title: Tunica albuginea decompression fails to alter the injury of prolonged arterial occlusion during testicular torsion.
abstract: OBJECTIVE
  The correlation between intratesticular pressure during torsion/detorsion and subsequent testicular function and viability has been reported in several recent studies. We assessed the impact of tunica albuginea incision with tunica vaginalis flap coverage on intratesticular pressure and future histopathological parameters in a rat testicular torsion model.
  
  
  METHODS
  A total of 21 rats were divided into 3 groups. Group 1 consisted of 7 controls undergoing a sham operation, group 2 consisted of 7 animals undergoing torsion-detorsion, and group 3 consisted of 7 animals undergoing testicular torsion-detorsion followed by tunica albuginea incision and tunica vaginalis flap coverage. Torsion was created by 720-degree counterclockwise rotation of the left testis for 2 hours. By using a compartment monitor, the intratesticular pressure of the torsed testes was measured before torsion (pre-torsion), immediately before torsion repair (pre-detorsion), 5 minutes after detorsion (post-detorsion), and after tunical incision and tunica vaginalis flap application. The correlations between intratesticular pressure values and testicular weight, modified Johnsen score and mean seminiferous tubule diameter were evaluated 4 weeks postoperatively.
  
  
  RESULTS
  Median pre-detorsion intratesticular pressure was significantly decreased after detorsion in group 2 (21 vs 7 mm Hg, p <0.001) and group 3 (23 vs 7 mm Hg, p = 0.001). In addition, median intratesticular pressure after tunica albuginea incision and tunica vaginalis flap coverage in group 3 was significantly less compared to median post-detorsion intratesticular pressure in group 2 (5 vs 7 mm Hg, p = 0.025). Overall no significant difference was detected between groups 2 and 3 regarding median modified Johnsen score, mean seminiferous tubule diameter or median testicular weight. The significant reduction of intratesticular pressure in group 3 did not correlate with testicular weight (r = 0.500, p = 0.391), modified Johnsen score (r = -0.205, p = 0.741) or mean seminiferous tubule diameter (r = -0.200, p = 0.747).
  
  
  CONCLUSIONS
  Tunica albuginea decompression with tunica vaginalis flap coverage is an effective technique for decreasing intratesticular pressure in torsed testes. However, this technique failed to alter the injury of prolonged arterial occlusion in testicular torsion.
authors: Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. tayfunoktar@hotmail.com
authors: Tayfun
authors: T
authors: Oktar
authors: Faruk
authors: F
authors: Kucukdurmaz
authors: Selcuk
authors: S
authors: Erdem
authors: Isın
authors: I
authors: Kilicaslan
authors: Canan
authors: C
authors: Ceylan
authors: Oner
authors: O
authors: Sanli
authors: Cenk Murat
authors: CM
authors: Unverdi
authors: Orhan
authors: O
authors: Ziylan
mesh_terms: D000818:Animals; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D004195:Disease Models, Animal; D007511:Ischemia / Q000209:etiology / Q000601:surgery*; D008297:Male; D011312:Pressure; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D015427:Reperfusion Injury / Q000503:physiopathology; D018570:Risk Assessment; D012671:Seminiferous Tubules / Q000098:blood supply / Q000473:pathology; D013086:Spermatic Cord Torsion / Q000150:complications / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*; D013737:Testis / Q000098:blood supply*; D017211:Treatment Failure