Modulation of Thrombosis Significantly Reduces Testicular Damage after Testicular Torsion in Rats: Anti-Thrombotic Treatment and Testicular Torsion

OBJECTIVE: It has been suggested that alterations of circulation during testicular torsion (TT) result in thrombus formation that might prevent sufficient perfusion after detorsion. Due to the narrow safety margin of testicular perfusion, even moderate disturbances in blood supply can cause major testicular damage. To evaluate the effects of thrombolysis and/or anticoagulation on testicular viability after TT was the aim of this study.

METHODS: In 112 rats the right testicle was torsed for 3 or 6 hours. After detorsion and randomization, they received either enoxaparin / alteplase / both / placebo, according to their subgroup. Thrombus formation was accessed via D-Dimers, pDNA, oxidative testicular damage was evaluated via glutathione peroxidase and malondialdehyde, cellular damage via inhibin B, testosterone, histological analysis (Johnsen score, Cosetino grading) and TUNEL assay.

RESULTS: One hundred and twelve rats were included in the study. The treatment with alteplase and/or enoxaparin showed significantly less testicular damage, and significantly improved Sertoli cell function. Enoxaparin significantly reduced oxidative impairment.

CONCLUSION: The results of the study indicate that TT induces thrombus formation and demonstrate that modulation of thrombosis significantly ameliorates testicular damage in rats. Hence, this treatment option after TT ought to be evaluated in humans.