Ischemia, whether from ligation or torsion, causes ultrastructural changes on the contralateral testis.

OBJECTIVE: Unilateral testicular torsion results with a decrease in contralateral testicular blood flow caused by a reflexive sympathetic response. The aim of this study was to investigate whether twisting of the spermatic cord, or testicular ischemia without twisting, activates this reflex mechanism and causes ultrastructural changes in the contralateral side. MATERIALS AND METHODS: Thirty adult male albino Wistar rats were randomly allocated into three groups of sham, torsion, and ligation. Right testes were twisted 720 degrees counterclockwise in the torsion group. Right spermatic cords were ligated permanently with a silk suture including the vas deferens in the ligation group. After 24 h of testicular ischemia, contralateral left testes were removed for electron microscopic evaluation. RESULTS: Contralateral testes showed similar ultrastructural changes in the torsion and ligation groups. The fibrous tunica propria enveloping the seminiferous tubule was thickened due to increased collagen fibers. The basal lamina was continuous but thickened and showed several foldings. The gap between basal lamina and the germ cells was increased because of collagen fibers. Leydig cells showed mitochondrial degeneration with the loss of its cristae. Leydig cells lost their contact with its neighborhood cells in some areas, and these gaps were filled with collagen fibers. Germ cells showed dilated cisternae of smooth endoplasmic reticulum, cytoplasmic electron-dense bodies and clear regions. CONCLUSIONS: Similar electron microscopic findings observed in the torsion and ligation groups indicate that testicular ischemia rather than twisting of the spermatic cord is responsible for the ultrastructural changes in the contralateral side.

Ectopic adrenocortical nodules along the spermatic cord of children.

OBJECTIVE: Nodules of ectopic adrenal cortex are found incidentally during inguinal operations. These rests have some clinical significance as they may undergo marked hyperplasia in conditions associated with excessive ACTH production, and occasionally may give rise to neoplasms. In the present study, it is aimed to evaluate the ectopic remnants of adrenal tissue encountered during the inguinal operations in children. PATIENTS AND METHODS: Four hundred and fifty-two inguinal operations were performed on 397 children (325 male/72 female; mean age 2.7 years), during a period of 36 months. Nodules resembling ectopic adrenal tissue from eleven patients (2.7%) were removed and the histopathological examination was performed using hematoxylin-eosin staining. RESULTS: Ectopic adrenal cortical tissues were found in eight male patients (2%), located within the distal end of the spermatic cord. Macroscopically, the nodules were round to oval in shape, 1 to 5 mm in diameter, and bright yellow to orange in colour. Microscopically, they had three layers of adrenal cortex surrounded by a fibrous capsule and none contained any medulla. Hyperplasia or neoplastic changes were not detected, and no fetal cortex was identified. CONCLUSIONS: It is important for surgeons to be conscious of the possibility that a nodule along the spermatic cord may be the ectopic adrenal cortical tissue. As they are associated with hyperplasia and neoplastic change, removal of ectopic adrenal cortical tissue is warranted whenever it is encountered, but a routine search for them is not mandatory.

Comparison of preputial sac and urine cultures in healthy children.

The aim of the present study was to examine subpreputial bacteriology and to compare it with the urine cultures of healthy male children. Seventy-two male children were divided into two groups as A and B according to age. In both groups preputial sac and urine cultures were taken simultaneously. Gram (+) enteric cocci were the most common isolated pathogens from the preputial sac in group B. Enterobacter, E. coli and staphylococci species were isolated from the urine cultures of three patients in group B. We could not find any difference between the preputial sac swabs of group A and B patients, but the isolation rate of urine cultures of group A patients was significantly higher than group B (p < 0.05). The findings of the present study support a potential role of the prepuce acting as a reservoir of faecal bacteria in the pathogenesis of UTI in male infants, especially in the first year of life. Improved penile hygiene after the first year of life does not alter the subpreputial bacteriology, but significantly decreases the contamination of urine.