Recently, Daguan County People's Hospital, under the guidance and help of the attending physician of the Department of Urology, a counterpart assistance expert from the First People's Hospital of Zhaotong City, successfully treated a patient with high testicular torsion.
The patient, a 13-year-old boy, was admitted to the Department of Surgery of the County People's Hospital with "pain in the left testicle for 3 hours". The emergency color ultrasound examination showed that there was no blood flow signal in the patient's left testicle, and the hospital immediately performed left testicular exploration for the patient.
During the operation, it was found that the patient's left testicle was torsioned at 720°, and the testicle was ischemia and blackened. Due to the torsion of one testicle, the probability of contralateral torsion is significantly increased, and the testicle with torsional reduction and fixation is performed intraoperatively, and the normal testis on the contralateral side is routinely fixed.
After testicular torsion reduction, the patient's testicular blood supply returned to normal and he has been discharged from the hospital with good recovery.
Health science popularization
Testicular torsion is rarely successfully rescued in clinical practice, and we must attach great importance to it in order to improve the success rate of treatment.
What is testicular torsion?
Testicular torsion is a male urinary emergency, which is based on the anatomical abnormality of the testicle and the spermatic cord or the increase in mobility, the testicles rotate clockwise or counterclockwise along the longitudinal axis of the spermatic cord, resulting in testicular torsion, blood vascular disorders, often accompanied by severe scrotal pain, testicular enlargement and other symptoms, is one of the common scrotal emergencies.
Causes of testicular torsion
1. The lower pole of the testis is not sufficiently fixed to the tunica vaginalis of the testis. If the lower pole of the testis is not fixed to the tunica vaginalis or the base of the tunica vaginalis is not wide enough and the spermatic cord is too long, the testis may twist on the spermatic cord, resulting in decreased blood inflow into the testicular arteries and obstruction of venous outflow, resulting in ischemia-hypoxia necrosis of the testis.
2. Factors such as strenuous exercise, scrotal trauma, deep sleep, cold season or sudden drop in temperature can also cause excessive scrotal contraction to cause cremaster muscle spasm and induce testicular torsion. The vagus nerve is excited during sleep, and the cremaster muscle contracts strongly with an erection, so testicular torsion can occur without warning, especially during sleep.
3. There is a familial genetic tendency.
What are the clinical manifestations of testicular torsion
1. Symptoms: Scrotal pain is the most common, mostly in a quiet state, strenuous activity or a few hours after minor scrotal trauma, with a sudden onset of moderate to severe testicular pain with obvious diffuse tenderness and swelling, which may be accompanied by nausea and vomiting. Some testicular pain also occurs during sleep, particularly in children and adolescents, and wakes up in the middle of the night or in the morning with pain, which is likely related to contraction of the levator testicis muscle due to nocturnal sexual stimulation during the REM sleep cycle. Because the pain of torsion and traction of the spermatic cord radiates to the lower abdomen, most children are in adolescence, and the manifestation and complaint may be lower abdominal pain, which is easily misdiagnosed as abdominal pain and delays the disease. Therefore, parents with boys should be vigilant when their children wake up in the scrotum.
2. Signs: swelling of the testicles in the scrotum on the affected side, changes in the diameter of the testis, hard texture, the position of the testis on the affected side can move upward, asymmetrically raised, and the position of the testicular axis changes, which is not a normal longitudinal position, and is in a "transverse position", which is related to the shortening of the spermatic cord caused by testicular torsion, which is called "pendulum deformity". Testicular lift pain is evident, and in the early stages, experienced examiners can often distinguish between a swollen, highly tender testicle and a softer, less tender epididymis in the posterior. The characteristic manifestation is: when the scrotum is lifted upward, the pain is not light but severe! The cremasteric reflex is usually absent in patients with testicular torsion, whereas the cremasteric reflex is usually intact in acute epididymitis or scrotal pain of epididymitis-orchitis or other etiologies.
3. Ancillary examination data: scrotal color ultrasound (superficial mass) found that the blood flow signal of the testicle on the affected side of the patient was lost, and the disease could be basically diagnosed in combination with the patient's medical history and signs.
What are the dangers of testicular torsion
The testicles are very fragile, and once torsion occurs, the degree of lesion is not only related to the degree of torsion, but also to the time of torsion. Once the torsion time exceeds 4 hours, irreversible ischemic damage to the testicular parenchyma can occur. Over 10 hours, most of the testicles atrophy. After 24 hours, severe atrophy of the testicles will occur. Clinical data show that 4-6 hours reduction, testicular salvage rate of 90%, commonly known as "golden 6 hours", 70% within 10 hours, 20% for more than 10 hours, and testicular necrosis for more than 24 hours.
How to confirm the diagnosis of testicular torsion
1. Sudden occurrence of severe testicular pain, which can radiate to the lower abdomen, testicular enlargement, persistent pain, persistent, accompanied by nausea and vomiting.
2. The testicle is obvious to the touch, and the testicular position is abnormal or the palpation is not clear.
3. Color Doppler ultrasonography: it is manifested as enlargement of the testicle on the affected side and decreased echogenicity. Color Doppler shows markedly reduced or absent blood flow signal in the testis.
What to do after you've been diagnosed
Surgical treatment should be done as soon as possible after diagnosis: suspected testicular torsion is managed by surgical exploration as soon as possible, and intraoperative reduction and immobilization of the testicle. Prolonged ischemia > 6 hours may result in testicular infarction with liquefaction, requiring orchiectomy.
1. Preservation of the testicle (intraoperative reduction and fixation of the testicle): when the testicular torsion is early (< 6 hours) or the torsion < 360°, it is mainly manifested as a low blood supply type, and at this time (within 6 hours) is the golden period for saving the testicle, which can make the twisted testicle have a greater chance of effective retention.
2. Orchiectomy: Testicular torsion in the middle and late stages > 6 hours, mainly manifested as lack of blood supply or ischemic type, more than 12 hours of torsion of the testicular survival rate is significantly reduced, after the intraoperative reduction of warm saline hot compress testicles to observe the recovery of testicular blood flow and testicular color changes, if the testicular color returns to normal, keep the testicles as much as possible. And when complete necrosis occurs in the testicle, only the affected testicle can be removed!
How to prevent testicular torsion
1. Avoid compression and squeezing of the testicles, such as maintaining a correct sleeping and sitting posture, reducing long-term cycling, and wearing less tight pants.
2. Avoid vibrating the testicles due to strenuous exercise and prevent external forces from hitting the testicles.
3. When the weather is cold, pay attention to keeping the perineum warm to prevent low temperature from inducing testicular torsion.
4. Once the testicle is painful, it should be paid attention to and immediately seek medical attention for color ultrasound examination.
5. If there has been transient pain in the testicle, but the color ultrasound examination does not show clear testicular torsion, follow-up observation should also be continued (some children have had testicular incomplete torsion but can reduce it spontaneously, and the possibility of re-torsion in such children is relatively high, and surgical fixation can be considered if necessary).
6. Parents should strengthen the scientific knowledge of testicular torsion, be aware of the seriousness of testicular torsion, and often educate and communicate with their children, especially for children who may be ashamed to speak up during puberty.
Source丨Daguan County People's Hospital Editor丨Bai Yang Editor|Li Zihong