Torsion of testis is a very important disease of the testicle. In this disease, spermatic cord including veins that carry blood around the testicle is twisted around itself, spermatic veins cannot carry blood and if this situation is not corrected at an early time, this situation becomes testicular necrosis (gangrene). The risk of torsion is quite high in undescended testes. Torsion is greater than ever seen during puberty.
Testicular torsion is in two ways:
- Intravaginal torsion: It is a torsion in the tunica vaginalis of testis and epididymis (the membrane that surrounds the testis) usually occurs during puberty. It is high to be double-sided.
- Extravaginal torsion occurs in newborns more than the other.
Testicular torsion is a table being very urgent.
Usually, these occur sudden onset (especially waking from sleep), testicular and groin pain, nausea and vomiting. Standing down from the top of the testicle in a child, not stop lying, strengthens the possibility of torsion. Testicle and epididymis are sensitive; children would not want the scrotums. Normally, torsion is supported by the increase of testicle pain (Prehn’s sign) which occurs as a result of turning the testicle which is under the scrotum and removing the withdrawal of the upper part.
Hydrocele and edema are often seen with torsion.
Testicular torsion is most commonly confused with Orchitis and epididymitis. The loss of time for differential diagnosis may cause the loss the testicle. Because of this reason, it has to be treated quickly.
These symptoms should direct the physician to consider in favor of torsion; in the history, sudden onset of the event, the testicle which held in takes place above and in horizontal position against the testicle, not handle usually the epididymis during examination (cannot be palpated), absence of flix, lack of combustion in the urine, being positive of Phren Symptom and lack of fever and PREVIOUSLY THE RELATED STATEMENTS MIGHT OCCUR FROM TIME TO TIME.
Blood flow can be measured from the testis and epididymis with doppler ultrasound and testicular scintigraphy. Despite the existence of a serious decrease in blood flow in torsion, increased blood flow is seen in orchitis and epididymitis. These data are very important criteria for a definitive diagnosis.
Torsion is a table being very urgent. Normally, if there isn’t a significant delay when patients the first refer to the patient (the first 4 hours is very important), the doctor should try to rotate the testicle who returned (detorsion) to the reinstates manually. The ideal approach is the fixation (stopping) of the testicles with surgery to the place in the scrotum after detorsion electively.
PATIENTS DELAYED 4 HOURS:
Testis and epididymis are reviewed (are explored) with emergency surgical intervention which will make ??with an incision over scrotums or the groin.
If they are live, the testis and epididymis are made detorsion and are detected in the scrotum. If they are gangrene like in the picture above, are removed completely (ORŞİO EPIDIDYMECTOMY). Because of the anomaly which cause torsion can cause the other testicle, the determination of the testicle on the opposite side, into the scrotum, is made in the same session.