ANALYTICAL AND QUANTITATIVE CYTOPATHOLOGY AND HISTOPATHOLOGY

1. 139
0884-6812/20/4205-0139/$18.00/0 © Science Printers and Publishers, Inc.
Analytical and Quantitative Cytopathology and Histopathology®
A
RTICLES
An Official Periodical of The International Academy of Cytology and the Italian Group of Uropathology
AQCH
ANALYTICAL and
QUANTITATIVE
CYTOPATHOLOGY and
HISTOPATHOLOGY®
OBJECTIVE: To investigate the antioxidant effects of
an AT1 receptor blocker losartan on the apoptosis of
spermatogenic cells in torsion/detorsion damage in rats
using the TUNEL assay method.
STUDY DESIGN: Forty male Wistar albino rats were
categorized into 4 groups. For Group 1 (sham group),
only the abdominal wall was opened and closed. In
Group 2 (torsion group), the left testis was rotated
720° degrees clockwise around the longitudinal axis of
the spermatic cord for 2.5 hours. For Group 3 (torsion/
detorsion), after 2.5 hours of the torsion process, a su-
ture that fixed the testis to the tunica dartos was cut
off for detorsion for the following 3 hours. In Group 4
(torsion/detorsion+losartan), 2.5 hours of ischemia was
followed by administration of 40 mg/kg losartan 30 min-
utes prior to a 3-hour detorsion/reperfusion. Biochemical
assays (MDA, SOD, CAT, and GSH levels) and his-
topathologic results were examined in testicular tissue.
The TUNEL assay method was used for DNA frag­
mentation analysis in testicular seminiferous tubule
sections.
RESULTS: Losartan treatment seemed to prevent the
increase in MDA levels of torsion/detorsion–induced
testis. Statistically, SOD, CAT, and GSH activities were
significantly decreased in the torsion/detorsion group,
while they were increased in the torsion/detorsion+
losartan group. Testicular tubule diameter measure-
ments were evaluated between groups. In the torsion
and torsion/detorsion group, degeneration and loss
in the germ cells together with organization disorder
were observed. In the losartan application, degenerative
changes were decreased and tubular structure was pre-
served. In the torsion and torsion/detorsion groups, an
increase in apoptosis was observed in the germ cells in
the tubules, and it was observed that the application of
losartan decreased germ cell apoptosis.
CONCLUSION: The experimental testis torsion/detor-
sion study suggests a protective role for losartan upon
Analytical and Quantitative Cytopathology and Histopathology®
Effects of Losartan on Ischemia/Reperfusion–
Induced Testicular Injury in a Rat Testicular
Torsion Model
Mehmet Yariş, M.D., and Engin Deveci, Ph.D.
From the Department of Urology, Genesis Hospital, Diyarbakır, and the Department of Histology and Embryology, Dicle University
Medical School, Diyarbakır, Turkey.
Mehmet Yariş is Surgeon, Department of Urology, Genesis Hospital.
Engin Deveci is Professor, Department of Histology and Embryology, Dicle University Medical School.
Address correspondence to: Engin Deveci, Ph.D., Department of Histology and Embryology, Dicle University Medical School, Univer-
sity Street, Diyarbakır 21280, Turkey (engindeveci64@gmail.com).
Financial Disclosure: The authors have no connection to any companies or products mentioned in this article.

2. ischemia and ischemia/reperfusion injury in rat testes.
(Anal Quant Cytopathol Histpathol 2020;42:139–
147)
Keywords: detorsion; ischemia-reperfusion inju-
ry; losartan; rats, Wistar; reperfusion injury; sper-
matic cord torsion; testicular torsion; testis; tor­
sion abnormality; torsion-detorsion; TUNEL assay
analysis.
Testicular torsion or torsion of the spermatic cord
is one of the most serious urological conditions
seen, occurring most commonly in newborn and
adolescent males. This condition causes testicular
injury, leading to infertility.1,2 The twisting of the
spermatic cords around themselves gives rise to
biochemical and histopathological changes and,
finally, dysfunction of the testes.3 With testicular
torsion, blood flow to the testicular tissues is in­
terrupted, leading to ischemia in the organ and
degradation products occurring in the tissue.4,5
When the testicular torsion resolves, detorsion (in
other words reperfusion) occurs, and that causes
severe damage in the tissue. This torsion/detor-
sion injury is a result of restored blood circulation.
When the blood enters the tissue, excessive free
oxygen radical production, intracellular calcium
overload, and lipid peroxidation occur, generating
testicular oxidative stress. This results in cellular
and tissue damage.6
The testes are very sensitive to free radical
damage, and therefore torsion and detorsion injury
is a subject of interest. Various therapeutic agents
have been used on testicular injury induced by
torsion/detorsion, such as antioxidants, phyto-
therapeutics, modulators of inflammation, and va­
sodilators.6,7 Losartan, a blocker of angiotensin II
type 1 receptor, inhibits oxidative damage in cells
during ischemia/reperfusion damage. Losartan
has several beneficial effects on the vasculatures,
including decreases in total peripheral resistance
and cardiac venous return.8 In a study, angiotensin
II type 1 receptor blocker was used to protect tis-
sues and alleviate the harmful effects of oxidative
damage.9 In this study we aimed to investigate
the antioxidant effects of losartan, angiotensin II
type 1 receptor blocker, on the apoptosis of mi-
crobe cells in torsion/detorsion damage in rats
using the TUNEL assay method.
Materials and Methods
All experimental protocols were conducted accord-
ing to the National Institutes of Health Guidelines
for the Care and Use of Laboratory Animals. The
study was approved by the local ethics commit-
tee. Forty male Wistar albino rats with a mean
weight of 200–250 g were used. They were housed
in an air-conditioned room with 12-hour light and
dark cycles, where the temperature (23±2°C) and
relative humidity (65–70%) were kept constant.
In this study all surgical procedures were per-
formed after intramuscular injection of 50 mg/kg
ketamine hydroxide (Ketalar, Pfizer, Turkey) and
10 mg/kg xylazine (Rompun, Bayer, Germany) for
general anesthesia. All operations were performed
under sterile conditions. The animals were ran-
domly divided into 4 groups. The experiment was
conducted with a total of 40 male rats divided into
4 groups (n=10 rats per group).
Control Group. These animals did not undergo any
surgical operation and were sacrificed at the end of
the experiment.
Torsion Group. Ischemia injury was induced by
torsion of the left testis, with a 720° twisting of
the spermatic cord to produce a total occlusion of
the testis for 2.5 hours.
Torsion/Detorsion Group. The left testicles were re-
perfused for 3 hours after 2.5 hours of ischemia.
Torsion/Detorsion+Losartan Group. The left testicles
were twisted clockwise 720°, and after 2.5 hours
of ischemia, 40 mg/kg of losartan was adminis-
tered to the animals. The scrotum sutures were
opened and the left testicles returned to the nor-
mal position. The scrotums were closed again, and
the testicles were reperfused for 3 hours. All ani-
mals were sacrificed at the end of the reperfusion
period.
Surgical Procedure
Rats were anesthetized under aseptic conditions
by intramuscular injection of 50 mg/kg ketamine
hydroxide and 10 mg/kg xylazine. The tunica was
removed with the help of a forceps to make the
tunica vaginalis testis visible. A scrotal pocket
was created to place the testicles back into the
scrotum after twisting. The left testicle was rotated
720° degrees clockwise for 2.5 hours around the
longitudinal axis of the spermatic cord to create
torsion. To prevent deterioration, testis dartos and
testicular tunica albuginea were fixed in the scro-
tal pocket by passing a 4/0 nontraumatic absorb-
140 Analytical and Quantitative Cytopathology and Histopathology®
Yariş and Deveci

3. able suture. After the torsion procedure, a return
was made for 3 hours for detorsion.
Biochemical Analysis
MDA, SOD, CAT, and GSH levels were exam-
ined in testicular tissue. Tissue samples were ho-
mogenized with ice-cold 150 mMKC. MDA levels
were assayed for products of lipid peroxidation,
and the results were expressed as nmol MDA/g
tissue.10 The SOD activity in the tissue was mea-
sured using the RANSOD kit (Randox Laborato-
ries, Crumlin, UK). GSH was determined by the
spectrophotometric method based on the use of
Ellman’s reagent, and the results were expressed
as μmol glutathione/g tissue.11 CAT activity was
determined by the spectrophotometric meth-
od based on the ability of hydrogen peroxide to
form a stable stained complex with molybdenum
salts.12
Histopathological Examination
Testes samples were fixed in neutral buffered for-
malin solution, directly dehydrated in a graded
series of ethanol solutions, and embedded in par-
affin wax. Sections 4–6 µm thick were cut with a
microtome (RM2265 rotary microtome; Leica, Ger-
many) and mounted on coated slides. The sections
were subjected to hematoxylin-eosin staining for
observation under a light microscope.
TUNEL Assay Analysis
Testicular apoptosis was analyzed using termi-
nal deoxynucleotidyl transferase enzyme-mediated
dUTP nick-end labeling (TUNEL) method. Sec-
tions 4–6 µm thick were cut from the paraffin
blocks of the samples. TUNEL staining of the
sections was done using ApopTag Plus Peroxi-
dase In Situ Apoptosis Detection Kit (Millipore,
#S7101, Burlington, Massachusetts, USA) in accor-
dance with the manufacturer’s instructions. Sec-
tions were dewaxed in xylene, rehydrated, and
incubated with proteinase K for 10 minutes and
rinsed in distilled water. Endogenous peroxidase
activity was inhibited by 3% hydrogen peroxide.
Sections were then incubated for 10–15 seconds
with equilibration buffer and TdT enzyme in a
moist atmosphere at 37°C for 60 minutes. It was
then placed in a pre­
heated working power stop/
wash buffer for 10 minutes at room temperature
and incubated with anti-digoxigenin-peroxidase
for 30 minutes. Each step was separated by care-
fully washing in PBS. The staining was done with
DAB, and the coun­
terstaining was done in Mayer’s
hematoxylin.
Statistical Analysis
Statistical analysis was performed with IBM SPSS
Statistics for Windows, version 20.0 (IBM Corp.,
Armonk, New York). Data were expressed as
mean±SD for each group. To evaluate the dis­
tribution of numerical variables, a normality test
(Shapiro-Wilk test, which is important for con-
sideration at p<0.05) was performed. Kruskal-
Wallis test and Dunn-Bonferroni post-hoc test
were used to compare the groups. P<0.05 was
taken as the level of significance.
Results
Biochemical Results
MDA levels in the testicular tissues of rats in the
torsion/detorsion group were significantly in-
creased as compared to the sham group, while
the MDA levels in the torsion/detorsion+losartan
group were significantly decreased as compared
to the torsion/detorsion group. Losartan treatment
prevented the torsion/detorsion-induced eleva-
tion of MDA levels in the testis. The SOD, CAT,
and GSH activities of testicular tissue significant-
ly decreased in the torsion/detorsion group as
compared to the control group. These values were
significantly increased in the torsion/detorsion+
losartan group as compared to the torsion/detor-
sion group. The MDA, SOD, CAT, and GSH levels
of the sham, torsion/detorsion, and torsion/de-
torsion+losartan groups are shown in Table I and
Figure 1.
Histopathological Findings
Testicular tubule diameter measurements were
evaluated among the groups. There was a signifi-
cant difference between the sham, torsion/detor-
sion, and torsion/detorsion+losartan groups. A
significant improvement in the seminiferous tu-
bule diameter was observed in the group treated
with losartan after torsion/detorsion injury (Ta­
ble I). Figure 2 shows the results of H-E stain-
ing of testicular tissue of all groups. The control
group showed normal histology of the seminifer-
ous tubules (Figure 2A). Degenerated spermato-
genic cells with pyknotic nuclei, deformed Sertoli
cells, increased connective tissue, and degenerated
(arrow) Leydig cells after torsion (yellow arrow)
are shown in Figure 2B. In the torsion/detor-
sion group, degenerated spermatogenic cells with
Volume 42, Number 5/October 2020 141
Losartan and Testicular Torsion Injury

4. apoptosis, disorganized Sertoli cells (arrow), and
mononuclear cell infiltration (red arrow) were
observed (Figure 2C). In the torsion/detorsion+
losartan group, Sertoli cells were structurally nor-
mal (Figure 2D). Spermatogenic cell lines seemed
to be organized with some degenerated primary
spermatogenic cells (arrow). In the intertubular
area we observed mild dilated blood vessels (red
arrow), decreased cell infiltration, and degenerated
Leydig cells (yellow arrow).
Apoptotic Findings
Apoptotic cells were identified by the TUNEL
assay, and statistical results are shown in Table II.
A graphical illustration of Table II is presented in
Figure 3. In testicular tissue evaluation the apo-
ptotic index was normal in terms of spermato-
genesis in the control group. In the torsion/de-
torsion group a significant increase in apoptosis
was observed in the torsion group as compared
to the control group. There was a significant loss
in germ cells (p<0.01). In the application of lo-
sartan, the apoptotic index reached a value close
to that in the control group, and a decrease in
the cells undergoing apoptosis was observed (p>
0.05).
TUNEL assay staining is shown in Figure 4
for apoptotic analysis. Negative expression was
abundant in Group 1 (control). In group 2 (tor-
sion) and 3 (torsion/detorsion) significant degen-
erative changes were observed in spermatogenic
cells of the testis. There was a significant decrease
in group 4 (torsion/detorsion+losartan) as com-
pared to groups 2 and 3.
Discussion
A number of experimental evidences have been
reported for the use of different components in
testicular torsion/detorsion injury treatment.13,14
These studies showed that those components pre-
vented or reduced testicular damage following
reperfusion, further showing that the primary
cause of testicular damage was generated by reac-
tive oxygen species (ROS) production, mitochon­
drial calcium overload, and cellular apoptosis.
Ozbek et al15 suggested in an experimental study
that testicular torsion significantly decreased SOD
and CAT levels when compared to the control
142 Analytical and Quantitative Cytopathology and Histopathology®
Yariş and Deveci
Table I Comparison of MDA, SOD, CAT, and GSH Activities and Diameter of Seminiferous Tubules in All Groups
Multiple
Kruskal- comparisons for
Wallis groups (Dunn-
Mean test Bonferroni test)
Parameter Group Mean±SD rank value (p<0.05)
MDA (1) Control 6.38±0.38 11.70 32.905 (3)
(2) Ischemia 8.69±0.81 25.40 p=0 (4)
(3) Ischemia/reperfusion 13.27±0.57 35.50 (1) (4)
(4) Ischemia/reperfusion/losartan 6.25±0.45 9.40 (2) (3)
SOD (1) Control 3.15±0.31 29.90 30.388 (2) (3)
(2) Ischemia 1.76±0.35 13.20 p=0 (1) (4)
(3) Ischemia/reperfusion 1.43±0.18 7.80 (1) (4)
(4) Ischemia/reperfusion/losartan 3.23±0.46 31.10 (2) (3)
CAT (1) Control 0.039±0.006 30.95 31.915 (2) (3)
(2) Ischemia 0.025±0.004 15.95 p=0 (1) (4)
(3) Ischemia/reperfusion 0.014±0.002 5.55 (1) (4)
(4) Ischemia/reperfusion/losartan 0.039±0.003 29.55 (2) (3)
GSH (1) Control 359.6±8.76 29.30 29.902 (2) (3)
(2) Ischemia 300.3±32.6 8.80 p=0 (1) (4)
(3) Ischemia/reperfusion 312.8±2.91 12.70 (1) (4)
(4) Ischemia/reperfusion/losartan 363.3±6.80 31.70 (2) (3)
Diameter of (1) Control 307.8±6.73 31.60 29.459 (2) (3)
seminiferous (2) Ischemia 260.3±14.2 10.20 p=0 (1) (4)
tubule (3) Ischemia/reperfusion 259.7±8.15 10.80 (1) (4)
(4) Ischemia/reperfusion/losartan 304.0±9.23 29.40 (2) (3)

5. groups. Meštrović et al16 suggested that GSH ac-
tivities in the ipsilateral testes of the treatment
group were significantly higher than those in the
torsion/detorsion group. MDA levels were found
Volume 42, Number 5/October 2020 143
Losartan and Testicular Torsion Injury
Figure 1 Graphical illustration of MDA (A), CAT (B), GSH (C),
SOD (D), and seminiferous tubule diameter (E) of all groups.

6. to be significantly higher in the torsion/detorsion
group as compared to the sham and torsion/de-
torsion+losartan groups. The SOD, CAT, and GSH
levels were found to be significantly lower in the
torsion/detorsion group as compared to the con-
trol and torsion/detorsion+losartan groups. There
was a decrease in the basal membrane thickness of
tubules in the torsion/detorsion+losartan group
as compared to the torsion/detorsion group (Ta­
ble I) (Figure 1). An antioxidant, Ebselen, given
after testicular torsion/detorsion exhibited ROS
144 Analytical and Quantitative Cytopathology and Histopathology®
Yariş and Deveci
Figure 2 H-E staining of testicular tissue of all groups. (A) The control group showed normal histology of the seminiferous tubules.
(B) Degenerated spermatogenic cells with pyknotic nuclei, deformed Sertoli cells, increased connective tissue, and degenerated (arrow)
Leydig cells after torsion (yellow arrow). (C) In the torsion/detorsion group, degenerated spermatogenic cells with apoptosis, disorganized
Sertoli cells (arrow), and mononuclear cell infiltration (red arrow) were observed. (D) In the torsion/detorsion+losartan group, Sertoli cells
were structurally normal. Spermatogenic cell lines seemed organized with some degenerated primary spermatogenic cells (arrow). In the
intertubular area was mild dilated blood vessels (red arrow), decreased cell infiltration, and degenerated Leydig cells (yellow arrow).
Table II Mean Apoptotic Cell Number in Testicular Tissue of All
Groups with Minimum and Maximum Values
Mini- Maxi-
Group Mean±SD mum mum p Value
Control 2.24±1.01 0.88 3.75 <0.01
Torsion 12.35±2.26 8.7 17.82
Torsion/detorsion 26.91±4.20 21.6 32.93
Torsion/detorsion+
losartan 3.63±1.39 1.54 6.4 >0.05

7. Volume 42, Number 5/October 2020 145
Losartan and Testicular Torsion Injury
Figure 3
TUNEL assay results of the
mean number of positive cells
in all groups. Positive cell rate
was highest in the torsion/
detorsion group. Control group
and torsion/detorsion+losartan
values were similar. Columns
with different asterisks are
significantly different
(*p<0.01 as compared to
control, **p<0.01 as
compared to control and
torsion groups). D = detorsion,
L = losartan, T = torsion.
Figure 4
Stainings of TUNEL assay for
control (A), torsion (B), torsion/
detorsion (C), and torsion/
detorsion+losartan (D) groups
with positive (arrow) and
negative (arrowhead)
expression in seminiferous
tubules. TUNEL assay.
Bar=50 µm.

8. scavenging activity and decreased histopathologi-
cal changes.17 Lycopene with its antioxidant prop-
erties was used for the torsion/detorsion injury
and was reported to offer protection in the early
phase.18 Kushwaha and Jena19 investigated pos-
sible protective mechanisms of telmisartan in the
germ cell of diabetic rats. However, they have
shown that telmisartan significantly reduces both
oxidative and nitrosative stresses, inflammation,
and germ-free death in testicles. In a study in rats,
losartan has been shown to partially reverse the
angiotensin II type 1 receptor–dependent increase
in interstitial fibrosis and spermatogenesis disrup­
tion during oxidative stress.20 Losartan has a pro-
tective effect against germ cell apoptosis in testic-
ular tissue caused by an experimental varicocele.21
Gokce et al22 showed that intraperitoneally inject-
ed 30 mg kg-1 losartan, which was higher than our
study dose, reduced tubular damage and apop-
tosis in contralateral testicles after unilateral tes-
ticular torsion in rats. It was revealed that the use
of melatonin as an antioxidant decreased tissue
damage and biochemical parameters of oxidative
stress.23 Another antioxidant, selenium, was shown
to reduce oxidative stress and protected against
testicular injury resulting from torsion/detorsion.24
In the torsion group of our study, degeneration
in spermatogenetic cells, pyknosis in lost nucleus,
and deformities in Sertoli cells were observed. In
addition, there was obstruction, dilation, and con-
nective tissue in the blood vessels in the intersti-
tial area and degeneration in the Leydig cells (Fig-
ure 2B). In the torsion/detorsion group, spermato-
genetic cells in seminiferous tubules increased in
degeneration and apoptosis in the cell nucleus
and organization disorder in Sertoli cells. Mono-
nuclear cell infiltration and degenerative changes
in Leydig cells were observed in the intertubular
area (Figure 2C). In the group where the torsion/
detorsion+losartan was applied, the structure of
the spermatogenetic cells regularly maintained the
triangular structure of the Sertoli cells along the
basement membrane towards the lumen, the slight
expansion of blood vessels in the intertubular area,
the decrease in cell infiltration, and the absence of
Leydig cells, indicating that the testicular tissue was
preserved (Figure 2D).
In the TUNEL staining technique, DNA thread
breaks can be induced not only by apoptosis but
also by necrosis.25 However, in terms of H&E
staining, inflammatory or necrotic changes have
not been demonstrated in regions showing strong
positive TUNEL staining. Therefore, the positive
TUNEL staining observed has been shown to be
the result of apoptosis rather than necrosis. In
groups 2 (torsion) and 3 (torsion/detorsion), sig-
nificant degenerative changes were observed in
the light microscopic spermatogenetic cells of the
testis (Table II) (Figure 3 and Figure 4B–C). There
was a significant decrease in group 4 (torsion/
detorsion+losartan) as compared to groups 2 and
3 (Table II) (Figure 3 and Figure 4D). Losartan
seems to lower the levels of germ cell apoptosis,
which may be important for protecting the testes
from torsion/detorsion injury.
Many pharmacological agents and therapies for
testicular torsion/detorsion injury have been stud-
ied in animal models, all of which had successful
results. Treatment with the angiotensin II type 1
receptor losartan, a drug that lowers blood pres-
sure, is thought to be an important antioxidant
alternative in preventing ischemia/reperfusion in-
jury and reducing oxidative stress damage by in­
hibiting apoptosis.
References
1. Unsal A, Devrim E, Guven C, Eroglu M, Durak I, Bozoklu
A, Balbay MD: Propofol attenuates reperfusion injury after
testicular torsion and detorsion. World J Urol 2004;22:461-465
2. Ringdahl E, Teague L: Testicular torsion. Am Fam Physician
2006;74:1739-1743
3. Tamamura M, Saito M, Kinoshita Y, Shimizu S, Satoh I,
Shomori K, Dimitriadi F, Satoh K: Protective effect of eda-
ravone, a free-radical scavenger, on ischaemia-reperfusion
injury in the rat testis. BJU Int 2010;105:870-876
4. Werns SW, Lucchesi BR: Free radicals and ischemic tissue
injury. Trends Pharmacol Sci 1990;11:161-166
5. Elshaari FA, Elfagih RI, Sheriff DS, Barassi IF: Oxidative
and antioxidative defense system in testicular torsion/detor-
sion. Indian J Urol 2011;27:479-484
6. Akbas H, Ozden M, Kanko M, Maral H, Bulbul S, Yavuz S,
Ozker E, Berki T: Protective antioxidant effects of carvedilol
in a rat model of ischaemia-reperfusion injury. J Int Med Res
2005;33:528-536
7. Arena S, Iacona R, Antonuccio P, Russo T, Salvo V, Gitto E,
Impellizzeri P, Romeo C: Medical perspective in testicular
ischemia-reperfusion injury. Exp Ther Med 2017; 13(5):2115-
2122
8. Li HW, Gao YX, Grobe JL, Raizada MK, Katovich MJ,
Sumners C: Potentiation of the antihypertensive action of
losartan by peripheral overexpression of the ANG II type 2
receptor. Am J Heart Circ Physiol 2007;292:H727-H735
9. Takaya T, Kawashima S, Shinohara M, Yamashita T, Toh R,
Sasaki N, Inoue N, Hirata K, Yokoyama M: Angiotensin II
type 1 receptor blocker telmisartan suppresses superoxide
production and reduces atherosclerotic lesion formation in
apolipoprotein E-deficient mice. Atherosclerosis 2006;186(2):
402-410
146 Analytical and Quantitative Cytopathology and Histopathology®
Yariş and Deveci

9. 10. Ellati RT, Parviz KK, Terry TT, Jeffrey J, Lysiak JJ: Twist and
shout: A clinical and experimental review of testicular tor-
sion. Korean J Urol 2009;50:1159-1167
11. Doğan G, I
·
pek H: The protective effect of Ganoderma lucid-
um on testicular torsion/detorsion-induced ischemia-reper-
fusion (I/R) injury. Acta Cir Bras 2020;35(1):e.202000103
12. I
·
rtegün S, Deveci E: Examining the expression level of VEGF
and Bcl-2 by immunohistochemistry and Western Blot in
testis tissue of diabetic rats. Dicle Med J 2016;43(4):527-533
13. Hanci V, Erol B, Bektas S, Mungan G, Yurtlu S, Tokgöz H,
Can M, Ozkoçak Turan I: Effect of Dexmedetomidine on tes-
ticular torsion/detorsion damage in rats. Urol Int 2010;84:
105-111
14. Tuglu D, Yuvanc E, Yilmaz E, Gencay IY, Atasoy P, Kisa U,
Batislam E: The antioxidant effect of dexmedetomidine on
testicular ischemia-reperfusion injury. Acta Cir Bras 2015;30:
414-421
15. Ozbek O, Altintas R, Polat A, Vardi N, Parlakpinar H, Sagir
M, Duran ZR, Yildiz A: The protective effect of apocynin
on testicular ischemia-reperfusion injury. J Urol 2015;193(4):
1417-1422
16. Meštrović J, Pogorelić Z, Drmić-Hofman I, Vilović K, Todorić
D, Popović M: Protective effect of urapidil on testicular
torsion-detorsion injury in rats. Surg Today 2017;47(3):393-
398
17. Rifaioglu MM, Motor S, Davarci I, Tuzcu K, Sefil F, Davar-
ci M, Nacar A: Protective effect of ebselen on experimental
testicular torsion and detorsion injury. Andrologia 2014;46:
1134-1340
18. Güzel M, Sönmez MF, Baştuğ O, Aras NF, Öztürk AB,
Küçükaydın M, Turan C: Effectiveness of lycopene on exper-
imental testicular torsion. J Pediatr Surg 2016;51:1187-1191
19. Kushwaha S, Jena GB: Telmisartan ameliorates germ cell
toxicity in the STZ-induced diabetic rat: studies on possible
molecular mechanisms. Mutat Res 2013;755(1):11-23
20. Shiraishi K, Yoshida K, Fujimiya T, Naito K: Angiotensin II
dependent testicular fibrosis and effects on spermatogenesis
after vasectomy in the rat. J Urol 2003;170(5):2104-2108
21. Bolat D, Oltulu F, Uysal A, Kose T, Gunlusoy B, Yigitturk
G, Turk NS, Turan T: Effects of losartan on experimental
varicocele-induced testicular germ cell apoptosis. Androlo-
gia 2016;48(7):840-846
22. Gokce G, Karboga H, Yildiz E, Ayan S, Gultekin Y: Effect of
angiotensin-converting enzyme inhibition and angiotensin
II type 1 receptor blockade on apoptotic changes in contra-
lateral testis following unilateral testicular torsion. Int Urol
Nephrol 2008;40(4):989-995
23. Parlaktas BS, Atilgan D, Ozyurt H, Gencten Y, Akbas A,
Erdemir F, Uluocak N: The biochemical effects of ischemia-
reperfusion injury in the ipsilateral and contralateral testes
of rats and the protective role of melatonin. Asian J Androl
2014;16:314-318
24. Kara Ö, Sari E, Akşit H, Yay A, Akşit D, Dönmez MI: Effects
of selenium on ischaemia-reperfusion injury in a rat testis
model. Andrologia 2016;48:1267-1273
25. Collins RJ, Harmon BV, Gobe GC, Kerr JF: Internucleosomal
DNA cleavage should not be the sole criterion for identifying
apoptosis. Int J Radiat Biol 1992;61:451-453
Volume 42, Number 5/October 2020 147
Losartan and Testicular Torsion Injury