Empirical Study Of Sonography In Predicting Contralateral Testicular Damage After Unilateral Testicular Hemodynamic Disorder

Objective To investigate the dependability between ultrasonic appearances of different degree of acute testicular hemodynamic disorder and contralateral testicular damage, and to study the haemodynamics of contralateral testicular after unilateral testicular hemodynamic disorder.Methods Thirty two white rabbits were randomly divided into 4 groups.Group A~C were subjected to testicular ischemia and color Doppler sonography (CDS) were continuoully performed in each case.The testes were not followed by reperfusion until the ultrasonic appearances were as follows: homogeneous appearance with reducing of blood perfusion(group A), increased echogenicity and heterogeneity with little blood perfusion(group B), inhomogeneous appearance with small pieces of low echogenic areas and no blood perfusion(group C).Group D was the control group.Changes of histologic structure,ultramicrostructure and apoptosis of contralateral testes were observed after a month.Control-enhanced ultrasonography(CEUS) in contralateral testes before reperfusion of unilateral testes in each group were analysed.Result It took 3～5 hours(3.68±0.43 in average)to form group A, 10～14h hours (11.10±1.24 in average) to form group B, 18～22h hours(20.15±2.68 in average) to form group C. CEUS time-enhancement curve of contralateral testes showed no statistical significance between the four groups in ascending slop(AS),descending slop(DS),peak intensity(PI),etc(P>0.05).Focal and mild pathological changes were observed in contralateral testes in group A~C,including the occasional presence of vacuoles in small or large clusters, the structural disorder in seminiferous epithelium, exfoliation of germ cells,insufficient spermatozoa, interstitial arterial hyperemia,as well as the presence of multinucleated cells.Johnsen score showed no statistical significance between the control group and group A~C(P>0.05). Apoptosis detected by terminal deoxynucleotidyl transferase-mediated deoxyuride triphosphate nick-end labeling (TUNEL) showed the total number of appotosis cells in group B(38.75±8.88) were significantly more than the control group(18.63±3.81) as well as group A (20.50±6.12)and group C(18.00±4.47)(P<0.001),while no statistical significance exsisted between group A,group C and the control group(P>0.05). Apoptosis occurred predominantly in spermatocyte and spermatid. The focal ultrastructural damage were observed by transmission electron microscope in group A~C especially in group B,such as endocytoplasmic reticulum extending, mitochondria swelling, spermatid malformation ,condensation of the nuclear chromatin with margination,etc.Conclusion Ultrasonic appearances of acute testicular hemodynamic disorder are related to contralateral testicular damage.Acute testicular hemodynamic disorder merely cause focal and mild pathological changes and ultrastructural damage in contralateral testes.If reperfusion were performed without proper protection, the number of appotosis cells in contralateral testes would increase,when CDS suggest increased echogenicity and heterogeneity with little blood perfusion in unilateral testes.No reflexive decrease in contralateral testicular blood flow after acute testicular hemodynamic disorder was detected,so it may not be the main cause of contralateral testicular damage.