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Segmental testicular ischaemia: presentation, management and follow-up
D Gianfrilli1, A M Isidori, A Lenzi
1Department of Medical Pathophysiology (DFM-Fisiopatologia Medica), Sapienza University, Rome, Italy.
International Journal of Andrology
|May 24, 2008
Summary
Segmental testicular infarction is a rare condition often mistaken for tumors. Early diagnosis using imaging and identifying MTHFR mutations can help avoid unnecessary orchiectomy and preserve fertility.
Area of Science:
- Urology
- Reproductive Medicine
- Radiology
Background:
- Segmental testicular infarction is a rare condition with unknown etiology, often misdiagnosed as testicular tumors.
- Accurate diagnosis is crucial to avoid unnecessary orchiectomy and preserve fertility.
Purpose of the Study:
- To increase awareness of segmental testicular infarction.
- To identify distinctive clinical and radiological features for pre-operative diagnosis.
- To screen for causative factors and propose fertility-sparing management.
Main Methods:
- Described three cases of partial testicular ischemia presenting with reduced sperm quality.
- Utilized ultrasound and magnetic resonance imaging to characterize testicular ischemia.
- Screened for risk factors, including methylenetetrahydrofolate reductase (MTHFR) mutations and homocysteine levels.
Main Results:
- Ultrasound and MRI revealed characteristic appearances of testicular ischemia.
- Histology showed stromal cell, leukocyte, and macrophage infiltration in lesion remodeling.
- All patients possessed the MTHFR 677C-->T mutation with elevated homocysteine levels, suggesting a link to folate metabolism defects.
Conclusions:
- Distinctive features allow for pre-operative diagnosis of segmental testicular ischemia.
- A surveillance strategy is safe and feasible, avoiding surgery.
- Folate metabolism defects may predispose individuals to testicular infarction and infertility.
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