Introduction
Testicular torsion (twisting) is a medical emergency requiring prompt care. Usually, testicular torsion repair surgery is required to relieve discomfort and swelling and to stop the testicle from potentially losing its structure. To guarantee the patient's comfort, the surgeon performs this surgical treatment under general anesthesia, which enables the physician to successfully repair the torsion and restore blood flow to the damaged testicle. To avoid problems and maintain testicular function, it is imperative that people with signs of testicular torsion, such as abrupt and intense testicular discomfort, seek medical attention immediately.
What Is Testicular Torsion?
Testicular torsion is an emergency that arises from a twisted spermatic cord, which supplies blood and sperm to the testicle. The testicle's blood supply is restricted by this twisting action, which causes abrupt and intense discomfort and swelling. An extended period of torsion, exceeding several hours, may cause irreversible harm to the testicle. If there is severe damage to the testicle, it might need to be surgically removed to avoid other problems. Thus, prompt medical intervention is essential to reduce the chance of testicular loss and maintain testicular function.
There are two primary forms of testicular torsion: intravaginal and extravaginal.
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Intravaginal Torsion: This is the torsion of the spermatic cord inside the protective cover that surrounds the testicle, the tunica vaginalis. Within the tunica vaginalis, which is normally firmly attached to the posterolateral part of the testicle, the spermatic cord is immobile. Intravaginal torsion can occur when the spermatic cord twists internally due to a high tunica vaginalis attachment point.
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Extravaginal Torsion: Newborns frequently have extravaginal torsion. This happens when the spermatic cord and tunica vaginalis are prone to twisting because the latter is not attached to the gubernaculum (a structure that helps the testicles descend during fetal development). This pathology is treated differently and may manifest weeks or months before delivery. It is crucial to remember that intravaginal torsion can also manifest in newborns.
How Is Testicular Torsion Repair Performed?
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Surgical Detorsion - For individuals presenting with clinical signs suggestive of testicular torsion, the definitive therapy option that is advised is immediate surgical detorsion followed by either orchiopexy (surgical treatment in which the testicle is sutured inside the scrotum to stop torsion episodes in the future) or orchiectomy (surgical removal of either or both testicles, done only if the testicles cannot be saved). To increase the likelihood of saving the damaged testicle and maintaining its function, this operation must be started as soon as possible. Comprehensive counseling on the potential dangers of either immediate or delayed testicular loss should be given to patients and caretakers. They should also be told that, even in the unlikely event that testicular recovery is successful, there might still be consequences for future fertility.
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Extravaginal Torsion - Due to the high risk of anesthesia and the low incidence of testicular salvage, the best time to explore surgical options for neonates who present with torsion at birth continues to be subject to dispute. While asynchronous torsion (involving only one testicle) is rare, testicular loss can have serious repercussions. Most of the literature supports the prompt examination and fixation of the contralateral testis (testis present on the opposite side) to reduce the possibility of asynchronous testis loss.
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Intravaginal Torsion - It is essential to do surgical exploration as soon as possible on boys who exhibit clinical indications of testis torsion without delaying confirmation by radiologic investigations. A midline longitudinal or bilateral transverse scrotal incision is the recommended surgical technique. The surgeon enters the afflicted testis and detorses it right away, evaluating its color, amount of torsion, and anatomy of the tunica vaginalis. The testis is covered in warm, damp gauze when detorsion is accomplished. Examining the opposite hemiscrotum and orchiopexy of the unaffected testis is performed to avoid further twisting. The viability of the afflicted testis is then evaluated once more. A tunica albuginea (fibrous tissue surrounding the penis) incision or intraoperative Doppler can be utilized for additional assessment if blood flow is still unclear. Orchiopexy is done if the testis is viable. If not, an orchiectomy might be required. If necessary, prosthesis insertion is usually postponed to a non-acute atmosphere.
Why Does Testicular Torsion Require Immediate Surgery?
Testicular torsion requires immediate medical attention. The more quickly the disease is treated, the more likely the damaged testicle will be saved. Generally, general anesthesia is used during the surgical process to treat testicular torsion. If required, the spermatic cord is untwisted during the procedure, which involves making a tiny incision in the scrotum. To stop further torsion, one or both testicles may be sutured to the interior of the scrotum.
Timely surgical intervention is often necessary to relieve pain and swelling and avoid the possible loss of the testicle. Surgery carried out within four hours after the onset of symptoms usually connects with the best results—the likelihood of testicle removal owing to injury increases dramatically six hours from the start of symptoms. A testicle may become irreversibly damaged when 12 hours have elapsed from the start of symptoms, requiring its removal. Consequently, to reduce the chance of testicular loss, prompt medical attention is required.
What Are the Post Surgical Considerations After Torsion Repair Surgery?
Scrotal surgery takes time to heal, regardless of if the testicle is removed. Taking pain medication for a few days after the procedure could be necessary. People can usually return to work or school in just a few days to a week, but to speed up the healing process, it is best to avoid physically demanding tasks or exercise for a few weeks. Most of the time, the stitches surrounding the testicles are invisible and do not hurt. Their function is to stop torsion from happening again. It is crucial to understand that neither medicine nor activity modifications can stop the other testicle from twisting. The only treatment that can stop torsion in the future is testicle stitching. Seek emergency medical assistance if there is any discomfort or swelling. The testicle may shrink if not removed because of possible long-term harm. One testicle may occasionally grow larger than usual after another is removed, called "compensatory hypertrophy."
Conclusion
The male population must be made aware of the gravity of genital pain. There could be serious repercussions if this discomfort is disregarded or ignored, including permanent damage to the testicle or possibly its removal. Early treatment of torsion reduces the likelihood of subsequent episodes and enables the application of prophylactic measures such as attaching the testicles to the scrotum. Young men should be reassured that they can still enjoy normal lives with little effects on their capacity to father children and sexual function, even though torsion may result in the loss of a testicle. Parents can contribute to securing their kids' present and future health by emphasizing awareness and early medical attention.
