Testicular torsion refers to the rotation of the testicles around the spermatic cord that feeds them. The incidence of this condition is 1/4000. Testicular torsion can affect men of all ages, but is most common in newborns and adolescence. Surgical intervention is required as soon as possible for the treatment of testicular torsion.
What is Testicular Torsion?
The scrotum is a bag-like structure that contains the testicles. Nutrition of the scrotum is provided by the spermatic cord. It causes the testicles to rotate on the spermatic cord, reducing the blood flow through the cord, and sometimes even stopping it. The decrease in blood flow causes sudden onset of severe pain and swelling in the testicles.
Testicular torsion is a condition that needs urgent intervention. If the decrease in blood flow continues for a long time, the testicles are damaged and become unable to function. In order to save the testicles with minimal damage, the patient should be operated as soon as torsion is detected.
What Causes Testicular Torsion?
Torsion; rotation means torsion. Torsion of the testicles on the spermatic cord, which provides nutrition to the scrotum, reduces the blood flow in the cord. If the testicles roll over the spermatic cord more than once, blood flow may come to a complete stop. In this case, the testis is damaged much more rapidly.
Mechanisms that cause testicular torsion have not been fully elucidated yet. However, most men with testicular torsion have a deformity called 'Bell clapper'. Bell clapper deformity allows the testicles to move freely within the scrotum. Normally, the testicles cannot easily move within the scrotum thanks to the strong and supportive connective tissue around them. The increased mobility of the testicles in the bell-knob deformity increases the risk of torsion. However, there is no rule that every man with a bell-knob deformity will experience testicular torsion.
Bell knocker deformity is a genetic condition. The deformity often affects both testicles. Testicular rotation; It can occur several hours after strenuous exercise, after a minor injury to the testicles, or during sleep. The rapid growth of testicles under the influence of testosterone during puberty increases the possibility of torsion. Cold weather too It is another factor that increases the risk of rheumatoid arthritis.
Testicular torsion is seen especially in men between the ages of 12-18. Men with a family history of testicular torsion are at risk for torsion. The testicles may detortion spontaneously in a short time after torsion. This torsion-detorsion situation may have occurred in men who feel a sudden pain in their testicles, but the pain goes away without resorting to any treatment. This situation tends to recur. The more severe the person's pain, the more severe the damage usually occurs in the testicles.
What are the Symptoms of Testicular Torsion?
Symptoms seen in testicular torsion:
- Sudden onset severe pain in the scrotum
- Redness, swelling in the testicles
- Abdominal pain
- Nausea, vomiting
- Testicle in a different position from its normal state
- Frequent urination
- It is in the form of fever.
Men who feel severe pain in their scrotum should apply to the nearest health center immediately. Testicular damage due to torsion can be prevented with early treatment. Men who experience severe testicular pain but whose pain resolves without treatment should also consult a doctor. These men may have a torsion-detorsion condition. This may lead to testicular rotation that does not resolve spontaneously in the future. Therefore, men who have this problem may need surgery to prevent torsion.
Severe complications may develop if testicular torsion is not intervened in a timely manner. These complications are as follows:
Testicular Damage: If the testicular rotation is not intervened within a few hours, the decreased blood flow may cause permanent damage to the testis. If the testicle cannot be fed for a long time, it may die, and this testicle may need to be surgically removed.
Infertility: Testicular damage or loss may reduce the reproductive capacity of the person.
How is Testicular Torsion Surgery Performed?
For the diagnosis of testicular torsion, the doctor first asks the patient what their complaints are. It tries to determine whether the symptoms seen in the patient are due to torsion or another reason. Afterwards, he examines the patient's abdomen and inguinal region and examines his testicles. Testicular torsion One of the diagnostic methods is reflex examination. The doctor gently scratches the inside of the patient's thigh on the affected side with a hard object. Under normal conditions, this causes the testicle to contract. However, this reflex may not occur in torsion patients. Some tests can be used to understand whether the patient's symptoms are due to torsion or another reason. These tests are:
Urine Analysis: A possible infection status is checked with urinalysis.
Scrotal Ultrasound: With a method called Doppler ultrasound, blood flow to the testis can be visualized. Decreased blood flow to the testicles may be a sign of torsion. If the patient has severe scrotal pain lasting for several hours and the findings on the examination are compatible with testicular torsion, the patient can be operated without additional tests. Because late intervention to testicular torsion can lead to serious consequences.
Surgery is needed to correct testicular torsion. Sometimes the doctor can detorsion the torted testicles manually with a method called the 'opening and closing the book' method. However, in this case, the patient should have surgery to prevent recurrence of the torsion.
Testicular torsion surgery, or orchiopexy, is performed under general anesthesia. During surgery, the surgeon makes a small incision into the scrotum, straightening the twisted spermatic cord. If necessary, one or both testicles of the patient are sutured into the scrotum. The sooner the testicle is corrected, the higher the chance of recovery. The risk of permanent damage to the testis increases gradually in interventions performed 6 hours after the onset of pain in the patient. If the intervention is delayed 12 hours or more after the onset of pain, the patient's testis is severely damaged and has a 75% chance of removal.
Testicular torsion can also be seen in newborn babies. The baby's testicles may be hard, swollen and dark in color. Ultrasound is used to detect torsion. The treatment of torsion in infants is surgery. Making the decision to have testicular torsion surgery in infants can be difficult. If the baby is born with signs of torsion, it may be too late for intervention. There will also be risks associated with general anesthesia for the surgery. However, sometimes taking the baby into surgery saves the testicle and prevents torsion in the other testis.
Correction of torsion by surgery, baby It can prevent the baby from having problems such as reproductive hormone production and fertility in the future. Testicular torsion surgery in newborns is a decision that the doctor and family can make together. The doctor explains to the family all the advantages and disadvantages of the surgery. Afterwards, the decisions taken in line with the family's request are applied.
After testicular torsion surgery (orchiopexy), the patient is usually discharged on the same day. Patients whose testicles have been removed may need to stay in the hospital for a while. During the postoperative recovery period, there may be swelling in the scrotum for 2-4 weeks. Generally, soluble material is used in sutures placed in surgery. Therefore, the patient does not need to go for suture removal. The patient can apply cold to the testicles for 10-20 minutes to reduce the postoperative pain. The only way to prevent testicular torsion is to fix the testicles to the scrotum with sutures. However, this procedure is applied to people who have had torsion before and who are going through torsion.
Testicular torsion is a health problem that needs urgent intervention. With the early detection of torsion and initiation of the necessary treatment within the first few hours, the testicles can be saved with little damage. Delayed intervention in torsion may lead to loss of the testis.
You can ask the expert team of Group Florence Nightingale Hospitals about testicular torsion and ask for suggestions regarding your question. You can use the contact form on our website to reach us.
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