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Mechanisms of testicular torsion and potential protective agents

Nature Reviews Urology volume 11, pages 391399 (2014) | Download Citation

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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.

Key points

  • Testicular torsion is a urological emergency that requires urgent treatment

  • The main pathophysiology of testicular torsion is ischaemia–reperfusion injury of the testis

  • Activation of the inflammatory cascade and apoptosis are the most important pathological mechanisms in testicular torsion and detorsion

  • Several drugs have been successfully tested in animal models to reduce the dangerous effects of ischaemia–reperfusion in testicular torsion

  • The challenge is now to translate the results of animal studies to clinical trials and then clinical practice

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  1. Department of Urology, Karadeniz Technical University, Faculty of Medicine, 61080 Trabzon, Turkey.

    • Ersagun Karaguzel
    •  & Omer Kutlu
  2. Department of Urology, Istanbul Training and Research Hospital, 34098 Istanbul, Turkey.

    • Mustafa Kadihasanoglu

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E.K. and M.K. researched data for the article and contributed to discussion of the content and writing of the article. All authors contributed to review and editing of the manuscript before submission.

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The authors declare no competing financial interests.

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Correspondence to Ersagun Karaguzel.

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https://doi.org/10.1038/nrurol.2014.135

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