REVIEWS Mechanisms of testicular torsion and potential protective agents Ersagun Karaguzel, Mustafa Kadihasanoglu and Omer Kutlu Abstract | Testicular torsion is a urological emergency most commonly seen in adolescence, involving a decrease in blood flow in the testis resulting from torsion of the spermatic cord that can result in gonad injury or even loss if not treated in time. Testicular ischaemia–reperfusion injury represents the principle pathophysiology of testicular torsion, with ischaemia caused by twisting of the spermatic cord, and reperfusion on its subsequent release. Many cellular and molecular mechanisms are involved in ischaemia-reperfusion injury following testicular torsion. Studies have investigated the use of pharmacological agents as supportive therapy to surgical repair in order to prevent the adverse effects of testicular torsion. Numerous substances have been proposed as important in the prevention of post-ischaemia–reperfusion testicular injury. A range of chemicals and drugs has been successfully tested in animal models for the purpose of mitigating the dangerous effects of ischaemia-reperfusion in testis torsion. Karaguzel, E. et al. Nat. Rev. Urol. advance online publication 17 June 2014; doi:10.1038/nrurol.2014.135
Introduction
Department of Urology, Karadeniz Technical University, Faculty of Medicine, 61080 Trabzon, Turkey (E.K., O.K.). Department of Urology, Istanbul Training and Research Hospital, 34098 Istanbul, Turkey (M.K.).
Testicular torsion is a common urological emergency involving rotation of the testis and twisting of the spermatic cord, which causes restricted blood flow to the affected testis, resulting in testicular atrophy. The testis is especially susceptible to ischaemic damage because the blood supply is terminal (that is, arteries in the testes do not form anastomoses) and because the tunica albuginea is an inelastic shell, which limits compensatory expansion of the testis during trauma.1,2 Testicular torsion usually affects newborns, children and adolescents. Two types of testicular torsion exist: supravaginal torsion, which occurs in the prenatal period and the first year after birth, and intravaginal torsion, which occurs during puberty and has a higher incidence.3 Surgical intervention is necessary to establish counter-rotation of the twisted spermatic cord and reperfusion of the tissue. Testicular torsion accounts for 13–54% of cases of acute paediatric scrotal disease,4,5 and occurs annually in 1 in 4,000 males aged
Introduction
Department of Urology, Karadeniz Technical University, Faculty of Medicine, 61080 Trabzon, Turkey (E.K., O.K.). Department of Urology, Istanbul Training and Research Hospital, 34098 Istanbul, Turkey (M.K.).
Testicular torsion is a common urological emergency involving rotation of the testis and twisting of the spermatic cord, which causes restricted blood flow to the affected testis, resulting in testicular atrophy. The testis is especially susceptible to ischaemic damage because the blood supply is terminal (that is, arteries in the testes do not form anastomoses) and because the tunica albuginea is an inelastic shell, which limits compensatory expansion of the testis during trauma.1,2 Testicular torsion usually affects newborns, children and adolescents. Two types of testicular torsion exist: supravaginal torsion, which occurs in the prenatal period and the first year after birth, and intravaginal torsion, which occurs during puberty and has a higher incidence.3 Surgical intervention is necessary to establish counter-rotation of the twisted spermatic cord and reperfusion of the tissue. Testicular torsion accounts for 13–54% of cases of acute paediatric scrotal disease,4,5 and occurs annually in 1 in 4,000 males aged
