Testicular torsion

　　Testicular torsion may be related to anatomical abnormalities or developmental defects, such as an overly large tunica vaginalis, an excessively long spermatic cord, or incomplete descent of the testis. Sometimes, external force is not obvious, and it can occur even during sleep, possibly due to vagus nerve excitement during sleep and the strong contraction of the cremaster muscle with the erection of the testis and penis. External trauma to the perineum,剧烈运动, or cold weather can also cause spasms of the cremaster muscle or sudden changes in body position, which can lead to excessive activity of the testis and trigger testicular torsion.

　　The mechanism by which torsion causes testicular damage is easy to understand. Circulatory obstruction and venous occlusion lead to testicular congestion and swelling. If delayed, venous thrombosis may occur, eventually leading to arterial embolism and tissue necrosis. The extent of testicular damage is related to two factors: the degree of torsion and the duration of time. Clinical evidence confirms that testicular atrophy can be seen after 4 hours of torsion. If treatment is not provided within 12 hours after torsion, most testicles will undergo atrophy. However, there is also a great deal of uncertainty in this situation. Some patients may have intermittent and self-healing torsion without causing testicular damage, while others may quickly develop complete vascular梗死, resulting in rapid testicular damage and necrosis. In summary, immediate surgical exploration should be performed within 4 hours after the onset of symptoms. Testicular necrosis is almost inevitable after 12 hours of ischemia.

　　After testicular torsion, the patient may experience severe pain and is usually willing to seek medical attention. The key is that the doctor should make a timely diagnosis and treatment. If the torsion is not reduced within 24 hours, it can lead to testicular necrosis or postoperative atrophy.

　　Testicular torsion has an acute onset, often occurring during sleep, with severe pain in one testicle and scrotum. Initially, the pain is confined to the scrotum, but it may later spread to the lower abdomen and perineum, accompanied by vomiting, nausea, or fever, with redness and tenderness in the genital area.

　　1, A sudden severe pain may occur in the abdomen.

　　2, The testicle may experience severe pain.

　　3, The testicle that has twisted appears higher in the scrotum than the normal testicle.

　　4, The child may experience nausea and vomiting.

　　5, Several hours after the onset of symptoms, the scrotum may become red and swollen, and it may be painful to the touch.

　　The clinical manifestations of testicular torsion are mainly pain and swelling. If it occurs in children, it is often more difficult to diagnose, as children may have unexplained anorexia and restlessness, and the condition usually progresses rapidly.

　　In our daily lives, male friends are not aware of the prevention of testicular torsion, so sometimes when testicular pain occurs, they just endure it, which delays the early cure of the disease. In severe cases, it may even lead to the loss of fertility and lifelong misfortune. Therefore, doing a good job in preventing testicular torsion is an important guarantee to avoid severe consequences.

　　1, Ischemic necrosis can occur within 4 to 12 hours after testicular torsion. Therefore, it is crucial to make an accurate diagnosis as soon as possible and never miss the opportunity for rescue. After an accurate diagnosis, a manual reduction can be attempted, generally with the left side rotating clockwise and the right side counterclockwise. However, this does not always conform to this pattern. If the pain decreases during reduction, it indicates the correct direction; if the pain intensifies, it means the direction is incorrect, and the opposite direction should be tried; if the pain does not decrease, it indicates failure. Immediate surgical exploration should be performed to save the testicle before necrosis occurs.

　　2, Adolescents are prone to this condition, although it can occur at any age, it is more common in infants, children, and adolescents. In a group of 718 cases analyzed, the average age of onset was 14.9 years old. Therefore, parents and teachers should closely monitor the symptoms of children and students, and not delay medical treatment because they may not be able to express or are ashamed to speak up.

　　3. Certain congenital factors are prone to cause this condition, such as underdeveloped testicles, incomplete descent (especially inguinal cryptorchidism), or elongated spermatic cord, which may all be predisposing factors for testicular torsion.

　　Common symptoms include sudden scrotal colic, pain that radiates to the lower abdomen, making it difficult to straighten the back, and pain can be extremely severe. Older children may cover the perineum with their hands, bend their backs, become pale, and sweat all over. The testicle swells, retracts to a horizontal position, is obviously tender, and the pain can be relieved by lifting the scrotum. If the child is too young to speak, parents or teachers should carefully examine these areas.

　　Patients with testicular torsion may have a slight increase in white blood cells during routine blood tests.

　　1. Doppler ultrasound examination shows reduced testicular blood flow.

　　2. Technetium-99m (99mTc) testicular scan shows reduced blood perfusion in the twisted side of the testicle, presenting as a radioactive cold area. The accuracy rate of diagnosis reaches 94%, and it is widely recognized as the most reliable auxiliary diagnostic measure.

　　3. Ultrasound examination and CT scan are helpful in determining whether the testicle is swollen, acute hydrocele, scrotal edema, and incarcerated hernia, but are not reliable in distinguishing testicular torsion from epididymitis.

　　The best treatment for testicular torsion is surgery. The surgical methods include surgical reduction and manual reduction.

　　1. Surgical Reduction

　　After diagnosis of testicular torsion, efforts should be made to perform immediate surgical reduction, aiming to complete the operation within 6 hours of symptom onset. After reducing the twisted testicle, observe that the blood supply is normal, and then perform intermittent suture and fixation of the testicle, spermatic cord, and inner tunica vaginalis of the scrotum to prevent recurrence after surgery. If the blood circulation of the testicle is extremely poor during the operation and cannot be restored after reduction, the testicle should be removed.

　　2. Manual Reduction

　　Generally, it can be tried at the beginning of the disease. Analgesics and antispasmodics should be administered first, and then the horizontally positioned and elevated testicle should be gently manipulated into the correct position after half an hour. After successful manipulation, the scrotum should be supported with a 'T' band to allow the affected testicle to rest fully. However, manual manipulation cannot prevent recurrence.

　　After surgery, ice packs can be applied to reduce pain and swelling. At the same time, the scrotum should be supported and fixed with a 'T' band for a week to gradually restore normal function.