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Torsion : Definition, Causes, Symptoms, Diagnosis and Treatment

Tuesday, August 21st 2012. | Disease, Uterine system

Torsion Definition

Twist “testicle” (the testicle rotates on its axis) is in fact a torsion of the spermatic cord which supports the upper pole of the testis.

Blocking the blood flow is very painful and causes death of the testicle in a few hours if surgery is not done quickly.Twisting of the spermatic cord is quite common affecting about a man under 25 years 4000. It usually occurs in newborns or adolescents.

The testicle is normally set in the purse three attachment points: the spermatic cord at the upper pole, a remnant of embryonic tissue (called gubernaculum ) at the lower pole) and a direct apposition back wall (mesorchium). Some anatomical abnormalities can promote itself torsion of the spermatic cord observable at birth or during growth in volume of testes at puberty.

The rotation of the spermatic cord is quickly problematic because it does not contain only the vas deferens from the epididymis but also vessels (arteries and veins), which normally feed the testis and vas deferens. Thus, when the spermatic cord rotates, the flow is suddenly interrupted. If it is not restored within hours, the loss of the testicle is possible.

Sometimes the torsion does not directly concern the spermatic cord but the appendices testis (embryonic anatomical formations established at the head of the epididymis or testis) and in this case, the pain lies at the top of the testicle and n ‘There is no risk for it.

In a study containing the records of 100 patients under 15 years who had a large purse brutally painful, 43% corresponded to a torsion of the spermatic cord, 32% of testicular torsion annexes, 8% explainable without cause edema, 6% to epididymo-orchitis and 3% hernia or varicocele.

Torsion

Anatomy Testicular Torsion (img thanks to urologyhealth.org)

Torsion Causes

Anatomical abnormalities of testicular fixation in the stock market may favor the occurrence of torsion of the spermatic cord, especially the absence of gubernaculum mesorchium or leaving a free testicle in the stock market as a “clapper”.

The twist is usually spontaneous but still describes predisposing circumstances:

  • Sex or masturbation
  • Sudden movements,
  • Cycling.

Torsion Symptoms

Pain is the main symptom

In the case of a newborn, the torsion may be present at birth and the stock is then not necessarily inflammatory, but the testis is small and firm. It is not necessarily painful.

If torsion occurs after birth (while considering scholarships at birth was normal), the signs are clear: the exchanges are red, swollen, hot and painful.

In children and adolescents, the first sign is scrotal pain that occurs suddenly.

Sometimes similar episodes resolved spontaneously (twisting or incomplete episodes of spontaneous torsion-detorsion) have occurred previously. The pain occurs on one side and may radiate to the groin, prolonged and constant.

Initially, the scholarship is not inflammatory but the testis is the groin wound, horizontalized and projected forward.Palpation, even delicate, testis is painful.

There may also be nausea and vomiting.

Torsion Diagnosis

The Doppler ultrasound examination is fast and efficient. It should not delay treatment.

A urine test (urinalysis) in search of an infection will be performed.

What is change?

Testicular torsion unsupported may lead to loss of the testicle.

If the cord twist is complete (360 °), the blood flow is completely stopped and the loss of the testicle possible. In the first 6 hours, the testicle can still be saved in 90% of cases, but beyond the chances of preservation of testicular decrease 70% between 6 and 12 hours, 20% between 12 and 24 hours, less than 10 % after 24 hours.

The party responsible for testicular hormone secretion seems longer resist anoxia (lack of oxygen) that contributes to fertility.

During surgery, the surgeon attaches the testicle surgically involved in the torsion and the other testicle. However, cases of testicular torsion “fixed” have been described, it is not an absolute guarantee.

Torsion Treatment

This is an emergency.

Testicular pain should be managed quickly to emergencies (ie a matter of hours!).

A surgeon must be promptly notified of the suspicion of testicular torsion and we should not waste time.

Some propose to attempt a manual untwisting but we do not know in which direction the torsion occurred (two out of three from the outside to the inside, one out of three in the other direction!), There is a risk of worse.

Two possibilities for the surgeon during the operation:

  • If during the untwisting the testicle, it returns to normal color quickly, preserving the testis is possible. It is fixed and the other testicle, because of the risk;
  • Testis is necrotic and must then be removed (orchiectomy).

Torsion Specialty Concern

Urologic surgery concerned with the diagnosis and treatment of patients congenital, infectious, lithiasis, trauma and tumors of male and female urinary tracts (kidney, renal pelvis, ureter, bladder, urethra) and those of the male reproductive system (prostate, testis, penis).

Urology is a surgical specialty both (all urologists today are trained urologists complete surgical), but also because medical supports some patients without resorting to surgery (benign prostate, kidney, testicular infections).

The study and treatment of reproductive disorders, male erectile dysfunction, ejaculation, fertility is andrology which is involved in urology with other specialties (psychiatry, endocrinology, gynecology , etc.).

The study and treatment of disorders of the urinary tract of children, mostly malformations but also infectious or tumor is urology child. It is performed by urologists or pediatric surgeons who have acquired a particular skill and is a border area between the two specialties.

Torsion References

Chevreau G., M. Peyromaure Torsion of the spermatic cord and testicular annexes. EMC (Elsevier, Paris), Emergency, 24-203-A-10, 2011.

F. Girard, P. Meria, F. Desgrandchamps Torsion of the spermatic cord. EMC (Elsevier, Paris), surgical techniques, Urology, 41-415, 2011.

Audenet F., M. Rouprêt torsion of the spermatic cord: aspects of clinical diagnosis and therapeutic principles, Progress in Urology (2010) 20, 810-814.

 

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