Intratesticular pressure after testicular torsion as a predictor of subsequent spermatogenesis: a rat model

Abstract

What’s known on the subject? and What does the study add? Testicular torsion results in atrophy rates of more than 25% despite prompt surgical management, and there is no reliable intraoperative critieria to judge the viability of the testis, except the testicular appearance after scrotal incision. We demonstrated that less reduction of ITP after detorsion correlated with worse subsequent spermatogenesis. This result suggests that ITP can be the index to determine removal of the affected testis during surgery. OBJECTIVE • To assess the correlation between intratesticular pressure (ITP) after testicular torsion and subsequent testicular function using a rat model and to show that ITP at surgery is a useful predictor of future spermatogenesis. MATERIALS AND METHODS • Fourteen rats were divided into a torsion group (n= 7) and a control group with sham operation (n= 7). • Torsion was created by 720° rotation of the left testis in a counter‐clockwise direction. • Using a handheld compartment monitor, the ITP of the torsed testes was measured three times: before torsion (pre‐torsion), just before torsion repair (pre‐detorsion) and 5 min after torsion repair (post‐detorsion). • We evaluated the correlation between ITP and testicular weight, epididymal sperm count or pathological findings, such as the seminiferous tubule diameter (STD) and the modified Johnsen’s score, 4 weeks after surgery. RESULTS • Mean (se) pre‐torsion, pre‐detorsion and post‐detorsion ITP values in the torsion group were 5.9 (2.5), 19.7 (10.7) and 8.2 (4.8) cm H2O, respectively. • The ITP in torsed testes significantly increased after torsion (P < 0.01) and decreased after detorsion (P < 0.01). • Strong correlations were observed between the reduction of ITP after detorsion and testicular weight (r= 0.87, P < 0.05), epididymal sperm count (r= 0.94, P < 0.05), STD (r= 0.87, P < 0.05) or the Johnsen’s score (r= 0.99, P < 0.001). CONCLUSION • A smaller reduction in ITP after detorsion can be a risk factor for subsequent disturbance of spermatogenesis, suggesting that ITP can be an index for determining whether the affected testis should be removed after testicular torsion.

Intracompartmental Pressure as a Predictor of Intratesticular Blood Flow: A Rat Model

“…17 Mean pre-torsion intratesticular pressure (5.9 cm H 2 O), 2-hour torsion pressure (19.7) and detorsed intratesticular pressure (8.2) were identified. A negative correlation between the differential ICPs (torsion ICP/detorsion ICP) and histological damage markers were observed and found statistically significant.…”

Contemporary review of testicular torsion: New concepts, emerging technologies and potential therapeutics

“…They showed in rats that smaller reductions in the intratesticular pressure following an episode of detorsion were more likely to result in disturbances of spermatogenesis. [39] These results are quite promising and should encourage a multi-institutional study to evaluate the efficacy of this surgical technique.…”

Compartment syndrome of the testicle: a case report and review of the literature

“…11 Moritoki et al demonstrated, using an animal model, increased intra-testicular pressures during torsion, as well as a positive correlation between the degree of pressure reduction post-detorsioning and later organ functionality. 12 This indicates compartment syndrome may well play a significant part in the pathophysiological process, and highlights the clinical question as to whether tunica albugenia fasciotomy has a role in surgical management. This was recognised by Figueroa et al, who preliminarily recommended its use following 11 documented fasciotomies, albeit acknowledging their limited sample size, in the management of clinically marginal torsed testes following detorsion.…”