|
|
| (9 intermediate revisions by 2 users not shown) |
| Line 1: |
Line 1: |
| '''For the patient information on this page, click [[{{PAGENAME}} (patient information)|here]]
| | __NOTOC__ |
| | |
| {{Infobox_Disease | | | {{Infobox_Disease | |
| Name = Testicular torsion - wd1 | | | Name = Testicular torsion - wd1 | |
| Image = Illu testis surface.jpg | | | Image = Illu testis surface.jpg | |
| Caption = |
| |
| DiseasesDB = 12984 |
| |
| ICD10 = {{ICD10|N|44||n|40}} |
| |
| ICD9 = {{ICD9|608.2}} |
| |
| ICDO = |
| |
| OMIM = 187400 |
| |
| MedlinePlus = |
| |
| MeshID = D013086 |
| |
| }} | | }} |
| {{Search infobox}} | | {{Testicular torsion}} |
| {{SCC}}
| |
|
| |
|
| | '''For the patient information on this page, click [[{{PAGENAME}} (patient information)|here]] |
|
| |
|
| | {{SCC}} |
|
| |
|
| ==Overview==
| | {{SK}} Torsion of the testis; testicular ischemia; testicular twisting |
| | | == [[Testicular torsion overview|Overview]] == |
| In '''testicular torsion''' the [[spermatic cord]] that provides the blood supply to a [[testicle]] is twisted, cutting off the blood supply, often causing [[orchalgia]]. Prolonged testicular torsion will result in the death of the testicle and surrounding tissues.
| |
| | |
| It is also believed that torsion occurring during fetal development can lead to the so-called neonatal torsion or [[vanishing testis]], and is one of the causes of an infant being born with [[monorchism]].
| |
| | |
| ==Risk factors==
| |
| | |
| In most males, the testicles are attached to the inner lining of the scrotum. Males whose attachment is higher up are at risk of testicular torsion. This condition is known as a bell clapper deformity (as in the central piece of a bell) and is a major cause of testicular torsion. A male who notices the ability of either or both testicles to freely rotate within the scrotum should be aware that he is at risk of testicular torsion. Testicles that are in a much lower position and/or in a slightly rotated position in the scrotal sack are a visual indicator of this risk.
| |
| | |
| Torsions are sometimes called "winter syndrome". This is because they often happen in winter, when it is cold outside. The scrotum of a man who has been lying in a warm bed is relaxed. When he arises, his scrotum is exposed to the colder room air. If the spermatic cord is twisted while the scrotum is loose, the sudden contraction that results from the abrupt temperature change can trap the testicle in that position. The result is a testicular torsion.
| |
| | |
| ==Prevalence== | |
| | |
| While torsion is more frequent among adolescents, it should be considered in all cases where there is testicular pain. Torsion occurs more frequently in patients who do not have evidence of inflammation or infection. Two risk factors are trauma and strenuous physical activity.
| |
|
| |
|
| ==Diagnosis== | | == [[Testicular torsion historical perspective|Historical Perspective]] == |
|
| |
|
| Emergency testing for torsion may be indicated when the onset of pain is sudden and/or severe, or the test results available during the initial examination do not enable a diagnosis of [[urethritis]] or [[urinary tract infection]] to be made. A [[ultrasound|doppler ultrasound scan]] of the scrotum, if available, is of immense help in the diagnosis by showing the presence or absence of blood flow to the testicle. Dizziness and nausea are often present when there is an absence of blood supply to the testicle, as well as a tremendous amount of pain. If the diagnosis is questionable, an expert should be consulted immediately, because testicular viability may be compromised. If physical examination suggests a compromised blood supply and the patient has had such symptoms for a significant period of time, medical personnel may choose to bring the patient directly to surgery without an ultrasound since the time required for ultrasound testing could affect testicular viability.
| | == [[Testicular torsion pathophysiology|Pathophysiology]] == |
|
| |
|
| '''Ultrasound images showing right testicular torsion'''
| | == [[Testicular torsion differential diagnosis|Differentiating Testicular Torsion from other Diseases]] == |
| <div align="left">
| |
| <gallery heights="175" widths="175">
| |
| Image:Testicular-torsion-001.jpg| <small>Image courtesy of RadsWiki and copylefted</small>
| |
| Image:Testicular-torsion-002.jpg| <small>Image courtesy of RadsWiki and copylefted</small>
| |
| Image:Testicular-torsion-003.jpg| <small>Image courtesy of RadsWiki and copylefted</small>
| |
| </gallery>
| |
| </div>
| |
|
| |
|
| Color Doppler sonography (color printout of an ultrasound echo test) is used to identify the absence of blood flow typically found in a twisted testicle, which distinguishes the condition from [[epididymitis]]. <ref>{{cite journal | author = Arce J, Cortés M, Vargas J | title = Sonographic diagnosis of acute spermatic cord torsion. Rotation of the cord: a key to the diagnosis. | journal = Pediatr Radiol | volume = 32 | issue = 7 | pages = 485-91 | year = 2002 | id = PMID 12107581}}</ref>
| | == [[Testicular torsion epidemiology and demographics|Epidemiology and Demographics]] == |
|
| |
|
| [[Urinalysis]] (analyzing chemical composition of urine) can be used to rule out [[bacterial]] infections. | | == [[Testicular torsion risk factors|Risk Factors]] == |
|
| |
|
| Surgical exploration may be necessary if diagnosis cannot be made using other methods. If there is the slightest hint of a torsion of the testicle, then doctors will perform surgery; even if the testicle turns out not to have twisted, they will still protect it by attaching the testicle to the scrotum wall.
| | == [[Testicular torsion natural history, complications and prognosis|Natural History, Complications and Prognosis]] == |
|
| |
|
| ==Treatment== | | == Diagnosis == |
|
| |
|
| With prompt diagnosis and treatment the testicle can be saved in a high number of cases.<ref>{{cite journal | author = Cattolica E, Karol J, Rankin K, Klein R | title = High testicular salvage rate in torsion of the spermatic cord. | journal = J Urol | volume = 128 | issue = 1 | pages = 66-8 | year = 1982 | id = PMID 7109074}}</ref>
| | [[Testicular torsion history and symptoms|History and Symptoms]] | [[Testicular torsion physical examination|Physical Examination]] | [[Testicular torsion laboratory findings|Laboratory Findings]] | [[Testicular torsion ultrasound|Ultrasound]] | [[Testicular torsion other diagnostic studies|Other Diagnostic Studies]] |
|
| |
|
| Testicular torsion is a [[medical emergency]] that needs immediate treatment. If treated within 6 hours, there is nearly a 100% chance of saving the testicle. Within 12 hours this rate decreases to 70%, within 24 hours is 20%, and after 24 hours the rate approaches 0. (eMedicineHealth) Once the testicle is dead it must be removed to prevent [[gangrene|gangrenous]] infection.
| | == Treatment == |
|
| |
|
| A simple and minor [[surgery]] will correct and prevent testicular torsion. It can be done in an emergency situation after determination that the testicle is cut off from blood supply or as an outpatient procedure for patients who have experienced frequent episodes with testicular torsion. If necessary, the surgeon will first untwist the testicle(s). The surgeon will then permanently [[suture]] the testicles to the inner lining of the scrotum. If only one testicle has been problematic, the surgeon may suture both testicles as a preventative effort.
| | [[Testicular torsion medical therapy|Medical Therapy]] | [[Testicular torsion surgery|Surgery]] | [[Testicular torsion primary prevention|Primary Prevention]] | [[Testicular torsion secondary prevention|Secondary Prevention]] | [[Testicular torsion cost-effectiveness of therapy| Cost-Effectiveness of Therapy]] | [[Testicular torsion future or investigational therapies|Future or Investigational Therapies]] |
|
| |
|
| ==References== | | ==Case Studies== |
| <references/>
| | [[Testicular torsion case study one|Case #1]] |
|
| |
|
| == External links ==
| |
| ''Adapted from the public domain document Centers for Disease Control and Prevention. 1998 Guidelines for Treatment of Sexually Transmitted Diseases. MMWR 1998;47(No. RR-1) at http://wonder.cdc.gov/wonder/STD/STD98TG/STD98T12.HTM and other sources.''
| |
|
| |
|
| {{Diseases of the pelvis, genitals and breasts}} | | {{Diseases of the pelvis, genitals and breasts}} |
| Line 74: |
Line 44: |
| [[Category:emergency medicine]] | | [[Category:emergency medicine]] |
| [[Category:Urology]] | | [[Category:Urology]] |
| | [[Category:Disease]] |
|
| |
|
| [[de:Hodentorsion]] | | [[de:Hodentorsion]] |
