DISCUSSION
compartment syndrome, bleeding, ITP, ischemia, Atrophy, pain, atrophy, necrosis, tissue damage
COMPARTMENT SYNDROME, BLEEDING, OXIDATIVE STRESS, ISCHEMIA, MINOR, TESTICULAR TORSION, TESTES, ATROPHY, ITP, ATROPHY, NECROSIS, OXIDATIVE STRESS, COMPLICATIONS
Prolonged or even short ischemia causes tissue damage and necrosis, which can produce high levels of oxidative stress in the testes, especially during the reperfusion period. Testicular torsion/detorsion increases lipid peroxidation and decreases antioxidant enzyme levels. Increased levels of peroxidase enzyme injury after testicular reperfusion can induce molecular damage to the DNA.To validate the TVF technique in humans and prove the compartment syndrome in testicular torsion, Kutikov et al. reported TVF in three cases. All treated 4-7 hours after the onset of pain. Testes without aspect improvement after detorsion and heating and those with active parenchymal bleeding after a wide anterior longitudinal albuginea incision were candidates for TVF. Intratesticular pressure was measured in only one patient and decreased from 34mmHg before detorsion to 5mmhg after TVF correction. Atrophy was reported in one case and Doppler flowmetry was positive in two cases.The initial technique, described in 2018In this series, all cases experienced a decrease in ITP before and after TVF. To investigate the impact of the detorsion maneuver only (P1-P2), we measured the pressure before (P1) and after detorsion and heating (P2). Most patients exhibited a slight decrease in ITP, with a median value of 4mmHg. Interestingly, detorsion did not lower the ITP in many cases. A major decrease occurred after the albuginea incision (P2-P3) with a median value of 45mmHg. The most important outcome was approximately the same pressure after TVF and the contralateral testicle, with a median range of 1mmHg. Based on our results, we concluded that TVF may achieve normal testicular pressure, which may improve testicular reperfusion. The puncture of non-twisted testicles appears to be safe. Once the Pc puncture point was planned to be in the same place as the fixation stitch, no minor or major complications regarding twisted or non-twisted organs were recorded in this study.In 2012, Figueroa et al. reported a retrospective analysis, where the TVF was compared between orchidopexy and orchiectomy groups. They applied TVF in selected cases within 96 hours of pain onset. The ITP was not assessed in this study. The testicular salvage rate in the TVF group was 54.6% (p=0.19), being successful within a median of 31.2 hours of pain onset. This report revealed a longer treatment time with preservation of nearly 50% of the testicular candidates for orchiectomy.However, a recent meta-analysis of orchidopexy techniques demonstrated an ipsilateral atrophy rate in only three studies, ranging from 9.1% to 47.5%.A clinical trial using TVF in a rat model demonstrated a reduction in ROS levels. Oxidative stress was assessed using malondialdehyde levels in the 1 In this clinical trial, prospective evaluation revealed a high atrophy rate of 66.6%, with a similar testicular salvage rate of 88.9%. Despite documented decompression, this high rate may be associated with the initial learning curve and lack of initial standardization of pressure measurement and surgical technique. This pilot project standardized TVF in a university hospital.