Editorial comment for 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

Abstract

The authors presented their experimental study investigating the effects of testicular torsion in a rat model. Not surprisingly they found that there is a linear increase in parameters of testicular distress with increasing duration of torsion (1, 5 and 9 h). A tunica vaginalis flap (TVF) placed in the incised tunica albuginea of an experimentally torsed testes reduced testicular histologic damage and reduced a serum marker of injury (MDA) only in testes torsed for 9 h. The authors found no measurable benefit in those testes torsed for lesser time intervals (1 and 5 h); indeed, there was worse injury in those animals subjected to the TVF intervention. While the authors stated in the Introduction that testicular torsion must be differentiated from other causes of scrotal pain so as to prevent the loss of the testicle in those with torsion, the real issue at hand is what to do with the ischemiclooking testes at the time of surgery. Few would want to leave necrotic testes, but how clinically are irrevocable changes discerned? Which testes can be helped with TVF? The duration of scrotal pain, as indicated by the patient’s history, is a poor indicator of testicular viability given the vagaries of adolescent male perceptions, the occasional but real occurrence of intermittent torsion and the anatomic variability (i.e. the number of twists) of spermatic cord torsion. There is literature [1] directly relating necrosis to duration of symptoms, but experience demonstrates many outliers to the general rules governing the relationship between testicular viability and duration of symptoms. Indeed, Sessions et al. [2] found that 40% of patients presenting with symptoms of >20 h duration had testicular salvage with standard detorsion and fixation. Would these patients be harmed with the TVF techniques, as were those rats