The torsion of the testicle consists in the rotation of the testicle with respect to the spermatic cord (or cord), that is the cord that connects the testicle to the inguinal canal.
The spermatic cord is formed by an intertwining of nerves, lymphatic vessels, the cremaster muscle, ligaments and veins and arteries that supply the blood supply to the didymus or to the entire testicle .
It is an extremely painful event resulting from an alteration of the normal position of the testicle with respect to the spermatic cord. More specifically, it refers to a structure called gubernaculum testis, which during fetal life has the task of guiding the descent of the testicles from the abdominal cavity to the scrotal bag.
When and why testicular torsion occurs
Generally it is a phenomenon that affects the younger male population, especially in the age group between 10 and 25 years, but it is not uncommon to find this problem also in children and infants .
As mentioned, there must be alterations in the structures of the testicle for the torsion to occur and as regards the situations that can determine it, we can list different favoring factors:
- physical exertion;
- trauma;
- strong emotions;
- accidental traumatic movements;
- intense sexual intercourse;
- severe cold climatic conditions.
Previous episodes of testicular torsion are also a risk factor for subsequent episodes of the same or both testicles.
What are the symptoms of testicular
torsion Torsion causes very intense testicular pain that can also radiate to the abdomen, so much so that it is easily mistaken for an episode of renal colic and this is associated with swelling from blood stasis of the scrotum. Pain is certainly the most evident and characteristic symptom of this disorder that should certainly alarm those who are experiencing it.
Both to the touch and to the sight the testicle then appears displaced with respect to its natural axis inside the scrotal bag, furthermore the very strong pain can trigger a feeling of nausea and vomiting .
After having made some hints of anatomy, let’s briefly illustrate the network of events that follows the torsion of the spermatic cord : at first there is a block of the normal venous flow and this results in a condition of congestion and edema affecting the structures of the testicle.
As a result of blood congestion, the scrotum will take on a reddish color (called a red testicle infarction).
Subsequently there is also a blockage at the level of the arteries, at this point an adequate blood supply does not arrive which hinders the supply of oxygen to the testicle which begins to change color turning towards bluish tones, until the necrosis process arises. and therefore the irreversible loss of the organ.
How soon is it necessary to intervene?
The time within which action is taken is a factor of primary importance in the treatment of testicular torsion and, the sooner one intervenes, the better the chances of restoring the correct blood supply to the testicle and thus recovering its functionality. Generally, if you intervene within 4 hours from the episode, the damages suffered are reversible and you can restore the initial condition.
Irreversible damage occurs between 4 and 6 hours, but usually the organ is not lost due to necrosis. If the operation is after 6 hours from the moment of torsion , the organ goes into necrosis as it does not receive sufficient oxygen and blood, causing the death of the cells that constitute it.
When we talk about testicular torsion we refer to a condition of andrological urgency that requires prompt medical intervention within a few of the onset of the problem, because the risk of irreversibly compromising the testicle is very high. As we have often seen, a delay in surgery can lead to organ loss due to insufficient blood circulation.
Usually the painit is so intense and unbearable that in most cases those who have suffered a torsion of the testicle immediately go to the emergency room to receive essential care. In these cases, timeliness plays a role of primary importance, but the important thing, it should be emphasized, is not to waste time and to rely on medical care within 3-4 hours from the episode.
As an information note, it is also good to mention other situations of real andrological urgency that require the same timeliness of intervention: trauma of the testicle, trauma of the penis, priapism (excessively prolonged and painful erection resulting from an obstruction of the venous flow in the corpora cavernosa of the penis ).
As we could understand, timely action in these cases is of paramount importance to avoid further damage. Therefore, it is necessary to diagnose and identify the problem immediately. How the diagnosis is made
Diagnosis: what are the identifying signs and symptoms of testicular torsion
During the visit, and therefore the physical examination, the doctor evaluates the existence of the symptoms described above and therefore:
- testicle pain;
- altered coloring;
- swelling and displacement of the axis of the testicle which appears raised and oriented in a horizontal position with respect to its natural arrangement within the scrotum.
The so-called Prehn’s sign
is also evaluated , i.e. the increase in pain when lifting the testicle upwards.
It is important to make a differential diagnosis with epididymitis, a condition that shows similar symptoms but also manifests fever and a different way of pain onset.
In general, the patient complains of such unbearable pain that in order to carry out the visit it is necessary to perform local anesthesia.
The use of instrumental diagnostics is fundamental, and in particular the ecocolordoppler of the spermatic cord., an examination that evaluates the circulation of the area and allows to observe the presence of a venous or arterial stasis inside the scrotal bag.
Sometimes an exploratory intervention is necessary in the case of more complex diagnostic pictures.
Testicular torsion
therapy Medical treatment as seen above can be decisive and restore the condition of the testicle to the state prior to the torsion : all this if medical intervention takes place within the first four hours of the episode.
Therefore, in case of sudden severe pain in a testicle it is recommended not to waste time looking for remedies on the internet, but to go to the nearest emergency room as soon as possible.
How to intervene
The appropriate treatment depends on the individual case, but usually manual maneuvers are of little efficacy and can further worsen the situation by adding further vascular damage to the testicle and scrotum.
In almost all cases, an urgent incision is made along the spermatic cord , therefore from the inguinal canal to the testicle, directly verifying how much the lack of proper blood circulation and therefore oxygen has negatively affected the state of the tissues. .
If stasis of the arteries has occurred and therefore a process of necrosis has arisen, the now irrecoverable organ is removed by surgerywhich is called orchiectomy.
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