Research progress in evaluating tissue vitality in patients with testicular torsion
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摘要: 睾丸扭转又称精索扭转,是青少年时期最常见的泌尿系急症之一。精索扭转导致睾丸组织血流供应减少,引起睾丸组织的缺血萎缩,甚至坏死;表现迟缓或未能正确诊断和处理,常常会导致患侧睾丸丢失,引起男性不育等症状。睾丸扭转疾病常需要通过紧急处理,包括急诊手术探查、复位和睾丸固定,以尽早恢复睾丸组织血流,挽救睾丸。本文对术中扭转睾丸组织活力的判断作一综述,提高临床医师对扭转睾丸挽救的水平。Abstract: Torsion of testis, also known as testicular torsion, is one of the most common urinary tract emergencies in adolescents. Torsion of the spermatic cord can reduce the blood supply to testicular tissue and cause ischemic atrophy and even necrosis of testicular tissue. Delayed presentation or failure to properly diagnose and manage often results in the loss of the affected testicle, causing symptoms such as male infertility. Testicular torsion disease often requires emergency management, including emergency surgical exploration, reduction, and testicular fixation, to restore blood flow to the testicular tissue as soon as possible. This article reviews the evaluation of testicular tissue vitality during operation to improve the level of salvage of testicular torsion by clinicians.
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Key words:
- testicular torsion /
- torsion of spermatic cord /
- scrotal exploration /
- ultrasound examination /
- necrosis /
- testis
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[1] Karaguzel E, Kadihasanoglu M, Kutlu O. Mechanisms of testicular torsion and potential protective agents[J]. Nat Rev Urol, 2014, 11(7): 391-399. doi: 10.1038/nrurol.2014.135
[2] Kylat RI. Perinatal testicular torsion[J]. Arch Pediatr, 2021, 28(1): 75-79. doi: 10.1016/j.arcped.2020.10.006
[3] Vasdev N, Chadwick D, Thomas D. The acute pediatric scrotum: presentation, differential diagnosis and management[J]. Curr Urol, 2012, 6(2): 57-61. doi: 10.1159/000343509
[4] Barada JH, Weingarten JL, Cromie WJ. Testicular salvage and age-related delay in the presentation of testicular torsion[J]. J Urol, 1989, 142(3): 746-748. doi: 10.1016/S0022-5347(17)38875-4
[5] Mäkelä E, Lahdes-Vasama T, Rajakorpi H, et al. A 19-year review of paediatric patients with acute scrotum[J]. Scand J Surg, 2007, 96(1): 62-66. doi: 10.1177/145749690709600112
[6] Zhao LC, Lautz TB, Meeks JJ, et al. Pediatric testicular torsion epidemiology using a national database: incidence, risk of orchiectomy and possible measures toward improving the quality of care[J]. J Urol, 2011, 186(5): 2009-2013. doi: 10.1016/j.juro.2011.07.024
[7] Cost NG, Bush NC, Barber TD, et al. Pediatric testicular torsion: demographics of national orchiopexy versus orchiectomy rates[J]. J Urol, 2011, 185(6 Suppl): 2459-2463.
[8] van Welie M, Qu LG, Adam A, et al. Recurrent testicular torsion post orchidopexy-an occult emergency: a systematic review[J]. ANZ J Surg, 2022, 92(9): 2043-2052. doi: 10.1111/ans.17592
[9] Vasconcelos-Castro S, Soares-Oliveira M. Abdominal pain in teenagers: Beware of testicular torsion[J]. J Pediatr Surg, 2020, 55(9): 1933-1935. doi: 10.1016/j.jpedsurg.2019.08.014
[10] 涂磊, 赵夭望, 何军. 儿童和青少年睾丸扭转109例诊断与治疗分析[J]. 中华男科学杂志, 2019, 25(1): 46-49. doi: 10.13263/j.cnki.nja.2019.01.008
[11] Dupond-Athénor A, Peycelon M, Abbo O, et al. A multicenter review of undescended testis torsion: A plea for early management[J]. J Pediatr Urol, 2021, 17(2): 191.e1-191.e6. doi: 10.1016/j.jpurol.2020.12.004
[12] Kargl S, Haid B. Torsion of an undescended testis-A surgical pediatric emergency[J]. J Pediatr Surg, 2020, 55(4): 660-664. doi: 10.1016/j.jpedsurg.2019.06.018
[13] 刘发全. 细胞坏死的研究近况[J]. 国外医学(生理、病理科学与临床分册), 2003, 23(6): 618-621. https://www.cnki.com.cn/Article/CJFDTOTAL-WYSB200306021.htm
[14] 祝艺. 细胞的"毁灭与重生"[J]. 现代医学与健康研究电子杂志, 2018, 2(2): 175-176. https://www.cnki.com.cn/Article/CJFDTOTAL-XYJD201802148.htm
[15] Jacobsen FM, Rudlang TM, Fode M, et al. The Impact of Testicular Torsion on Testicular Function[J]. World J Mens Health, 2020, 38(3): 298-307. doi: 10.5534/wjmh.190037
[16] Mentese A, Turkmen S, Karaguzel E, et al. The predictive value of ischemia-modified albumin in long-term results of ischemia-reperfusion injury in an experimental testicular torsion model[J]. Urology, 2012, 80(3): 689-694. doi: 10.1016/j.urology.2012.05.031
[17] 宁金卓, 程帆, 余伟民, 等. MiR-29a靶向调控瞬时受体电位通道家族4在睾丸缺血再灌注损伤中对GC-1细胞增殖及凋亡的影响及作用机制[J]. 国际泌尿系统杂志, 2021, 41(1): 124-128.
[18] Yulu E, Türedi S, Karagüzel E, et al. The short term effects of resveratrol on ischemia-reperfusion injury in rat testis[J]. J Pediatr Surg, 2014, 49(3): 484-489. doi: 10.1016/j.jpedsurg.2013.08.028
[19] Sharp VJ, Kieran K, Arlen AM. Testicular torsion: diagnosis, evaluation, and management[J]. Am Fam Physician, 2013, 88(12): 835-840.
[20] 陈晓峰, 张威, 邓毕华, 等. 85例睾丸扭转的临床特点及诊治分析报告[J]. 国际泌尿系统杂志, 2021, 41(2): 345-347.
[21] Overholt T, Jessop M, Barnard J, et al. Pediatric testicular torsion: does patient transfer affect time to intervention or surgical outcomes at a rural tertiary care center?[J]. BMC Urol, 2019, 19(1): 39. doi: 10.1186/s12894-019-0473-5
[22] Yagil Y, Naroditsky I, Milhem J, et al. Role of Doppler ultrasonography in the triage of acute scrotum in the emergency department[J]. J Ultrasound Med, 2010, 29(1): 11-21. doi: 10.7863/jum.2010.29.1.11
[23] Munden MM, Williams JL, Zhang W, et al. Intermittent testicular torsion in the pediatric patient: sonographic indicators of a difficult diagnosis[J]. AJR Am J Roentgenol, 2013, 201(4): 912-918. doi: 10.2214/AJR.12.9448
[24] McDowall J, Adam A, Gerber L, et al. The ultrasonographic "whirlpool sign" in testicular torsion: valuable tool or waste of valuable time? A systematic review and meta-analysis[J]. Emerg Radiol, 2018, 25(3): 281-292. doi: 10.1007/s10140-018-1579-x
[25] Bandarkar AN, Blask AR. Testicular torsion with preserved flow: key sonographic features and value-added approach to diagnosis[J]. Pediatr Radiol, 2018, 48(5): 735-744. doi: 10.1007/s00247-018-4093-0
[26] Qin KR, Qu LG. Diagnosing with a TWIST: Systematic Review and Meta-Analysis of a Testicular Torsion Risk Score[J]. J Urol, 2022, 208(1): 62-70. doi: 10.1097/JU.0000000000002496
[27] Tian XM, Tan XH, Shi QL, et al. Risk Factors for Testicular Atrophy in Children With Testicular Torsion Following Emergent Orchiopexy[J]. Front Pediatr, 2020, 8: 584796. doi: 10.3389/fped.2020.584796
[28] Kaye JD, Shapiro EY, Levitt SB, et al. Parenchymal echo texture predicts testicular salvage after torsion: potential impact on the need for emergent exploration[J]. J Urol, 2008, 180(4 Suppl): 1733-1736.
[29] Zheng WX, Hou GD, Zhang W, et al. Establishment and internal validation of preoperative nomograms for predicting the possibility of testicular salvage in patients with testicular torsion[J]. Asian J Androl, 2021, 23(1): 97-102. doi: 10.4103/aja.aja_31_20
[30] Cao W, Cui S, Yang L, et al. Contrast-Enhanced Ultrasound for Assessing Renal Perfusion Impairment and Predicting Acute Kidney Injury to Chronic Kidney Disease Progression[J]. Antioxid Redox Signal, 2017, 27(17): 1397-1411. doi: 10.1089/ars.2017.7006
[31] Dieckmann KP, Frey U, Lock G. Contemporary diagnostic work-up of testicular germ cell tumours[J]. Nat Rev Urol, 2013, 10(12): 703-712. doi: 10.1038/nrurol.2013.254
[32] Schlomer BJ, Keays MA, Grimsby GM, et al. Transscrotal Near Infrared Spectroscopy as a Diagnostic Test for Testis Torsion in Pediatric Acute Scrotum: A Prospective Comparison to Gold Standard Diagnostic Test Study[J]. J Urol, 2017, 198(3): 694-701. doi: 10.1016/j.juro.2017.03.134
[33] Beşler MS, Gökhan MB, Ölçücüoǧlu E, et al. Shear wave elastography for the evaluation of testicular salvage after testicular torsion[J]. Andrologia, 2022, 54(11): e14565.
[34] Barbosa JA, Tiseo BC, Barayan GA, et al. Development and initial validation of a scoring system to diagnose testicular torsion in children[J]. J Urol, 2013, 189(5): 1859-1864. doi: 10.1016/j.juro.2012.10.056
[35] Monteilh C, Calixte R, Burjonrappa S. Controversies in the management of neonatal testicular torsion: A meta-analysis[J]. J Pediatr Surg, 2019, 54(4): 815-819. doi: 10.1016/j.jpedsurg.2018.07.006
[36] Hisamatsu E, Haruna A, Sugita Y, et al. Validation of testicular workup for ischemia and suspected torsion score in patients with acute scrotum[J]. J Pediatr Urol, 2022, 18(5): 684-690. doi: 10.1016/j.jpurol.2022.07.013
[37] Arevalo MK, Sheth KR, Menon VS, et al. Straight to the Operating Room: An Emergent Surgery Track for Acute Testicular Torsion Transfers[J]. J Pediatr, 2018, 192: 178-183. doi: 10.1016/j.jpeds.2017.09.009
[38] Koh YH, Granger J, Cundy TP, et al. Sutured point-fixation versus Jaboulay fixation for salvaged testicular torsion in children[J]. J Pediatr Surg, 2019, 54(12): 2631-2635. doi: 10.1016/j.jpedsurg.2019.08.018
[39] Samson P, Hartman C, Palmerola R, et al. Ultrasonographic Assessment of Testicular Viability Using Heterogeneity Levels in Torsed Testicles[J]. J Urol, 2017, 197(3 Pt 2): 925-930.
[40] Dogra VS, Gottlieb RH, Oka M, et al. Sonography of the scrotum[J]. Radiology, 2003, 227(1): 18-36. doi: 10.1148/radiol.2271001744
[41] Bartsch G, Frank S, Marberger H, et al. Testicular torsion: late results with special regard to fertility and endocrine function[J]. J Urol, 1980, 124(3): 375-378. doi: 10.1016/S0022-5347(17)55456-7
[42] Visser AJ, Heyns CF. Testicular function after torsion of the spermatic cord[J]. BJU Int, 2003, 92(3): 200-203. doi: 10.1046/j.1464-410X.2003.04307.x
[43] Chu DI, Gupta K, Kawal T, et al. Tunica vaginalis flap for salvaging testicular torsion: A matched cohort analysis[J]. J Pediatr Urol, 2018, 14(4): 329.e1-329.e7.
[44] Grimsby GM, Schlomer BJ, Menon VS, et al. Prospective Evaluation of Predictors of Testis Atrophy After Surgery for Testis Torsion in Children[J]. Urology, 2018, 116: 150-155. doi: 10.1016/j.urology.2018.03.009
[45] Lian BS, Ong CC, Chiang LW, et al. Factors Predicting Testicular Atrophy after Testicular Salvage following Torsion[J]. Eur J Pediatr Surg, 2016, 26(1): 17-21.
[46] Abbas TO, Abdelkareem M, Alhadi A, et al. Suspected testicular torsion in children: diagnostic dilemma and recommendation for a lower threshold for initiation of surgical exploration[J]. Res Rep Urol, 2018, 10: 241-249. http://www.xueshufan.com/publication/2902097122
[47] Arda IS, Ozyaylali I. Testicular tissue bleeding as an indicator of gonadal salvageability in testicular torsion surgery[J]. BJU Int, 2001, 87(1): 89-92. doi: 10.1046/j.1464-410x.2001.00021.x
[48] Hyun GS. Testicular Torsion[J]. Rev Urol, 2018, 20(2): 104-106.
[49] 郑皓, 林涛. 单侧睾丸扭转对男性生殖的影响研究进展[J]. 现代医药卫生, 2018, 34(13): 2004-2008. https://www.cnki.com.cn/Article/CJFDTOTAL-XYWS201813023.htm
[50] Kutikov A, Casale P, White MA, et al. Testicular compartment syndrome: a new approach to conceptualizing and managing testicular torsion[J]. Urology, 2008, 72(4): 786-789. doi: 10.1016/j.urology.2008.03.031
[51] Rouzrokh M, Mirshemirani A, Khaleghnejad-Tabari A. Outcomes of Second Look Exploration in Testicular Torsion of Children[J]. Iran J Pediatr, 2015, 25(4): e528.
[52] Józsa T, Klárik Z, Kiss F, et al. Morphological and microcirculatory evaluation of the rat testis after detorsion with or without a capsular release with a tunica vaginalis flap[J]. Asian J Androl, 2016, 18(3): 462-466. doi: 10.4103/1008-682X.157546
[53] Fabiani A, Calabrese M, Filosa A, et al. Explorative surgery for acute scrotal pain: The importance of patient age, side affected, time to surgery and surgeon[J]. Arch Ital Urol Androl, 2016, 88(3): 189-194. doi: 10.4081/aiua.2016.3.189
[54] Gold DD, Lorber A, Levine H, et al. Door To Detorsion Time Determines Testicular Survival[J]. Urology, 2019, 133: 211-215. doi: 10.1016/j.urology.2019.08.003
[55] Zhou L, Song K, Xu L, et al. Protective Effects of Uncultured Adipose-Derived Stromal Vascular Fraction on Testicular Injury Induced by Torsion-Detorsion in Rats[J]. Stem Cells Transl Med, 2019, 8(4): 383-391. doi: 10.1002/sctm.18-0063
[56] Zvizdic Z, Aganovic A, Milisic E, et al. Duration of symptoms is the only predictor of testicular salvage following testicular torsion in children: A case-control study[J]. Am J Emerg Med, 2021, 41: 197-200. doi: 10.1016/j.ajem.2020.11.023
[57] Lord T, Oatley JM. Testicular-borne factors affect sperm fertility[J]. Science, 2020, 368(6495): 1053-1054. doi: 10.1126/science.abc2732
[58] Anderson MJ, Dunn JK, Lipshultz LI, et al. Semen quality and endocrine parameters after acute testicular torsion[J]. J Urol, 1992, 147(6): 1545-1550. doi: 10.1016/S0022-5347(17)37622-X
[59] Nowicka-Bauer K, Nixon B. Molecular Changes Induced by Oxidative Stress that Impair Human Sperm Motility[J]. Antioxidants(Basel), 2020, 9(2).
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