What are the signs of testicular torsion. How is testicular torsion diagnosed and treated. Who is at risk for testicular torsion. What complications can arise from untreated testicular torsion. How can testicular torsion be prevented.

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, causing sudden and often severe pain and swelling. While it can happen at any age, testicular torsion is most prevalent among adolescents between 12 and 18 years old.

The condition requires immediate medical attention, as prompt treatment is crucial for saving the affected testicle. If left untreated for too long, the lack of blood supply can lead to severe damage, potentially necessitating the removal of the testicle.

Recognizing the Symptoms of Testicular Torsion

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

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

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

When Should You Seek Medical Help?

If you experience sudden or severe testicle pain, it’s crucial to seek emergency care immediately. Prompt treatment can prevent severe damage or loss of the testicle. Additionally, if you’ve had sudden testicle pain that subsided without treatment, you should still seek medical attention, as this could indicate intermittent torsion and detorsion, which may require surgery to prevent recurrence.

The Underlying Causes of Testicular Torsion

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

• Inherited anatomical trait: Most males who experience testicular torsion have an inherited condition that allows the testicle to rotate freely inside the scrotum.
• Physical activity: Torsion often occurs several hours after vigorous activity or following a minor injury to the testicles.
• Sleep: Some cases occur during sleep.
• Temperature: Cold temperatures might play a role in triggering torsion.
• Rapid growth: The rapid growth of the testicle during puberty may contribute to the condition.

Identifying Risk Factors for Testicular Torsion

While testicular torsion can affect males of any age, certain factors may increase the risk:

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

Potential Complications of Untreated Testicular Torsion

Delaying treatment for testicular torsion can lead to severe complications:

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

Can Testicular Damage Be Reversed?

The reversibility of testicular damage depends on how quickly treatment is administered. If blood flow is restored within 6 hours, the testicle can usually be saved. However, after 12 hours, the chances of saving the testicle decrease significantly. This underscores the importance of seeking immediate medical attention for any sudden testicular pain.

Diagnosis and Treatment of Testicular Torsion

Diagnosing testicular torsion typically involves a physical examination and, in some cases, imaging tests such as ultrasound. Once diagnosed, emergency surgery is usually required to untwist the spermatic cord and restore blood flow to the testicle.

What Does the Surgical Procedure Involve?

The surgical procedure, known as orchiopexy, involves making a small incision in the scrotum, untwisting the spermatic cord, and then stitching the testicle to the inside of the scrotum to prevent future torsion. In cases where the testicle is too damaged to be saved, it may need to be removed in a procedure called an orchiectomy.

Preventive Measures for Testicular Torsion

For males with the inherited trait that allows testicles to rotate freely in the scrotum, the only way to prevent testicular torsion is through preventive surgery. This procedure, also called orchiopexy, involves attaching both testicles to the inside of the scrotum to prevent rotation.

Is Preventive Surgery Recommended for Everyone?

Preventive surgery is not routinely recommended for all males. However, it may be considered for those with a history of intermittent torsion or a strong family history of the condition. The decision to undergo preventive surgery should be made in consultation with a healthcare provider, weighing the risks and benefits for each individual case.

Living with the Aftermath of Testicular Torsion

For those who have experienced testicular torsion, especially if it resulted in the loss of a testicle, there may be physical and psychological impacts to navigate. It’s important to discuss any concerns with healthcare providers, including:

• Fertility concerns
• Hormonal implications
• Body image issues
• Psychological support needs

Remember, many men who have lost a testicle due to torsion go on to lead normal, healthy lives and are able to father children. Regular follow-ups with healthcare providers can help address any ongoing concerns and ensure overall health and well-being.

Educating Young Males About Testicular Health

Given that testicular torsion is most common in adolescents, it’s crucial to educate young males about testicular health and the importance of seeking immediate medical attention for any sudden scrotal pain. This education can be incorporated into school health programs, sports physicals, and routine medical check-ups.

What Should Be Included in Testicular Health Education?

Comprehensive testicular health education should cover:

• Basic anatomy and function of the testicles
• Signs and symptoms of testicular torsion and other testicular problems
• The importance of prompt medical attention for testicular pain
• How to perform testicular self-examinations
• Debunking myths and addressing common concerns about testicular health

By promoting awareness and understanding, we can empower young males to take charge of their testicular health and potentially prevent serious complications from conditions like testicular torsion.

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.

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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.

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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.

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, resemble 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 unpleasant sensations, which are mostly dull, aching in nature, intensify 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

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 exacerbation 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. The doctors of the Garvis clinic have a great positive experience in the elimination of varicocele through the Marmara operation. Indications for its implementation:

• severe pain syndrome;
• infertility;
• testicular atrophy.

During this intervention, a micro incision is made in the groin area. Then, using an ultramodern microscope, veins that have undergone pathological changes are detected. They are tied up and excised to free the arteries. The operation lasts about an hour, and the restoration of health after the intervention takes several weeks. The risk of recurrence is virtually zero.

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Prevention of the disease

Prevention of varicocele consists in regular examination by a urologist. Don’t wait for testicular varicose veins to jeopardize your fertility and quality of sex life. Sign up for a consultation at the Garvis clinic now, and we will definitely help you get rid of the pathology as soon as possible!

Testicular infarction – causes, symptoms, diagnosis and treatment

Testicular infarction is the necrosis of gland tissues due to circulatory disorders. 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.

General

Testicular infarction occurs 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. Involvement of the gonad disrupts the inflow and outflow of blood. 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 overexertion, 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 may 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

There are hemorrhagic, ischemic and idiopathic infarctions. 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. Rare, predominantly in men aged 20-40 years, 70-80% 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.

Symptoms of testicular infarction

The most common symptom of a focal process is testicular pain, which is nonspecific and indistinguishable from pain associated with 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, 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 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.

Diagnosis

Early diagnosis of acute scrotal conditions is extremely important, as 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.

Treatment of testicular infarction

The choice of therapy methods 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

Not applicable for extensive testicular infarction. 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 performed 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 Davydov D.S.)

In the postoperative period, antibiotics, drugs to improve blood supply, and 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.

Forecast 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 careful attitude to the organs of the scrotum: wearing protective equipment during traumatic sports, choosing clothes according to the season, timely treatment of chronic urological diseases. Refusal of casual sexual intercourse prevents infection with STDs, which are often complicated by orchitis.