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Kamis, 27 Desember 2012

Testicular torsion

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Testicular torsion
Testicular torsion

Definition:
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 is most common between ages 12 and 16, but it can occur at any age, even before birth.

Testicular torsion usually requires emergency surgery. If treated within a few hours, the testicle can usually be saved. But waiting longer can cause permanent damage and may affect the ability to father children. When blood flow has been cut off for too long, a testicle may become so badly damaged it has to be removed.

Symptoms:
Signs and symptoms of testicular torsion include:
  • Sudden or 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
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 the cause of the pain is 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). Even though the testicle untwisted on its own, you still need to see a doctor because 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.

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.

What causes testicular torsion is unknown. Signs and symptoms of testicular torsion may follow:
  • Physical activity
  • An injury to the scrotum
  • Cold temperatures
  • Rapid growth of the testis during puberty
  • Sleep
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 or death of 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.
Treatments and drugs:
Surgery is required to correct testicular torsion. In some cases, the doctor may be able to untwist the testicle by pushing on the scrotum (manual detorsion), but you'll still need surgery to prevent torsion from occurring again.

Surgery for testicular torsion is usually done under general anesthesia, which means you won't be conscious. The surgery generally doesn't require a stay in the hospital. During surgery, your doctor will:
  • Make a small cut in your scrotum
  • Untwist your spermatic cord, if necessary
  • Stitch one or usually both testicles to the inside of the scrotum to prevent rotation
The sooner the testicle is untwisted, the greater the chance it can be saved. The success rate is about 95 percent when treatment occurs within six hours, but declines steadily to about 20 percent after 24 hours.

Testicular torsion in newborns and infants
Testicular torsion may occur in newborns and infants, though it's rare. The infant's testicle may be hard, swollen or a darker color. Ultrasound may not detect reduced blood flow to the infant's scrotum, so surgery may be needed to confirm testicular torsion.

Treatment for testicular torsion in infants is controversial. If a boy is born with signs and symptoms of testicular torsion, it may be too late for emergency surgery to help. In some cases, the doctor may recommend a later, nonemergency surgery. But emergency surgery can sometimes save all or part of the testicle and can prevent torsion in the infant's other testicle. Treating testicular torsion in infants may prevent future problems with male hormone production and with fathering children.

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