimulated the phosphorylation of signal transducer and activator of transcription (STAT)‐3 in the ipsilateral testes following detorsion. Administration of Ag490 suppressed STAT‐3 phosphorylation, thereby abrogating the protective effects exerted by aloperine on the ipsilateral testis.Aloperine has a strong testicular protective effect on the ipsilateral and contralateral testes after testicular torsion/detorsion. This aloperine‐induced ipsilateral testicular protection is mediated via the STAT‐3 signaling pathway. [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]

An 8-year-old male German Shepherd dog with a history of dyschezia, tenesmus and perineal swelling for1monthwas referred. Thedogwasknown tobeunilaterally abdominal cryptorchid. The normally descended testis had been surgically removed a few years ago. On physical examination, a firm, non-painful, irreducible mass was palpable in the left perineal region. Digital rectal examination revealed rectal deviation, and the pelvic diaphragm was absent on the left. The prostate gland was normal upon palpation. Abdominal radiography revealed that the urinary bladder was present in the caudal abdomen. Based on clinical, laboratory and imaging findings, a diagnosis of perineal hernia was made. Surgical exploration revealed the presence of left spermatic cord torsion in the perineal hernia. The testis was removed, and internal obturator muscle transposition was performed for herniorrhaphy. The dog had an uneventful recovery, and the results of re-examinations 10 days, 6 months and 12 months later were normal. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Testicular torsion is an uncommon but time‐critical condition in EDs. If the diagnosis is missed or delayed, there are significant medicolegal and patient fertility implications. Scoring tools are advocated for use in children but have limited validation in adults. The aim of the present study was to explore the predictive accuracy of the testicular torsion scoring tools, Testicular Workup for Ischemia and Suspected Torsion (TWIST) and Boettcher Alert Score (BALS), in adult patients with a final ED diagnosis of torsion.All patients with an ED working diagnosis of testicular torsion were identified retrospectively. Data collected from digital medical records included demographics, processes of care and clinical information. The outcome of interest was the predictive performance of the scores for a confirmed diagnosis of testicular torsion as adjudicated by an urologist or a surgeon.Fifty‐four patients had complete clinical data, of whom 13 had confirmed torsion. The TWIST score had a high area under the receiver operating characteristics curve (AUROC) of 0.89 (95% confidence interval [CI] = 0.78–0.999) with a score of 6–7 corresponding to a positive predictive value (PPV) of 80% (95% CI = 38–96%). The BAL score had an AUROC of 0.79 (95% CI = 0.69–0.92). PPV for a score ≥2 was 38% (95% CI = 22–56%).A high TWIST score correlates to a high likelihood of torsion and can inform surgical decision‐making in the absence of US. [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]

Manual detorsion is infrequently performed in pediatric emergency medicine, particularly in centers with urology coverage. In no other emergency condition does an emergency physician not take immediate action to alleviate pain and damage, even if definitive care is close by. A small number of case reports exist in which pediatric emergency physicians have performed manual detorsion. This review the literature presents the case for routine manual detorsion prior to definitive orchiopexy. [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]

Background: Literature on paediatric surgical conditions in low- and middle-income countries (LMICs) remains limited. As a common emergency, timely treatment of testicular torsion acts as a benchmark of adequate emergency service delivery in paediatric surgery. This scoping study aims to synthesise all existing literature on paediatric testicular torsion in LMICs. Methods: A database search was conducted by the OxPLORE global paediatric surgery research group to identify studies containing the terms 'testicular torsion' or 'acute scrotum' originating from LMICs. A thematic analysis was applied to the results of the search and the quality of evidence was appraised for all included articles. Results: This review included 17 studies with 1798 patients. All studies originated from middle-income countries and the majority (76%) had sample sizes smaller than 100 patients. All studies were appraised as providing less than adequate evidence. Included studies identified long delays to treatment and highlighted ongoing debates on the value of scoring systems and Doppler ultrasonography in diagnosing torsion. Major heterogeneity in surgical approaches to treatment of testicular torsion in children was also observed. Conclusions: Literature on paediatric testicular torsion in LMICs is scarce and heterogeneous. Prospective, multi-centre research on the management of this common paediatric surgical emergency is urgently required. [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]

Objective: Testicular torsion is an urological emergency that requires early intervention. When torsion is diagnosed late, the possibility of organ loss increases. In this study, we investigated the role of preoperative hematological parameters in predicting orchiectomy. Material and Methods: A total of 136 patients who had undergone surgery due to testicular torsion were included in this study. Patients are divided into two groups as orchiectomy (n=48) and testicular fixation (n=88). The groups were compared with age, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), platelet count (PLT), mean platelet volume (MPV), neutrophil count, lymphocyte count, symptoms of duration, side and the degree of torsion. Results: The mean age was 18.2 ± 9.6 in orchiectomy group and 17.2 ± 6.1 in testicular fixation group (p=0.569). The symptoms of duration was statistically higher in orchiectomy group (57.4±35.7 vs. 8.7±7.4 (p=0.001)). NLR was 5.03±2.93 in orchiectomy group and 6.72±3.51 in testicular fixation group (p=0.005). MPV was found to be significantly higher in the orchiectomy group (p=0.001). There were no differences between the groups in terms of the PLR (p=0.137), PLT (p=0.251), neutrophil count (p=0.309) and lymphocyte count (p=0.895). In multivariate analysis, the degree of torsion and the duration of symptoms were found to be predictive for orchiectomy (p=0.003, p<0.001). Conclusion: Many studies have reported that preoperative haematological parameters predict orchiectomy. However, no predictive factor was found in our study [ABSTRACT FROM AUTHOR]

Copyright of Die Urologie is the property of Springer Nature 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.)

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]

Background: Suspicion of testicular torsion represents a urological emergency, necessitating immediate surgery. Comprehensive data on the current trends and perioperative outcomes regarding surgical exploration are sparse. Therefore, we utilized nationwide data on the prevalence and results of this surgery, aiming to provide evidence on this matter. Methods: We assessed the GeRmAn Nationwide inpatient Data (GRAND) from 2005 to 2021, provided by the Research Data Center of the Federal Bureau of Statistics. We performed multiple regression analyses to evaluate the perioperative outcomes (length of hospital stay, transfusion, and surgical wound infection) after surgical exploration due to suspected testicular torsion based on both the outcome of surgery (orchiectomy, detorsion with preservation of the testicle, and no testicular torsion) and on the department of operation (urological versus non-urological). Results: A total of 81,899 males underwent surgical exploration due to suspected testicular torsion in Germany from 2005 to 2021. Of them, 11,725 (14%) underwent orchiectomy, 30,765 (38%) detorsion with preservation of the testicle and subsequent orchidopexy, and 39,409 (48%) presented no testicular torsion. Orchiectomy was significantly associated with longer length of hospital stay (day difference of 1.4 days, 95%CI: 1.3–1.4, p < 0.001), higher odds of transfusion (1.8, 95% CI: 1.2–2.6, p = 0.002) and surgical wound infections (1.8, 95%CI: 1.4–2.3, p < 0.001) compared to no testicular torsion. The proportion of patients undergoing orchiectomy was significantly lower in urological departments (14%) versus non-urological departments (16%) and the proportion of patients undergoing preservation of testicle after detorsion was significantly higher in urological departments (38%) versus non-urological departments (37%), p < 0.001. Patients undergoing treatment in a urological department were discharged earlier and presented lower odds of transfusion and surgical wound infection (p < 0.001) compared to patients undergoing treatment in a non-urological department. Conclusions: Nearly half of patients who underwent surgery for suspected testicular torsion did not have intraoperatively the condition confirmed. Patients treated in urological departments had significantly better perioperative outcomes compared to those treated in non-urological departments. Therefore, we advise to refer patients to urological treatment as early as possible. [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]

Objectives: This study aimed to establish a nomogram for predicting the probability of testicular salvage after testicular torsion in children. Methods: We retrospectively collected data of children with testicular torsion who were treated at Shenzhen Children's Hospital between September 2005 and August 2022. Of the training cohort, 113 patients who underwent orchiectomy and five with testicular atrophy after orchiopexy were included in the failed testicular salvage group. Additionally, 37 patients who underwent orchiopexy without postoperative testicular atrophy were included in the successful testicular salvage group. The predictive factors affecting testicular salvage were determined using univariate and multivariate logistic regression analyses; a nomogram was constructed. The nomogram was verified using data from the validation group. Results: Using multivariate logistic regression analysis, the independent risk factors of testicular salvage after testicular torsion were symptom duration (p = 0.034), intratesticular blood flow (p = 0.003), spermatic cord torsion degree (p = 0.037), and monocyte count (odds ratio: 0.012, p = 0.036). A nomogram was established based on these four risk factors. In the training cohort, the area under the receiver operating characteristic curve was 0.969. The area under the receiver operating characteristic curve of the verification cohort was 0.965, indicating good discrimination ability of the nomogram. Increased symptom duration without intratesticular blood flow increased the monocyte count and spermatic cord torsion degree and decreased the success rate of testicular salvage. Conclusion: This prediction model could obtain the corresponding probability of testicular salvage according to the clinical characteristics of different patients with testicular torsion, providing reference for clinicians and parents. [ABSTRACT FROM AUTHOR]

This document is an abstract journal from the ANZ Journal of Surgery, containing summaries of several research studies in the field of pediatric surgery. The studies cover a wide range of topics, including the management of empyema in children, fibroepithelial polyps in the ureter, congenital diaphragmatic hernias, randomized controlled trials and systematic reviews in pediatric surgery, minimally invasive correction of pectus carinatum, combined pelvi-ureteric and vesico-ureteric junction obstructions, and the use of the TWIST score in scrotal explorations for testicular torsion. Other studies focus on subdiaphragmatic extra-lobar sequestrations, neonatal inguinal herniotomy, meso-rex shunts, pain assessment in infants undergoing hernia repair, racial disparities in orchidopexy, cryoablation for postoperative pain management, congenital heart disease in patients with Hirschsprung's disease, pre-referral ultrasound for testicular descent disorders, esophageal atresia, trichobezoars, probiotic supplementation for necrotizing enterocolitis, and the incidence of small bowel obstruction post-appendicectomy. The abstracts provide brief overviews of each study's purpose, methodology, and key findings. [Extracted from the article]

• Isolated fallopian tube torsion (IFTT) is a rare gynecological emergency. • Common symptoms include unilateral lower abdominal pain, nausea and vomiting. • In general, imaging has low sensitivity and diagnosis is often delayed or missed. • Laparoscopic detorsion is optimal, however currently salpingectomy is most common. • This is the first systematic review consolidating multiple case reports on IFTT. To combine all literature describing cases of isolated fallopian tube torsion in adult non pregnant patients in a systematic manner, to optimize knowledge and practice both for diagnosis and management. EMBASE and PubMed databases were searched for the terms 'tubal' OR 'fallopian tube' AND 'isolated' AND 'torsion' from the inception of these databases to July 5, 2023. All case reports or case series of adult patients (18 years or older) with isolated fallopian tube torsion were included. Exclusion criteria included: all other study types; cases involving children and adolescents (less than 18 years old); pregnant patients of all trimesters; tubo-ovarian torsion; studies not published in English; duplicates and those not available in text. Following the database search, two authors independently screened the studies and search results were subsequently reported in accordance with PRISMA guidelines. Data was extracted independently by two authors and analysed using Excel. All cases were assessed for bias using a modified version of the tool proposed by Murad et al. 92 unique articles enrolling 131 individual cases were included in this systematic review. Isolated fallopian tube torsion most commonly occurs during reproductive ages between 18 and 45 years. It is uncommon in postmenopausal women. The most common presenting symptoms include unilateral lower abdominal or pelvic pain along the affected side with nausea and vomiting. Risk factors can be intrinsic or extrinsic and can include conditions such as hydrosalpinx, sterilization, pelvic inflammatory disease or cysts. Ultrasound is the optimal imaging modality however Computed Tomography and Magnetic Resonance Imaging can also be used. Imaging in general has low sensitivity, however isolated fallopian tube torsion can be identified with appropriate expertise. The gold standard for isolated fallopian tube torsion management is laparoscopy and detorsion however currently, the most common intervention performed is salpingectomy. Isolated fallopian tube torsion is a rare but important gynaecological emergency with significant fertility implications. This study summarizes the most common presentations, investigation findings and surgical interventions in patients with isolated fallopian tube torsion. This study also emphasizes the importance of clinicians maintaining a high degree of suspicion and low threshold for early laparoscopic intervention to retain fertility. [ABSTRACT FROM AUTHOR]

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Copyright of Revista Latinoamericana de Hipertension is the property of Revista Latinoamericana de Hipertension 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.)

Copyright of Türk Radyoloji Seminerleri is the property of Galenos Yayinevi Tic. LTD. STI 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.)

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]

This document provides concise summaries of research papers and exhibits related to pediatric radiology. The research papers focus on topics such as the use of machine learning in automating calculations for neuroblastoma patients, the detection of tibial lesions using machine learning, the reduction of radiation dose in pediatric coronary CT angiography, and the automatic detection of pediatric lymphoma on PET/MRI images. The exhibits cover topics such as the diagnosis and treatment of pediatric brain tumors, the diagnosis of pediatric adrenal masses, the management of pediatric chest wall masses, and the evaluation of pediatric musculoskeletal infections. These summaries and exhibits offer valuable insights in the field of pediatric radiology. Additionally, the document includes a list of papers and posters presented at a conference. [Extracted from the article]

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]

Scrotal conditions are frequently seen in male children and can reflect a wide spectrum of underlying pathologies. Detailed history and prompt examination is essential to differentiate between those that require urgent surgical management and benign conditions that can be treated conservatively. Testicular torsion remains the most time critical event with a high risk of gonadal loss. This article provides a brief review of all aspects of diagnosis and management of such conditions, highlighting the principles of surgical management and outcome. [ABSTRACT FROM AUTHOR]

An incidental testicular torsion was discovered during orchiectomy of an approximately 4-month-old intact male kitten. His spermatic cord was twisted numerous times, which caused necrosis and swelling of the right teste. Despite these changes, the patient had no signs of painor clinical signs typical of testicular torsionthat is seeninother species. The owner of the kitten reported that the kitten was eating normally and did not show any signs of pain. The physical examination of the kitten did not reveal any tenderness upon palpation of the enlarged testicle. This case illustrates that testicular torsion is possible even in the absence of pain or discomfort in cats. [ABSTRACT FROM AUTHOR]