testicular torsion
Introduction
Introduction to testicular torsion Testicular torsion (torsionoftestis), also known as spermatic cord torsion, is strongly contracted by the cremaster muscle that spirally attaches to the spermatic cord due to strenuous exercise or violent injury, causing torsion and causing acute blood circulation disorder of the testis. Clinically, it is not uncommon, often Occurred in congenital testicular mesangial length, testicular dysplasia, cryptorchidism, testicular insufficiency, epididymis and testicular connection is incomplete, epididymis and some spermatic cord excessive activity, spermatic cord is too long. There are two types of intrathecal type and sheath type, and the testicular torsion direction is mostly from the outside to the inside. The cryptorchidism has no testicles in the congenital scrotum. It includes testicular insufficiency, testicular ectopic, and testicular deficiencies. Testicular insufficiency indicates that the testicle does not fall to the bottom of the scrotum after birth and stays in a certain part of the way down, including those who stay in the abdominal cavity. Clinically, testicular insufficiency is often referred to as cryptorchidism. Testicular ectopic is the testicular leaving the normal descending pathway, reaching the perineum, the thigh, the pubis, and even the contralateral scrotum. basic knowledge The proportion of illness: 0.005% Susceptible people: male Mode of infection: non-infectious Complications: orchitis
Cause
Cause of testicular torsion
Dysplasia (45%):
Under normal circumstances, the essential cause of testicular torsion is the congenital malformation of the reproductive organs. This disease may be related to anatomical malformation or dysplasia, such as excessive testicular sac sac, long spermatic cord or incomplete testicular decline.
External force (15%):
Trauma, strenuous exercise and even cold weather in the genital area can cause the testicular tendon or body position to suddenly change, etc., which can also cause excessive testicular activity, sometimes the external force is not obvious, and even in sleep, it may be vagus nerve excitement and cremaster muscle in sleep. Caused by strong contraction of the testis penis erection. Inducing testicular torsion.
Cryptorchidism (20%):
The cryptorchidism has no testicles in the congenital scrotum. It includes testicular insufficiency, testicular ectopic, and testicular deficiencies. Testicular insufficiency indicates that the testicle does not fall to the bottom of the scrotum after birth and stays in a certain part of the way down, including those who stay in the abdominal cavity. Clinically, testicular insufficiency is often referred to as cryptorchidism. Testicular ectopic is the testicular leaving the normal descending pathway, reaching the perineum, the thigh, the pubis, and even the contralateral scrotum.
Pathogenesis
Reversing the mechanism of testicular damage is easy to understand, circulatory dysfunction, venous occlusion leads to testicular congestion, swelling, if delayed, venous thrombosis, and finally arterial embolization and tissue necrosis, the extent of testicular damage is related to two factors, namely the degree of torsion And in the continuous time, in 1961, the Sonde and Lapides animal experiments proved that the spermatic cord was completely rotated for 4 weeks, and the irreversible change of testicular tissue was produced in 2 hours, while the rotation was performed for 1 week (360°), and the testis was not produced for 12 hours or more. Adverse effects, clinical case evidence confirmed: late testicular atrophy can be seen after 4 hours of torsion, if there is no treatment 12h after reversal, most testicles will shrink, but this situation is also very uncertain, some patients are gaps Sexual and self-healing reversal does not cause testicular damage, while other patients may rapidly develop complete vascular infarction, and testicular damage and necrosis will occur soon. In short, surgery should be performed as soon as possible 4 hours after the onset of symptoms, testis After 12 hours of ischemia, necrosis was almost spared.
Prevention
Testicular torsion prevention
In daily life, many men are numb to the testicles, and they endure the pain. As a result, they delay the early treatment. Some people lose their fertility and cause misfortune for life. Therefore, men in adolescence and before and after they suddenly appear scrotum. Swelling, pain, especially in adolescents, should consider the possibility of testicular torsion. It is necessary to go to the hospital for urological examination and treatment in a timely manner. In the early stage of testicular torsion, it can be achieved with a freehand reset, but the onset time is long and can only be treated surgically. In addition, if the testicular torsion unfortunately occurs, the doctor should be asked to do a routine examination of the semen after treatment to understand the function of the diseased side testicle and the contralateral testicle. This seems to be more important for unmarried young men.
Complication
Testicular torsion complications Complications orchitis
After the testicular torsion, the patient has severe pain and can actively seek medical advice. The key is that the doctor should promptly diagnose and treat it. If the patient does not reset after more than 24 hours of reversal, it will cause testicular necrosis or postoperative atrophy.
Symptom
Testicular torsion symptoms Common symptoms Severe pain Scrotum swells pain Nausea anorexia Testicular varicose veins Testicular droop
1. Symptoms: The onset of testicular torsion is rapid, and the testicular and scrotum on the affected side will be severely painful. The pain at the beginning of the reversal is limited to the scrotum, and will develop in the lower abdomen and perineum, accompanied by vomiting. Nausea or fever, edema and redness, tenderness, as the spermatic cord also reverses, the blood vessels in the spermatic cord are blocked, the testicles lack blood supply, if not treated in time, the testicles will develop ischemic necrosis, the color is black, gradually Atrophy and loss of function.
2. Examination: The testicular swelling is moved up, the transverse position is the specific sign of the disease, the tenderness is obvious, the spermatic cord is twisted and twisted, and the pain is not reduced or exacerbated when the scrotum or the testis is lifted, that is, the Prehn sign is positive. The testicular epididymis was swollen, the boundary was unclear, and the light transmission test was negative. The clinical manifestations of testicular torsion are mainly pain and swelling. If it occurs in children, the diagnosis is often not easy. In general, children will have anorexia with unexplained causes, restlessness, and the disease usually develops rapidly. Sometimes, treatment is delayed because there is no certain diagnosis. , causing unnecessary harm to the patient.
Examine
Testicular torsion check
Patients with testicular torsion may have mild leukopenia during routine blood tests.
1. Doppler ultrasound examination of testicular blood flow reduction.
2. Radionuclide 99m(99mTc) testicular scan showed that the blood flow perfusion of the torsion testis was reduced, and it was a radioactive cold zone with a diagnostic accuracy of 94%. It is recognized as the most reliable auxiliary diagnostic measure.
3. Ultrasound examination and CT scan are helpful in determining whether the testicles are swollen, acute hydrocele, scrotal edema, incarceration, but not reliable in identifying testicular torsion and epididymal orchitis.
Diagnosis
Testicular torsion diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
1. Acute orchitis and epididymitis may have symptoms such as testicular pain, accompanied by fever, increased white blood cells, more common in adults, slower onset, and less painful symptoms.
2. Incarcerated patients have a history of inguinal hernia, when the inguinal hernia is incarcerated, the scrotum can have severe pain, accompanied by obvious tenderness, abdominal tenderness, accompanied by nausea and vomiting, stop anal defecation and platoon Symptoms such as Qi, auscultation can be heard and bowel sounds hyperthyroidism, there is gas over water, testicular and epididymis examination without abnormalities.
3. Ureteral calculi manifested as sudden lumbar and abdominal cramps, and can be radiated to the thigh, perineum, scrotum, with nausea and vomiting, but the scrotum and its contents are normal.
4. Testicular attachment torsion The clinical symptoms of testicular attachment torsion are similar to testicular torsion. Symptoms of nausea, vomiting, and abdominal discomfort can also occur. The onset is generally mild, gradually worsening within a day or two, but there are also severe pain, acute attacks, and physical fitness. Examination can touch the mass on the upper pole of the testicle, rest in bed, apply non-hormonal anti-inflammatory drugs, lift the scrotum to relieve symptoms.
5. Scrotal hematoma: This type of patient has a significant history of trauma.
6. Hydrocele: This is a chronically developed disease that is generally not very painful.
7. Testicular epididymal torsion: These diseases are generally more common in young people.
If the patient has swelling of the testicles and does not have a fever, the doctor will suspect that it may be a testicular torsion and should be immediately explored.
It should also be differentiated from varicocele, idiopathic scrotal edema, fat necrosis, and viral infection.
