TORSION OF TESTES
Definition: Torsion of testes is an emergency condition where the spermatic cord of a testicle becomes twisted, cutting off the blood supply.
Types:
- Complete torsion
- Incomplete torsion
- Idiopathic torsion
- Torsion due to trauma
Pathophysiology:
- Abnormal fixation of the tunica vaginalis to the scrotal wall
- Abnormal development of the gubernaculum testis
- Abnormal anatomy of the scrotum
- Increased sensitivity to pain in testis
- Sudden increase in scrotal temperature
- Rapid increase in intratesticular pressure
Causes:
- Abnormal fixation of the tunica vaginalis
- Abnormal development of the gubernaculum testis
- Abnormal anatomy of the scrotum
- Trauma to the testis
- Increased sensitivity to pain in testis
- Sudden increase in scrotal temperature
Signs and Symptoms:
- Sudden onset of severe testicular pain
- Nausea and vomiting
- Abdominal pain
- Testicular swelling
- High scrotal position of the affected testis
- Elevation of the affected testis
- Absence of cremasteric reflex
Clinical features:
- Severe scrotal pain
- Testicular swelling
- High scrotal position of the affected testis
- Elevation of the affected testis
- Absence of cremasteric reflex
- Absence of testicular pulsation
Investigations:
- Clinical examination
- Ultrasound
- Doppler ultrasound
Complications:
- Testicular atrophy
- Infertility
- Chronic pain
- Absence of cremasteric reflex
Management:
- Emergency surgical exploration
- Orchiectomy
- Torsion of testis can be prevented by orchiopexy (surgical fixation of the testis)
Treatment:
- Emergency surgical exploration
- Immediate orchiectomy if the testis is dead
Homeopathic Therapeutic Medicines:
- Arnica: For pain and inflammation
- Lachesis: For pain and inflammation
- Chamomilla: For anxiety and restlessness
- Aconitum: For sudden onset of pain
Operative method: 1 → Incision through the scrotum 2 → Exposing the spermatic cord 3 → Untwisting the spermatic cord 4 → Clamping the spermatic cord 5 → Cutting the spermatic cord 6 → Removing the testis (orchidectomy)
Blood supply:
- Testicular arteries
- Pampiniform plexus of veins
- Cremasteric veins
Nerve supply:
- Preganglionic sympathetic fibers
- Preganglionic parasympathetic fibers
- Postganglionic sympathetic fibers
Clinical anatomy:
- Testis
- Epididymis
- Spermatic cord
- Cremaster muscle
- Scrotal wall