An emergency that, although it may not affect the life of the patient, may affect the birth of offspring if not handled properly. This emergency is called: testicular torsion.
The testicle is attached to the scrotum by the testicular tract, which holds the testicle to the scrotum. After birth, the testicle and the spermatic cord are very mobile. If the testicle is suddenly subjected to force or violent shock, the testicle and the spermatic cord will be twisted to a certain extent, which is also called spermatic cord torsion.
1.Clinical manifestations
The onset of testicular torsion is rapid, mostly during sleep, and the patient will have severe pain in one testicle and scrotum. At the beginning of the torsion, the pain is limited to the scrotum, but later it will develop to the lower abdomen and perineum, accompanied by vomiting, nausea or fever, 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 torsioned testicle appears to be higher in the scrotum than the normal testicle.
(4) The child may experience nausea and vomiting.
(5) Several hours after the onset of symptoms, the scrotum may become red, swollen, and painful to the 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 more rapidly.
2.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 testes and epididymis is abnormal or unclear to palpation.
(3) Color Doppler ultrasonography: blood circulation to the testis is impaired due to torsion of the spermatic cord itself, which is manifested by enlargement of the affected testis and hypoechogenicity. Color Doppler flowmetry shows that the blood flow signal within it is significantly reduced or disappeared.
3.Differential diagnosis
(1) Acute epididymitis: there is usually fever, pain gradually increases, no change in the position of the testicle attached in the scrotum, no thickening and shortening of the spermatic cord, and the pain can be slightly reduced by holding up the scrotum.
(2) Scrotal hematoma: there is a history of trauma.
4.Treatment
If testicular torsion occurs, the best treatment is to perform surgery. Surgical methods include 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 onset 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 even 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 the 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 the surgery, ice packs can be applied to reduce the pain and edema, and the scrotum should be supported and fixed with the “D” band for one week so that the normal function can be gradually restored.
5. 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 lifelong misfortune for others who lose their fertility. 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 hospital urology department 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.