Differential Tissue Responses to Papaverine and Platelet Rich Plasma in Testicular Torsion: Evidence From a Controlled Rat I/R Model.

Testicular torsion leads to ischemia reperfusion (I/R) injury, causing germ cell loss and impaired testicular function. Although papaverine and platelet rich plasma (PRP) have shown protective effects in separate models, their comparative efficacy within the same experimental design remains unclear. This study evaluates and compares the histopathological and biochemical effects of papaverine and PRP in a rat torsion detorsion model. Thirty two adult male Wistar rats were assigned to five groups: sham, torsion, torsion + PRP, torsion + papaverine, and healthy control. A 720° torsion was applied for 3 h, followed by detorsion. PRP or papaverine (1 mg/mL) was injected intratesticularly before detorsion. Necrosis, Cosentino score, fibrosis, interstitial edema, congestion, Johnsen score, apoptosis (TUNEL), and serum testosterone were evaluated. The torsion group exhibited significant increases in necrosis, fibrosis, edema, and apoptosis, with decreased Johnsen scores. Both PRP and papaverine reduced tissue injury. Papaverine showed greater improvement in necrosis and fibrosis, whereas PRP yielded higher testosterone levels and improved spermatogenic activity. Apoptosis decreased significantly in both treatment groups (p < 0.001). Papaverine and PRP provide complementary protective effects against testicular I/R injury through vascular and regenerative mechanisms, respectively. Combined or sequential administration may offer a promising therapeutic strategy following detorsion. Further translational and long-term studies are required.