Torsion of the spermatic cord - Causes, symptoms and treatment. MF.

Torsion of the spermatic cord is an acute disease of the scrotum organs, which arises from the twisting of the neurovascular bundle of the testicle, along with the vas deferens. The immediate cause of the twist of the spermatic cord is a strong contraction of the muscle that lifts the testicle. As a rule, it occurs in children, when there is an inconsistency of connective tissue. This can happen if there is severe physical strain or a scrotal injury.

Torsion of the spermatic cord is an acute disease of the scrotum organs, which arises from the twisting of the neurovascular bundle of the testicle, along with the vas deferens.

Torsion of the spermatic cord

Reasons for torsion of the spermatic cord

The immediate cause of the twist of the spermatic cord is a severe contraction of the muscle that lifts the testicle. As a rule, it occurs in children, when there is an inconsistency of connective tissue. This can happen if there is severe physical strain or a scrotal injury.

The mechanism of development of pathology is simple. Because of the strong contraction of the muscle, the spermatic cord, in which it passes, simply twists in its axis, turning into a spiral. At the same time, all the vessels and nerves that are there are pinched. Naturally, it finds an instant response from the parenchyma of the testicle, which suddenly loses its blood supply. Together with the vessels in the cavity of the spermatic cord, the seminal duct also contracts. The result of this pathological process is the stasis of the sperm fluid in the testicle parenchyma.

Symptoms of torsion of the spermatic cord

The first clinical symptom of this disease is the sharp pain that occurs in one of the half of the scrotum. As a rule, the pain has a clear localization and with development the disease does not extend to surrounding tissues. Soon, a swelling of the scrotum joins this symptom, which at first, also, is localized only on one side, and then spreads to the second. At the same time, the skin over the testicle acquires a red, if not purple, hue.

When palpation in one of the halves of the scrotum, a dense rounded formation is determined, which is somewhat larger in size than the testicle. Even with minor touches, patients notice a sharp increase in the pain syndrome.

As a rule, at this stage, most patients are already seeking help from specialists, and they are performing emergency surgery. More rare cases are when, due to lack of medical care or inadequate delivery, the twisting of the spermatic cord ends with necrosis of the testicle, which passes into the gangrene of the scrotum. At the same time, black spots begin to appear on the surface of the body, which, as a rule, softens for a short period of time and turns into ulcers. Pain symptomatology at this stage disappears due to damage to the nerve endings that go to the skin of the scrotum and testicle parenchyma.

If the patient has at least minor pain in the scrotum, he should immediately seek help from a urologist, since later treatment can end not only with erectile dysfunction, but with a complete loss of fertility.

Diagnosis of torsion of the spermatic cord

Torsion of the spermatic cord is a group of diseases that make up the syndrome of the acute scrotum. This clinical unit implies immediate surgical intervention. Therefore, if a patient enters the clinic with suspicion of torsion of the spermatic cord, he must, in the shortest possible time, based on the history and objective examination, make an accurate diagnosis and decide the need for a surgical operation.

In addition to a general examination of the patient, the method of diaphanoscopy is often used to diagnose, since it is easy to use and does not take much time. To do this, a light source is put on the scrotum, which allows one to evaluate the density of its tissues. As a rule, when the spermatic cord is twisted on the corresponding side of the scrotum, a rounded dense formation is visualized, which transmits light much worse than surrounding tissues.

If the patient does not have a severe clinical symptomatology and the diagnosis of torsion of the spermatic cord is not definitively confirmed, then he can perform ultrasound examination of the scrotum. With good technical equipment, ultrasound can be seen not only a modified testicle, but even a place of twisting of the spermatic cord. The limited use of this method of research is explained by the fact that it requires a certain time for its conduct, whereas in the acute pathology of the scrotal organs every minute of delay leaves its imprint on the functional state of the testicle.

In some cases, there is an incomplete torsion of the spermatic cord, which is manifested by a sufficiently erased symptomatology. In such cases, it is recommended that a scrotal biopsy be performed with a fluid intake to establish an accurate diagnosis. Rapid laboratory diagnosis of the isolated material allows us to establish the nature of the pathology. If it has a large number of leukocytes and a minimum protein content, this indicates an inflammatory nature of the pathology, including the twisting of the spermatic cord. If in the isolated liquid there is an insignificant leucocyte content, and the protein reaches high figures, then one can think of a dropsy testicle or a malignant neoplasm.

Treatment of torsion of the spermatic cord

When the exact diagnosis of the torsion of the spermatic cord is made, the patients are sent for urgent surgical intervention. The volume of the operation is determined only after the opening of the scrotum cavity. In the case when the testicle is viable, the seed cord is untwisted. Among all possible options, this is the simplest operation. True, some surgeons make the mistake of suturing the scrotum wound immediately after the seed cord is untwisted. Medicine is known for rare cases when the testicle, at first glance, was viable, and after a while after the operation, there were clinical signs of its necrosis.

If testicle testis cavity is not viable, then it becomes necessary to remove the testicle. In such a situation, unwinding the spermatic cord is unacceptable, since those pathological metabolic products that have already formed in the necrotic testicle get into the blood, causing a common infection.

Removed testes - macro preparation

When removing the testicle, immediately re-bandage the spermatic cord above the torsion point. This is also done to prevent the ingress of toxins into the bloodstream. Before suturing the wound of the scrotum, it is necessary to introduce tubular or rubber drainage into its cavity in order that all remains of blood and inflammatory fluid can flow through it.

Rehabilitation after illness

Egg removal is difficult not only in technical, but also in psychological terms. It is especially difficult to rehabilitate after such an operation teenagers who feel their inferiority in the team. To do this, invented silicone prosthesis testicles, which are available in three sizes. If the operation to remove the testicle was carried out in childhood, the child is placed a silicone prosthesis of the testicle number 1, which changes at the age of 13-14 years to the prosthesis number 2, and at the end of puberty on the prosthesis number 3.

The technical evolution of the testicle prosthesis has reached its perfectionand modern implants can not be distinguished by touch from the present organ. Thus, if the patient's sexual partner does not know about carrying out such an operation, then this fact can be completely hidden. Moreover, the process of fertilization is possible and with a single, normally functioning testicle.

Special features of nutrition and lifestyle

There is no special diet that helped to cure the wound of the scrotum as soon as possible, so a high caloric balanced table number 15 according to Pevzner is recommended to all patients after such an operation.

The lifestyle of patients with a twisted spermatic cord concerns, in the first place, sexual relations. Of course, if it's a child, then there are no special problems. Much more difficult is the situation with adolescents and adults. By itself, the operation on the scrotum excludes sexual intercourse for a period of about one month, and if the patient has to undergo another operation and implantation of the artificial testicle, then the period of restriction of sexual relations is extended to three months.

Treatment with folk remedies

As already mentioned, surgery for twisting the spermatic cord is carried out according to vital indications and any delay can cost the patient a testicle. Thus, on the basis of this, it can be concluded that all other methods of treatment, except for surgery, including folk, are ineffective.

Complications of the torsion of the spermatic cord

The most common complication of twisting of the spermatic cord is necrosis of the testicle, which occurs when the treatment is inadequate or the patient's late treatment for help. Removal of the testicles remains the only effective method of treatment. If after a similar operation the patient retains the ability to fertilize, then the outcome of the disease can be considered successful. In rare cases, when necrotic phenomena in the scrotum spread to another testicle, treatment can result in the removal of two organs at once. Naturally, in such a situation, there is no question of preserving the sexual function. Such patients need a lifelong introduction of sex hormones.

Prevention of torsion of the spermatic cord

Because the only cause leading to twisting of the spermatic cord can not be called, the standards of prevention of this disease have not been developed. The only thing that can be advised patients who have encountered this pathology, it is faster to seek help from a urologist, since the complexity of the course of the disease and the postoperative period does not depend on the causes of the patient's pathology or age, namely, from the beginning of treatment.

Also, patients with torsion of the spermatic cord are subjected to secondary prevention after the operative intervention. It consists in prescribing antibacterial agents to prevent secondary infection of the wound. Typically, limited to a standard set of antibiotics, which includes one drug from the group of cephalosporins and one drug from the group of aminoglycosides. Practice shows that the oral administration of cefuroxime and amikacin is sufficient to ensure that the postoperative period proceeds without complications and ends with wound healing by primary tension.

Rev.the doctor the urologist, the sexologist-andrologist Plotnikov А.N.