Role of Papaverine in Salvaging Torsion Testis: a Pilot Study

Abstract

Torsion of the testis is usually salvageable until 4–6 h. In the present study, we have tried to investigate the effect of papaverine on salvaging the testis. This is the first pilot study of its kind on the effect of papaverine in the human testis. A total of 11 patients presented at our hospital during February 2018–September 2019 with the diagnosis of testicular torsion. Scrotal exploration, detorsion, and warm saline immersion were done and return of color was observed. When no blood flow returned by needle prick, then diluted papaverine injection (1/5 dilution of 2 ml of 30 mg/ml strength) was infiltrated using 30-gauge needle into the distal 3 cm of the spermatic cord. The testis was again placed in warm saline for 5 min and needle prick was done to confirm the vascularity. Orchiopexy or orchidectomy was performed depending upon the vascularity status. Mean time elapsed to operation theater was 5–32 h (mean 7.8 h). Mean age of the patients was 19.27 years. Seven out of eleven (66.63%) cases underwent orchiopexy. Five out of seven patients benefitted from papaverine injection (mean time 13.4 h). In 2 patients, vascularity returned just after warm saline immersion, and papaverine was not required (mean time 5.5 h). Four out of eleven patients needed orchidectomy (mean time 21.2 h). Papaverine has a promising protective effect in restoring the vascularity in torsion testis cases after surgical exploration and detorsion.