Letter to the editor regarding “Long-term protective effects of the combination of intermittent reperfusion and hypothermia on reperfusion injury in an experimental testicular torsion model”

Abstract

With attention and curiosity, we read the article by Erdem et al. [ [1] Erdem A.O. Ozkisacik S. Mersinli B. et al. Long-term protective effects of the combination of intermittent reperfusion and hypothermia on reperfusion injury in an experimental testicular torsion model. J Pediatr Surg. 2021; 56: 2037-2044 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar ]. We would like to commend the authors for focusing their research on surgical methods that may be useful in ischemia-reperfusion injury of testicular tissue. We believe that there will be many more useful studies in the future that will combine intermittent reperfusion, hypothermia and tunica albuginea incision. In the domain of all research on this topic, the temperature of 4 °C proved to be the most optimal, which was followed by the authors. In evaluating the effectiveness of hypothermia as a protective strategy, there are three key variables: the time of onset of hypothermia from the moment of torsion, the duration of controlled hypothermia, and the temperature of hypothermia. We also want to draw attention to the fact that research has been done on male adult rats. We know that testicular torsion most commonly occurs in neonatal and pubertal age. For such a model, the most suitable models are rats aged 35–50 days. It is also important to note that testicular tissue is most susceptible to ischemia-reperfusion injury at puberty [ [2] Heindel R.M. Pakyz R.E. Cosentino M.J. Spermatic cord torsion. Contralateral testicular degeneration at various ages in the rat. J Androl. 1990; 11: 506-513 PubMed Google Scholar ]. We must also point to the fact that intermittent reperfusion was performed with a vascular clamp. We find it useful to see results if reperfusion were performed by intermittent manual torsion and detorsion rather than vascular clamping because the natural processes of torsion initially clog veins but not arteries and thus causes partial ischemia [ [3] Akgür F.M. Kilinç K. Aktuğ T. et al. The effect of allopurinol pretreatment before detorting testicular torsion. J Urol. 1994; 151: 1715-1717 Crossref PubMed Scopus (81) Google Scholar ]. Although various studies have shown that the first 60–90 min of detorsion is crucial for reperfusion damage [ [4] Prillaman H.M. Turner T.T. Rescue of testicular function after acute experimental torsion. J Urol. 1997; 157: 340-345 Crossref PubMed Scopus (126) Google Scholar ], it is nice to see that the authors opted to observe long-term effects, which better illustrates natural processes if we do not opt for an orchidectomy.