An experimental investigation of the effects of detorsion+ fixation and orchiectomy on testes after testis torsion

Aim: Testicular torsion is an urgent surgical condition that needs to be rapidly diagnosed and treated. Ischemia / reperfusion injury occurs after testicular torsion, increased free oxygen radicals and inflammatory cytokines play role cause testicular damage on both ipsilateral and contralateral testis. The aim of this study, investigate the effect of detorsion + fixation and orchiectomy on testes after testicular torsion in the long term. Material and Method: 98 wistar male rats was used in seven group in this study. Torsion of the left testis was created in the experimental groups for 4 hours during the 720-degree. After 4 hours, left testiculer orchiectomy was performed to 3 groups and detorsion + fixation was performed to 3 groups. At day 1, month 3 and 6, blood sample were taken from rats. At the end of the experiment, the testes were collected for the histopatologic and immunohistochemical evaluation. Results: In the detorsion + fixation group at the end of the third month, FSH, LH and Testosterone levels were significantly lower than in the other groups (p<0.05). At the end of the 6th month, no significant difference was observed between the groups in hormonal parameters (p> 0.05). In the ipsilateral testes after detorsion + fixation at 3 and 6 months compared to the control group, testicular weight, Johnsen score and Seminifer tubulus diameter were significantly reduced (p<0.05). There was no significant difference in the Johnsen score and Seminifer tubulus diameters of the contralateral testes (p>0.05). Immunohistochemically, iNOS expression was increased in the ipsilateral testes of orchiectomy and detorsion + fixation groups at the end of the first day and iNOS values were decreased at the 3rd and 6th months in this groups (p<0.05). At the end of 3 months, iNOS expression was significantly decreased in the contralateral testes of detorsion + fixation group compared to the other contralateral testes (p <0.05). Conclusion: FSH, LH and Testosterone levels were found to be low in the 3th month of the torsion. Testes which was performed detortion + fixation were atrophied. In the 3th month after torsion, iNOS expression was significantly decreased in the bilateral testes of the detorsion + fixation group. In the 6th month after torsion iNOS expression on ipsilateral testis further decreased whereas on the contralateral testes of detorsion + fixation group iNOS expresion was in the normal value. Johnsen score and Seminifer tubulus diameters were found to be low in ipsilateral testes detorsion+fixation groups. As a result; testis torsion is affected by both testes, however, the injury of the contralateral testis is temporary and improves in the long term. After 4 hours of torsion, detorsion + fixation or orchiectomy has no effect on future fertility. In the long term, the contralateral testes in both groups remain healthy to maintain fertility.