The Effect of Tunica Albuginea Incision on Testicular Tissue After Detorsion in the Experimental Model of Testicular Torsion

Aynur Gultekin, Halil Ibrahim Tanriverdi, Sevinc Inan, Omer Yilmaz, Cuneyt Gunsar, Aydin Sencan

Abstract


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Purpose: Testis torsion is a surgical emergency, and sometimes we cannot sufficiently prevent injury even surgical detorsion of the testis is performed in the appropriate time period due to some reasons such as tissue edema. In this experimental study, we investigated the effect of tunica albuginea incision (TAI) on testicular torsion-detorsion model (TDM).
Materials and Methods: Twenty four male rats were used. The rats were randomly divided into three groups. In Group I, testicular torsion (TT) of 720° was created. After 4 hours of torsion period, the testis was detorsioned. Then three longitudinal incisions were made on tunica albuginea of the testis. In Group II, torsion and detorsion was created by the same way as in Group I, but TAI was not added to the procedure. Group III was Sham group. At the end of the first week, rats in the experimental groups were sacrificed and the testes were harvested for histological, immunohistological examinations and for the assessment of apoptotic activity.
Results: In Group I, the procedures led to partial improvement in color of the testes. Modified Johnsen Scores in Groups I, II and III were detected as 7.8, 4.3 and 9.6 respectively (P = .001). In Group I, immunoreactivity of anti-APAF-1 was moderate in 7 rats, and strong in 1 rat. Immunoreactivity of anti-cytochrome C and anti-caspase
3 were moderate in 6 rats, and strong in 2 rats. Immunoreactivity of anti-caspase 8 and 9 were moderate in 5 rats, and strong in 3 rats. The differences of immunoreactivity between the groups were statistically significant. TUNEL percentages were detected as 40, 62% in Group I, 60% in Group II and 11,75% in Group III respectively (P = .001).
Conclusion: As a result, multiple incisions made on tunica albuginea after detorsion in the TDM in rats, decrease the amount of ischemia- reperfusion injury. This effect might be related with the decrease in testicular edema and free oxygen radicals together with increase in tissue perfusion. Moreover, the decreased apoptotic activity seems to play a role in the decrease in inflammatory response and preservation of tissue parenchyma consequently.

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References


Kolbe A, Sun CCJ, Hill JL. Unpredictability of capsulotomy in testicular torsion. J Pediatr Surg. 1987;22:1105-09.

Kutikov A, Casale P, White MA, Meyer WA, Chang A, Gasalbez R, et al. Testicular com-partment syndrome: A new approach to conceptualizing and managing testicular torsion. Urology. 2008;72:786-89.

Figueroa V, Salle JLP, Braga LHP, Romao BR, Koyle MA, Bagli DJ, et al. 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;188:1417-23.

Oktar T, Küçükdurmaz F, Erdem S, Kılıçaslan I, Ceylan C, Sanli O, et al. Tunica albuginea decompression fails to alter the injury of prolonged arterial occlusion during testicular torsion. J Urol. 2013;190:239-43.

Johnsen SG. Testicular biopsy score count-a method for registration of spermatogenesis in human testes: Normal values and results in 335 hypogonadal males. Hormones. 1970;1:2.

Anaya-Prado R, Toledo-Pereyra LH, Lentsch AB, Ward PA. Ischemia/reperfusion injury. J Surg Res. 2012;105:48-58.

Mars M, Hadley GP. Raised intracompartmental pressure and compartment syndromes. In-jury. 1998;29:403-11.

Balogh ZJ, Butcher NE. Compartment syndromes from head to toe. Crit Care Med. 2010;38:445-51.

Nandi S, Banerjee PP, Zirkin BR. Germ cell apoptosis in the testes of Sprague Dawley rats following testosterone withdrawal by ethane 1,2-dimethanesulfonate administration: relationship in Fas? Biol Reprod. 1999;61:70-5.

Dunkel L, Taskinen S, Hovatta O, Tilly JL, Wikstrom S. Germ cell apoptosis after treatment of cryptorchidism with human Tunica albuginea incision at testicular torsion-Gultekin et al.chorionic gonodotropin in associated with impaired reproductive function in the adult. J Clin Invest. 1997;100:2341-46.

Lee J, Richburg JH, Younkin SC, Boekelheide K. The Fas system is a key regülatör of germ cell apoptosis in the testis. Endocrinology. 1997;138:2081-88.

Turner TT, Tung KSK, Tomomasa H, Wilson LW. Acute testicular ischemia results in germ cell-specific apoptosis in the rat. Biol Reprod. 1997;57:1267-74.

Thompson CB. Apoptosis in the pathogenesis and treatment of disease. Science. 1995;267:1456-62.

Johnson TM, Yu XZ, Ferans VJ, Lowenstein RA, Finkel T. Reactive oxygen species are downstream mediators of p53-dependent apoptosis. Proc Natl Acad Sci. 1996;93:11848-52.

Packham G, Ashmun RA, Cleveland JL. Cytokines suppress apoptosis independent of increases in reactive oxygen species. J Immunol. 1996;156:2792-800.

Payabvash S, Kiumehu S, Tavangar SM, Deppour AR. Ethyl pyruvatereduces germ cell-specific apoptosis and oxidative stress in rat model of testicular torsion/detorsion. J Pediatr Surg. 2008;43 705-12.

Guimaraes SB, Aragao AA, Santos JM, Kimura OS, Barbosa PH, Vasconcelos PR. Oxidative stress induced by torsion of the spermatic cord in young rats. Acta Cir Bras. 2007;22:30-3.

Lysiak JJ, Turner SD, Turner TT. Molecular pathway of germ cell apoptosis following ischemia/reperfusion of the rat testis. Biol Reprod. 2000;63:1465-72.

Moritoki Y, Kojima Y, Mizuno K, Kamisawa H, Kohri K, Hayashi Y. Intratesticular pressure after testicular torsion as a predictor of subsequent spermatogenesis: a rat model. BJU Int. 2012;109:466-70.




DOI: http://dx.doi.org/10.22037/uj.v0i0.3804


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