The testicle is attached to the scrotum by the testicular tract, which holds the testicle in the scrotum. Some fetuses develop with one or both testicular tracts too long, and after birth, the testicle and spermatic cord become very mobile. If there is a sudden force or violent shock, the testicle and spermatic cord will twist to some extent, also called spermatic cord torsion.
Clinical manifestations
The onset of testicular torsion is rapid and usually occurs during sleep, with severe pain in one testicle and scrotum. The pain is initially confined to the scrotum, but later develops in the lower abdomen and perineum, accompanied by vomiting, nausea or fever, and redness, swelling and pressure pain in the pubic area.
1. Sudden onset of severe pain in the abdomen.
2. Severe pain in the testicles.
3.The testicle with torsion appears to be higher in the scrotum than the normal testicle.
4.The child may experience nausea and vomiting.
5.A few hours after the symptoms appear, the scrotum will be red, swollen and painful to touch.
The clinical manifestations of testicular torsion are mainly pain and swelling. If it occurs in a pediatric patient, it is often more difficult to diagnose. The pediatric patient will have unexplained anorexia and restlessness, and the condition usually develops quickly.
Diagnosis
1.Sudden onset of severe testicular pain and rapid swelling of the testicles, accompanied by severe nausea and vomiting.
2.Testicular tenderness is obvious, and the pain cannot be relieved or aggravated by holding up the testicles. The position of the testicles and epididymis is abnormal or indistinct on palpation.
3.99mTC testicular scan, showing reduced blood perfusion in the affected testis.
4.Color Doppler ultrasonography: testicular blood circulation is impaired due to torsion of the spermatic cord itself, which shows enlarged and hypoechoic testis on the affected side. Color Doppler flowmetry shows that the blood flow signal within it is significantly reduced or disappeared.
Differential diagnosis
1. Acute epididymitis
Patients are often febrile, and purulent cells are seen on urinalysis.
2. Scrotal hematoma
These patients have a clear history of trauma.
3.Syringomyelia
This is a chronic developing disease, usually not very painful and transmissible.
Treatment
If testicular torsion occurs, the best treatment is to perform surgery. The surgical method includes both surgical repositioning and manual repositioning.
1.Surgical repositioning
After the diagnosis of testicular torsion is made, time should be sought for immediate surgical repositioning, and the surgery should be completed within 6 hours of the appearance of symptoms. After resetting the torsioned testicle and observing normal blood flow, the testicle, spermatic cord and inner scrotal sheath should be fixed with interrupted sutures to avoid recurrence after surgery. If the blood circulation of the testis is found to be extremely poor during the operation, and the testis cannot be restored after the reset, the testis should be removed.
2.Manual repositioning
Generally, it can be tried at the beginning of the disease. Analgesics and antispasmodics should be given first, and then after half an hour, the testicle in transverse position and elevated should be gently repositioned by manipulation. After successful repositioning, the scrotum should be held up with a “d” belt to allow the affected testicle to rest fully. However, after the repositioning, it is not possible to prevent recurrence.
After surgery, ice packs can be applied to reduce pain and edema, and the scrotum should be supported with a “d” band for a week to allow normal function to return gradually.
Prevention
In daily life, many patients are paralyzed by testicular torsion and tolerate the pain again and again, thus delaying the early treatment and causing others to lose their fertility, resulting in lifelong misfortune. Therefore, patients around the time of puberty who suddenly develop scrotal swelling and pain, especially adolescents, should consider the possibility of testicular torsion and go to the urology department of the hospital for examination and treatment in a timely manner.
In the early stage of testicular torsion, good results can be obtained with freehand reset. However, when the onset is longer, only surgery can be performed. In addition, if testicular torsion unfortunately occurs, after treatment, you should ask your doctor to do a routine semen examination to understand the function of the diseased testicle and the opposite testicle, which is more important for unmarried young men.