Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
J Urol. 2013 Jul;190(1):239-43. doi: 10.1016/j.juro.2013.01.012. Epub 2013 Jan 9.
The correlation between intratesticular pressure during torsion/detorsion and subsequent testicular function and viability has been reported in several recent studies. We assessed the impact of tunica albuginea incision with tunica vaginalis flap coverage on intratesticular pressure and future histopathological parameters in a rat testicular torsion model.
A total of 21 rats were divided into 3 groups. Group 1 consisted of 7 controls undergoing a sham operation, group 2 consisted of 7 animals undergoing torsion-detorsion, and group 3 consisted of 7 animals undergoing testicular torsion-detorsion followed by tunica albuginea incision and tunica vaginalis flap coverage. Torsion was created by 720-degree counterclockwise rotation of the left testis for 2 hours. By using a compartment monitor, the intratesticular pressure of the torsed testes was measured before torsion (pre-torsion), immediately before torsion repair (pre-detorsion), 5 minutes after detorsion (post-detorsion), and after tunical incision and tunica vaginalis flap application. The correlations between intratesticular pressure values and testicular weight, modified Johnsen score and mean seminiferous tubule diameter were evaluated 4 weeks postoperatively.
Median pre-detorsion intratesticular pressure was significantly decreased after detorsion in group 2 (21 vs 7 mm Hg, p <0.001) and group 3 (23 vs 7 mm Hg, p = 0.001). In addition, median intratesticular pressure after tunica albuginea incision and tunica vaginalis flap coverage in group 3 was significantly less compared to median post-detorsion intratesticular pressure in group 2 (5 vs 7 mm Hg, p = 0.025). Overall no significant difference was detected between groups 2 and 3 regarding median modified Johnsen score, mean seminiferous tubule diameter or median testicular weight. The significant reduction of intratesticular pressure in group 3 did not correlate with testicular weight (r = 0.500, p = 0.391), modified Johnsen score (r = -0.205, p = 0.741) or mean seminiferous tubule diameter (r = -0.200, p = 0.747).
Tunica albuginea decompression with tunica vaginalis flap coverage is an effective technique for decreasing intratesticular pressure in torsed testes. However, this technique failed to alter the injury of prolonged arterial occlusion in testicular torsion.
在最近的几项研究中，已经报道了扭转/复位过程中睾丸内压与随后的睾丸功能和活力之间的相关性。我们评估了在大鼠睾丸扭转模型中，白膜切开联合鞘膜瓣覆盖对睾丸内压和未来组织病理学参数的影响。
总共 21 只大鼠分为 3 组。第 1 组为 7 只接受假手术的对照动物，第 2 组为 7 只接受扭转-复位的动物，第 3 组为 7 只接受睾丸扭转-复位后白膜切开联合鞘膜瓣覆盖的动物。通过逆时针旋转左睾丸 720 度造成扭转，持续 2 小时。使用隔室监测器，在扭转前（术前）、在扭转修复前（术前）、在复位后 5 分钟（术后）测量扭转睾丸的睾丸内压，并在进行鞘膜切开和鞘膜瓣应用后测量。评估术后 4 周时睾丸内压值与睾丸重量、改良 Johnsen 评分和平均生精小管直径之间的相关性。
第 2 组（21 对 7mmHg，p＜0.001）和第 3 组（23 对 7mmHg，p=0.001）中，中位术前睾丸内压在复位后显著降低。此外，第 3 组白膜切开联合鞘膜瓣覆盖后中位睾丸内压明显低于第 2 组术后中位睾丸内压（5 对 7mmHg，p=0.025）。第 2 组和第 3 组的中位改良 Johnsen 评分、平均生精小管直径或中位睾丸重量之间无显著差异。第 3 组睾丸内压的显著降低与睾丸重量（r=0.500，p=0.391）、改良 Johnsen 评分（r=-0.205，p=0.741）或平均生精小管直径（r=-0.200，p=0.747）均无相关性。
白膜减压联合鞘膜瓣覆盖是降低扭转睾丸内压的有效技术。然而，这种技术未能改变睾丸扭转中长时间动脉阻塞造成的损伤。
