Abstract
Background and Objectives: It is of great importance to obtain information about the severity of ischemic damage and duration of testicular torsion for an effective treatment strategy. Nucleolar-organizing regions (NORs) are sites of the ribosomal genes composed of ribosomal DNA and proteins. Post-silver staining NORs are termed “AgNOR”. Since AgNORs clearly reveals the self-renewal potential of cells damaged in ischemic events, we performed the current study. Materials and Methods: The study was carried out in four groups as control, sham, early, and late T/D. In the surgical groups, testes were corrected after a 4-h ischemia period. Testicular tissue samples were taken on the third day after detorsion in group 1, 2, 3, and on the tenth day after detorsion in group 4. TUNEL and silver stainings were applied to all samples. Results: The differences were significant among the groups for both mean AgNOR number and total AgNOR area/total nuclear area (TAA/TNA). Moreover, the differences between control and early torsion-detorsion (T/D), between control and late T/D, between sham and early T/D, between sham and late T/D, and between early T/D and late were statistically significant for AgNOR amount. Furthermore, statistically significant differences among the groups for an average number of apoptotic cells per tubule and the percentage of apoptotic tubule values were detected. Discussion: The apoptotic index gives the ratio of cells that are damaged and will die in a programmed way and cells that remain intact, rather than show the viability of the returning testicle. However, by measuring cells that regenerate with AgNOR, we can show not only those that survive but also cells that can repair themselves. Conclusion: AgNOR proteins are usable for the early observation of ischemic injury levels. The amount of AgNOR protein can enlighten us about the extent of testicular damage after T/D treatment. It may also help the physician in the development of effective treatment strategies for cases.
Highlights
Acute scrotum is encountered frequently by pediatric surgeons/urologists in pediatric emergency departments
The rats were indiscriminately separated into four groups each including 5 rats: Group I: The control group; Group II: The sham group, consisting of animals that have gone through all surgical stages but whose testicles are not torsioned; Group III: Early T/D group:; Group IV: Late T/D group: Testicular T/D surgery was performed on rats in this group such as group III but the orchiectomies were carried out 10 days later
When all groups to be taken into consideration, the differences were statistically significant among the groups for both mean AgNOR number (χ2 = 355.977, p < 0.001)
Summary
Acute scrotum is encountered frequently by pediatric surgeons/urologists in pediatric emergency departments. Testicular torsion, which involves twisting of all testicles and testicular structures, differs from other acute scrotum causes, especially in terms of urgency in treatment. The rate of orchiectomy in boys operated for testicular torsion is 42% and responsible for about 10% to 15% of emergency ailments of the scrotum in patients under 18 years of age [2]. Surgical correction in torsion treatment should be done urgently and in good time because the degree and duration of the torsion increase the complication rate and even result in atrophy. The pathophysiology of testicular torsion-detorsion (T/D) focuses on acute ischemia-reperfusion (I-R) damage to the testicle, including the ischemic duration of the torsion and reperfusion injury of the detorsion, that may result in a possible impairment in fertility [3]
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