The Dependability Study Of Experimental Acute Testicular Hemodynamic Disorder And Reversed Diastolic Flow Of Artery

Objective To investigate the value of reversed diastolic flow in the diagnosis of acute testicular hemodynamic disorder, through studying the color Doppler ultrasonic(CDU) appearances of the dogs` acute testicular hemodynamic disorder at each stage within 30 hours, in which the changes of the flow spectral waveform, peak systolic velocity(PSV) and resistant index(RI) of the testicular artery and its branches were mainly analyzed, and studying the reference of the reversed diastolic flow of testicular artery to the testicular perfuse and patho-changes.Methods Sixteen Experimental models of acute testicular hemodynamic disorder were established in 8 dogs. CDU images of scrotal content, testicular artery and its branches were continually observed for 30 hours with the probe of 7～14MHz after operation. Within the observation, interval of 3 hours was in the first 12 hours and 6 hours afterward. The 2D-image,Color Doppler Flow Image(CDFI),Color Doppler Energy(CDE) and frequency spectrum Doppler of the scrotal content and each segment of testicular artery were observed and recorded at different stages after operation. CDFI with CDE of intratesticular flow were Compared with the image analysis software. The testis Tru-Cut biopsy was performed by 18G needle at the time of pre-operation, the time when the reversed diastolic flow emerged and the time when intratesticular flow vanished. The changes of testicular pathology were viewed by the light and electron microscope, and then were investigated and compared with the CDU images at corresponding stages.Results In the control group ,the average of PSV and RI of the spermatic artery, capsular artery and intratesticular artery were 10.54±0.54cm/s,6.64±0.47 cm/s,4.71±0.33cm/s;0.65±0.03,0.40±0.03,0.34±0.03 respectively. In the case group, with the aggravation of intratesticular congestion, the RI of supra-obstructive segment of the spermatic artery was significantly increased(P<0.05),while PSV increased significantly first and then lysised after the time when the reversed diastolic flow emerged. Both PSV and RI of the obstructive and infra-obstructive segment were a little higher than the control`s in the earlier period, and then lysised. The PSV and RI of the capsular artery and intratesticular artery were gradually decreased. And those two arteries whose flow spectra present"tardus-parvus"in the earlier period resulted in nonpulsatile flow. With the testicular ischemia prolonging, both CDFI and CDE show that the intratesticular blood flow tapered, and disappeared in 18～24h after operation. Except the pre-operation, There was greatly different blood flow display between CDFI and CDE at the time of 3h,6h,9h,12h,18h after operation. The volume of testis after operation(11.09±0.88 cm3)was obviously increased compared with that of the control(7.00±0.53cm3)(P<0.05). Echogenicity of testis didn`t became unhomogeneous until the time when the reversed diastolic flow emerged, and it changed more markedly as the time of the testicular ischemia prolonged. Pathology results showed that there was just little pathological changes when the reversed flow of"tiny pointed end"emerged in the earlier period of diastole, sporadic necrotic cells emerged in the testicular tissue when the reversed flow of"cap-form or wall-type"emerged in the whole period of diastole, and when intratesticular flow vanished, the cell necrosis was striking in region.Conclusions There was conspicuous dependability between the CDU appearances of the acute testicular hemodynamic disorder and its corresponding patho-changes. When the reversed flow of"tiny pointed end"emerged in the earlier period of diastole in the supra-obstructive segment of the spermatic artery whose PSV was obviously higher than the control`s, the intratesticular blood flow still existed, the echogenicity of testis changed little or slightly enhanced and the testicular pathology changed little. Thus, the reversed flow of"tiny pointed end"emerged in the earlier period of diastole can be considered as specific sign for the early diagnosis of the acute testicular hemodynamic disorder.