Testis torsiyonu sonrasında detorsiyon+ fiksasyon ve orşiektominin testisler üzerine etkilerinin deneysel olarak araştırılması
Küçük Resim Yok
Tarih
2019
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Testis torsiyonu hızla teşhis ve tedavi edilmesi gereken acil cerrahi bir durumdur. Testis torsiyonundan sonra iskemi/reperfüzyon hasarlanması oluşmakta hem torsiyone testiste hem de karşı testiste serbest oksijen radikalleri ve inflamatuar sitokinler artarak testis hasarlanmasına neden olmaktadır. Çalışmanın amacı; testis torsiyonundan sonra detorsiyon+fiksasyon ve orşiektomi yapılmasının testisler üzerine olan etkilerini uzun vadede araştırmaktır. Materyal ve Metod: Çalışmamızda 7 grupta 98 adet rat kullanıldı. Deney gruplarındaki ratlara 4 saat süresince 720 derece sol testis torsiyonu oluşturuldu. 4. saatın sonunda 3 deney grubumuzda bulunan ratların sol testislerine orşiektomi, diğer 3 grubumuzda bulunan ratların sol testislerine detorsiyon+fiksasyon işlemini uygulandı. 1 gün, 3. ay ve 6 ayın sonunda ratlardan hormon ölçümü yapılmak üzere kan alındı. Testisler histopatolojik ve immünohistokimyasal inceleme için çıkarılarak ratlar sakrifiye edildi. Bulgular: Biyokimya sonuçlarında 3. ay sonunda detorsiyon+fiksasyon yapılan grupta FSH, LH ve Testosteron düzeyleri diğer gruplardan anlamlı olarak düşük düzeyde bulunmuştur (p<0.05). 6. ay sonunda hormonal parametrelerde gruplar arasında anlamlı bir fark izlenmemiştir (p>0.05). Torsiyon sonrası detorsiyon+fiksasyon yapılan testislerde 3. ve 6. aylarda kontrol grubuna göre testis ağırlığı azalmış olup, histopatolojik olarak ta Johnsen skoru ve Seminifer tubulus çaplarında belirgin azalma izlenmiştir (p<0.05). Grupların karşı testislerinde Johnsen skoru ve Seminifer tubulus çapları arasında fark bulunmamıştır. İmmünohistokimyasal olarak 1. gün sonunda orşiektomi ve detorsiyon+fiksasyon yapılan grupların ipsilateral testislerinde iNOS ekspresyonunda artış izlenirken 3. ve 6. ayda ise iNOS expresyonu azalmıştır. 3. ay sonunda detorsiyon+fiksasyon yapılan grubun karşı testisinde iNOS ekspresyonu diğer grupların karşı testislerinden anlamlı olarak azalmıştır (p<0.05). Sonuçlar: Torsiyonun 3. ayında FSH, LH ve Testosteron düzeyleri düşük olarak bulunurken 6. ayda bu değerler normale dönmüştür. Detorsiyon+fiksasyon yapılan testisler atrofiye gitmiştir. Torsiyonun 3. ayında detorsiyon yapılıp yerinde bırakılan testislerin ve karşı testislerin iNOS expresyonu düşük olarak bulunmuştur. 6. ayda ipsilateral testiste iNOS expresyonu daha da azalırken karşı testiste normal değere dönmüştür. Detorsiyon+fiksasyon yapılan testislerde Johnsen skoru ve Seminifer tubulus çapları düşük olarak bulunmuştur. Sonuç olarak; Testis torsiyonundan her iki testis te etkilenmektedir, ancak karşı testisin etkilenmesi geçici olup uzun vadede iyileşmektedir. 4 saatlik torsiyon sonrasında torsiyone testise detorsiyon+fiksasyon ya da orşiektomi yapılmasının gelecekteki fertilite üzerine etkisi yoktur. Uzun vadede karşı testisler fertiliteyi devam ettirecek düzeyde sağlıklı hale gelmektedir.
Aim: Testicular torsion is an urgent surgical condition that needs to be rapidly diagnosed and treated. Ischemia / reperfusion injury occurs after testicular torsion, increased free oxygen radicals and inflammatory cytokines play role cause testicular damage on both ipsilateral and contralateral testis. The aim of this study, investigate the effect of detorsion + fixation and orchiectomy on testes after testicular torsion in the long term. Material and Method: 98 wistar male rats was used in seven group in this study. Torsion of the left testis was created in the experimental groups for 4 hours during the 720-degree. After 4 hours, left testiculer orchiectomy was performed to 3 groups and detorsion + fixation was performed to 3 groups. At day 1, month 3 and 6, blood sample were taken from rats. At the end of the experiment, the testes were collected for the histopatologic and immunohistochemical evaluation. Results: In the detorsion + fixation group at the end of the third month, FSH, LH and Testosterone levels were significantly lower than in the other groups (p<0.05). At the end of the 6th month, no significant difference was observed between the groups in hormonal parameters (p> 0.05). In the ipsilateral testes after detorsion + fixation at 3 and 6 months compared to the control group, testicular weight, Johnsen score and Seminifer tubulus diameter were significantly reduced (p<0.05). There was no significant difference in the Johnsen score and Seminifer tubulus diameters of the contralateral testes (p>0.05). Immunohistochemically, iNOS expression was increased in the ipsilateral testes of orchiectomy and detorsion + fixation groups at the end of the first day and iNOS values were decreased at the 3rd and 6th months in this groups (p<0.05). At the end of 3 months, iNOS expression was significantly decreased in the contralateral testes of detorsion + fixation group compared to the other contralateral testes (p <0.05). Conclusion: FSH, LH and Testosterone levels were found to be low in the 3th month of the torsion. Testes which was performed detortion + fixation were atrophied. In the 3th month after torsion, iNOS expression was significantly decreased in the bilateral testes of the detorsion + fixation group. In the 6th month after torsion iNOS expression on ipsilateral testis further decreased whereas on the contralateral testes of detorsion + fixation group iNOS expresion was in the normal value. Johnsen score and Seminifer tubulus diameters were found to be low in ipsilateral testes detorsion+fixation groups. As a result; testis torsion is affected by both testes, however, the injury of the contralateral testis is temporary and improves in the long term. After 4 hours of torsion, detorsion + fixation or orchiectomy has no effect on future fertility. In the long term, the contralateral testes in both groups remain healthy to maintain fertility.
Aim: Testicular torsion is an urgent surgical condition that needs to be rapidly diagnosed and treated. Ischemia / reperfusion injury occurs after testicular torsion, increased free oxygen radicals and inflammatory cytokines play role cause testicular damage on both ipsilateral and contralateral testis. The aim of this study, investigate the effect of detorsion + fixation and orchiectomy on testes after testicular torsion in the long term. Material and Method: 98 wistar male rats was used in seven group in this study. Torsion of the left testis was created in the experimental groups for 4 hours during the 720-degree. After 4 hours, left testiculer orchiectomy was performed to 3 groups and detorsion + fixation was performed to 3 groups. At day 1, month 3 and 6, blood sample were taken from rats. At the end of the experiment, the testes were collected for the histopatologic and immunohistochemical evaluation. Results: In the detorsion + fixation group at the end of the third month, FSH, LH and Testosterone levels were significantly lower than in the other groups (p<0.05). At the end of the 6th month, no significant difference was observed between the groups in hormonal parameters (p> 0.05). In the ipsilateral testes after detorsion + fixation at 3 and 6 months compared to the control group, testicular weight, Johnsen score and Seminifer tubulus diameter were significantly reduced (p<0.05). There was no significant difference in the Johnsen score and Seminifer tubulus diameters of the contralateral testes (p>0.05). Immunohistochemically, iNOS expression was increased in the ipsilateral testes of orchiectomy and detorsion + fixation groups at the end of the first day and iNOS values were decreased at the 3rd and 6th months in this groups (p<0.05). At the end of 3 months, iNOS expression was significantly decreased in the contralateral testes of detorsion + fixation group compared to the other contralateral testes (p <0.05). Conclusion: FSH, LH and Testosterone levels were found to be low in the 3th month of the torsion. Testes which was performed detortion + fixation were atrophied. In the 3th month after torsion, iNOS expression was significantly decreased in the bilateral testes of the detorsion + fixation group. In the 6th month after torsion iNOS expression on ipsilateral testis further decreased whereas on the contralateral testes of detorsion + fixation group iNOS expresion was in the normal value. Johnsen score and Seminifer tubulus diameters were found to be low in ipsilateral testes detorsion+fixation groups. As a result; testis torsion is affected by both testes, however, the injury of the contralateral testis is temporary and improves in the long term. After 4 hours of torsion, detorsion + fixation or orchiectomy has no effect on future fertility. In the long term, the contralateral testes in both groups remain healthy to maintain fertility.
Açıklama
Anahtar Kelimeler
Çocuk Cerrahisi, Pediatric Surgery
