Testicular torsion

introduction

Among the most common and important urological emergencies belongs to testicular torsion. Torsion, from Latin torquere (to turn), describes a rotation or twisting around its own axis. This is also the case with testicular torsion, which usually immediately leads to an undersupply of the tissue. Testicular torsion is therefore an immediate indication for operative treatment; the faster the problem is resolved, the greater the chances of complete regeneration of the Testicle.

frequency

Especially infants in the 1st year of life and boys who are in the puberty often experience a Testicular twist. In 60% of the cases it is left testicleaffected by the twist. Statistically speaking, one boy or young man out of 4,000 in the age group up to 25 years of age experiences this emergency. When a twist occurs, it is often associated with growth, which is reflected in the frequency peaks above.
Of course, a different age does not rule out the possibility of testicular torsion. In recent years, for example, an increasing number of cases of newborns have been observed in which one Twisting already in the mother's womb happened. This is usually noticed quickly after the birth and must also be treated. Unfortunately, the testicular tissue is rarely preserved in these cases.
Last are testicular torsions even in adults not an exceptionally rare disease. In about half of the cases the occurs Turning at night, out of sleep. Also at exercise there is a risk of testicular torsion.

Symptoms of testicular torsion

A testicular torsion is noticeable as an acute, very strong, permanent pain in the area of ​​the testicle and scrotum (Latin: scrotum).

Under certain circumstances, this pain can also be perceived as radiating to neighboring tissue. From the outside, a reddening, an enlarged testicle and a swelling of the testicle is usually visible.

These signs can of course also indicate other diseases of the genital area, but arouse suspicion of testicular torsion.

Even the slightest suspicion can be an urgent emergency. The victim should go to a hospital immediately.

Some patients also complain of more general symptoms such as nausea, vomiting, and sweating that may accompany the acute event.

Read more about the topic here: Swollen testicle

Baby Child

As mentioned earlier, testicular torsion is involved Children up to 2 years very often. Notes leading to diagnosis are given in Infants naturally more difficult to interpret than in older patients. Loud, persistent screaming in these cases indicates the severe pain, but it cannot be specified in more detail. Other reasons are also conceivable, so that especially with restless children there is a risk that Urgency of the situation to misunderstand. As a rule, however, the pain is so strong and long-lasting that the child cannot be calmed down and the parents quickly become involved altered testicle notices.
An experienced pediatrician will recognize this Emergency situation, as well as particularly vulnerable age groups, and can by palpation of the testicle give correct advice quickly. Nonetheless, it is advisable to the child without detours, to the nearest hospital bring to.

Detect

Are characteristic of testicular torsion severe painthat appear suddenly and no longer fade. Starting at the testicle, they can extend into the strip, possibly up to the Lower abdomen, broadcast. The scrotum is reddened or bluish-red discolored and bloated. The Skin foldsthat are normally visible are elapsed and no longer recognizable. On Touches or pressure A person affected feels severe pain on the testicles. In absolutely exceptional cases, twisting the testicles can be painless. These cases are the big exception.

root cause

The problem that causes testicular torsion is one Testicles, which around the spermatic cord and the The vascular bundle supplying it is twisted. One speaks of a so-called Stem rotationbecause the torsion happens around its own attachment. This is always possible when a testicle more agile is. That can happen if the Spermatic cord for example grows very quickly or in the course too long is for testes and scrotum. This increases the ability of the testicle to move, and rotation is anatomically possible.
As a result of twisting, the testicle constricts its own blood supply, which together with the spermatic cord pulls from the groin down to the scrotum, and is no longer adequately supplied with blood. Through the decreased blood flow it comes to one Lack of oxygen in the tissue that triggers the acute pain and the testicles as it progresses quickly irreversibly damage can.

diagnosis

The diagnosis of testicular torsion can be made relatively clearly based on the symptoms described above and a physical examination. Further clues result from an ultrasound of the testicle (Sonography), which in the best case is carried out as a so-called color-coded Doppler sonography. Statements can be made about the current blood flow in a tissue.
With testicular torsion, normal blood flow is no longer apparent.
However, even if the findings of the ultrasound examination are normal, torsion cannot be completely ruled out if there are symptoms.
In case of doubt, the suspicion of the examining doctor counts. An immediate operative check-up will be carried out and, if necessary, treatment will be given. This procedure is justified in the case of testicular twisting, as it is an emergency and failure to recognize the problem and skipping therapy have far more serious consequences than possible surgery.

Read more on the topic: Doppler sonography

Therapy / treatment

The therapy one Testicular torsion is a absolute emergency operationthat under general anesthetic and must be done immediately after the patient arrives at the hospital. Any conservative treatment with cooling compresses or medication is in no way indicated. Such measures may reduce the pain under certain circumstances, but they are very dangerous as they do not eliminate the root cause. A Restoration of blood supply of the testicle must be reached and is the primary therapeutic goal.

Surgery of a testicular torsion

Operative therapy begins with the Open the scrotum. The scrotum is incised lengthways. The surgeon feels and examines the testicle with the vessels supplying it and removes the torsion. The testicular tissue is then observed to see if it recovers. As a rule, you wait up to 20 minutes if the testicle still doesn't well supplied with blood again seems to have to be removed.
One tries beforehand with warm, moist envelopes To stimulate the resumption of blood flow intraoperatively. The Removal of the testicle is always only the last option if you are absolutely sure that this Tissue already dead is. If there is only the slightest hope of recovery, leave the testicle in any case. Has the Testicles recovered after a reasonable waiting period, he will At the second step with two seams (both on the outside and on the inside of the testicle) fixed on the inside of the scrotumto prevent it from twisting again.

After the operation

Detected and treated in time usually has testicular torsion no drastic consequences. It can be a slight functional restrictions stay behind, but this often goes unnoticed. The earlier the blood circulation is restored has been, the better is the result in the further course. After a successful operation, the skin suture to close the wound is usually made with absorbable sutures that dissolve by themselves after a few days. For the inner fixation sutures, on the other hand, permanent threads are used so that the testicle is firmly fixed in the future. With a prompt restoration of the blood flow, the tissue of the testicle recovers, the bruise or the discoloration disappears and the swelling also goes down quickly. Depending on the cut required, one remains small to medium scarthat disappears in the already rather wrinkled skin relief of the scrotum and soon almost invisible is.

forecast

Of the most important prognostic factor if the testicle is twisted time. After the event occurs, there are still about four to six hours. After just four hours, irreversible tissue damage occurs as a result of the insufficient oxygen supply. After six hours is this entire tissue as a rule dead and no longer to be saved. Therefore are quick action, an immediate hospitalization as well as a Emergency operation Absolutely necessary at any time of the day or night.
The Repetition rate of torsions is very high because the cause lies in the excessive mobility of the testicle. Because of this, the restoration of blood supply to the testicle follows always a fixation of the organ. After successful fixation of the testicle, repetition of the event is almost impossible. A increased risk of torsion for the second side but remains of course.

consequences

The most drastic consequence of testicular torsion is this Necrosis of the tissue in the event of a long-standing interruption in the blood supply. This means that the tissue of the testicle dies and cannot recover. If this happens, the testicle must be completely removed. In a second operation, a Testicular prosthesis can be used if the patient so desires. In this way, visually appealing aesthetic results can be achieved. However, one of the two sperm production sites is missing, that is, the one fertility this man will limited be and stay. In most cases the quantity and quality is what is produced on the other hand Sperm still sufficient so that children can still be conceived. In these cases, however, the second side treated prophylactically to avoid endangering the remaining testicle.

prophylaxis

After an emergency operation for testicular torsion on one side, there is always the operative fixation of the other side makes sense. Then there is the Suspicion, that the other testicles also more mobile and it is only a matter of time before torsion can be expected there too.
Especially if a patient has had a testicle removed due to a late diagnosis or treatment that was too slow or for other reasons, prophylactic surgery is performed on the other side so as not to put it at risk. If a patient loses both testicles due to unfortunate circumstances, he would be missing the entire sperm production site; he would be sterile. Since this should be avoided as far as possible, one decides relatively quickly for prophylactic treatment.
If the tissue conditions allow it, it is possible to use the second side already in the context of emergency care also to operate. The patient saves one more anesthetic and one more procedure. If the tissue is still inflamed or swollen, you wait until the tissue has stabilized and after about six weeks a so-called elective operation is carried out. The goal is the to fix the second testicle promptly, but since there is no acute danger until the time of the operation, the appointment can be planned by arrangement.
Without previous testicular torsion consists no reason for prophylactic restraint the testicles, even if the father or brothers were affected. The rule is normal growth of the testicles and the spermatic cord and the associated stable fixation of the testicle in the scrotum. As long as no torsion was detectable, it is assumed that the anatomical conditions are normal.