Testicular torsion

February 2017


Definition


Testicular torsion is a twisting of the spermatic cord. The spermatic cord is the organ that connects the testicle to the rest of the reproductive system and includes the vas deferens and blood vessels and nerves to foster the testicle. Testicular torsion causes a lack of oxygen to the cells of the testis, which can lead to necrosis and loss of testicular function. In case of testicular torsion, the diagnosis must be quick to make an emergency operation, practiced within six hours.

Symptoms


Symptoms caused by testicular torsion are:
  • a very sudden onset of severe pain;
  • a significant increase in testicular volume;
  • pain that can sometimes cause an inability to walk;
  • nausea and vomiting.

Sometimes, before testicular torsion itself occurs, sub-torsion accidents can occur, with the same symptoms, but that disappear spontaneously.

Diagnosis


The diagnosis of testicular torsion must be made quickly. Upon palpation of the testis, which is often difficult because of the pain, the latter appears increased in size compared to the other testicle, which is not painful. An ultrasound can confirm the diagnosis by clearly showing the twist, however it is not recommended because it is a surgical emergency and the diagnosis will be confirmed during surgical exploration.

Treatment


In cases of suspected testicular torsion, care must be quick so as to avoid testicular necrosis and functional loss. A surgical treatment is necessary, and after opening the scrotum, the spermatic cord must be untwisted. In case of early treatment, the tissues will regain their original color, and the testicle will keep its functionality. In this case, the testicle is set in place to avoid the occurrence of a new twisting: this is called orchiopexy. An absence of recoloring signifies that the tissues are necrotic, and the testicle must thus be removed: this is an orchiectomy. In both cases, the testicle located in the other side of the scrotum must be also set. Note that if care is too late (more than six hours from the onset of symptoms) a manual untwisting can be undertaken until an operating room is ready, but this is often very difficult.

Prevention


The only preventive technique is orchidopexy, which prevents the occurrence of a new twist.

Related

Published by Jeff. Latest update on July 23, 2013 at 12:32 PM by Jeff.
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