HERNIA
Before birth, the testicle descends from the abdominal cavity into the scrotum through an open canal that usually closes when the child is born. Girls also have this open channel. If the channel does not close, a hernia may develop. A hernia occurs when a piece of intestine slips into the canal. In approximately 6% of men, this canal remains open.
Possible Problems
Hernia is a blockage of the intestine (called an incarcerated hernia) or It can be a serious problem at any age as it can cause loss of blood circulation. Therefore, it is best to correct the hernia with surgery immediately after diagnosis. Hernias that cause obstruction or obstruct blood circulation may require surgery.
HerniaSymptoms
Hernia >causes swelling in the groin area. It may occur when your child cries, coughs, or strains. If the swelling does not go away on its own or with gentle pressure, take your child to the doctor immediately. If the intestine gets stuck in the herniated canal, your child may have a fever, whine, or start vomiting.
Who gets a hernia?
Hernia is more common in children with undescended testicles and children born prematurely. The risk may be even higher for children with surgical shunt tubes that connect the brain to the abdomen. A hernia may also occur in girls, but they are rare.
Recommended Treatment
Treatment is recommended as soon as possible after diagnosis. Surgery is performed under general anesthesia through an incision in the groin area. The duct is separated from other tissues and connected. If the hernia is only on one side, the probability of a hernia on the other side in children younger than one year is 10-20%, and in older children the probability is five percent.
Surgical Treatment
Since general anesthesia will be applied, it is very important to comply with some eating and drinking rules specified by your doctor before the surgery. If your child is less than two or three months old, an overnight stay in hospital may often be required after surgery. The process usually takes an hour or less. Stitches are placed under the skin It is formed and dissolves on its own. For post-operative pain, your child may need acetaminophen or ibuprofen every 4-6 hours. After the surgery, the child should wait 24 hours to bathe and avoid any strenuous activity after two weeks. He/she can return to school two to three days after surgery. You should make an appointment to see the doctor one to two weeks after surgery.
Possible Complications of Surgery
Complications from surgery are rare, but are more likely to occur if your child has had groin surgery before. Possible risks are infection, bleeding recurrence, withdrawal of the testicle, and injury to the testicle or its ducts.
TESTICULAR TORSION
Practical principles
p>Testicular torsion means that the spermatic cord structure turns and then the same side testicle loses blood flow. This is a urological emergency; Early diagnosis and treatment are vital for preserving the testicle and future fertility. Testicular viability decreases markedly 6 hours after the onset of symptoms.
Testicular torsion is primarily a disease of adolescents and newborns. It is the most common cause of testicular loss in these age groups. However, torsion can also be seen frequently in men aged 40-50.
The diagnosis of testicular torsion is clinical and diagnostic tests should not delay treatment.
Normally, the testicles are in the scrotum. cannot move freely. The surrounding tissue is strong and supportive.
Testicular torsion occurs due to twisting of the spermatic cord and blood vessels feeding the testicle. The tunica vaginalis is securely attached to the posterior side of the testicle, and the spermatic cord is not very mobile.
Men experiencing torsion sometimes have weaker connective tissue in their scrotum. If the attachment of the tunica vaginalis to the testicle is inappropriately high, the spermatic cord may twist within it, causing intravaginal torsion. This defect is called bell clapper deformity. This occurs in approximately 17% of men and is bilateral in 40% of these cases. Bell-clapper deformity allows spontaneous rotation of the testicle over the spermatic cord.
Intravaginal torsion usually occurs in adolescents. . In addition to the increased weight of the testicle after puberty, the sudden narrowing of the cremasteric muscles (which attach to the spermatic cord in a spiral manner) is a cause for acute torsion.
On the contrary, extravaginal torsion is more common in newborns. This is because the tunica vaginalis is not yet fixed to the gubernaculum and the spermatic cord and tunica vaginalis as a whole are subject to rotation. Extravaginal torsion is not associated with bell clapper deformity. This can occur up to months before birth and is therefore managed differently depending on the situation. Of course, newborns may present with intravaginal torsion and this should be managed in the same way as adolescents.
Testicular torsion is associated with testicular malignancy, especially in adults. One study found an association with testicular malignancy in 64% of testicular torsion. This is thought to be secondary to a relative increase in the width of the affected testicle compared to its blood supply. However, in the examination of 32 patients diagnosed with testicular torsion, testicular cancer was detected in 2 of 20 patients (6.4%) who underwent orchiectomy.
Testicular stroke
For normal development and optimal sperm production, the testicle must descend into the scrotum from its original position near the kidney. During the 23rd week of pregnancy, the testicle migrates transabdominally to a position close to the internal inguinal ring. The testicle does not migrate transinguinally to its final position after the 28th week of pregnancy, and this is usually completed between the 30th and 32nd weeks of pregnancy.
Pathophysiology
In newborns, the testicle has not yet descended into the scrotum by being attached to the tunica vaginalis. This mobility of the testicle makes it prone to rotation (extravaginal testicular torsion). Insufficient fusion of the testicle to the scrotal wall is typically diagnosed in the first 7-10 days of life.
Blood flow to the testicle decreases when the testicle rotates between 90° and 180°. Complete torsion usually occurs when the testicle rotates 360° or more. With fewer degrees of rotation, incomplete or partial torsion occurs. The degree of rotation can extend up to 720°.
Rotation of the testicle causes venous occlusion and engorgement, as well as arterial ischemia and infarction of the testicle. The degree of rotation in the testicle determines the viability of the testicle over time.
In addition to the degree of torsion, the duration of torsion significantly affects both immediate recovery and late testicular atrophy rates. If the torsion duration is at least 6-8 hours, testicular salvage is likely. After 24 hours or more, testicular necrosis develops in most patients.
Etiology
Extravaginal torsion occurs in the fetus or newborn because the testicles are free to move through the tunica vaginalis of the scrotum before testicular fixation develops. It can rotate.
The normal testicular sling provides a solid fixation of the epididymal-testicular complex posteriorly and prevents the spermatic cord from rotating. In men with bell-clasp deformity, torsion may occur due to lack of fixation, leaving the testicle hanging free within the tunica vaginalis.
Abnormal mesentery between the testicle and the vessels supplying blood to the testicle can make the testicle prone to rotation, especially if the testicle is wider than the mesentery. . Contraction of the spermatic muscles shortens the spermatic cord and may initiate testicular torsion.
Epidemiology
Extravaginal torsion accounts for 5% of all torsions. 70% of these testicular torsion cases occur prenatally and 30% occur postnatally. The condition is associated with high birth weight.
Intravaginal torsion accounts for approximately 16% of patients presenting to the emergency department with acute scrotum. This form of testicular torsion is mostly seen in men younger than 30 years of age, most commonly between the ages of 12 and 18. Peak incidence occurs at ages 13-14. Young children with testicular torsion often wake up in the middle of the night or in the morning due to scrotal pain. The left testicle is more frequently affected. Bilateral cases account for 2% of all torsions.
Prognosis
Success in spermatic cord torsion management is measured by the incidence of immediate testicular salvage and late testicular atrophy. A recent publication documents that approximately 32% of pediatric torsion cases result in orchiectomy. The higher association with younger age may be secondary to delayed diagnosis in young children who may not be able to communicate symptoms to caregivers.
Pain and swelling of the scrotal sac are the primary symptoms of testicular torsion. The onset of pain is quite It may be sudden and the pain may be severe. The swelling may be limited to just one side or occur throughout the scrotum. You may notice that one testicle is higher than the other. Some men also experience:
- dizziness
- nausea
- vomiting
- lumps in the scrotal sac
- blood in semen
There are other potential causes of severe testicular pain, such as epididymitis, but these symptoms should still be taken seriously and treated.
Some tests can be used to diagnose torsion. . These include:
- physical examination
- urine tests detect infection
- imaging of the scrotum
During a physical exam, the doctor will check the scrotum for swelling. It can also compress the inner part of the hip. Normally this causes the testicles to contract. However, if there is torsion, the reflex may be lost.
VARICOCELE
What is varicocele?
Varicocele is the expansion of the veins in the scrotum (the sac of skin that holds the testicles). It is the same as a varicocele in the leg.
Sperm is produced, stored and excreted in the male reproductive system. The scrotum is a sac of skin that contains the testicles. Sperms and the hormone testosterone are produced in the testicles. Sperms mature as they pass through the spiral tubes (epididymis) located behind the testicles.
Sperms reach the prostate from the epididymis using tubes called vas deferens. During ejaculation, sperm combine with the semial fluid secreted from the prostate to form semen. Semen passes through the urethra and comes out from the tip of the penis.
The spermatic cord covers the artery that carries blood to the vas deferens and testicles. It also includes a network of veins that carry blood out of the testicles. This network cools the blood going to the testicle before it reaches the testicle. In this way, the testicles remain at the temperature that enables sperm production.
However, when this vascular network expands, a problem called varicocele occurs. These veins are similar to varicose veins in the legs. Varicocele starts to form in adolescence and grows larger and more prominent over time. Male anatomy is the same on both sides
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