In daily life, many adolescent boys with scrotal pain are embarrassed to seek medical attention, do not recognize the danger of testicular torsion, paralyze and tolerate the pain again and again, and even some non-urosurgical doctors may treat it as epididymitis and other diseases, thus delaying early treatment, resulting in the loss of fertility of individuals and lifelong misfortune. Therefore, patients in and around puberty who suddenly develop scrotal swelling and pain, especially teenagers, should consider the possibility of testicular torsion and go to a hospital urology department for examination and treatment as soon as possible.
Because, 6 hours from the onset of the disease determines whether the testicle can be preserved or not!
Definition
The testicle is attached to the scrotum by the testicular tract, which holds the testicle to the scrotum. Some fetuses develop with one or both testicular tracts being too long, and after birth, the testes become very mobile with the spermatic cord. In some cases, some degree of torsion of the testicle and spermatic cord can occur, also called spermatic cord torsion. It occurs mainly between the ages of 10 and 30 years, with a peak age of 13 to 15 years. 2% of cases can occur with bilateral testicular torsion.
Clinical presentation
It is most common in boys between 13-15 years of age in the prepubertal period. 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 into 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. Nausea and vomiting may occur.
5.A few hours after the symptoms appear, the scrotum will be red, swollen and painful to touch.
Diagnosis
1.Sudden onset of severe testicular pain, rapid swelling of the testicles, and severe nausea and vomiting.
2.Tenderness of the testicle is obvious, and holding the testicle high cannot relieve or aggravate the pain. The position of the testicles and epididymis is abnormal or unclear to palpation.
3.Color Doppler ultrasonography: The testicular blood circulation is impaired due to torsion of the spermatic cord itself, which is manifested by enlargement of the affected testicle and hypoechogenicity. 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, it should be treated as soon as possible within 6 hours. It includes both surgical repositioning and manual repositioning.
1.Surgical repositioning (recommended)
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 testis and observing normal blood flow, the testis, spermatic cord and inner scrotal sheath should be intermittently sutured and fixed to avoid postoperative recurrence. 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 the testicle in transverse position and elevated should be gently repositioned after half an hour. After successful repositioning, hold the scrotum and let the affected testicle rest fully. However, the manipulation cannot prevent recurrence after the resetting.
After surgery, ice packs can be applied to reduce pain and edema, while the scrotum is elevated and supported by tight underwear for one week to allow for gradual recovery of normal function.