TESTICULAR TORSION: DIAGNOSIS, THERAPIES AND RISKS

Premise

In the previous article we defined testicular torsion as an "anatomical anomaly which consists in the rotation of the spermatic cord around its axis. In this concluding discussion we will focus on the diagnosis, on the therapies and on the possible risks that the patient incurs when postponing diagnosis and treatment.

Testicular torsion diagnosis

Given the severity of the disorder, it should be stressed once again that prompt and immediate intervention is the only solution to ensure complete healing of testicular torsion. Clearly, a thorough diagnosis is required before intervening.
The affected child often complains of inaccurate genital pain: in young patients, testicular torsion is almost always accompanied by abdominal pain. In this regard, it is necessary to examine the child carefully, particularly when he recriminates abnormal genital pain accompanied by pain in the lower abdomen.
First of all, the doctor proceeds with the physical examination, essentially based on the observation of the anatomical anomaly and on palpation.
Urinalysis is also useful: in case of ascertained infection, the diagnosis could prove in favor of orchitis (testicular inflammation).
The testicular echo-Doppler ultrasound shows the possible absence of blood flow in the didymus, as well as verifying the spiral on the spermatic cord: this diagnostic strategy has a specificity equal to 90% and a sensitivity that reaches 88%.
The differential diagnosis with: trauma, varicocele, orchitis, orchi-epididymitis, idiopathic scrotal edema, torsion of the testicular appendage (potential cause of testicular torsion) and incarcerated hernia is also substantial.

Therapies

The treatment is urgent and surgical in most cases: however, manual, rapid and non-invasive detorsion, clearly practiced by experts, is successful in 26% of patients.
In case of severity, the patient, completely anesthetized, undergoes a "medical surgery operation which consists in the incision of the scrotal sac, followed by a counter-twist (detorsion) and the repositioning of the testicle in the normal position." When the operation is not performed immediately, the testicle could take on an abnormal, blue-blackish color (index of lack of blood flow): in similar situations, we proceed with the ablation, then with the removal of the didymus, followed by replacement with a prosthesis.
Immediate urological observation is absolutely essential: hesitating and lingering in the specialist visit, as well as hesitating or giving up surgical treatment, represent completely inappropriate behaviors, responsible for the "inevitable"castration from negligence". [adapted from Emergency Medicine Signs and Symptoms, by S. R. Votey, M. A. Davis]

Risks

When the problem is not treated promptly, the damage is such that it permanently atrophies the structure of the testicle. The risk is represented by local tissue necrosis, with consequent and inevitable destruction of the testicle itself. [taken from www.androweb.it/]
In case of severity, the seminiferous tubules can suffer permanent lesions already after a few hours from the onset of symptoms: sometimes, the parenchymal damage occurs just 4 hours after the onset of symptoms and, 2 hours later, the testicle is not viable.
In the event of presumed torsion of the testicle, a medical examination is recommended as soon as possible, trying not to delay for more than 20-24 hours: it has been observed, in fact, that the probability of complete healing increases considerably when the intervention occurs within this time frame.
More precisely, it is estimated that the probability of preserving the testicle is around 90% when testicular detorsion occurs within 6 hours from the onset of symptoms, 50% after 12 hours and 10% after 24 hours. , we talk about the probability of testicular recovery dependent time.