Acute Spermatic Cord Torsion Alters the Microcirculation of the Contralateral Testis

Abstract

Acute spermatic cord torsion altered the microcirculation by increasing the amplitude of vasomotion and decreased total blood flow to the opposite testis. Because the hydraulic resistance of a blood vessel exhibiting vasomotion is always less than a vessel with the same average but static diameter, the observed microcirculatory changes may be an adaptive response to preserve local flow in the presence of decreased total flow. The long-term consequences of these changes in the microcirculation may affect testicular function and ultimately fertility.

Hemodynamic Monitoring of the Contralateral Testis during Unilateral Testicular Torsion Describes the Mechanism of Damage

“…An afferent stimulus from the twisted testis has been suggested to initiate a reflex decrease in the contralateral testicular blood flow, and a prolonged low perfusion state has been suggested to be the main mechanism of deterioration. Subsequently experimental studies have supported the decrease in the contralateral testicular blood flow [16, 17]. The 47% decrease in contralateral testicular blood flow after 180 min of torsion in the present experimental design has also confirmed previous studies.…”

“…Therefore, 1 h of torsion would be an inadequate interval for the required decrease in blood flow to be manifested through decreased intratesticular pO 2 values. On the other hand, it is known that ipsilateral testicular torsion is followed by an immediate decrease in contralateral testicular blood flow [15, 16, 17]. In the present experimental design, not only the blood flow, but also the relative oxygen contents have been found to be decreased within 1 h of ipsilateral torsion.…”

“…Recent studies have revealed some evidence on decreased blood flow in the contralateral testis during unilateral testicular torsion [15, 16, 17]. Additionally, increases in parameters of tissue hypoxia, and decreases in adenylate energy charge have supported the presence of decreased contralateral testicular blood flow during unilateral testicular torsion [18, 19].…”

Capsaicin in Albino Rats Prevents Contralateral Testis from the Damaging Effects Posed by Ipsilateral Testis That Underwent Torsion

“…Different theories have been put forward to explain contralateral testicular damage. The proposed theories include reflex decrease in contralateral testicular blood flow [4, 5, 6, 7, 8, 9], autoimmunity [10, 11], associated congenital anomalies [12, 13]and subclinical torsion attacks of the contralateral testis [14]. Since spermatic cord torsion even in the absence of testis and epididymis is shown to cause contralateral testicular injury and contralateral testicular injury has been demonstrated by DNA flow cytometry within 24 h of ipsilateral testicular torsion [15], autoimmunity, associated congenital anomalies and subclinical torsion attacks of the contralateral testis seem unlikely.…”

DNA Flow Cytometry Reveals Depressed Spermatogenetic Activity in the Contralateral Testis within 24 h of Ipsilateral Spermatic Cord Torsion Independently of the Presence of the Testis and Epididymis

“…Therefore, hypoxia resulting from decreased blood flow has been proposed to be the mechanism of damage [11, 12, 13, 14, 15]. It has additionally been shown that hypoxia and histologic damage in the contralateral testis may develop following torsion of only the epididymis without the testis [16, 17].…”