Comparison of High Spermatic Vessel Ligation and Low Spermatic Vessel Ligation in an Undescended Model of Rat Testis

Abstract

Aims: The aim of this study was to compare the immediate and long-term outcomes after high spermatic vessel ligation (HSVL) and low spermatic vessel ligation (LSVL) in a high undescended testis (UDT) model in rats.

Materials and methods: A prospective randomized controlled study was conducted on 24 male Wistar rats. The rats were randomly divided into three groups. Group A underwent a sham laparotomy and acted as the control. Group B underwent HSVL of both testicular vessels. Group C underwent LSVL of both testicular vessels. Each group was again subdivided into two subgroups. One sub-group underwent blood collection and testicular biopsy of both testes 24 h after the procedure to demonstrate immediate changes. Other subgroups underwent blood sample collection and testicular biopsy of both testes on day 50 following the procedure for hormonal changes and long-term changes.

Results: All the testes in HSVL showed atrophy (100%) in the long term, whereas LSVL showed atrophy in 12.5% of testes, even though both groups showed adequate neovascularization. Testes in HSVL showed poor bleeding on incision at both 24 h and day 50. On histology, 75% of testes in HSVL showed complete necrosis, and 50% in LSVL showed partial necrosis at 24 h. On day 50, all the testes in HSVL (100%) showed complete necrosis with dystrophic calcification, whereas all the testes in LSVL showed normal histology with good maturation of seminiferous tubules. There was no significant difference in testosterone levels between both groups.

Conclusions: Both immediate and long-term changes following LSVL showed an increase in blood flow to the testis after ligation through collaterals and reverses early ischemic changes to the testis. Given the higher testicular atrophic rate after HSVL, LSVL or at least low ligation can be preferred for the management of high intra-abdominal UDT.

Keywords: High spermatic vessel ligation; Johnsen's score; low spermatic vessel ligation; testis morphology; testosterone assay; undescended testis.

Figure 1

Schematic diagram of the study

Figure 2

Procedure on rats: Upper-sham laparotomy, Middle-high spermatic vessel ligation, Lower-low spermatic vessel ligation

Figure 3

Morphology of testis: Upper: 24 h after the procedure, normal testis in sham group versus congested and edematous testis in low spermatic vessel ligation (LSVL) group. Lower: day 50 of the procedure. The sham group testis looks normal, the LSVL test is smaller than the sham group, high spermatic vessel ligation group test is small and atrophic

Figure 4

Light microscopy of the testis, right upper: Sham group at 24 h showing normal seminiferous tubules, upper-middle: high spermatic vessel ligation (HSVL) group at 24 h showing necrosis, Left upper: LSVL group at 24 h showing mild necrosis of seminiferous tubules, Right lower: Sham group at day 50 showing normal seminiferous tubules and maturation, Lower middle: HSVL group at day 50 showing loss of structure and dystrophic calcification, Left lower: LSVL group at day 50 showing normal seminiferous tubules with maturation