Torsion of the spermatic cord - Causes, Symptoms and Treatment .MF .
torsion of the spermatic cord - is an acute disease of bodies of scrotum, which occurs due to the torsion of the neurovascular bundle eggs, along with the vas deferens. The immediate cause of the twisting of the spermatic cord is a strong contraction of the muscle that raises the egg.Usually, it occurs in children where there is failure of the connective tissue.This can happen with a strong physical exertion or injury to the scrotum.
torsion of the spermatic cord - is an acute disease of bodies of scrotum, which occurs due to the torsion of the neurovascular bundle eggs, along with the vas deferens.
torsion of the spermatic cord
reasons torsion of the spermatic cord
The immediate cause of the twisting of the spermatic cord is a strong contraction of the muscle that raises the egg.Usually, it occurs in children where there is failure of the connective tissue.This can happen with a strong physical exertion or injury to the scrotum.
mechanism of uncomplicated disease.Due to the strong mus
Symptoms of torsion of the spermatic cord
first clinical sign of the disease is sudden pain that occurs in one half of the scrotum.Usually, the pain is clear localization and developmental disorder not extend to the surrounding tissue.Soon, this symptom also joins scrotal swelling, which first well is localized only on one side, and then extends to the second.At the same time the skin over the testicle becomes red, and even purple hue.
On palpation of the scrotum in one of the halves is defined by a dense rounded education that exceeds the size of a few egg.Even with minor touches patients note a sharp increase in pain.
Typically, at this stage the majority of patients have to seek professional help, and they performed an emergency surgery.More rarely, when due to lack of medical care or inadequate provision of it, torsion of the spermatic cord ends testicular necrosis, gangrene that goes into the scrotum.Thus, on the surface of body begin to appear black spots, which tend to soften and become ulcers in a short period of time.Pain symptoms at this stage disappears due to damage to nerves that go to the skin of the scrotum and testicular parenchyma.
the presence of the patient even minor pain in the scrotum, it should immediately seek help from a urologist because delayed treatment can result not only from erectile dysfunction, but also a complete loss of the ability to fertilize.
diagnosis of torsion of the spermatic cord
torsion of the spermatic cord is part of a group of diseases that constitute a syndrome of acute scrotum.This clinical unit involves immediate surgical intervention.Therefore, if a patient comes to the clinic with suspected torsion of the spermatic cord, it is necessary, for the shortest period of time, based on the history and physical examination, an accurate diagnosis and decide on the need for surgery.
Besides the general examination of the patient, often used for diagnosis diaphanoscope method, as it is easy to use and does not take much time.To do this, start up the scrotum of a light source that allows us to estimate the density of its fabric.As a rule, torsion of the spermatic cord on the appropriate side of the scrotum rendered dense rounded education, which transmits light is much worse than the surrounding tissue.
If the patient has a place not too severe clinical symptoms and the diagnosis of torsion of the spermatic cord is not completely confirmed, then it is possible to perform ultrasound of the scrotum.With a good technical equipment, an ultrasound can be seen not only altered the egg, and even place torsion of the spermatic cord.The limitations of using this research method because it requires a certain amount of time on their conduct while in acute pathology scrotum every minute of delay, leaves its mark on the functional state of the egg.
In some cases, there is an incomplete torsion of the spermatic cord, which is manifested quite erased symptoms.In such cases, an accurate diagnosis is recommended to carry out a biopsy of the scrotum with a fence fluid.Rapid laboratory diagnosis of selected material allows to establish the nature of the pathology.If it notes a large number of white blood cells and the minimum protein content, it testifies to the inflammatory nature of the disease, including a torsion of the spermatic cord.If in the discharged liquid is marked insignificant white blood cell count and protein reach high numbers, then we can think of hydrocele or malignancies.
Treatment of torsion of the spermatic cord
With accurate diagnosis torsion of the spermatic cord, patients are sent to emergency surgery.The volume of transactions is determined after the opening of the cavity of the scrotum.In that case, when the egg is viable, produced the unwinding of the spermatic cord.Among all the options this is the most simple operation.However, some surgeons err when sutured wound scrotum immediately after the unwinding of the spermatic cord.Medicine known rare occasions when the egg, at first glance, is a viable, and some time after the operation had clinical signs of necrosis.
If the revision of the scrotum cavity egg is viable, then it becomes necessary to remove the latter.In this situation, perform the unwinding of the spermatic cord is inadmissible, since those abnormal metabolic products that have already formed in the necrotic testis, enter the bloodstream, causing septicemia.
Remote testicles - macropreparations
When removing the testis should immediately bandage the spermatic cord torsion of space above.This is also done to prevent toxins entering the bloodstream.Before suturing wounds scrotum, in its cavity must necessarily enter drainage tube or rubber, to ottekli thereon all traces of blood and inflammatory fluid.
rehabilitation after illness
Removal of the testicle is a complex not only in technical, but also psychologically.It is especially difficult to rehabilitate after such an operation, adolescents who feel their inferiority in the team.For this purpose were designed silicone prostheses eggs, which are available in three sizes.If the removal of the testicle operation was performed in childhood, the child set a silicone prosthetic testicle number 1, which in 13-14 years, changes to the denture number 2, and upon completion of puberty on the denture number 3.
Technical evolution prosthetic testicles reached itsperfection and modern implants can not be distinguished from the touch of the body.Thus, if the sexual partner of the patient does not know to conduct such an operation, this fact can and does hide.Especially because the process of fertilization is possible, and if there is one, well-functioning, eggs.
Feeding habits and lifestyle
special diet, which contributed to the early wound healing b scrotum does not exist, therefore all patients after such surgery is recommended high-calorie balanced table number 15 on Pevsner.
Lifestyle patients with torsion of the spermatic cord is concerned, first of all sexual relations.Of course, if it is a child, there is no problems arise.It is much more difficult situation with adolescents and adult patients.By itself, the operation on the scrotum preclude sexual intercourse for a period of approximately one month, and if the patient will move more and an operation to implant an artificial testicle, then the period of restriction of sexual relations is extended to three months.
Treatment folk remedies
As already mentioned, the operation at a torsion of the spermatic cord is carried out for health reasons, and any delay could cost the patient testicle.Thus, the conclusion can be drawn from this that all the other treatments except for operation, including people, are ineffective.
Complications torsion of the spermatic cord
The most common complication of torsion of the spermatic cord is testicular necrosis, which occurs when inadequate treatment or late treatment of the patient for help.In this case the only effective treatment is removal of the testicle.If after such an operation the patient retains the ability to fertilize, the outcome can be considered successful.In rare cases, when the necrotic phenomena in the scrotum and spread to the other testicle, treatment may result in removal of two bodies.Naturally, in such a situation, no question of maintaining sexual function can not go.Such patients require lifelong administration of sex hormones.
Prevention of torsion of the spermatic cord
Since the only reason leading to the torsion of the spermatic cord, called the impossible standards of prevention of this disease is not well developed.The only thing that can advise patients faced with this disease, it will seek the help of a urologist, since the complexity of the disease and the postoperative period does not depend on the causes of disease and the patient's age, namely from the beginning of treatment.
also patients with torsion of the spermatic cord is held secondary prevention after the surgery.It lies in the appointment of antibiotics to prevent secondary infection of wounds.As a general rule, limited to a standard set of antibiotics, which includes a drug from the group of cephalosporins and one drug from the group of aminoglycosides.Practice shows that oral administration of cefuroxime and amikacin enough to post-operative period was uneventful and ended up wound healing by first intention.
Ed.urologist, sexologist-andrologist Plotnikov AN