What is testicular torsion. How does it affect blood flow to the testicles. What are the main symptoms of testicular torsion. When should you seek emergency care for testicle pain. How is testicular torsion treated. Who is at highest risk for developing testicular torsion. What complications can arise from untreated testicular torsion.

Understanding Testicular Torsion: A Medical Emergency

Testicular torsion is a serious condition that occurs when a testicle rotates, twisting the spermatic cord that supplies blood to the scrotum. This rotation results in reduced blood flow, leading to sudden and often severe pain and swelling. While it can happen at any age, even before birth, testicular torsion is most prevalent among adolescents and young adults between the ages of 12 and 18.

The condition typically requires emergency surgical intervention. If addressed promptly, the affected testicle can usually be saved. However, prolonged interruption of blood supply can cause irreversible damage, potentially necessitating the removal of the testicle.

The Mechanism of Testicular Torsion

During testicular torsion, the affected testicle rotates within the scrotum, causing the spermatic cord to twist. This cord, which contains blood vessels, nerves, and the vas deferens, is crucial for testicular health and function. As it twists, blood flow becomes increasingly restricted, leading to tissue damage and intense pain.

Recognizing the Symptoms of Testicular Torsion

Identifying the signs of testicular torsion is crucial for timely intervention. The primary symptoms include:

• Sudden, severe pain in the scrotum
• Swelling of the scrotum
• Abdominal pain
• Nausea and vomiting
• A testicle positioned higher than normal or at an unusual angle
• Frequent urination
• Fever

It’s worth noting that young boys experiencing testicular torsion often wake up due to scrotal pain in the middle of the night or early morning.

When to Seek Medical Attention

Any sudden or severe testicle pain should be treated as a medical emergency. Prompt treatment is essential to prevent severe damage or loss of the affected testicle. Even if the pain subsides on its own, it’s crucial to seek medical help, as this could indicate intermittent torsion and detorsion, which may still require surgical intervention to prevent recurrence.

Exploring the Causes of Testicular Torsion

The exact cause of testicular torsion remains unclear. However, several factors have been identified that may contribute to its occurrence:

• Inherited anatomical traits allowing free rotation of the testicle within the scrotum
• Vigorous physical activity
• Minor testicular injury
• Cold temperatures
• Rapid testicular growth during puberty

It’s important to note that while an inherited trait allowing free testicular rotation is common in those who experience torsion, not everyone with this trait will develop the condition.

Identifying Risk Factors for Testicular Torsion

Understanding the risk factors associated with testicular torsion can help individuals and healthcare providers remain vigilant. The primary risk factors include:

1. Age: The condition is most common between ages 12 and 18.
2. Previous episodes of testicular torsion: If you’ve experienced testicular pain that resolved without treatment, you’re at higher risk for recurrence.
3. Family history: Testicular torsion can run in families, suggesting a genetic component.

The Role of Genetics in Testicular Torsion

Recent research has shed light on the genetic factors that may predispose individuals to testicular torsion. While the exact genes involved are still being studied, it’s clear that some males inherit a trait that allows for greater testicular mobility within the scrotum. This increased mobility, while not always problematic, can increase the risk of torsion under certain circumstances.

Potential Complications of Untreated Testicular Torsion

Delayed or absent treatment of testicular torsion can lead to severe complications:

• Testicular damage or death: If blood flow is blocked for several hours, permanent damage to the testicle can occur, potentially requiring surgical removal.
• Fertility issues: In some cases, damage or loss of a testicle can affect a man’s ability to father children.

These potential outcomes underscore the importance of seeking immediate medical attention at the first sign of testicular pain or discomfort.

Diagnostic Approaches for Testicular Torsion

Accurate and swift diagnosis of testicular torsion is crucial for effective treatment. Healthcare providers typically employ a combination of physical examination and imaging studies to confirm the condition:

Physical Examination

A thorough physical examination is the first step in diagnosing testicular torsion. The healthcare provider will assess the appearance of the scrotum, check for swelling or discoloration, and evaluate the position of the testicles. They may also perform the Prehn sign test, which involves lifting the affected testicle to see if it alleviates pain.

Imaging Studies

While not always necessary, imaging studies can provide valuable information in cases where the diagnosis is unclear:

• Doppler ultrasound: This non-invasive test can assess blood flow to the testicles, helping to identify reduced or absent flow indicative of torsion.
• Nuclear scans: In some cases, a nuclear scan may be used to evaluate blood flow and testicular viability.

It’s important to note that while these diagnostic tools are valuable, they should not significantly delay treatment if testicular torsion is strongly suspected based on symptoms and physical examination.

Treatment Options for Testicular Torsion

The primary treatment for testicular torsion is surgical intervention. However, in some cases, manual detorsion may be attempted as a temporary measure:

Manual Detorsion

In some instances, a healthcare provider may attempt to manually untwist the spermatic cord. This procedure, known as manual detorsion, is performed by rotating the testicle in the opposite direction of the twist. While this can provide temporary relief and restore blood flow, it is not a definitive treatment and surgery is still typically required to prevent recurrence.

Surgical Intervention

Surgery, known as orchiopexy, is the definitive treatment for testicular torsion. During this procedure:

1. The surgeon untwists the spermatic cord, restoring blood flow to the testicle.
2. The affected testicle is then secured to the inside of the scrotum to prevent future torsion.
3. The unaffected testicle is typically also secured as a preventive measure.

The success of the surgery largely depends on how quickly it is performed after the onset of symptoms. If blood flow is restored within 6 hours, there’s a high chance of saving the testicle. Beyond 24 hours, the likelihood of salvaging the testicle diminishes significantly.

Long-term Prognosis and Follow-up Care

The long-term outlook for patients who have experienced testicular torsion varies depending on several factors:

Testicular Viability

If the affected testicle is saved, most patients recover fully and maintain normal testicular function. However, in cases where the testicle has been severely damaged or removed, there may be implications for fertility and hormone production.

Fertility Considerations

While many men who have experienced testicular torsion go on to father children without difficulty, some may face challenges. Factors influencing fertility outcomes include:

• Whether one or both testicles were affected
• The duration of reduced blood flow before treatment
• The overall health of the remaining testicular tissue

Men who have undergone treatment for testicular torsion should discuss fertility concerns with their healthcare provider and may benefit from fertility assessments if they are trying to conceive.

Follow-up Care

After treatment for testicular torsion, regular follow-up appointments are crucial to monitor healing and assess long-term testicular health. These appointments may include:

1. Physical examinations to check for any signs of recurrence or complications
2. Ultrasound scans to evaluate blood flow and testicular structure
3. Hormone level tests to ensure proper endocrine function
4. Semen analysis to assess sperm production and quality, if fertility is a concern

Patients should also be educated on the importance of regular self-examinations to detect any future testicular abnormalities promptly.

Preventing Testicular Torsion: Current Approaches and Future Directions

While complete prevention of testicular torsion is challenging, especially for those with an anatomical predisposition, there are some strategies that can help reduce the risk:

Surgical Prophylaxis

For males known to have the anatomical trait that increases the risk of torsion, preventive surgery may be recommended. This procedure, similar to the treatment for acute torsion, involves securing both testicles to the inside of the scrotum to prevent rotation.

Protective Measures

While not guaranteed to prevent torsion, some protective measures may help reduce the risk of injury that could lead to torsion:

• Wearing appropriate protective gear during sports and physical activities
• Avoiding extremely tight-fitting underwear or pants that may constrict the scrotum
• Being cautious during activities that may involve impacts to the groin area

Future Research Directions

Ongoing research into testicular torsion focuses on several areas:

1. Genetic studies to better understand the hereditary factors contributing to torsion risk
2. Development of non-invasive diagnostic tools for faster and more accurate identification of torsion
3. Exploration of pharmacological interventions that could help protect testicular tissue during periods of reduced blood flow
4. Investigation of novel surgical techniques that could offer improved outcomes or reduced risk of recurrence

As our understanding of testicular torsion continues to evolve, new preventive strategies and treatment options may emerge, offering hope for improved outcomes for those at risk of this condition.

The Psychological Impact of Testicular Torsion

While the physical aspects of testicular torsion are well-documented, the psychological impact on patients is an area that deserves attention. Experiencing testicular torsion can be a traumatic event, particularly for adolescents and young adults who may already be navigating complex emotions related to body image and sexuality.

Common Psychological Reactions

Patients who have undergone treatment for testicular torsion may experience a range of emotional responses:

• Anxiety about recurrence or future testicular health
• Depression, particularly if a testicle was lost
• Concerns about masculinity and sexual function
• Worry about fertility and future family planning
• Post-traumatic stress related to the sudden onset of pain and emergency medical intervention

Addressing Psychological Needs

Healthcare providers should be aware of the potential psychological impact of testicular torsion and be prepared to offer support or referrals as needed. This may include:

1. Providing clear, age-appropriate information about the condition and its treatment
2. Offering counseling or support group referrals
3. Discussing strategies for coping with anxiety about recurrence
4. Addressing concerns about sexual function and fertility openly and honestly
5. Encouraging patients to express their feelings and concerns throughout the recovery process

By addressing both the physical and psychological aspects of testicular torsion, healthcare providers can help ensure comprehensive care and support for patients navigating this challenging condition.

Testicular torsion – Symptoms & causes

Overview

Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling.

Testicular torsion

During testicular torsion a testicle rotates, twisting the spermatic cord that brings blood to the scrotum, the loose bag of skin under the penis that contains the testicles. The reduced blood flow causes sudden and often severe pain and swelling.

Testicular torsion is most common between ages 12 and 18, but it can occur at any age, even before birth.

Testicular torsion usually requires emergency surgery. If treated quickly, the testicle can usually be saved. But when blood flow has been cut off for too long, a testicle might become so badly damaged that it has to be removed.

Products & Services

Symptoms

Signs and symptoms of testicular torsion include:

• Sudden, severe pain in the scrotum — the loose bag of skin under your penis that contains the testicles
• Swelling of the scrotum
• Abdominal pain
• Nausea and vomiting
• A testicle that’s positioned higher than normal or at an unusual angle
• Frequent urination
• Fever

Young boys who have testicular torsion typically wake up due to scrotal pain in the middle of the night or early in the morning.

When to see a doctor

Seek emergency care for sudden or severe testicle pain. Prompt treatment can prevent severe damage or loss of your testicle if you have testicular torsion.

You also need to seek prompt medical help if you’ve had sudden testicle pain that goes away without treatment. This can occur when a testicle twists and then untwists on its own (intermittent torsion and detorsion). Surgery is frequently needed to prevent the problem from happening again.

Causes

Testicular torsion occurs when the testicle rotates on the spermatic cord, which brings blood to the testicle from the abdomen. If the testicle rotates several times, blood flow to it can be entirely blocked, causing damage more quickly.

It’s not clear why testicular torsion occurs. Most males who get testicular torsion have an inherited trait that allows the testicle to rotate freely inside the scrotum. This inherited condition often affects both testicles. But not every male with the trait will have testicular torsion.

Testicular torsion often occurs several hours after vigorous activity, after a minor injury to the testicles or while sleeping. Cold temperature or rapid growth of the testicle during puberty also might play a role.

Risk factors

• Age. Testicular torsion is most common between ages 12 and 18.
• Previous testicular torsion. If you’ve had testicular pain that went away without treatment (intermittent torsion and detorsion), it’s likely to occur again. The more frequent the bouts of pain, the higher the risk of testicular damage.
• Family history of testicular torsion. The condition can run in families.

Complications

Testicular torsion can cause the following complications:

• Damage to or death of the testicle. When testicular torsion is not treated for several hours, blocked blood flow can cause permanent damage to the testicle. If the testicle is badly damaged, it has to be surgically removed.
• Inability to father children. In some cases, damage or loss of a testicle affects a man’s ability to father children.

Prevention

Having testicles that can rotate in the scrotum is a trait inherited by some males. If you have this trait, the only way to prevent testicular torsion is surgery to attach both testicles to the inside of the scrotum.

Testicular torsion – Symptoms & causes

Overview

Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling.

Testicular torsion

During testicular torsion a testicle rotates, twisting the spermatic cord that brings blood to the scrotum, the loose bag of skin under the penis that contains the testicles. The reduced blood flow causes sudden and often severe pain and swelling.

Testicular torsion is most common between ages 12 and 18, but it can occur at any age, even before birth.

Testicular torsion usually requires emergency surgery. If treated quickly, the testicle can usually be saved. But when blood flow has been cut off for too long, a testicle might become so badly damaged that it has to be removed.

Products & Services

Symptoms

Signs and symptoms of testicular torsion include:

• Sudden, severe pain in the scrotum — the loose bag of skin under your penis that contains the testicles
• Swelling of the scrotum
• Abdominal pain
• Nausea and vomiting
• A testicle that’s positioned higher than normal or at an unusual angle
• Frequent urination
• Fever

Young boys who have testicular torsion typically wake up due to scrotal pain in the middle of the night or early in the morning.

When to see a doctor

Seek emergency care for sudden or severe testicle pain. Prompt treatment can prevent severe damage or loss of your testicle if you have testicular torsion.

You also need to seek prompt medical help if you’ve had sudden testicle pain that goes away without treatment. This can occur when a testicle twists and then untwists on its own (intermittent torsion and detorsion). Surgery is frequently needed to prevent the problem from happening again.

Causes

Testicular torsion occurs when the testicle rotates on the spermatic cord, which brings blood to the testicle from the abdomen. If the testicle rotates several times, blood flow to it can be entirely blocked, causing damage more quickly.

It’s not clear why testicular torsion occurs. Most males who get testicular torsion have an inherited trait that allows the testicle to rotate freely inside the scrotum. This inherited condition often affects both testicles. But not every male with the trait will have testicular torsion.

Testicular torsion often occurs several hours after vigorous activity, after a minor injury to the testicles or while sleeping. Cold temperature or rapid growth of the testicle during puberty also might play a role.

Risk factors

• Age. Testicular torsion is most common between ages 12 and 18.
• Previous testicular torsion. If you’ve had testicular pain that went away without treatment (intermittent torsion and detorsion), it’s likely to occur again. The more frequent the bouts of pain, the higher the risk of testicular damage.
• Family history of testicular torsion. The condition can run in families.

Complications

Testicular torsion can cause the following complications:

• Damage to or death of the testicle. When testicular torsion is not treated for several hours, blocked blood flow can cause permanent damage to the testicle. If the testicle is badly damaged, it has to be surgically removed.
• Inability to father children. In some cases, damage or loss of a testicle affects a man’s ability to father children.

Prevention

Having testicles that can rotate in the scrotum is a trait inherited by some males. If you have this trait, the only way to prevent testicular torsion is surgery to attach both testicles to the inside of the scrotum.

Testicular infarction. What is testicular infarction?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

A testicular infarction is the necrosis of the tissues of the gland due to impaired blood circulation. Symptoms depend on the prevalence of the process. With a segmental infarction, a painful dense formation is palpated, accompanied by edema. Extensive testicular infarction has clinical manifestations similar to acute orchiepididymitis, torsion: severe pain, enlargement of the scrotum on the side of the lesion, hyperemia. Diagnosis is based on the results of ultrasound with dopplerography, MRI, histological examination. The ambiguity of the data is an indication for a diagnostic operation. Treatment correlates with the depth of ischemia, the impossibility of normalizing blood flow implies orchiectomy.

ICD-10

N50.9 Disease of male genital organs, unspecified

• Causes
• Pathogenesis
• Classification
• Testicular infarction symptoms
• Complications
• Diagnostics
• Testicular infarction treatment
  • Conservative therapy
  • Surgical treatment
• Prognosis and prevention
• Prices for treatment

General information

Testicular infarction is registered in men of any age, including newborns. Most often, gonadal necrosis is detected as a result of ischemia, the death of testicular tissues due to vascular catastrophe is rare. In 70%, the exact cause cannot be determined, although some authors name potential triggers. According to statistics, adult patients with acute diseases of the scrotum account for 5-7% of all cases of urgent urological pathology, children – 20%. Specialists in the field of clinical andrology and urology consider early active management of testicular ischemia of any origin to be a priority, since untimely treatment entails irreversible consequences.

Testicular infarction

Causes

Testicular infarction potentiates testicular compression, torsion of its vascular pedicle or blockage of the lumen of the testicular artery. Pathology can be total (with involvement of the entire gonad) or segmented (with necrosis of part of the gland). The scale of the lesion depends on the severity of the provoking factor, the presence of concomitant conditions leading to changes in the blood system or blood vessels: vasculitis, periarteritis, sickle cell anemia. Conditions that cause necrosis of part or all of the testicle include:

• Injuries of the scrotum. Damage to the testis with a direct blow is often accompanied by rupture of blood vessels. Compression of the main arteries, veins and lymphatic drainage tracts exacerbates edema and blood extravasation, which initiates oxygen starvation and tissue destruction. In children, trauma to the gonad during childbirth leads to a violation of trophism and necrosis of all testicular structures. Some experts consider asphyxia during childbirth as a provoking factor for testicular infarction in a newborn.
• Urgent conditions. When the gonad is twisted, the inflow and outflow of blood is disturbed. The predisposing factor is cryptorchidism. Full torsion potentiates significant venous occlusion, arterial ischemia, which causes testicular infarction. A strangulated inguinal hernia affects the patency of the vessels that feed the gonad. Ischemia not associated with emergency surgical conditions is less common, due to the abundant blood supply to the testes.
• Inflammatory process. A heart attack is rarely provoked by orchitis, but with background immunosuppression of any origin (HIV infection, diabetes, hormone intake), without timely adequate therapy, necrosis of tissue structures may occur due to edema that prevents blood supply. Ischemic inflammation in the testis manifests itself 2-3 days after interventions on the pelvic organs, when the structures responsible for the life support of the testicle are damaged. It is associated not only with alteration, but with thrombosis, angiospasm.

Predisposing factors include a sharp increase in intra-abdominal pressure as a result of overstrain, masturbation, intense sexual intercourse. Recently, the role of the atherosclerotic process has been proven, when the formation of a cholesterol embolus can cause occlusion of the feeding vessel. The likelihood of local ischemia is increased by congenital malformations, microangiopathy as a complication of diabetes mellitus, and wearing tight underwear.

Pathogenesis

Testicular infarction can be hemorrhagic or ischemic. In the first case, the cause is a hemorrhage with a violation of the integrity of the vessels, in the second – the development of acute ischemia due to compression or obstruction. Ischemic infarction is caused by any factor that cuts off the blood supply to the gonad from the testicular artery: torsion, thrombus, immobile large embolism, vascular changes due to severe vasculitis. Complete blockage of blood circulation after 15-20 minutes triggers destructive processes, after 6-12 hours ischemia initiates the death of testicular structures.

Hemorrhagic infarction is usually segmental, associated with embolic events, impaired microcirculation. Pathology is secondary to inguinal hernia surgery, varicocele. Similar changes occur with orchiepididymitis, when venous circulation is disturbed due to massive inflammatory edema. Conditions associated with increased blood clotting also cause blockage of the veins with subsequent tissue necrosis. There are observations on the development of hemorrhagic testicular infarction in response to thrombosis of the inferior vena cava.

Classification

Allocate hemorrhagic, ischemic and idiopathic infarction. According to histological signs, it is possible to establish the duration of the existence of the pathology. The presence of coagulative necrosis, erythrocytes, fibrin extravasation is considered an indicator of acute infarction. The cessation of sperm production in the seminiferous tubules with thickening of the basement membrane is considered as a subacute process. Chronic infarction is defined by foci of sclerosed seminiferous tubules with hyalinized interstitial fibrosis. Depending on the scale of the lesion develops:

• Segmental infarction. It is rare, predominantly in men aged 20-40 years, in 70-80% it is considered idiopathic. Any localization is possible, but the lesion of the upper segment of the gonad is more typical. The nature of the pathology is more often established after orchiectomy according to the results of histological examination.
• Total heart attack. It is recorded mainly in infants and boys in prepuberty, which is associated with imperfection of the ligamentous apparatus, congenital anomalies of the structure, disproportionate development of the genital organs. In adults, a total heart attack is detected against the background of acute orchiepididymitis.

Testicular infarction symptoms

The most common symptom of a focal process is testicular pain, which is nonspecific and indistinguishable from pain in other diseases of the scrotum. Painful motionless (adhered to the surrounding tissues, more often in the upper pole of the gland) formation is palpated, the testicle itself is somewhat swollen, other tissues are not changed. The increase in symptoms usually occurs gradually over 2-3 days, the irradiation of pain can be any.

With a total lesion of the gonad, the clinical manifestations are bright, pain occurs suddenly, due to the main pathology – bruise, torsion, pinching. The testicle significantly increases in size, dense, tense. Skin color is variable, initially ischemia leads to a whitish coloration (no microcirculation of blood), then a bluish tint appears, an increase in temperature is noted. The severity of sensations borders on pain shock, tachycardia, pallor, clammy sweat, and collapse are typical. Sometimes there is nausea, vomiting, confusion.

Complications

Testicular infarction is a complication of a number of urological conditions, its negative consequences are expressed in the loss of the gonad. With a one-sided process, the function of producing spermatozoa and testosterone production is performed by the second gonad. With concomitant vascular pathologies or against the background of a bilateral lesion, for example, with underdevelopment of the ligamentous apparatus that fixes the testicles to the scrotum, a repetition of the situation cannot be ruled out. Repeated heart attacks can lead to hypogonadism with lifelong hormone replacement therapy, infertility.

Initially, necrosis is aseptic, but when the secondary microflora is attached, the affected gonad becomes a source of infection. There is a possibility of abscessing, the risk of developing Fournier’s gangrene, a purulent-necrotic fasciitis with high mortality, increases. In some men, after an orchiectomy, a decrease in sexual function is recorded, which is also associated with psychological aspects. Patients after conservative treatment should be observed by a urologist due to an increased likelihood of developing cancer within 10-13 years.

Diagnostics

Early diagnosis of acute scrotal conditions is extremely important, since the timely initiation of therapy ensures the prevention of complications. After a conversation with the patient, during which the circumstances of the development of the disease and contributing factors are clarified, the urologist proceeds to a physical examination. The use of modern methods of examination (MRI, duplex testicular scanning) in focal infarction allows avoiding organ-removing surgery. The diagnostic algorithm includes:

• Laboratory tests. In the general blood test, the number of leukocytes is above normal, ESR is accelerated, C-reactive protein is detected; indicators tend to increase. For differential diagnosis between focal infarction and a malignant neoplasm of the gonad, tests are prescribed for tumor markers: AFP, β-hCG, LDH, which increase in 60% of cases with oncological lesions.
• Imaging techniques. Ultrasound scanning is considered the gold standard for all types of pain in the scrotum. With a localized infarction, a wedge-shaped hypoechoic lesion with signs of ischemia is located. With ambiguous results (suspicion of a hypovascular tumor), an MRI of the genitals is indicated. Duplex scanning allows you to assess the pulsation of the testicular artery, with extensive necrosis it is absent.
• Search operation. If it is impossible to establish the cause of an acute scrotum, they resort to a diagnostic surgical intervention: they cut the skin of the scrotum, conduct an audit of the internal structures (testis, epididymis, appendage pendants, vascular bundle). If necessary, detorsion (unwinding) is performed during testicular torsion, tissue viability is assessed.

Differential diagnosis is carried out with allergic swelling of the scrotum, purulent-inflammatory diseases: abscess, phlegmon, erysipelas. With a partial infarction of the gonad, there is always a suspicion of a tumor process. With orchiepididymitis, in addition to a sharp pain in the testicle, there is a pronounced increase in temperature, but hyperthermia can develop several hours after a heart attack or testicular torsion. The final diagnosis can be established only after a comprehensive examination.

Testicular infarction treatment

The choice of methods of therapy is influenced by the pathogenetic factor, the possibility of restoring blood flow, and the age of the patient. The degree of destructive changes correlates with the duration of obstruction of the vessels of the spermatic cord. With ischemia lasting less than 6 hours, the probability of a successful outcome remains 90-100%. After 12-24 hours, tissue death is recorded in 20-50%. After a day, the probability of saving the testicle is 0-10%, orchiectomy is required. With a total infarction, the gonad is removed completely, with a segmental process, local excision of altered tissues is possible.

Conservative therapy

With extensive testicular infarction is not applicable. The management of segmented necrosis remains controversial, but confidence in a local lesion confirmed by duplex scanning and MRI leaves the possibility of prescribing medications to improve blood circulation, antispasmodics, and blood thinners. A prerequisite is monitoring the state in dynamics. With the failure of therapy, an increase in the focus resort to surgical intervention.

Surgical treatment

Urologists consider the condition as urgent, operations are carried out on an emergency basis. In the localized form, the goal of the intervention is to preserve healthy testicular tissue. Partial orchiectomy is considered the best choice for younger patients. However, most cases of segmental testicular infarction end with organ removal surgery due to the inability to exclude a malignant lesion.

After exposure of the testis, the doctor evaluates the color of the gland tissue, in large centers it is possible to conduct an intraoperative histological examination to differentiate between a tumor and a focal infarction. When twisting, unwinding is performed, after restoration of blood flow, the testicle is fixed to the scrotum (orchidopexy). Idiopathic infarction implies total orchiectomy due to the likelihood of developing a purulent-necrotic process, atrophy with malignancy. In the remote period, plastic surgery is possible with the restoration of the normal anatomical dimensions of the scrotum.

Testicular infarction. Macroperparat. (photo by D.S. Davydov)

In the postoperative period, antibiotics, means to improve blood supply, vitamins are prescribed. To prevent hydrocele, it is recommended to wear a suspensorium, avoid lifting weights. Sexual life can be resumed after 4-6 weeks. The transferred ischemia negatively affects spermatogenesis, even with a favorable course for 36-40 weeks, the full production of spermatozoa and testosterone by the affected gonad remains impaired.

Prognosis and prevention

With timely treatment and treatment, the prognosis for life is favorable. After a unilateral lesion, the state of hypogonadism (androgen deficiency), infertility does not develop. Undiagnosed testicular infarction against the background of torsion of the vessels of the cord with spontaneous detorsion (untwisting) leads to atrophy of the gland with the risk of malignancy, so it is recommended to remove the testicle even in the absence of pain.

Prevention implies a careful attitude to the organs of the scrotum: wearing protective equipment during traumatic sports, choosing clothes for the season, timely treatment of chronic urological diseases. Refusal of casual sexual intercourse prevents infection with STDs, which are often complicated by orchitis. In vascular pathologies, it is important to take drugs to improve the rheological properties of the blood, the condition of the vascular wall. Newborn boys should be examined by a urologist for the timely detection of cryptorchidism.

You can share your medical history, what helped you in the treatment of testicular infarction.

Sources

1. Long-term results of surgical treatment of acute testicular diseases in children. Abstract of the dissertation / Majid Amin Abdul-Kader Mogalles – 2004.
2. Idiopathic testicular infarction. Acute testicular disease in children: A practical guide / Bolotov Yu.N. – 2014.
3. Segmental testicular infarction: conservative management is feasible and safe/ Madaan S, Joniau S, Klockaerts K Costa M, Calleja R, Ball RY, Burgess N.// Eur Urol – 2008 – No. 53.
4. This article was prepared based on the materials of the site: https://www. krasotaimedicina.ru/

IMPORTANT
Information from this section cannot be used for self-diagnosis and self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

stages, consequences, what is dangerous, how to treat

Varicocele is a varicose vein of the spermatic cord of the testis. Violations of blood flow lead to stagnation in tissues, their atrophy, in about 10% of cases it contributes to infertility. Varicocele in men is successfully treated by surgery, even at the most advanced stages.

What is a varicocele and why is it dangerous?

1. Why does testicular varicose veins occur?
2. Symptoms of testicular varicocele
   1. Is it possible to visually determine a varicocele
   2. What can hurt with varicocele
3. What are the stages of testicular varicose veins or varicose veins on the testicles
   1. Varicocele 1st degree
   2. Varicocele grade 2
   3. Varicocele grade 3
4. What is dangerous varicose veins of the spermatic cord
   1. How does varicocele affect sex life?
5. Treatment methods for testicular varicocele and which doctor to contact
6. Disease prevention

Why testicular varicose veins occur

Varicose veins of the spermatic cord are most often caused by a genetic predisposition (weakness of the vessel walls).

Let’s list other causes of varicose veins in men on the testicles:

• high venous pressure in the small pelvis;
• regular strenuous exercise, legwork, cycling;
• injuries of the scrotum and groin;
• tumors.

Important!

The risk of developing varicocele is significantly increased by past infections of the genitourinary system (urethritis, prostatitis). Sometimes the causes of varicocele lie in the transferred sexually transmitted diseases, for example, gonorrhea.

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Symptoms of testicular varicocele

At the initial stage of the disease, symptoms are virtually invisible. Later, it becomes more pronounced and is characterized by a deterioration in well-being. The patient may note minor pains that make themselves felt after physical exertion and pass while lying down.

We list other symptoms that testicular varicose veins in men have:

• drawing pains in the groin area, increasing with heavy physical exertion and in a state of sexual arousal;
• asymmetry of the scrotum;
• heaviness and pain in testicles;

Is it possible to visually identify varicocele? It is indicated by such signs revealed during visual self-examination and palpation:

• testicles lost elasticity;
• outwardly the veins become more pronounced, resembling a “ball of worms”;
• Enlarged vessels are clearly visible when the man is standing or lying down.

What can hurt with varicocele

Running testicular varicose veins provokes discomfort, which are mostly dull, aching in nature, aggravated after physical exertion and sexual intercourse. Most often, patients complain of pain in the scrotum and perineum. This indicates that the spermatic cord hurts.

Important!

The most pronounced and severe pain becomes in the evening and at night. At stage 2 of the disease, you can alleviate your condition by taking a horizontal position for several hours. But on 3 and 4 this is not enough: the pain syndrome almost does not go away after rest, pursuing the patient virtually around the clock. Therefore, it is not recommended to delay a visit to the doctor.

What are the stages of testicular varicose

Varicose veins of the spermatic cord has several stages, each of which is characterized by its own characteristics. As the disease progresses, the health and quality of a man’s sexual life worsens, and the risk of infertility increases.

Varicocele of the 1st degree

It is characterized by mild symptoms and blurred clinical picture. A slight discomfort in the testicles is usually attributed to other causes. The following factors contribute to the aggravation of the condition and the transition of the disease to stage 2:

• Injuries of the testicle and scrotum.
• Kidney problems causing impaired blood flow in the testicular vein.

Grade 1 varicocele can only be diagnosed during a special ultrasound examination.

Varicocele 2nd degree

Initially, pain and general symptoms do not actually increase. But the swelling of the veins, which is felt during self-examination and palpation, should alert. There may also be a slight increase in temperature, which makes it difficult for blood to flow to the testicles, which, in turn, leads to a slowdown in sperm growth.

Then the pain and discomfort become more and more distinct. Edema manifests itself especially clearly during the heat, in the evening, with a sedentary lifestyle.

Varicocele grade 3

This is the most advanced stage. It is characterized by pain and deterioration of well-being. The testicle undergoes strong visual changes, decreases in size. The scrotum, on the contrary, is getting larger due to constant edema. The veins are visible to the touch and visually. Pain can haunt the patient around the clock.

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What is the danger of varicose veins of the spermatic cord

The consequences of varicocele can be the most deplorable:

• Infertility. Due to the increase in temperature in the testicles, the level of oxygen in the scrotum decreases, so the maturation and production of sperm become impossible.
• Inability to play sports. The presence of a varicocele prohibits any sports activity associated with the tension of the abdominal muscles.

Aesthetic defect. If the pathology is not operated on, the scrotum sags over time, and a pronounced venous network appears on the testicles. Many men and adolescents with advanced varicocele experience discomfort due to these visual changes.

How varicocele affects sexual life

Contrary to popular stereotype, there is no direct connection between varicocele and impotence. But the quality of sexual life is deteriorating, because with the progression of the disease, the pain syndrome also increases. Its severity affects the duration of sexual intercourse and sexual desire.

Methods of treatment of testicular varicocele and which doctor to contact

Medical treatment of the disease is carried out by conservative and surgical methods. For help, you need to contact a urologist-andrologist. Conservative therapy is possible with normal spermogram parameters. To improve the patient’s condition, medication is prescribed to normalize blood pressure, massage and therapeutic exercises. You will also need to wear special corrective underwear.

But most often the only way to get rid of the pathology and avoid complications is surgery.