Abstract
Acute torsion of the testicle(s) is one of the common emergencies in the field of urology; it results in either decrease or complete disruption of testicular blood flow, it affects about 4.5/100000 less than 25 years male. The golden period of testicular saving intervention is the first 6 – 8 hours from the onset of symptoms. The aim of this study is to obtain a statistic about patients with testicular torsion treated at our center, concentrating on patients ended with orchiectomy. A total number of 25 patients presented to our center during the study period (2 years). After taking a full history and scrotal examination, all patients sent to Doppler scrotal ultrasonography to confirm the diagnosis and assess vascularity, and then all patients un- derwent scrotal exploration through a scrotal incision. Orchiopexy or orchiectomy was done depending on viability of the testis. Contralateral orchiopexy was done in all patients. Forty percent of our patients ended with orchiectomy, the incidence of orchiectomy was higher in patients lived in rural areas (70 %), there also was strong relationship between cold weather and the incidence of orchiectomy. The most important factor in detecting testis salvageability was the duration of symptoms before the presentation.
Highlights
For diagnosis of acute testicular torsion, detailed history and careful physical examination, concentrating on scrotal examination is essential and usually enough to decide the need for surgical intervention, radiological imaging study using Color Doppler Sonography may be needed to confirm the diagnosis in equivocal cases [6]
The urologist must depend on detailed history and a careful physical examination to reach the diagnosis and surgical intervention should be done in any suspected cases. [7] [8]
Eighty percent of patients presented with left side testicular torsion, while the right side affected in only 20 % of patients, 15 (60 %) of patients lived in urban area, were as 10 (40%) from rural areas. (Table number 2)
Summary
Acute torsion of the testicle(s) is one of the common emergencies in the field of urology; it results in either decrease or complete disruption of testicular blood flow, it affect about 4.5/100000 less than 25 years male. [1]The golden period of testicular saving intervention is the first 6 – 8 hours from the onset of symptoms. [2]It has been estimated that about 1/3 of cases ended with orchiectomy because of nonviability of the testis at the time of intervention. [3]Regarding the etiology, it has been postulated that some anatomical abnormalities may increase the risk of testicular torsion, these include; long intra vaginal part of the spermatic cord (bell clapper deformity) and cryptorchidism. [4] many cases of torsion occur spontaneously during sleep without any precipitating event, external trauma and exercise, especially ridding bicycle are the main triggering that may precipitate the condition. [5]For diagnosis of acute testicular torsion, detailed history and careful physical examination, concentrating on scrotal examination is essential and usually enough to decide the need for surgical intervention, radiological imaging study using Color Doppler Sonography may be needed to confirm the diagnosis in equivocal cases [6]Generally, the urologist must depend on detailed history and a careful physical examination to reach the diagnosis and surgical intervention should be done in any suspected cases. [7] [8]Treatment of testicular torsion is usually require surgical intervention, manual detorsion, sometime, is a possible option, in order to salvage the testis, surgical intervention should be done as quickly as possible and the first 6 hours after the symptom is considered the golden period. The golden period of testicular saving intervention is the first 6 – 8 hours from the onset of symptoms. For diagnosis of acute testicular torsion, detailed history and careful physical examination, concentrating on scrotal examination is essential and usually enough to decide the need for surgical intervention, radiological imaging study using Color Doppler Sonography may be needed to confirm the diagnosis in equivocal cases [6]. Treatment of testicular torsion is usually require surgical intervention, manual detorsion, sometime, is a possible option, in order to salvage the testis, surgical intervention should be done as quickly as possible and the first 6 hours after the symptom is considered the golden period. Whether surgical treatment ended by testicular loss or preservation of the ipsilateral testis, most urologist does contralateral orchiopexy. Testicular compartment syndrome can occur after reperfusion of the affected testis, the longer the period of ischemia, the higher the risk of this syndrome. [9]
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