Empirical Study Of The Correlation Between Ultrasonic Appearances Of Testicular Torsion And The Protective Effect Of Allopurinol

Objective: To investigate the relevance between the gray-scale, color Doppler and contrast-enhanced ultrasound performances of experimentally induced the varying degrees of acute unilateral testicular hemodynamic disorder and following reperfusion and the protective effect of allopurinol treatment of ischemic/reperfusion (I/R) injury, and to explore its relevant mechanisms.Methods: Forty two New Zealand white rabbits were randomly divided into 7 groups: control group (sham operation group), 3 injury groups and 3 treatment groups, with 8 in each . The acute testicular hemodynamic disorder models were established in injury groups and treatment groups for periods of ischemia lasting 6, 12 and 24 hours. Groups treatment were given allopurinol (200mg/kg, intraperitoneal injection) before reperfusion 30 miniates. Bilateral testicular were done the gray-scale, color Doppler and contrast-enhanced ultrasound preoperatively, before reperfusion and after reperfusion 3 days, analysising of imaging parameters ( Maximum Intensity, IMAX; Rise Time, RT; Time To Peak, TTP; mean Transit Time,mTT). Both testes were harvested after reperfusion 3 days in injury groups and treatment groups, and both testes were harvested after sham operation was done 3 days in control group. The histology, apoptosis, ultrastructure, testicular malondialdehyde (MDA) of ipsilateral testicular and testosterone in peripheral blood were determined. Johnsen score was used to assess morphological damage caused by the ischemia. Analysis the correlation between histological, biochemics, endocrinological changes and the gray-scale, color Doppler and contrast-enhanced ultrasound performances of each groups.Results: Ultrasound performance, with the extension of ischemic time, homolateral testicular echo gradually uneven, diminishing blood flow. Ultrasound contrast, each parameter ( IMAX, RT, TTP, mTT )was no significant difference between bilateral testes before ligation in each groups (P > 0.05). Compared with the control side, with ipsilateral testicular ischemia time gradually lengthened, IMAX been gradually reduced before reperfusion in each group. There is significant difference between all imaging parameters (P <0.05). Compared with the control side, with ipsilateral testicular ischemia time gradually lengthened, IMAX been gradually increased after reperfusion in each group. There is significant difference between all imaging parameters (P <0.05). Before reperfusion, , the ipsilateral testicular volume increased significantly compared with pre-operation (P <0.05), after reperfusion 3d, the volume of 6h treatment group had no significant increase (P> 0.05), other groups had no significant increase (P <0.05).With ipsilateral testicular ischemia time gradually lengthened, ischemic side of the number of spermatogenic cells decreased gradually reduced spermatogenesis, Johnsen's score gradually reduced (P <0.05). Compared with the corresponding ischemic group, 6h and 12h treatment group Johnsen's score were significantly enhance (P <0.05), 24h treatment group had no significant Johnsen's score improve (P> 0.05). The results of TUNEL showed that, with the extension of ischemic time, ischemic testis spermatogenic cell apoptosis in the number gradually increased, a gradual increase in apoptotic index (P <0.05). Compared with corresponding ischemic group, 6h and 12h treatment group apoptotic index were significantly lower (P <0.05), 24h treatment group apoptotic index did not reduce significantly (P> 0.05). There are varying degrees of cell swelling, necrosis and apoptosis on ipsilateral testis'ultrastructure in each group, with the extension of ischemic time, the extent and scope of such local changes gradually increased. Sperm cells deformity can also be found in 24h ischemic group.MDA content of ipsilateral testis in each group showed, with the extension of ischemic time, MDA content increased gradually (P <0.05). Compared with the corresponding ischemic group, 6h, 12h and 24h treatment group MDA content had significantly lower (P <0.05) and MDA content of 6h treatment group and control group, were no significant difference (P> 0.05).The testosterone concentration in peripheral blood showed that each group of testosterone content after ligation were significantly lower than before ligation (P <0.05).Compared with corresponding ischemic group, 6h and 12h treatment group testosterone content has significantly high (P <0.05), 24h treatment group no significant increase (P> 0.05). 6h, 24h ischemia group and 12h, 24h treatment group, testosterone content in these four groups of had no significant changes ( P> 0.05). Conclusions:â‘ The gray-scale, color Doppler and contrast-enhanced ultrasound performances of experimentally induced the varying degrees of acute unilateral testicular hemodynamic disorder are difficult. The ultrasound helps to determine the extent of damage to testicular torsion.â‘¡The extent of testicular torsion is related to the protective effect of allopurinol treatment of ischemic/reperfusion (I/R) injury. Allopurinol can reduce the testicular tissue ischemia-reperfusion injury on a lesser extent testicular torsion.â‘¢Ultrasonography is helpful for judgeing of the extent of the ischaemia and infarction,and is helpful for predicting of spermatogenesis function of the ischemic testes after reperfusion, and it provide a basis line drug therapy. To reset again after testicular torsion by ultrasound examination, especially in contrast-enhanced ultrasound examination, can be more accurate and sensitive to reflect the testicular tissue after reperfusion injury.