Torsion of testicular hydatids - Causes, symptoms and treatment. MF.
Jun 24, 2018
Torsion of testicular hydatids is a pathological condition characterized by a torsion of the epididymis around its pedicle. The adherence of the testicle, in turn, is a rudimentary formation located at the upper pole of the testicle. The original name of this organ is an appendix, but in order not to confuse it with the appendicitis of the caecum located in the abdominal cavity, it was decided to call the rudiment hydatida.
Types of hydatids
Reasons for torsion of testicular hydatids
The very existence of testicular hydatids does not cause the patient any inconvenience. Most men live with this rudiment, even without realizing the existence of the latter. But, in some situations, for example, with a scrotal injury, there may be a torsion of the hydatid around its leg. Then comes the necrosis of the latter, which is manifested by a bright clinical symptomatology.
In addition to traumatic damage to the scrotum, other factors may be the cause of torsion. A strong contraction of the muscle that lifts the testicle, which happens when hypothermia, emotional excitement or minor trauma, can also contribute to the twisting of the testicle appendix.
A significant role in the development of torsion of the testicles is played by the maturity of the connective tissue of the scrotum organs. That is why, the disease is more common in children, when the nervous regulation of the muscles is not yet perfect, and the connective tissue has a higher percentage of fluid, compared with adults.
Symptoms of tester hydatidia
Symptoms of torsion of testicular hydatids, to some extent, depends on the stage of the disease. At the initial stage of patients, severe pain in one of the half of the scrotum is disturbed. Together with this there is edema of this part of the body and hyperemia( reddening), more concentrated at the upper pole of the scrotum.
In the second stage of the disease the swelling of the scrotum begins to subside, and instead, the upper pole of one of the testicles shows a purple oblong formation, the size of the bean. This is the hydatid. The skin over the appendix is highly hyperemic and sharply painful. The slightest touch to it delivers the strongest pain to the patient.
As a rule, during these two stages of the disease it is diagnosed and the patients are subject to surgical treatment. In rare cases, when there is a hypodiagnosis or patients simply do not turn for help to a doctor, they develop necrosis hydatida, which leads to purulent fusion of the entire scrotum. Although such cases are very rare today, the literature describes patients who have torsion of testicular hydatids and caused scrotal amputation.
Diagnosis of titanium hydatide torsion
Torsion of testicular hydatid, together with other surgical pathologies of this organ, is invested in acute scrotal syndrome. All these diseases are subject to prompt treatment, so urologists often go to surgery, even without knowing a reliable diagnosis. After opening the cavity of the scrotum, they see the immediate cause of the pathology and eliminate it. This is called intraoperative diagnostics.
Preoperative diagnostic methods are also used. The rarity of their use is explained by the fact that a full examination of the patient delays the time before the operation, which contributes to the progression and spread of inflammation.
The most common and simple method of diagnosing hydatids is diaphanoscopy. It involves scintillating the scrotum with a conventional flashlight. When hydatide against a background of light in the upper pole of the scrotum, a bean-shaped darkening is visualized, which is a pathologically altered epididymis.
In addition, it is often used ultrasound, which makes it possible to more clearly determine the position and size of education. Ultrasound is necessary not only to diagnose the disease, but also to determine the location of the incision in a future operation.
Testicular Hydatidic Torsion Torsion
The only justified method for the treatment of testicular tertigrade torsion is surgery. For older children and adults, it is performed under local anesthesia, the younger one under general anesthesia.
During surgery, a skin incision is made at the upper pole of the altered testicle. Revision of the scrotum cavity is performed, where, as a rule, a bean-like compaction of scarlet or black color is revealed. After the hydatide is pinched at the base, it is cut off with a scalpel and must be sent for histological examination. Then, under the clamp, the thread is tied, which is tied. This is done to prevent intraoperative bleeding.
After the drainage tube or gum is inserted into the scrotum cavity, the surgical wound is sutured layer by layer.
hydatidia removal operation In the postoperative period, all patients are prescribed broad-spectrum antibiotics to prevent secondary infection of the wound. For this purpose, drugs such as ceftriaxone and ampicillin can be used.
In addition to systemic use of antibiotics, local antiseptic of a postoperative wound plays an important role in the prevention of secondary infection. For this, as a rule, daily aseptic dressings using an alcohol or aqueous solution of iodine are used. The sutures are removed, approximately, on the seventh-eighth day after the operation.
Since the removal of testicular gidatida is not very traumatic operation, after its implementation, there is no need to use elastic meltings to fix the scrotum. However, older children, in the presence of serous or purulent effusion in the cavity of the scrotum, still recommend the use of bandages of this type.
In addition, some urological hospitals practice the use of physiotherapeutic treatment in the postoperative period in the form of magnetotherapy, galvanization and UHF.The sensors of the apparatus are located on both sides of the scrotum, and the duration of the procedure does not exceed 20 minutes, since the increase in temperature of the testicles has a bad effect on spermatogenesis.
Features of diet and lifestyle
For some time after the operation, patients need to be very cautious in terms of colds, since even a minor viral infection can badly affect further rehabilitation. The fact is that the operation can partially destroy the hematotestick barrier, which normally protects testicular tissue from various pathological agents. And until this barrier is restored, patients should avoid prolonged exposure to cold, bathing in cool water and drinking low temperature drinks.
Treatment with folk remedies
This type of therapy is completely contraindicated in the twist of testicular hydatids. The fact that all the compresses and lotions that are recommended by folk healers only exacerbate the inflammatory process and contribute to the active spread of the infection, not only in the scrotum, but throughout the body. There are cases when the result of folk treatment of the torsion of testicular gidatids was the onset of sepsis or infection of blood, which eventually led to a lethal outcome.
Complications of testatine tester
As a rule, complications can occur in this disease only if the patient is untreated for a long time or the latter is done incorrectly. The primary complication can be considered purulent melting hydatida, which results in the formation of purulent exudate in the scrotum cavity. Against this background, as a rule, secondary orchitis and epididymitis develops. If the inflammation data is catarrhal, then they have a very good chance of being resolved. But when the purulent inflammation of the testicles with appendages develops, there is a high probability that it may be necessary to perform an operation to remove these organs.
If even with the background of secondary purulent orchitis there is no adequate treatment with sanation of the focus of infection, the next stage in the development of the disease is blood infection or sepsis. In patients, the body temperature rises, sweaty sweats appear, and a feeling of constant fatigue. Patients become inhibited, drowsy. The end point of development of sepsis is toxic coma. As practice shows, patients rarely get out of this state. In most cases, it ends with the death of the patient.
It is worth noting that today the described picture is quite rare. More often you can see local complications, which are the result of an unsuccessful operation. If the operative intervention accidentally binds the vas deferens, the patient is threatened with a violation of spermatogenesis followed by the development of infertility. If one of the branches of the femoral-genital nerve is damaged, erectile dysfunction may develop. As a rule, it is temporary or transient, but in the absence of adequate treatment it grows into a permanent or organic form.
Prevention of torsion of testicular hydatids
Prophylaxis of this disease is very difficult, because in most cases, patients even do not guess about the existence of some appendectomy of the testicle. Determine the presence of a similar education is possible only with a planned examination of the urologist. And that's not always, since in most cases the hydatida looks like a small pendant, which is very easy to confuse with the epididymis.
As it shows, the real prevention of the disease begins after the appearance of its first symptoms. In such a situation, it is very important to seek help in time, because it is the timely start of treatment that is the key to its successful completion.
For the purpose of secondary prevention of bacterial flora attachment, broad-spectrum antibiotics, such as ceftriaxone and ampicillin, are used.
Prognosis of torsion of testicular hydatids
The prognosis for recovery is usually favorable, with the exception of those rare cases when the inflammation is generalized and proceeds in the form of sepsis.
The prognosis for life is favorable in almost all cases. Rare deaths in the twist of testicular hydatids occur only in the absence of timely treatment.
The prognosis for working capacity is favorable. Even difficult situations, which end with the removal of the testicle, have almost no effect on the patient's performance.
Rev.the doctor the urologist, the sexologist-andrologist Plotnikov AN