Testicles twisted

definition

A twisted testicle is used in medical terminology as Testicular torsion designated. This is the twisting on one or both sides of the testicle in the scrotum due to a acute hypermobility of the entire spermatic cord. The twisted testicle represents a threatening situation there, there Blood flow to the testicle restricted becomes.

introduction

The twisting of the testicle can occur different way and at different anatomical locations happen. Hence the Twist classified according to type.

Intravaginal testicular torsion

In the intravaginal twist of the testicle, the twist occurs in the testicle itself. The twist of the spermatic cord is closer to the testicle. In addition, the Blood circulation disturbed or even completely interrupted. This type of testicular twist is common young adults in front.

Extravaginal testicular torsion

In this form of testicular twisting, the spermatic cord is twisted above the testicle cover. This process occurs more often male infants and young children in front. Here, too, the supply of the testicle is massively disrupted.

causes

A twisted Testicles usually comes about with people who have a certain anatomical disposition to have. So there is one from birth Hypermobility of the testicles, which may be due to anatomical abnormalities.
A little Trigger like Exertion in sports can then be enough to cause the testicle to twist. A faulty anatomical system the testicular membrane, which can form during embryonic development, therefore ceases big risk factor for a twisted testicle.

In many malformations, the Testicular covers during the development phase not properly connected. Thus, they leave too much leeway, which can lead to twisting in the event of unfortunate movements. Another anatomical condition favors a twisted testicle. During the embryonic phase, the Testicular anlage from the abdomen through the inguinal canal into the scrotum. A natural process known as Testicular descent (Descensus testis) referred to as. The lower layer of the gonad is responsible for this descent of the testicles. If this gonad leaf is insufficiently developed or not developed at all, this ultimately results in a incomplete testicle descent.

The Testicles are then higher and are not held in the scrotum by the gonad leaf, which is later also responsible for the secure position of the testicles. From this can then easier testicular torsion arise. If the testicles sink during development, they become a part of it Muscle cord, accompanies the cremaster muscle. This muscle is used to protection, is involved in the Temperature control the testicles and when erect pulls the testicles closer to the body. The muscle attaches to the testicle. If the point of attachment of the muscle is anatomically unfavorable, the contraction of the muscle can also cause the testicle to twist due to the tensile forces that act.

In some patients, due to anatomical conditions a twisted testicle does arise in sleep. If the testicles have too much slack, movement during sleep is sufficient to twist the testicle. In these cases one often speaks of one idiopathic testicular torsion. Furthermore, a Twisting in sports activities occur. Also at Cycle testicular torsion can be triggered because the testicle is constantly moved back and forth when sitting on the bicycle saddle. Also in the context of accidents the testicles can twist. Another possible cause can also be the direct manipulation of the testicles during surgery be.

Symptoms

A Twisting of the testicle mostly goes with you, especially in young adulthood sudden severe pain in the affected scrotum. The testicle is very sensitive to the touch and tender. Every touch worsens often the pain. The uncomfortable pain can too through the inguinal canal in the radiate lower half of the abdomen. As a result, the search for the cause of the pain can sometimes be misleading.

Furthermore can also nausea, Vomit and heavy sweating occur. Because of the severe pain increases in patients often die Heart rate on. By twisting the spermatic cord, the Blood supply to the testicle disturbed. On the one hand, this leads to a Discoloration of the affected testicle to blue-purple, on the other hand, the pent-up blood can no longer drain away. After a while the injured testicle becomes increasingly swell. Swelling of the injured testicle can usually be recognized by the fact that the typical folding of the testicle gradually abolished becomes. A twisted testicle should recognized as quickly as possible and treated directly The testicles will eventually become, since there is no guaranteed blood flow to the organ die can.

More information can be found here: acute scrotum

Testicular twist without pain

A testicular torisone can even without pain occur. Also one short-term relief the pain can occur if, for example, the blood circulation is temporarily guaranteed again. This course often occurs with one incomplete twisting of the testicle in front. The symptoms then subside temporarily and gradually come back. Did the patient initially no pain, you can then increasingly develop. Painless testicular torsion can also be present if it even before birth originated. The children then usually have one red and hardened testicles.

diagnosis

A twisted testicle is often very easy to diagnose without having to do many examinations. In most cases, the symptoms and signs are clear. However, twisting the testicle can also be atypical. Accompanying symptoms such as nausea and vomiting or increased radiation of the pain in the abdominal area can initially point to another cause. If possible, the doctor should also think of a twisted testicle and can carry out further diagnostics. In this way, certain parameters in the blood can be determined, which help to differentiate testicular torsion from inflammation of the epididymis.

In acute inflammation, certain levels such as CRP, leukocytes and the rate of sedimentation rise rapidly. They are typical inflammation parameters. If the testicle were twisted, they would slowly rise much later. Various imaging methods are also available to secure the diagnosis. The ultrasound of the testicle is a very popular tool. The testicle can be shown together with its texture and blood flow.

In Doppler sonography, the vessels can be assessed more precisely because the blood flow is measured here. Typically this is reduced or even completely closed with a twisted testicle.

Read more on the topic: Doppler sonography

You can also do a testicular scintigraphy. A radioactive contrast agent is administered to the patient. Due to the radioactive substance, the distribution of the substance in the body can be measured, including in the testes. Since the supply of the testicle is disturbed in the event of a twist, the distribution of the contrast medium in the affected testicle is delayed or even fails completely. This examination method is time-consuming, which is why it is not often used when a twisted testicle is suspected, as quick action is required.

Detect testicular twist

There a twisted Testicles in the worst case the Loss of the organ can mean, it is even more important that a twisting of the Testicle recognized quickly and treated accordingly becomes. There are a few Investigations and signs the doctor may observe that may indicate torsion of the testicle. You step next to the typical symptoms how Pain, swelling and Redness of the testicle up and can the Additionally secure diagnosis. If there is a twist, to let the Painwhen the Scrotum raised becomes, not after. In this case one speaks of a negative Prehn's signwhich is typical of a torsion.

You also do this test on a Epididymitis. In the case of inflammation, the causes Raising the testicle an improvement of complaints, that Prehn sign is then positive. A another sign for a twist that is Brunzel sign. The twisted testicle is pulled through the Contraction of the cremaster muscle in the inguinal canal pulled up. The patient can do this too Pain to have. Through this reflex tension of the muscle, the reflex (Cremaster reflex) are no longer triggered on the opposite side, as the muscles are also tense here. The cremaster reflex describes the reflex-like tensioning of the muscle after brushing the inside of the thigh, which pulls the testicles upwards. As Tenkhoff sign becomes a faint audible crackling denotes that at Touching the twisted testicle occurs. It is considered a rather late indication of torsion of the testicle.

treatment

The treatment a twisting of the testicle should as soon as possible take place, because thereby the Blood supply to the testicle not guaranteed is, the dangerthat increasing Tissue dies and thus ultimately the function of the testicle is lost. Until the testicle completely dies, the attending physicians have about four to six hours to restore the supply. Depending on Severity The testicular torsion can cause the twist even without surgery be solved.

The attending physician, usually a urologist, tries to do this through targeted handles the spermatic cord again to untwist. Then the The position of the testicle is checked using ultrasound become. In most cases this is done manual therapy as Initial treatment in an acute emergency situation. However, since it cannot always be guaranteed whether the reverse rotation was successful, usually an operation directly preferred. In addition, the testicle can also be used in the operation after the reverse rotation fixed with small seams to avoid re-torsion of the testicles.

What to do?

Sudden pain in the Testicles- and groin areas can indicate twisting of the testicle, especially if straight physical activity or cycling preceded the pain. The patient should then have one See a doctor. Since every touch can worsen the discomfort, the person affected should also Refrain from any permanent manipulation of the testicle. That includes that too Cooling the testicle or that too Wearing tight pants. Best should consulted a doctor as soon as possible who can quickly find the cause.

surgery

In the operative treatment will the Scrotum opened itself or the Access takes place to the testicle through the inguinal canal. First of all, the Testicles exposed to get an exact overview and to determine the direction of rotation. After the testicle brought back to its original position it waits whether the Blood supply secured again is. In addition, the doctors observe whether the testicles tend to twist again. To a To prevent recurrence of the twist, the Testicles sewn into the scrotum with small sutures. This significantly reduces the risk of twisting. This measure is called Orchidopexy designated. Often this is also done on the opposite side, because there is also the risk that the testicle will twist at some point. If the tissue is already partially damaged, that is tried remove damaged tissue. One hopes that the testicle will still have one Residual function has and is still able to To produce sperm cells. If during the operation the Blood flow to the testicle does not start again, the tissue is too badly damaged and already dead. This Testicles it will then awaybecause he can no longer perform his function.