Testicular torsion: how to recognize this surgical emergency?

Testicular torsion: what is it?

A torsion of the testicle, also called a testicular torsion, refers to a “kinking of the cord containing the veins and arteries which supply the testicle”. This problem of “coiling” of the spermatic cord at the level of the male reproductive gland is not trivial, because it can damage it, by depriving it of irrigation.

Torsion of the testis, which can occur on a single gland, or both at the same time, therefore represents a urological emergency and requires treatment by a specialist.

Testicular torsion: risk factors

Torsion of the testicular cord mainly affects infants, children, adolescents and young men, but can occur at any age.

Some risk factors exist such as an anatomical abnormality, such as:

• A testicular cord longer than normal
• Poor fixation of the stock market

How do you know if you have testicular torsion?

The management of testicular torsion must be rapid, to avoid complications in the reproductive gland.

The signs that should alert are different, depending on the age of the patient, and should be taken seriously.

In newborns, symptoms of testicular torsion can be:

• Inflammation of the bursa, which becomes red and tender
• Pain, manifested by heavy crying
• A significant asymmetry between the stock exchanges

Note that a testicular torsion can be observed at the birth of the child by the pediatrician, but cannot be taken care of, the gland being already destroyed, for lack of irrigation.

In adolescents or young adults, testicular torsion could be identified by certain signs, such as:

• A sharp and sudden local pain, at the level of a bursa (following movement, or which sometimes occurs during sleep)
• Pain that spreads to the groin
• Pain in the bursa that makes it difficult to walk
• Nausea, vomiting can accompany this intense pain
• An absence of urinary disorders
• An asymmetry between the stock markets
• The presence of reactive edema

Put a testicle back in place, take charge… What to do in case of testicle torsion?

The symptoms, specific to each age, mentioned above, should alert and give rise to an emergency consultation. Management must be done quickly (within 6 hours of the first symptoms), in an emergency surgical department, to avoid the risk of permanent destruction of the reproductive gland.

In case of testicular torsion:

• Contact 15 or 112
• Go to the emergency room as soon as possible

The clinical examination can then be carried out, in order to confirm or not the diagnosis. In the event of a proven testicular torsion, surgery will be necessary to remedy this kinking of the cord, which prevents blood from circulating to the reproductive gland.

The testicular torsion surgery, which should take place within 6 hours, aims to:

• Undo the cord winding, and check that the irrigation of the gland is done correctly again
• Secure the testicle to the scrotum (which is the skin covering the testicles), in order to avoid further testicular torsion

Following this surgical intervention, medical supervision is necessary for a few months, in order to check that the testicle which has been operated on does not suffer from atrophy (decrease in the volume of the testicle).

In the case of too late a surgical intervention, the surgeon can proceed to an orchiectomy (which is the amputation of a testicle destroyed by the twisting of the cord).

For aesthetic reasons, the replacement of this testicle by a silicone prosthesis can be proposed.

In infants who have reportedly suffered from testicular torsion before birth, removal of a testis is rare, due to the possible survival of cells in the reproductive glands.

Source : www.ameli.fr

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