[Long-term and late results of treatment in patients with a history of testicular torsion].
Testicular torsion is a surgical urgency. It may lead to loss of that organ and moreover, as revealed by experimental studies and clinical findings in adults, induces autoimmunological reactions with subsequent male infertility. To elucidate these sequellae the following questions seem to be relevant 1. Are there any antisperm antibodies or shifts in T cell CD4+, CD8+ and NK subpopulations in boys with a history of testicular torsion? 2. Is production of antisperm antibodies initiated and maintained in childhood, and amplified after puberty? 3. Does the age at testicular torsion and duration of exposure to sperm antigens/testicular tissue have an effect on induction and levels of antisperm antibodies? 4. Is hormonal function of testis/testes and gonadotropic activity of the pituitary gland normal in these patients? 5. What conditions (duration, subjective and objective symptoms) are associated with testicular torsion; what kind of intraoperative findings can be expected; what is the influence of testicular torsion on the twisted testis? The study group (GB) consisted of 37 boys and men aged from 8 months to 27 years (mean 12.3 years) recruited from 86 patients seen for testicular torsion at the Department of Pediatric Surgery, Pomeranian Academy of Medicine in Szczecin, between 1967 and 1992. The control group (GK) comprised 42 healthy boys and men aged 3 to 33 years (mean 12.1 years) (Tab. 1). The analysis was based on: 1) clinical files; 2) follow-up results; 3) laboratory findings; 4) statistics. According to clinical data and physical examination, testicular torsion usually appeared during puberty, neonatal period and infancy and the mean duration of torsion was 12.4 days. The best prognosis for salvage of the twisted testis was for torsions lasting no longer than 8 hours. Only 8 of 37 twisted testes could be salvaged (including 4 hypotrophic testes; Tab. 2). There were 21 positive ELISA tests (level of antisperm antibodies exceeding 2 fg/pl) in the study group (mean 4.45 +/- 5.6 fg/pl), including 13 boys with testicular torsion in the prepubertal age and 8 during puberty (Tab. 3). A tendency to higher levels of antibodies with age was observed. In the control group there were 35 negative and 7 positive results (mean 1.05 +/- 1.86 fg/pl) (Tab. 4), significantly less than in the study group (p < 0.001). Trend curves (Fig. 1) and Pearson's correlation coefficients (Fig. 2) for levels of antibodies and age at presentation of testicular torsion were established for both groups. Mean percentages of CD4+, CD8+ and NK cells (indirect immunofluorescence test with monoclonal antibodies) were insignificantly lower in the study group (Fig. 3). Shifts in favor of CD4+ and NK subpopulations found in some patients correlated with high levels of antisperm antibodies (Tab. 5 and Fig. 4). Elevated LH and/or FSH (21 patients) and/or testosterone levels (13 patients) were usually observed during puberty (Tab. 6). The results indicate that antisperm antibodies are detected in more than half of the boys with a history of testicular torsion. This is accompanied in some cases by shifts in CD4+ and NK lymphocyte subpopulations correlating with high antibody levels. Production of antisperm antibodies initiated during prepuberty (in infancy or even in the neonatal period) persists and is amplified after puberty due to increasing amounts of antigen material. Age at testicular torsion (age at potential exposure to spermatic antigens/testicular tissue from the twisted or de-twisted testis with severe haemorrhagic lesions or left in the abdominal cavity) has an effect on the future production and levels of antisperm antibodies. Disturbances in the secretion of LH and/or FSH were observed in 2/3 of the boys/men with a history of testicular torsion. Abnormal secretion of testosterone was found in 1/3 of the patients. These hormonal disorders seem to have no influence on virilization, libido or sexual potency.
Rybkiewicz
M
M
Kliniki Chirurgii i Onkologii Dzieciecej Pomorskiej Akademii Medycznej w Szczecinie, ul. Unii Lubelskiej 1, 71-252 Szczecin.
D000328:Adult; D000367:Age Factors; D000728:Androgens / Q000097:blood; D000906:Antibodies / Q000032:analysis; D018791:CD4 Lymphocyte Count; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007694:Killer Cells, Natural / Q000276:immunology; D008297:Male; D010808:Physical Examination; D013086:Spermatic Cord Torsion / Q000175:diagnosis / Q000276:immunology* / Q000378:metabolism / Q000628:therapy*; D013094:Spermatozoa / Q000276:immunology; D016896:Treatment Outcome
D000728:Androgens; D000906:Antibodies