Wednesday, February 1, 2017

Testicular Torsion

 A young male , age 16 years presents to the emergency with the complain of the sudden onset of pain in one testicle, followed by swelling of the affected testicle, reddening of the overlying scrotal skin, lower abdominal pain, nausea, and vomiting.
An examination reveals a swollen, tender, retracted testicle that often lies in the horizontal plane (bell-clapper deformity).

A diagnosis of Testicular torsion was made and the patient was prepared for immediate surgery.

Case Discussion:



Testicular torsion is one of the urologic emergencies and is very painful on presentation.

Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling.

Testicular torsion is most common between ages 12 and 16, but it can occur at any age, even before birth.


Testicular torsion usually requires emergency surgery. If treated quickly, the testicle can usually be saved. But when blood flow has been cut off for too long, a testicle might become so badly damaged that it has to be removed.

Etiology: The most common underlying cause is a congenital malformation known as a "bell-clapper deformity" wherein the testis is inadequately affixed to the scrotum allowing it to move freely on its axis and susceptible to induced twisting of the cord and its vessels.

Clinical Features: Signs and symptoms of testicular torsion include:
  • Sudden, severe pain in the scrotum
  • Swelling of the scrotum
  • Abdominal pain
  • Nausea and vomiting
  • A testicle that's positioned higher than normal or at an unusual angle
  • Painful urination
  • Fever
Young boys who have testicular torsion typically wake up due to scrotal pain in the middle of the night or in the morning.
The spermatic cord is frequently swollen on the affected side. In delayed presentations, the entire hemiscrotum may be swollen, tender, and firm.

Diagnosis: The diagnosis should usually be made on the presenting signs and symptoms and an urgent ultrasound should only be done when the diagnosis is unclear. 
The urine is usually clear with a normal urinalysis. In one-third of cases, there is a peripheral leukocytosis.
Irreversible ischemia begins around six hours after onset and emergency diagnosis and treatment is required within this time to minimize the risk of testicle loss.

Treatment: With prompt diagnosis and treatment the testicle can often be saved. Typically, when a torsion takes place, the surface of the testicle has rotated towards the midline of the body. 
Non-surgical correction can sometimes be accomplished by manually rotating the testicle in the opposite direction (i.e., outward, towards the thigh); if this is initially unsuccessful, a forced manual rotation in the other direction may correct the problem. The success rate of manual detorsion is not known with confidence.

Testicular torsion is a surgical emergency that requires immediate intervention to restore the flow of blood. If treated either manually or surgically within six hours, there is a high chance (approx. 90%) of saving the testicle.

Common treatment for children is surgically sewing the testicle to the scrotum to prevent future recurrence (orchiopexy).

3 comments:

  1. Don't You Think It's High Time You Tried Herbal Remedy?

    In 2015, I was diagnosed of genital herpes.. I was 21 years old and I had no idea what that was. When my doctor explained to me what Genital Herpes was all about and what type I had...I was freaked out! if I had missed coming to the ER any sooner, I would have possibly died without having the slightest clue of what led to my death, as i have never heard of, or experienced the virus before! The rashes grew and i have been living with it ever since then. Most of the time, I feel dirty knowing i was living with herpes. Though the doctor already encouraged me to keep using my medications even though there is no permanent cure for the virus. So i continued with my medications, which only makes the rashes to disappear, and reappear after some days. Late last year, I started surfing the web, seeking for herbal treatment as alternative. So i was on YouTube one evening,i stumbled upon a comment about Dr. Ugo and how his herbal medications cured a woman's daughter of Herpes and I decided to reach out to him. He asked me some questions which i answered, after which He prepared some herbs and sent them to me. He then guided me on how to use them. i used the herbal medications for about ,21days. The rashes gradually dried up. So i went for a test and came back home Herpes free. So My experience with this virus made me to realize, people should find out more about themselves before it's too late. So that when tested positive, they will know how to go about it before it becomes late. If you are having any sickness or virus and needs deliverance contact Dr.Ugo (for your permanent healing) He is the right person to tell your health challenges to. You can contact the doctor via his email address : ugoherbalhome@gmail.com

    ReplyDelete

  2. I feel so excited today because it's just a year since I got my breakthrough from Herpes.I was diagnosed of HSV1 on the 12/4/2015 and latter i got affected with the HSV2. That was my 2nd outbreak after i lost my ex fiance that got me affected with the virus. I was so scared when he died and what i heard about the Herpes virus as he's deathly and such has no cure. I feel so pity and and a disgrace to my personality,in my career and my family to have been in with the deathly sickness, and that would makes my love ones siblings stay far from me. I was going to my regular church activities when i begin to hear testimonies of how people get cure online, i never gave it a thought till my cousin Stephanie who was affected with HIV told me, Lenny you need not to worry cos i met i man today online , i traditional herbal healer whom two of her friends confirmed he cure them with his herbal herbs that i should give it a try. I saw the interest in her and she did contact the herbal doctor again in my present, luckily for me he picked and show up himself, behold he was at about to attain to some patients that have came back with appreciation of how he cure them from Cancer, HIV, and off much too the herpes he cured an 18 years old daughter.
    I was so happy that day, i wanted to be there but the distance was a barrier to me. I told him how the virus had eaten me up and and a truly believe there's cure for herpes. He told me me with assurance that my case wont be different and he had been curing lots of people With his herbal medicine and most people due contact him from the States and preperd the medicine and made use of the DHL to reach him.
    Honestly speaking Dr. Akpu power his a great and gifted herbalist,His destined to herbs.
    He made me do away with the medical prescription,the acyclovir (Zovirax), famciclovir(Famvir), and valacyclovir (valtrex). you don't know him because you haven't meet this man try and contact him yourself Dr. Akpu in Africa is popularly known in his City,and you can request for his address yourself. I'm so happy now cos,I and my cousin had been confirmed negative till date..the Lord is good in my life. Dr. Akpu sent me his herbal medicine that heal me too, 🙏 🙏 Dr. Akpu for giving me another life.
    Contact Dr.akpu for all kids of sickness@
    Dr.akpupowerherbscenter@gmail.com

    ReplyDelete
  3. I started on COPD Herbal treatment from Ultimate Life Clinic, the treatment worked incredibly for my lungs condition. I used the herbal treatment for almost 4 months, it reversed my COPD. My severe shortness of breath, dry cough, chest tightness gradually disappeared. Reach Ultimate Life Clinic via their WEBSITE www.ultimatelifeclinic.com . I can breath much better and It feels comfortable!

    ReplyDelete