TWISTED IN THE GOLDEN HOUR

by Neddy Makonza | NUST-ZW

THE most embarrassing thing to do is tell someone about your manhood. Can you however live with telling someone about the disability of your manhood? This can happen if you feel excruciating pain around your groin area and decide to be strong and not seek help.

torsion-of-testis

Testicular torsion is a true urologic emergency and must be differentiated from other complaints of testicular pain because a delay in diagnosis and manage­ment can lead to loss of the testicle. Al­though testicular torsion can occur at any age, including the prenatal and perinatal periods, torsion is most frequent among adolescents with about 65% of cases presenting between 12 – 18 years of age. It occurs in about 1 in 4,000 to 1 per 25,000 males per year before 25 years of age. , it is the most frequent cause of testicle loss in that population.

The testicles are 2 organs that hang in a pouch of skin called the scrotum which sits below the penis. This is where sperm and male sex hormone (testosterone) are made. The blood supply for each testicle comes from the spermatic cord. This cord starts in the abdomen and extends into the scrotum. This cord also contains the vas deferens, which carries sperm from the testicles to the urethra. Damage to these structure is detrimental as they determine the fertility of an individual. However luckily one has two of them.

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 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 due to ischaemia. The testicle is deprived of oxygen and also swelling occur causing compression of the structure and pain. This occurs in about 17% of males and is bilateral in 40%.The following features are associated with higher likelihood of torsion :

  • Pain duration of less than 24 hours
  • Nausea or vomiting
  • High position of the testicle
  • Transverse lie of the affected testis
  • Abnormal cremasteric reflex

 

Embarrassment in the young patient may prevent disclosure of scrotal pain, and scrotal pain referred to the lower abdomen may be perceived as not being of scrotal or testicular origin. For this reason, any young male who com­plains of lower abdominal pain should undergo examination of the external genitalia to rule out the possibility of scrotal or testicular pathology.

In contrast intravaginal torsion most commonly occurs in adolescents. It is thought that the increased weight of the testicle after puberty, as well as sudden contraction of the cremasteric muscles (which inserts in a spiral fashion into the spermatic cord), is the impetus for acute torsion. Testicular torsion is also associated with testicular malignancy, especially in adults; one study found a 64% association of testicular torsion with testicular malignancy. This is thought to be secondary to a relative increase in the broadness of the testicle compared with its blood supply.

This is a urological emergency; early diagnosis and treatment are vital to saving the testicle and preserving future fertility. Testicular torsion requires emergency surgical treatment to prevent further ischemic damage to the testis. If treated quickly, the testicle can 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.

@kidshealth

 

To prevent loss of the testicles the patient must present within 6 hours after onset of symptoms. Salvaging of the testicle in this instance is possible. This period is called the ‘golden hour’ as it determines whether the testicle survives or not. However if pa­tient delays and present within 24 hours there is a very slight chance to save the testicle but it is indefinite. Presentation after 24 hours the testicle is most likely damaged so nothing can be done to revive the testicle.

History and physical examination are imperfect in ruling out testicular torsion. However very useful and time conscious as patient is quickly taken to theatre if torsion is suspected. Imaging studies (eg, ultrasonography, nuclear scans) may be useful when a low suspicion of testicular torsion is noted. Surgical exploration should not be delayed for the sake of performing imaging studies as this will eat into the golden hour.

Complications that can occur due to un­treated testicular torsion are ;Testicular infarction( death of testicle), Scrotal ab­scess (pus in the scrotum and infection), Gangrene of testis (death and loss of testi­cle), Recurrence, Chronic epididymitis.

In conclusion immediate action in the golden hour is vital to save one’s testicles, fertil­ity, pride and prevent future marital problems.

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