Testicle twist

Testicular torsion is an emergency condition caused by the rotation of the testicle, as well as a subsequent failure in the normal blood supply.

The content of the article:
Causes of testicular torsion
Symptoms of testicular torsion
Diagnosis of testicular torsion
Treatment of testicular torsion
Technique of surgery for testicular torsion
Rehabilitation period
Testicle twist
Testicular torsion is not a common disease, it occurs once in 500 patients, according to urological clinics. Symptoms of testicular torsion among young children are noticed only in 20% of cases; in 10 years and adolescence, the disease is determined much faster. The consequences of testicular torsion can lead to male infertility.

Classification of testicular torsion
Modern medicine distinguishes between two forms of the disease:

Extravaginal testicular torsion — observed in boys up to a year;
Intravaginal torsion of the testicle.
Causes of testicular torsion
The first reason for the appearance of testicular torsion are all kinds of injuries and various bruises of the scrotum, sharp sports exercises and movements, frequent abdominal strains that provoke muscle contraction, which raises the testicles.

The mechanism of development of this anomaly is as follows:

When the testicle is twisted, a rotation around the axis occurs. If the rotation of the testicle with the spermatic cord exceeds 180 °, blood circulation is disrupted in the testicle, the skin of the scrotum swells, hemorrhages form, and vein thrombosis occurs in the spermatic cord.

Testicular torsion in most cases, unilateral, bilateral torsion occurs — this is very rare, according to the mechanism of development of torsion, there are: extravaginal and intravaginal.

Extravaginal torsion of the testicle develops together with its shell.

Intravaginal testicular torsion develops in the cavity of the vaginal membrane. This twist is observed in boys over the age of 3 years, and especially at the age of 16. The twisting of the testicle in this case develops as follows: in the process of contraction of the muscle that lifts the testicle, together with the surrounding membranes, the testicle itself rises up and makes rotational movements. The spermatic cord in children after 3 years of age is already well developed, which does not allow the testicle to make a complete revolution, so rotation around the axis will be stopped at a certain moment. In the upper part of the scrotum, the testicle, raised up, is fixed and held with the help of its convex parts in a horizontal position. In the future, the muscles lifting the testicle will contract and the twisting will continue.

Symptoms of testicular torsion
Testicular torsion has clearly pronounced acute symptoms, which are manifested by sharp pain in the corresponding part of the scrotum, often the pain radiates to the groin and perineum, sometimes this deviation is accompanied by severe nausea and vomiting. A general increase in body temperature is also possible. First of all, the symptoms of testicular torsion directly depend on the duration of the disease and the age of the boy. In newborn boys, testicular torsion is found in the form of a noticeable increase in the affected half of the scrotum. Doctors often note paleness of the skin on the scrotum, cyanosis, as well as hydrocele. Older boys often complain of sharp pain in the lower abdomen, perineum and groin area. Patients with testicular torsion have a syndrome such as frequent urination.

Diagnosis of testicular torsion
The urologist can diagnose this disorder only by the combination of symptoms that the patient describes and the results of tactile, ultrasound and laboratory examination.

First of all, it is necessary to examine the patient’s abdominal area, genitals and perform a rectal examination. Doctors pay special attention to the presence of characteristic secretions from the patient’s urination channel, the presence or absence of a hydrocele on the opposite side, the presence of excess tissue in the testicle and appendage, as well as a change in the color of the scrotum.

Usually, the texture is palpated from above the scrotum, this is directly related to the shortening in the size of the spermatic cord. During palpation, the scrotum will be slightly painful. Sometimes, if there is a twist, the appendage may be located in front of the testicle, which is why the patient has swelling of the scrotum and hyperemia. In order to exclude any infection from entering the patient’s body, a laboratory urine test is mandatory. Ultrasound examination is also recommended. With ultrasound, an experienced urologist can obtain evidence of the presence or absence of blood flow in the testicle.

Differential diagnosis of this disease often reveals orchitis complicated by infectious mumps and allergic edema. When twisted, as a rule, the scrotum as a whole increases, the liquid permeates all layers and forms a watery bubble under the skin.

Treatment of testicular torsion
In 3% of cases, testicular torsion can be eliminated in the first hours without medical intervention, by external manual detorsion.

Testicular detorsion is performed during the torsion of the right testicle and the torsion of the left testicle in the same way:

the patient is laid on his back, detorsion is performed in the opposite direction to the inversion of the testicle. Simultaneously with detorsion, the testicle is pulled downwards. If the detorsion was carried out successfully, then the pain in the testicle disappears or noticeably decreases. The testicle becomes more mobile and occupies its usual position in the scrotum. If the detorsion was ineffective, the patient has to be operated on. The earlier the detorsion was performed and the older the child, the better the result of this operation will be.

With such a syndrome as swelling of the scrotum, immediate surgery is needed, since after 6 hours the testicle may die.

The choice of access for surgery depends on the shape of the inversion itself and, of course, the age of the boy. In newborns and infants, inguinal access is chosen for surgery, in young children and adults, access through the scrotum area is more convenient for surgery.

Technique of surgery for testicular torsion
At the very beginning, the twisted testicle is exposed down to the protein shell, this makes it possible to make a wide resection and determine the shape of the inversion. The testicle is pushed into the wound produced, then detorsion is performed and the vital capacity of the testicle is evaluated. To improve the overall microcirculation and determine the safety and functionality of the testicle in the future, it is strongly recommended to inject 10-20 ml of 0.25-0.5% novocaine solution with sodium heparin into the area of the spermatic cord. If blood circulation does not improve 15 minutes after injection, then orchiectomy is indicated. When normal blood circulation is restored, the testicle will acquire its usual color.

The testicle should be removed only if it has undergone complete necrosis. When it is difficult for doctors to determine the viability of the affected testicle, well-known scientists Y.B. Yudin. and A.F. Sakhovsky advise to conduct a transilluminational study. X-ray of the testicle always indicates viability, and if there is no X-ray symptom, you need to make an incision of the protein membrane at the lower pole of the testicle. If bleeding subsequently appears, this will also be evidence of the viability of the sexual organ.

The testicle is subjected to necrosis, if, despite all the measures, it does not change color, pulsation will be completely absent, and the vessels of the protein shell will not bleed. The preserved testicle is sewn directly to the scrotum septum with two or three stitches for the lower ligament of the appendage. Doctors insert a drainage tube into the wound and arrange irrigation with antibiotics.

Rehabilitation period
After surgery, during the rehabilitation period, patients are given sensitizing agents, physiotherapy, as well as drugs that normalize microcirculation in the testicle. The use of acetylsalicylic acid is mandatory, it is prescribed to the patient for 0.3-1.5 g per day for 6-7 days. Stitches after surgery are usually removed in a week.

Since the removal of the testicular torsion is quite a traumatic operation, then after it is carried out there is no urgent need to wear elastic swimming trunks, which ensure the fixation of the scrotum. Although older children, adolescents or young men in the presence of purulent effusion in the scrotum, it is highly recommended to use a fixing bandage.

Some hospitals constantly practice in the process of rehabilitation, the use of treatment with galvanization, magnetic therapy and UHF. The sensors of these devices are located on both sides of the patient’s scrotum, and the duration of the entire procedure should not exceed 20 minutes, since high temperatures have a very bad effect on the process of spermatogenesis.

For some time after the operation, patients need to be careful enough in terms of various colds, since even a small and insignificant viral infection will negatively affect the further rehabilitation process. This can be explained by the fact that the hematotesticular barrier is partially destroyed during surgery, normally it is designed to protect testicular tissue from pathological agents. Until this barrier is fully restored, patients need to avoid a long stay in the cold, bathing in icy water and drinking cool drinks.

In 40-80% of men who have suffered from diseases of the scrotum, atrophy of the spermatogenic epithelium may occur, resulting in male infertility and impotence. Also, according to medical statistics, testicular torsion in men is directly related to testicular cancer and 64% of men who have ever suffered testicular torsion develop testicular cancer. But in general, I must say that modern medicine can quite cope with this deviation if you contact a doctor as soon as possible. The more delay with surgical intervention, the worse the result will be later.

Men should know that if they had to remove one testicle, it’s not so scary, removing the testicle will not affect a man’s ability to conceive in any way. One healthy testicle will be quite enough to maintain normal reproductive function and release the optimal amount of male sex hormones ― spermatozoa. If you are concerned about the appearance after the operation of the genital organ, then you can use a testicular prosthesis to replace the lost testicle. Today, the choice of prosthesis is simply huge — there are soft, hard, polymer and silicone prostheses. Usually, a testicular prosthesis is installed to the patient after he reaches puberty.

Most people, before turning to doctors, turn to folk medicine. In this case, treatment in this way is simply unacceptable, since all compresses and various types of lotions, which are often recommended by folk healers, aggravate inflammatory processes and in many cases only contribute to the spread of infection. There are numerous cases when, as a result of folk self-treatment of testicular torsion, sepsis and blood poisoning appear, which eventually leads patients to death.

Today, there are no methods of preventing testicular torsion, but all young men and boys should always try to be especially careful and careful with the area of their genitals. Moreover, any pain or discomfort in the intimate area requires urgent treatment to the doctor. You can prevent testicular torsion by using specialized protection during sports activities, as well as wearing loose clothing that does not press anywhere. Boys and young men who have already suffered testicular torsion once are strongly recommended to perform preventive orchipexy with the testicle of the opposite side as planned, this will prevent the torsion of the collateral testicle in the future.

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