Molecular Mechanisms of Testis Damage and Target Drug Development in the Ischemic-Reperfusion Injury of Acute Testicular Torsion: A Pediatric Urological Perspective

Acute testicular torsion (TT) in children is one of the most common urogenital emergencies, which potentially causes serious clinical outcome including testicular dysfunction, infertility, orchiectomy. Clinically, surgical correction must be performed within 6 hours to preserve the testis. Unfortunately, most children with acute TT came in after the golden time of 6 hours. As a result, testicular function significantly decreases due to ischemic or ischemic-reperfusion (I/R) injury to the testis, and in the worst case, orchiectomy may be required. Acute TT is well known to cause testicular damage through I/R injury mechanism. Ischemic injury can directly lead to tissue damage and organ dysfunction. Following testicular detorsion, testicular reperfusion causes also more severe damage than that induced by ischemia. The immediate restoration of blood flow is the primary therapeutic approach to treat TT. A number of previous experimental studies of TT in animals have been suggested a model of I/R injury in humans, and the use of different types medication and their role in decreasing cellular damage following reperfusion. However, there are currently no effective medications available for the clinical practice. Besides, according to the available evidence, the pharmacological mechanism of the currently known agents to avoid or reduce I/R injury, as well as their toxicity, side effects, safe doses and other issues, remain to be further elucidated in future preclinical and clinical trials. Based on recently published literatures, the authors would like to review the molecular mechanisms and target drug development of testis damage in the I/R injury of acute TT from a pediatric urological perspective.