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The protective effect of dehydroepiandrosterone on ovarian tissues after torsion-detorsion injury: a stereological and histopathological study.

OBJECTIVE
Ovarian torsion is a rare problem in pre-pubescent girls that must be included in the differential diagnosis of patients with abdominal or pelvic pain. Current advice for treatment to support ovary preservation considers the macroscopic appearance of the ovary, but this is not a reliable indicator of the degree of injury in cases of ovarian torsion. The aim of this study was to determine the effects of dehydroepiandrosterone (DHEA) treatment on the rat ovary after torsion-detorsion injury using a histopathological approach and stereological methods.


MATERIALS AND METHODS
Fifteen adult female Sprague Dawley rats were divided into three groups: sham operated (Control; n=5), torsion-detorsion with saline (Saline; n = 5), and torsion-detorsion with DHEA (DHEA; n = 5). Rats in the sham-operated group underwent a surgical procedure similar to the other groups, but the adnexa were not torsioned. The DHEA group was injected intraperitoneally 3 hours before detorsion and saline was administered to the saline group. After 24 h of adnexal detorsion, the rats in all groups were sacrificed and the adnexa were removed. The volume of ovarian stroma and edema were estimated using the Cavalieri Principle and were applied to serial paraffin sections. Ovary sections were also evaluated histopathologically.


RESULTS
The volume of ovarian edema was 35.4% lower in the saline group compared to the control group (p> 0.05). The volume of ovarian edema increased by 73.4% in the DHEA group (p<0.05). In the experimental groups, stromal volume was 41.0% higher in the saline group and 52% higher in the DHEA group in comparison to the control group. Statistically significant differences were found when comparing the volume of both ovarian edema and stroma between experimental groups (Detorsion/Saline group - Detorsion/DHEA group; p< 0.01). Histopathologically, mononuclear cell infiltration and vascular dilatation, perivascular edema and common necrotic changes were obvious in the torsion-detorsion damaged ovary. These changes were partially ameliorated by DHEA treatment.


CONCLUSIONS
The present study shows that administration of DHEA has beneficial effects in the prevention of ischemia-reperfusion injuries of the ovaries.