Testicular torsion, oxidative stress and the role of antioxidant therapy.

Testicular torsion is a urological syndrome caused mainly by a twist in the spermatic cord. It constitutes a surgical emergency and affects newborns, children and adolescent boys. The torsion must be treated promptly to avoid loss of function of ipsilateral and contralateral testis. This syndrome often leads to infertility of the ipsilateral (torted) and contralateral (not torted) testis,but the mechanisms of cellular injury remain still incompletely understood. The primary pathophysiologic event in testicular torsion is ischemia followed by reperfusion; thus, testicular torsion/detorsion is an ischemia/reperfusion (I/R) injury to the testis. Testicular torsion and detorsion causes morphological and biochemical changes by both ischemia and reperfusion of the tissues. These I/R injury is associated with overgeneration of reactive oxygen species (ROS) and reactive nitrogen species (RNS), and also with a common mechanism to other organs such as brain, heart and kidneys. Although the results are not conclusive and the molecular mechanism by which antioxidants control male fertility have not yet been clearly identified, several antioxidant enzymes and antioxidant drugs have been studied to prevent such I/R injury in testis. As a result, antioxidant therapy may represent a new non-hormonal option within a broader therapeutic strategy in men with ROS-mediated infertility such as testicular torsion.