Acute scrotum

definition

The so-called acute scrotum is a collective term for all diseases that are sudden Pain or one swelling of the testicle (scrotum). The diagnosis "acute scrotum“Is therefore not to be assigned to a specific cause of illness, but is used as a work diagnosis that falls under a urological emergency and immediate clarification of the cause and a prompt treatment makes necessary.

root cause

There are several possible causes that affect the clinical picture of the acute scrotum can evoke. The most serious cause here is the so-called Testicular torsion to call. This is a clinical picture in which the testicle rotates within its sheaths, whereby the blood vessels supplying the testicular tissue can become clamped. The cause of this rotation (torsion) are mostly congenital factors, for example insufficient anatomical fixation of the testicle in its sheaths so that it can move beyond the normal range, which ultimately favors testicular torsion. Testicular torsion is an absolute one urological emergencybecause the poor blood supply can cause irreversible damage to the testicular tissue after a short time. Although only about 25 percent of acute scrotum cases are caused by testicular torsion, this is the most important cause that needs to be clarified in acute scrotum, as it can lead to severe damage within a short period of time and must therefore be treated quickly.

Another common cause of acute scrotum is one inflammation in the area of ​​the testicle. Several structures can be affected, such as the Testicles self (orchitis), the Epididymis (Epididymitis), as well as the vas deferens or the spermatic cord. Finally, traumas, i.e. the effects of violence on the testicles, also cause one acute scrotum.

Symptoms

The leading symptom of the acute scrotum is the acute and usually very severe pain in the area of ​​the testicle, which can also radiate into the groin. This pain is often so intense that it is also known as the pain of annihilation. The pain can easily be provoked by touching or even pressing the affected area (Tenderness), but mostly it occurs at rest. The accompanying one is also typical of an acute scrotum swelling (Scrotal edema). Often, redness also occurs over the affected area. An equally characteristic sign of an acute scrotum is that the symptoms are mostly limited to the affected side of the testicle and that this shows the symptoms mentioned on one side. Due to the extremely severe pain, the vegetative nervous system can also be involved, which can be expressed in accompanying nausea or vomiting.

The symptoms like Pain, redness, and swelling occur in the same way despite various causes of acute scrotum, but are caused by different mechanisms. This is how it happens with the Testicular torsion by cutting off the blood supply directly to the symptoms mentioned. In addition, there is sometimes a Undescended testicles on the affected side, which can be explained by the rotation of the testicle around its hanging structures and the resulting shortening.

In the case of inflammation, however, the symptoms are through Inflammation mediators, that is, causes messenger substances in the body. These ensure that there is pain and that the inflamed area is supplied with more blood. This leads to a reddening and the blood vessels become more permeable, what a leakage of liquid from the blood into the tissue and such a thing swelling of the testicle. It is also typical for an inflammatory cause of the acute scrotum that the pain usually does not start as acute as with a traumatic genesis or one Testicular torsionbut rather that they begin insidiously and steadily increase in intensity. In some cases an inflammation in the area of ​​the testicle still occurs concomitantly fever on.

diagnosis

There a acute scrotum In the worst case, it is triggered by a testicular torsion, which can lead to the destruction of the testicular tissue and thus also to the inability to conceive, it is very important to quickly find out the cause of the suspected diagnosis of "acute scrotum" so that an adequate therapy can be initiated immediately and the tissue thereby to be able to save. The diagnosis of an acute scrotum is usually made in the anamnesis, in which the doctor asks specific questions about the characteristics of the pain. After that, the physical exam when inspecting for symptoms such as Redness, swelling, and tenderness looked over the testicle. In order to narrow down the causes after the working diagnosis of "acute scrotum", other examinations follow. For one thing, there is usually a Urine status raised, by which one can recognize an inflammatory cause, on the other hand that plays Testicular ultrasound (Ultrasound examination) plays an important role. If testicular torsion cannot be excluded in these examinations, a so-called exploratory operation follows, in which the cause of the pain is searched for on the open testicle and then in the same surgery is treated.

Sonography

Sonography (ultrasound) plays an important role in the diagnosis of the acute scrotum, since in this clinical picture there is usually no clear examination result based solely on the anamnesis and physical examination. A great advantage of sonography is the cost-effective and quick availability of the method. This is very important in order to quickly arrive at a clear diagnosis. In addition, soft tissues, which include testicular tissue, can be easily visualized in sonography. For this purpose, the size (volume) and the sound density of the testicle are assessed in a side comparison and the values ​​determined are compared with normal values. To do this, the testicles are fixed with a cloth or by hand so that the examiner can attach the ultrasound head in the desired position. Another type of sonography is Doppler sonography. This is an ultrasound method that shows the blood flow in vessels well. This is severely limited in the case of testicular torsion, which can usually be shown well using Doppler sonography.

Read more on the topic: Doppler sonography

therapy

The therapy of the acute scrotum is different depending on the cause. In the case of testicular torsion, when the testicle cannot be turned back manually is one surgery unavoidable, in which the testicle is turned back into its original position (Detorquation) and one then observes whether the under-supplied testicular tissue recovers. If there is an inflammatory cause, it is antibiotic therapy the means of choice. In addition, in this case it is also physical Protection and cooling of the testicular tissue is recommended. However, if the testicular tissue can no longer be saved and it is irreversibly damaged, therapy consists of it surgical removal to avoid infection of the whole body from the dead tissue.

forecast

The prognosis of the acute scrotum varies depending on the cause. When it comes to testicular torsion, time is of the essence. The time interval between onset of symptoms and operative therapy should be no longer than four hours be to get a good forecast. If treatment comes too late, it comes to irreparable damage to testicular tissuewhat must then be removed. Here the prognosis is bad due to the loss of fertility. The other causes of an acute scrotum usually have one better prognosisbecause there is not such a tight time frame in their treatment.

prophylaxis

One acute scrotum you cannot prevent yourself. However, if there is an acute scrotum due to a Testicular torsion before, the testicle that is not affected by this is also treated prophylactically by fixing it in its sheath, which greatly reduces the likelihood that the testicle will also twist.

Acute scrotum in the child

The acute scrotum in the child Although it has the same causes as in adults, more cases of the tends to occur in childhood critical testicular torsion on, because the excessive mobility of the testicle in its sheaths, which then leads to the rotation of the testicle, mostly innate and therefore usually becomes symptomatic in childhood. Another special feature of the child is that the time window of four to six hours for testicular torsion therapy is shorter, the younger the child is.