Testicular necrosis

The testicle is the main organ for men to produce sperm. In order to ensure the quality of sperm, men must protect their testicles. Testicular torsion and necrosis occur in many men, mainly because of male friends after exercise, so everyone must be careful when exercising. If you can get timely treatment after the torsion, it can be cured. Let's learn how to treat the torsion~

1. Vigorous exercise can cause testicular torsion

The doctor said that testicular torsion, also known as spermatic cord torsion, is caused by intense contraction of the testicular muscle attached to the spermatic cord during strenuous exercise or violent injury to the scrotum, which leads to torsion and acute blood circulation disorder in the testicles. It manifests as severe pain in the scrotum, which may radiate to the lower abdomen or inner thigh, accompanied by nausea and vomiting, and the testicles become enlarged and move upward, with obvious tenderness. The spermatic cord is twisted and shortened like a rope.

Doctors point out that testicular torsion can occur in men of all ages, with the highest incidence in adolescents aged 12 to 18. Potential congenital developmental abnormalities, cryptorchidism, and after strenuous exercise are all prone to testicular torsion. The best treatment time is within 6 hours of testicular torsion. If it does not exceed 12 hours, manual reduction can be tried immediately for correction. If manual reduction fails, surgical testicular fixation can be performed. After 12 hours, the testicle is obviously necrotic, and only orchiectomy on the affected side can be performed. Therefore, if testicular pain or swelling occurs, you should seek medical attention immediately.

2. How to treat testicular torsion?

1. Manual restoration

Once the diagnosis is confirmed, within 12 hours, manual reduction can be tried immediately for correction. Manual reduction may relieve the torsion and restore testicular blood supply, so that selective surgery can be performed later. During reduction, 1% 5-10ml is first injected around the spermatic cord at the outer ring for blocking anesthesia, and reduction is performed 5 minutes later. Knot-like changes can be felt in the spermatic cord at the torsion, which can disappear immediately after successful reduction in the opposite direction. Pain is also relieved quickly. Selective orchiopexy can be postponed to within 48 hours.

2. Surgical exploration and orchiopexy

If the manual reduction fails, or if testicular necrosis is suspected, or the diagnosis of testicular torsion cannot be ruled out, scrotal exploration should be performed immediately. It is important to prevent inappropriate delays for special examinations, because testicular necrosis is related to the time of testicular torsion. Research data show that patients can achieve the best results if they undergo surgery within 4 hours of the onset of symptoms. If the torsion lasts for 8 hours or more, the occurrence of testicular atrophy in the later stage will increase significantly. After 24 hours of torsion, saving the testicle has lost its meaning.

3. Orchiectomy

In the past, most surgeons felt that if the testicle still had a chance of survival, it should be retained, and only the obviously necrotic testicle should be removed. Recent data indicate that a testicle lacking blood supply can stimulate the production of anti-sperm antibodies and can harm the healthy testicle, so some scholars suggest retaining only the testicle that has clearly restored circulation after torsion. Surgery 12 hours after torsion, most damaged testicles will atrophy in the later stage, and the sperm count will decrease. We believe that under the current circumstances, retaining a testicle that has been torsion for more than 12 hours should be cautious, and the decision should be made to remove it. If the survival of the testicle is still difficult to determine during the operation, fluorescein can be injected and the testicle can be observed under ultraviolet light. Fluorescent infusion into the testicles can keep the testicles alive. Testicular prosthesis can be placed at the same time or in the second stage for patients with necrotic testicles.