Oliveira Alessandro V, Sampaio Ana Luiza N, Junior Rui W Mascarenhas, Andriolo Regis B
Department of Medicine, Center of Biological and Health Sciences, University of Pará State, Belém, Pará, Brazil.
Laboratory of Experimental Surgery, University of Pará State, Belém, Pará, Brazil.
Andrology. 2024 Oct 29. doi: 10.1111/andr.13785.
Testicular torsion is a common urological emergency in children and teenagers that, in most cases, requires surgical exploration and detorsion. However, even after a successful intervention, a high number of patients still develop irreversible damage.
To investigate whether the administration of phosphodiesterase inhibitors (PDE) in animal models of testicular torsion can reduce damages caused by the ischemia-reperfusion syndrome.
A systematic search of the Medline, Web of Science, Embase, and Ovid databases for studies up to December 2023 was performed using PRISMA guidelines. A detailed search was conducted using the following key terms: "testicles," "ischemia," "reperfusion," and "phosphodiesterase inhibitors." There was no restriction regarding language or year of publication. We investigated spermatogenesis by the Johnsen's biopsy score (JTBS) and histological damage by the Cosentino's biopsy score (CBS). Malondialdehyde (MDA), nitric oxide (NO), superoxide dismutase (SOD), and glutathione peroxidase (GPx) testicular levels were also analyzed.
Initially, 296 articles were identified. However, only 20 studies met the inclusion criteria. PDE inhibitors improved JTBS (MD = 2.53, CI = 1.94 to 3.13), CBS (MD = -1.11, CI = -1.25 to -0.97) and SOD (SMD = 3.27, CI = 1.59 to 4.95) outcomes. PDE did not improve MDA (SMD = -0.93, CI = -2.19 to 0.34), NO (SMD = -0.54, CI = -1.56 to 0.48), and GPx (SMD = 0.77, CI = -0.38 to 1.92) outcomes. A higher dose of PDE inhibitors only improved CBS outcome.
This review indicates that the administration of PDE inhibitors in rats ameliorated the outcomes, representing a promising complementary strategy for spermatogenesis recovery following testicular torsion. Our review suggests that JTBS and CBS could be translated into future human studies, validating and extending these findings within the context of human physiopathology, while providing applicability of interventions in real clinical practice.
睾丸扭转是儿童和青少年常见的泌尿外科急症，在大多数情况下需要手术探查和扭转复位。然而，即使干预成功，仍有大量患者会出现不可逆损伤。
研究在睾丸扭转动物模型中给予磷酸二酯酶抑制剂（PDE）是否能减少缺血再灌注综合征造成的损伤。
按照PRISMA指南，对截至2023年12月的Medline、科学网、Embase和Ovid数据库进行系统检索。使用以下关键词进行详细检索：“睾丸”“缺血”“再灌注”和“磷酸二酯酶抑制剂”。对语言和发表年份无限制。我们通过约翰森活检评分（JTBS）研究精子发生情况，通过科森蒂诺活检评分（CBS）研究组织学损伤情况。还分析了睾丸组织中丙二醛（MDA）、一氧化氮（NO）、超氧化物歧化酶（SOD）和谷胱甘肽过氧化物酶（GPx）的水平。
最初识别出296篇文章。然而，只有20项研究符合纳入标准。PDE抑制剂改善了JTBS（MD = 2.53，CI = 1.94至3.13）、CBS（MD = -1.11，CI = -1.25至-0.97）和SOD（SMD = 3.27，CI = 1.59至4.95）的结果。PDE未改善MDA（SMD = -0.93，CI = -2.19至0.34）、NO（SMD = -0.54，CI = -1.56至0.48）和GPx（SMD = 0.77，CI = -0.38至1.92）的结果。更高剂量的PDE抑制剂仅改善了CBS结果。
本综述表明，在大鼠中给予PDE抑制剂可改善结果，这是睾丸扭转后精子发生恢复的一种有前景的辅助策略。我们的综述表明，JTBS和CBS可转化为未来的人体研究，在人体生理病理学背景下验证和扩展这些发现，同时提供干预措施在实际临床实践中的适用性。
