Which agent should be used to reduce ischemia-reperfusion injury after testicular torsion: a comparative animal experiment

Introduction Testicular torsion is an acute urological emergency that causes severe damage of testis. In order to prevent testicular damage, early diagnosis and surgical intervention is essential. Also pain management in both pre-operative and postoperative periods remains a challenging entity. Objective In this study, we aimed to determine the possible positive effects of three different analgesics (ibuprofen, metamizole, and paracetamol), which are widely used in clinical practice on testicular tissue, in addition to pain control. Study design Forty prepubertal rats (180-210 g) were divided into five experimental groups. Group 1 was sham group in which the left testis was brought out through a scrotal incision and then replaced in the scrotum without torsion. Group 2 was control group (only 0.9% NaCl was applied). Also in group 3, paracetamol, in group 4, ibuprofen, and in group 5, metamizole was applied 1 h after the torsion. Torsion duration was planned as 4 h for all groups. Results In the biochemical evaluation, malondialdehyde (MDA), myeloperoxidase (MPO), and total nitrate (NO) levels were measured in the testicular tissue. All groups were compared with group 2 (control group). In group 3, although the MDA level was lower and the MPO level was found to be higher, these were not statistically significant. In group 4, the NO level was low but statistically significant. Histological findings were evaluated due to Cosentino's classification, and the scores of group 4 were better than all groups. Discussion In this study, severe damage was observed at the end of torsion period of 4 h. This is in line with previous published data. The beneficial effects of all three drugs have been observed. Conclusions Biochemical results did not clearly highlight any agents. According to pathology results, meta mizole was better than paracetamol and the most ideal analgesic preparation was observed as ibuprofen.