Testicular torsion - Testicular torsion

Torsion of the spermatic cord

In the medical field, testicular torsion indicates a particular and evident rotation of the testicle around its axis. Although the name "testicular torsion" gives an "immediate idea of the disorder in question, it would be more correct to speak of torsion of the spermatic cord: in fact, it is the torsion of this cord - responsible for the connection between the testicle and the groin - that gives rise to the so-called testicular torsion.
and in any case of torsion of the testicle.

What's this ?

Testicular torsion designates an alarming and dangerous clinical picture: it is an "urgency of urological - surgical competence in all respects. When the disorder is neglected, untreated or underestimated, the consequences can be irreversible, up to degenerating into atrophy of the testicle.
We have seen that the main cause of the torsion of the didymus is the rotation of the spermatic cord: the latter groups together a set of nerve endings and blood vessels, whose function is to supply the testicle.
The chances of a twist increase enormously when:

The cord is anatomically too long
The didymus is not well anchored to the terminal part of the scrotal bursa

In this regard, rather than talking about a real disease, it would be more correct to understand testicular torsion as an "anatomical anomaly; so much so" that there is no risk factor directly related to the rotation of the didymus.

Patients at risk

In most cases, testicular torsion is an "anomaly that affects newborns, infants and adolescents; it rarely occurs in" adult men. Statistics have observed that approximately 66% of patients who complain of this disorder are between the ages of 12 and 18. However, testicular torsion can come on suddenly at any age.
Testicular torsion is estimated to occur in one in every 14,000 males under the age of 25.

Causes

The underlying causes of testicular torsion are mostly genetic. Some affected patients are predisposed to the problem; it seems that the cause lies in an "anatomical anomaly concerning the" grafting of the vaginal tonic on the spermatic cord (we speak of intravaginal torsion of the testicle, responsible for 90% of cases of torsion of the didymus), or the "increase in testicular volume (typical of pubertal age).
In the case of testicular rotation in the pre / neonatal age, the causes lie in the "excessive mobility of the testicle inside the scrotal sac, therefore in the immaturity of the testicular anchoring systems: in such situations, the lack of structures generally occurs. specific anatomical support (extravaginal torsion).
The extra genetic causes are not currently identifiable with certainty: however, some possible risk factors have been hypothesized, including repeated trauma, sexual activity, cryptorchidism, testis placed horizontally, testicular volumetric increase and neoplasms affecting the didymus.

How does the twisting of the didymus happen?

As we have seen, testicular torsion consists in the rotation of the spermatic cord along its axis: in similar situations, a series of dramatic and painful events are triggered that begin with a venous block (responsible for parenchymal ischemia), continue with the formation of a noticeable edema and ending with the loss of arterial flow.

Symptoms

For further information: Symptoms Testicular torsion

It is almost impossible not to realize the testicular torsion: the symptoms are certainly very painful, acute, brutal and sudden, regardless of the co-presence of further clinical pathologies. Most of the time, the pain begins during the night in the testicle, and then spreads to the surrounding areas - inguinal canal and ring.
Subsequently, the testicular gland tends to gradually increase in volume and swell; sometimes, the inflammation is accompanied by skin changes affecting the scrotum.
Furthermore, it is not uncommon for patients suffering from testicular torsion to complain of generalized malaise and nausea; however, concomitant fever and pain during urination are unlikely.
It should be pointed out that testicular torsion involves, most of the time, only one testicular sac: consequently, the other scrotal bursa - uninjured - does not show any pathological or abnormal signs.

Other characteristic signs of testicular torsion:

Marked testicular swelling
Abnormal positioning of the twisted testicle in the scrotum (the didymus is located higher)
Presence of a solid lump in the upper pole of the testicle, also evident on palpation
In case of dysuria accompanied by infections, the likelihood of testicular torsion increases