Cause
The problem that causes testicular torsion is a testicle that twists around the spermatic cord and the vascular bundle that supplies it. This is called stem torsion because the torsion happens around its own attachment. This is always possible when a testis is increasingly mobile.
This can happen, for example, if the spermatic cord grows very quickly or is too long for the testicles and scrotum. This increases the mobility of the testicle and makes rotation anatomically possible. By twisting, the testicle cuts off its own blood supply, which together with the spermatic cord from the groin down to the scrotum, and is no longer sufficiently supplied with blood.The reduced blood circulation leads to a lack of oxygen in the tissue, which triggers the acute pain and can quickly cause irreversible damage to the testicles.
Diagnosis
The diagnosis of testicular torsion can be made relatively clearly on the basis of the symptoms described above and a physical examination. Further indications result from an ultrasound of the testis (sonography), which is in the best case performed as a so-called color-coded Doppler sonography. This allows statements to be made about the current blood flow in a tissue.
In the case of testicular torsion, normal blood flow is no longer apparent. However, even if the findings of the ultrasound examination are inconspicuous, torsion cannot be completely ruled out with corresponding symptoms. In case of doubt, the suspicion of the examining physician counts. An immediate operative control will be carried out and, if necessary, treatment will be administered. This procedure is justified in the case of testicular torsion, since it is an emergency and not recognizing the problem and omitting therapy has much more serious consequences than the possible surgery.
Therapy/treatment
The treatment of testicular torsion is an absolute emergency operation, which must be performed under general anesthesia and immediately after the patient arrives at the hospital. A possible conservative treatment with cooling compresses or medication is not indicated under any circumstances. Such measures may be able to relieve the pain under certain circumstances, but they are very dangerous as they do not eliminate the actual cause.
A restoration of the blood supply to the testicles must be achieved and is the primary therapeutic goal. The surgical therapy begins with the opening of the scrotum. The scrotum is incised lengthwise for this purpose.
The surgeon palpates and examines the testicle with the vessels supplying it and removes the torsion. The testicular tissue is then observed to determine whether it is recovering. As a rule, the surgeon waits up to 20 minutes, but if the testicle still does not seem to have a good blood supply, it must unfortunately be removed.
Before that, one tries to stimulate the reestablishment of blood circulation with warm, moist compresses intraoperatively. The removal of the testicle is always only the last resort, when one is absolutely sure that the tissue has already died. If there is only the slightest hope of recovery, the testicle is left in any case.
If the testicle has recovered after a reasonable waiting period, the second step is to fix it with two sutures (on the outside as well as on the inside of the testicle) from the inside of the scrotum to prevent a new twisting. Timely recognition and treatment of testicular torsion usually has no drastic consequences. A slight functional impairment may remain, but this is often not noticeable.
The sooner the blood circulation is restored, the better the result in the further course of the procedure. After successful surgery, the skin suture for closing the wound is usually made with absorbable sutures, which dissolve automatically after a few days. For the internal fixation sutures, on the other hand, permanent sutures are used so that the testicle is firmly fixed in the future. If the blood circulation is restored promptly, the tissue of the testicle recovers, the bruise or discoloration disappears and the swelling also rapidly decreases. Depending on the required incision, a small to medium scar remains, which disappears in the anyway rather wrinkled skin relief of the scrotum and is soon almost invisible.
