Torsion of the testis is a very dangerous condition, which is accompanied by the turning of the testicle around its axis and the unnatural twisting of the spermatic cord. As a result of such changes in the structure, the nerves and blood vessels that pass inside the cord are infringed, which can lead to an acute lack of blood supply to the organ.
Of course, many people are interested in additional data. Why does testicular torsion occur in boys and adult men? What symptoms are accompanied by pathology? What treatment methods can be considered effective? What threatens the lack of therapy? This is important information not to be missed.
General pathology information
This pathology is accompanied by twisting of the spermatic cord around its vertical axis. As you know, through the spermatic cord passes the vas deferens, nerves, lymphatic vessels, as well as arteries and veins, which provide tissue of the testis with oxygen and nutrients.
When torsion, the lumen of the blood vessels narrows, which leads to a violation of trophic tissue. Testicles do not receive a sufficient amount of energy substrates and are deprived of the ability to excrete cell waste products. That is why torsion is so dangerous - in a matter of hours, pathology can lead to necrosis.
According to statistics, the problem is recorded in a ratio of 1: 4000. In most cases, pathology is diagnosed in adolescents aged 10 to 16 years. Nevertheless, torsion is not excluded in infants, as well as in patients of mature age.
Testicular torsion: causes
In fact, the causes of this condition may be different.
- If we are talking about torsion of the testicle in an infant, it often develops against the background of the immaturity of the reproductive system, as well as disproportionate growth of the genital organs. Sometimes the pathology is associated with cryptorchidism (in some cases, during the intrauterine development, the testicle does not descend into the scrotum; the pathology is usually diagnosed in premature boys).
- Risk factors include some anatomical features of the male body. Torsion is sometimes associated with hypoplasia or aplasia of the ligament of the testis, congenital lengthening of the spermatic cord, improper attachment of the testicle to the bottom of the scrotum.
- Potentially dangerous is an inguinal-scrotal hernia.
- Risk factors also include the separation of the structures of the spermatic cord (for example, sometimes for one reason or another, there is a separation of the vas deferens and the bundle of nerves, blood vessels).
- In adulthood, various injuries can provoke testicular torsion. Potentially dangerous are considered intense physical activity, as well as active movements (for example, during sports games).
- Risk factors include excessive sexual activity (we are talking about both sexual acts and masturbation).
- To aggravate the situation, wearing too tight underwear and trousers can.
Unfortunately, the reasons can not be determined in every case.
What symptoms should I look for?
Symptoms of torsion are very characteristic. They appear suddenly, and their intensity is constantly increasing. If we are talking about adolescents and adult patients, the clinical picture has a number of features.
- The first symptom is an acute sharp pain in the scrotum. Unpleasant sensations often spread throughout the groin and perineum.
- Sometimes the pain is so strong that it causes reflex reactions. Nausea, vomiting and weakness appear (the patient often temporarily loses the ability to move). A sharp drop in blood pressure is also possible, which leads to a collapse.
- The skin on the scrotum turns pale or acquires a bluish tint. Tissues in this area become very sensitive - any touch or pressure is accompanied by increased pain.
- The scrotum swells, a very noticeable swelling appears. At the same time, you can notice that the twisted testicle is much higher than a healthy testicle.
- Sometimes there is a torsion of testicular hydatides in children and adult men. Hydatide is a rudimentary process, a kind of appendix. The clinical picture in this case is similar. Nevertheless, hydatid necrosis is accompanied by an accumulation of purulent masses, which then fall into all the structures of the scrotum.
It is immediately worth noting that testicular torsion in boys of the first year of life can be completely painless. The main symptom in this case is significant swelling of the scrotum. In addition, the child often behaves uneasily, sleeps poorly, refuses to eat. Possible increase in body temperature.
Classification of pathological conditions
It’s worth mentioning right away that torsion can be either unilateral or bilateral (such cases are extremely rare). In addition, depending on the pathogenesis, two forms of this ailment are distinguished.
- Non-vaginal (suprashell) torsion - a condition in which the spermatic cord is curled together with its membranes. A similar form in most cases is diagnosed in young boys, as it is associated with the immaturity of the structures of the scrotum, as well as the presence of a wide and short inguinal canal.
- Intravaginal torsion is accompanied by twisting of the spermatic cord inside its own membrane.
Possible complications
Torsion of the testis hydrates is a very dangerous condition, which in no case can be ignored. The consequences of refusing therapy can be dire. It is worth reading an impressive list of complications:
- the formation in the tissues of the testicle or scrotum of the abscess, in the cavity of which pus accumulates (under certain conditions, the abscess can open, as a result of which purulent masses and, accordingly, the infection spread to nearby tissues and organs);
- the development of various disorders of the genitourinary system, which is accompanied by pain and burning during urination, as well as the appearance of blood impurities in the urine;
- development of hydrocele is possible - fluid begins to accumulate in the inner shell of the testicle (men complain of a feeling of heaviness in the scrotum, the appearance of discomfort and even pain during walking, sexual intercourse, etc.);
- acute delay in the outflow of urine;
- foci of necrosis in the tissues of the testis are possible, which leads to disruption of sperm production processes and, accordingly, infertility;
- According to statistics, a high probability of the appearance of malignant neoplasms in the testis.
That is why in no case can not hesitate. Having noticed the symptoms of testicular torsion in a child or adult, you need to urgently consult a specialist. The sooner the patient is provided with care, the lower the likelihood of complications.
Diagnostic chart
Diagnosis of this condition is rarely fraught with difficulties. During the examination, the doctor may notice swelling of the scrotum. Palpation is accompanied by sharp pain. The testicle loses its natural mobility. In addition, a specialist can feel for a short but thick spermatic cord. Of course, further studies are carried out in the future, as some other diseases are accompanied by approximately the same symptoms (for example, inflammation of the testicle or appendage).
An ultrasound of the scrotum organs is mandatory. Assessing the echogenicity of various structures, the doctor can determine the presence of necrosis and the degree of its spread. In addition, an ultrasound examination of the vessels of the scrotum is performed, which allows you to determine the quality of blood supply to the organs of the scrotum. To examine the testicles, a diaphanoscopy is performed - with the help of a special device, the doctor “shows through” the scrotum, determines the density of organs.
Sometimes an additional puncture of the testicles is performed. This procedure allows you to determine the composition of the contents of the membranes (for example, whether there is blood in the liquid, notes of pus, etc.).
Conservative treatments
Sometimes a testicle can be corrected conservatively, but only if the patient consulted a doctor when the first symptoms appeared (no later than 6-12 hours). It is worth recalling once again that with every hour the probability of the onset of the necrotic process increases. But cell death is an indication for removal.
The procedure is quite simple and is carried out according to a certain scheme.
- First, the patient changes into comfortable hospital clothing and lies on his back.
- The doctor rotates carefully. If there is a torsion of the right testicle, then it is untwisted clockwise, if it is necessary to return the left testicle "to the place", then the movements are counterclockwise. During the procedure, the testicles are pulled down all the time.
- All manipulations are carried out several times in a row.
After the procedure, the testicle returns to its natural position and becomes mobile. Discomfort and pain also subside. On the other hand, such a procedure is effective in no more than 1-2% of cases. Sometimes in this way it is possible to correct the torsion of testicular hydatides in infants. But adolescents and adult patients in the vast majority of cases require further surgical intervention.
If the procedure is still successful, then in the first few days a man needs to observe a strict regimen. In the first few weeks, it is important to abandon excessive physical activity, establish nutrition (helps prevent constipation), temporarily suspend sexual activity and wear lining specialists who will keep the scrotum and its structure in the right position.
Testicular torsion: operation
It is immediately worth noting that in such a condition the patient needs urgent surgical intervention.
The procedure is performed under general anesthesia. The surgeon makes an incision in the tissues of the scrotum, thus opening up access to its internal structures. Next, the type of inversion is determined. Through transillumination translucence, the doctor determines the degree of damage to the testicles. If most are affected by necrosis, then complete removal is necessary. If the testicle can be saved, then it is suspended in the scrotum so that the spermatic cord does not stretch.
The incision is sutured, leaving a small hole for the drainage tube - this facilitates the outflow of fluid during rehabilitation. If healing is normal, then the drainage tube is removed after a few days.
This is how the testicular torsion is eliminated. After surgery, patients are prescribed a course of antibiotics - this helps prevent further inflammation. The wound is periodically treated with antiseptics, constantly changing dressings.
Unfortunately, sometimes resection is the only treatment for testicular torsion. After the testicles are completely removed, prostheses can be installed. Today, the choice of implants is simply huge.
Hormonal disorders are possible only with bilateral lesions of the testicles with their subsequent resection. In such cases, patients are prescribed hormone therapy. If during the operation only one testicle was removed, then the endocrine system continues to function quite normally.
Rehabilitation period: what rules should be followed?
Surgery for testicular torsion is considered relatively simple. Nevertheless, after the procedure, patients need to follow some recommendations - this will help speed up the healing process and minimize the likelihood of complications.
It is immediately worth noting that the recovery period lasts from 2 to 6 weeks. In the first few days, it is important to constantly change the dressings, treat damaged tissues with antiseptic solutions, as well as decoctions of some medicinal herbs (sage, chamomile, oak bark relieve swelling and inflammation).
In the first few weeks, patients are advised to wear special bandage underwear, which keeps the scrotum organs in position and prevents the formation of edema. Men are sometimes sent to various physiotherapeutic procedures. In addition, hot tubs must be discarded.
Gradually, patients return to their usual way of life. Nevertheless, in the first few months, you should refuse to visit baths and saunas. Hypothermia is also harmful - it is better to dress according to the weather.
Also, experts recommend avoiding heavy lifting and intense physical exertion - this can lead to relapse or torsion of another testicle. During the first 2-3 months, it is better to abandon sexual intercourse, as this also increases the likelihood of complications.
Of course, the patient is registered with a doctor and regularly undergoes scheduled medical examinations (even if some disturbing symptoms are completely absent).
Predictions for Patients
Predictions actually depend on when the pathology was diagnosed and whether the patient received appropriate assistance on time. According to statistics, only in 2-3% of cases, testicular torsion can be eliminated conservatively.
In the vast majority of cases, the patient requires surgery. The success of the procedure largely depends on how quickly the operation was performed after the onset of symptoms. If the patient went to the doctor immediately (up to 6 hours), then the success of the procedure is almost one hundred percent. If about 12-24 hours have passed since the first signs appeared, then the testicle can be saved in about 50-20% of cases.
After the operation, the patient is required to be registered with a doctor and regularly take tests, since an ailment increases the risk of developing cancer.
Preventive actions
Unfortunately, specific prophylaxis of testicular torsion does not exist. Men are nevertheless advised to avoid injuries to the perineum. For example, when it comes to contact or potentially dangerous sports, you should always use special protective guards for the groin.
Also, do not wear tight underwear made of synthetic fabrics - it is better to give preference to models of free cut with natural materials. When the first alarming symptoms appear (for example, pain or swelling of the testicles), you should immediately consult a doctor. The sooner treatment is started, the lower the likelihood of complications.