AIM: Even with prompt diagnosis and treatment, testicular torsion may lead to infertility and atrophy after testicular salvage. The aims of this study were to investigate the long-term protective effects of short-interval postconditioning on testicular atrophy and to optimize the reperfusion period. MATERIALS AND METHODS: Forty adult male rats were divided into 5 subgroups: sham operated; torsion + detorsion; torsion + postconditioning, 5 seconds (PC5); torsion + postconditioning, 10 seconds; and torsion + postconditioning, 20 seconds. Torsion was created by rotating the left testis 1080° counterclockwise and then fixing the testis to the scrotum with 3 sutures. Torsion was maintained for 4 hours. The testicular artery was visualized, and an atraumatic vascular clamp was applied to prevent reperfusion in all study groups. Detorsion of the testis was then performed. In the torsion + detorsion group, the clamp was released just after detorsion. In all the other intervention groups, the subsequent procedures were repeated 10 times. In the PC5 group, the clamp was released for 5 seconds and applied for 10 seconds; in the torsion + postconditioning, 10 seconds group, the clamp was released for 10 seconds and applied for 10 seconds; and in the torsion + postconditioning, 20 seconds group, the clamp was released for 20 seconds and applied for 10 seconds. Then, reperfusion was allowed. After 60 days, rats in all study groups were killed, both testes were removed, and the histopathology was evaluated. The χ(2) test was used for statistical analysis. RESULTS: Compared with the other groups, the extent of tissue injury determined by histopathologic grades according to Cosentino et al (J Androl. 1986;7:23-31) was significantly less in group PC5 (P < .05). CONCLUSION: We conclude that short-interval postconditioning can protect against long-term testicular reperfusion injury. Furthermore, the optimal time for reperfusion during postconditioning was 5 seconds in our rat model of testicular torsion. This technique seems easily applicable, and evidence suggests that similar techniques may be useful during testicular surgery.
AIM: Even with prompt diagnosis and treatment, testicular torsion may lead to infertility and atrophy after testicular salvage. The aims of this study were to investigate the long-term protective effects of short-interval postconditioning on testicular atrophy and to optimize the reperfusion period. MATERIALS AND METHODS: Forty adult male rats were divided into 5 subgroups: sham operated; torsion + detorsion; torsion + postconditioning, 5 seconds (PC5); torsion + postconditioning, 10 seconds; and torsion + postconditioning, 20 seconds. Torsion was created by rotating the left testis 1080° counterclockwise and then fixing the testis to the scrotum with 3 sutures. Torsion was maintained for 4 hours. The testicular artery was visualized, and an atraumatic vascular clamp was applied to prevent reperfusion in all study groups. Detorsion of the testis was then performed. In the torsion + detorsion group, the clamp was released just after detorsion. In all the other intervention groups, the subsequent procedures were repeated 10 times. In the PC5 group, the clamp was released for 5 seconds and applied for 10 seconds; in the torsion + postconditioning, 10 seconds group, the clamp was released for 10 seconds and applied for 10 seconds; and in the torsion + postconditioning, 20 seconds group, the clamp was released for 20 seconds and applied for 10 seconds. Then, reperfusion was allowed. After 60 days, rats in all study groups were killed, both testes were removed, and the histopathology was evaluated. The χ(2) test was used for statistical analysis. RESULTS: Compared with the other groups, the extent of tissue injury determined by histopathologic grades according to Cosentino et al (J Androl. 1986;7:23-31) was significantly less in group PC5 (P < .05). CONCLUSION: We conclude that short-interval postconditioning can protect against long-term testicular reperfusion injury. Furthermore, the optimal time for reperfusion during postconditioning was 5 seconds in our rat model of testicular torsion. This technique seems easily applicable, and evidence suggests that similar techniques may be useful during testicular surgery.
Authors: Erin R McNamara; Ramiro J Madden-Fuentes; Jonathan C Routh; Douglas Rouse; John F Madden; John S Wiener; Harry G Rushton; Sherry S Ross Journal: J Pediatr Urol Date: 2014-07-10 Impact factor: 1.830