Protective effect of tunica albuginea incision with tunica vaginalis flap coverage on tissue damage and oxidative stress following testicular torsion: role of duration of ischemia

Summary Objective This experimental study used a rat model to investigate the effect of a tunica albuginea incision with tunica vaginalis flap coverage on tissue damage and oxidative stress caused by testicular torsion and its relationship with the duration of ischemia. Materials and methods The test animals were divided into the following groups: G1, sham procedure; G2, testicular torsion for 1, 5, or 9 hours followed by detorsion; G3, testicular torsion for 1, 5, or 9 hours followed by detorsion using flap technique. Testicular torsion was induced by 720° counterclockwise rotation of the left testis. After the period of torsion, the flap technique was employed for detorsion. The oxidative stress and testosterone levels were measured at 24 hours post procedure. Further assessment was carried out by histomorphometry at 30 days post procedure. The histological parameters included the Johnson score, diameter of the seminiferous tubules, and thickness of seminiferous tubule epithelium. Results The histological parameters in the G2 group showed a significant change in relationship with the duration of ischemia. In the G3 group, flap coverage improved the histological parameters only for the 9-hour torsion subjects. The levels of testosterone, GPX, and superoxide dismutase significantly decreased in all subgroups of G2 and G3, and the malondialdehyde level increased as the duration of ischemia increased. Flap coverage decreased the malondialdehyde level only in the 9-hour torsion subjects. Conclusions Flap coverage reduced tissue damage as the duration of ischemia increased. The findings of the rat model suggested that a tunica albuginea incision with tunica vaginalis flap might have provided a protective effect in long-term ischemia.