Indocyanine Green Fluorescence Imaging As a Predictor of Long-term Testicular Atrophy in Testicular Torsion: a Pilot Study

Overview

Journal Surg Today

Specialty General Surgery

Date 2024 Jul 31

PMID 39085699

Authors

Shugo Komatsu

Keita Terui

Ayako Takenouchi

Yunosuke Kawaguchi

Katsuhiro Nishimura

Satoru Oita

Hiroko Yoshizawa

Shota Takiguchi

Tomoro Hishiki

Affiliations

Soon will be listed here.

Abstract

Purpose: This pilot study evaluated indocyanine green-guided near-infrared fluorescence (ICG-NIRF) imaging of testicular blood flow to predict long-term testicular atrophy after testicular torsion (TT) surgery.

Methods: The subjects of this retrospective study were patients who underwent surgery for TT at our hospital between December, 2020 and July, 2022. After detorsion, testicular blood flow was evaluated by ICG-NIRF imaging and classified into three categories: fluorescence detected, no fluorescence detected, and fluorescence detected only in the tunica albuginea vessels. Testicular volume was measured by ultrasonography up to 12 months after surgery to evaluate long-term outcomes.

Results: Twelve patients were included in this analysis. We found a 100% correlation between the absence of ICG-NIRF signals and subsequent testicular atrophy. In three patients without an ICG-NIRF signal, the median testis size 12 months postoperatively was significantly smaller (16.5% of the contralateral testis; range 13-20%) than that in six patients with an ICG-NIRF signal (96%; 89-115%) (p = 0.013). Mild atrophy (74.5%; 73-76%) was also observed in the three patients for whom an ICG-NIRF signal was detected only in the tunica albuginea vessels.

Conclusions: Our pilot study highlights the potential of ICG-NIRF imaging as a prognostic tool for guiding surgical decision-making for patients with TT, by predicting postoperative testicular atrophy.

References

Komatsu S, Terui K, Nakata M, Shibata R, Oita S, Kawaguchi Y . Combined Use of Three-Dimensional Construction and Indocyanine Green-Fluorescent Imaging for Resection of Multiple Lung Metastases in Hepatoblastoma. Children (Basel). 2022; 9(3). PMC: 8947451. DOI: 10.3390/children9030376. View

Kohler R, Hamdani A, Gramiger M . Use of intraoperative Indocyanine green fluorescence to assess testicular perfusion and viability when managing testicular torsion in a 26-year old man. Urol Case Rep. 2019; 28:101063. PMC: 6854066. DOI: 10.1016/j.eucr.2019.101063. View

Grimsby G, Schlomer B, Menon V, Ostrov L, Keays M, Sheth K . Prospective Evaluation of Predictors of Testis Atrophy After Surgery for Testis Torsion in Children. Urology. 2018; 116:150-155. PMC: 6291205. DOI: 10.1016/j.urology.2018.03.009. View

Hiyama E . Fluorescence Image-Guided Navigation Surgery Using Indocyanine Green for Hepatoblastoma. Children (Basel). 2021; 8(11). PMC: 8617810. DOI: 10.3390/children8111015. View

Figueroa V, Pippi Salle J, Braga L, Romao R, Koyle M, Bagli D . Comparative analysis of detorsion alone versus detorsion and tunica albuginea decompression (fasciotomy) with tunica vaginalis flap coverage in the surgical management of prolonged testicular ischemia. J Urol. 2012; 188(4 Suppl):1417-22. DOI: 10.1016/j.juro.2012.02.017. View

Lian B, Ong C, Chiang L, Rai R, Nah S . Factors Predicting Testicular Atrophy after Testicular Salvage following Torsion. Eur J Pediatr Surg. 2015; 26(1):17-21. DOI: 10.1055/s-0035-1566096. View

Cimador M, DiPace M, Castagnetti M, DeGrazia E . Predictors of testicular viability in testicular torsion. J Pediatr Urol. 2008; 3(5):387-90. DOI: 10.1016/j.jpurol.2007.01.194. View

Liu X, Xu Y, Li L, Bai D . Evaluation of testicular blood flow during testicular torsion surgery in children using the indocyanine green-guided near-infrared fluorescence imaging technique. Front Pediatr. 2023; 11:1272659. PMC: 10642505. DOI: 10.3389/fped.2023.1272659. View

Namikawa T, Sato T, Hanazaki K . Recent advances in near-infrared fluorescence-guided imaging surgery using indocyanine green. Surg Today. 2015; 45(12):1467-74. DOI: 10.1007/s00595-015-1158-7. View

10.

Hyun G . Testicular Torsion. Rev Urol. 2018; 20(2):104-106. PMC: 6168322. DOI: 10.3909/riu0800. View

11.

Kutikov A, Casale P, White M, Meyer W, Chang A, Gosalbez R . Testicular compartment syndrome: a new approach to conceptualizing and managing testicular torsion. Urology. 2008; 72(4):786-9. DOI: 10.1016/j.urology.2008.03.031. View

12.

Tian X, Tan X, Shi Q, Wen S, Lu P, Liu X . Risk Factors for Testicular Atrophy in Children With Testicular Torsion Following Emergent Orchiopexy. Front Pediatr. 2020; 8:584796. PMC: 7686235. DOI: 10.3389/fped.2020.584796. View

13.

Yamada Y, Ohno M, Fujino A, Kanamori Y, Irie R, Yoshioka T . Fluorescence-Guided Surgery for Hepatoblastoma with Indocyanine Green. Cancers (Basel). 2019; 11(8). PMC: 6721588. DOI: 10.3390/cancers11081215. View

14.

MacDonald C, Kronfli R, Carachi R, OToole S . A systematic review and meta-analysis revealing realistic outcomes following paediatric torsion of testes. J Pediatr Urol. 2018; 14(6):503-509. DOI: 10.1016/j.jpurol.2018.09.017. View

15.

Handa T, Katare R, Sasaguri S, Sato T . Preliminary experience for the evaluation of the intraoperative graft patency with real color charge-coupled device camera system: an advanced device for simultaneous capturing of color and near-infrared images during coronary artery bypass graft. Interact Cardiovasc Thorac Surg. 2009; 9(2):150-4. DOI: 10.1510/icvts.2008.201418. View

16.

Chu D, Gupta K, Kawal T, Van Batavia J, Bowen D, Zaontz M . Tunica vaginalis flap for salvaging testicular torsion: A matched cohort analysis. J Pediatr Urol. 2018; 14(4):329.e1-329.e7. PMC: 6078825. DOI: 10.1016/j.jpurol.2018.01.010. View

17.

Jacobsen F, Rudlang T, Fode M, Ostergren P, Sonksen J, Ohl D . The Impact of Testicular Torsion on Testicular Function. World J Mens Health. 2019; 38(3):298-307. PMC: 7308234. DOI: 10.5534/wjmh.190037. View

18.

Kameoka Y, Yoshimura S, Matsufuji H, Umeyama T, Machigashira S, Yada K . Criteria for Preserving Grossly Ischemic Torsed Testicles Using Indocyanine Green Fluorescence Imaging: A Single-Center Case Series. Urology. 2023; 178:133-137. DOI: 10.1016/j.urology.2022.11.061. View

19.

Sharp V, Kieran K, Arlen A . Testicular torsion: diagnosis, evaluation, and management. Am Fam Physician. 2013; 88(12):835-40. View

20.

Sencan A, Tanriverdi H, Simsek F, Usta I, Ucoz M, Ozbilgin K . Intraoperative evaluation of testicular vascularization and perfusion in rat testicles with indocyanine green (ICG)/near-infrared (NIR) fluorescent imaging after torsion-detorsion and reperfusion. Pediatr Surg Int. 2022; 38(11):1625-1633. DOI: 10.1007/s00383-022-05211-1. View