مقاله پيچ خوردگي بيضه ...Testicular Torsion

[Doctor_Shovan مهمان]

Introduction

 

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. Though testicular torsion can occur at any age, including the prenatal and perinatal periods, it most commonly occurs in adolescent males; it is the most frequent cause of testicle loss in that population

پيچ خوردگي بيضه عبارت است از پيچ خوردگي طناب اسپرماتيك بيضه كه گاهي به طور برگشت ناپذير به بيضه آسيب مي زند. پيخ خوردگي بيضه معمولاً تنها در يك طرف رخ مي دهد. مردان را در تمام سنين مبتلا مي كند ولي در نوجوانان (20-12 ساله ) شايع تر است .

[Doctor_Shovan مهمان]

Pathophysiology

 

The testicle is covered by the tunica vaginalis, a potential space that encompasses the anterior two thirds of the testicle and where fluid from a variety of sources may accumulate. The tunica vaginalis attaches to the posterolateral surface of the testicle and allows for little mobility of the testicle within the scrotum

In patients who have an inappropriately high attachment of the tunica vaginalis, the testicle can rotate freely on the spermatic cord within the tunica vaginalis (intravaginal testicular torsion). This congenital anomaly, called the bell clapper deformity, can result in the long axis of the testicle being oriented transversely rather than cephalocaudal. This congenital abnormality is present in approximately 12% of males, 40% of whom have the abnormality in the contralateral testicle as well.

[url=http://javascript:showcontent('active','references')]1 [/url]The bell clapper deformity allows the testicle to twist spontaneously on the spermatic cord. Torsion occurs as the testicle rotates between 90° to 180°, causing compromised blood flow to the testicle

Complete torsion usually occurs when the testicle twists 360° or more; incomplete or partial torsion occurs when the twisting is less than this. The twisting of the testicle causes venous occlusion and engorgement as well as arterial ischemia and infarction of the testicle. How tightly the testicle is twisted appears to correlate with how quickly the testicle becomes nonviable from ischemia

In the neonatal age group, the testicle frequently has not yet descended into the scrotum, where it becomes attached within the tunica vaginalis. This mobility of the testicle predisposes it to torsion (extravaginal testicular torsion). Inadequate fusion of the testicle to the scrotal wall typically occurs within the first 7-10 days of life

[Doctor_Shovan مهمان]

Frequency

United States

Incidence of torsion in males younger than 25 years is approximately 1 in 4000. Torsion more often involves the left testicle. Of the cases of testicular torsion that occur in the neonatal population, 70% occur prenatally and 30% occur postnatally

Mortality/Morbidity

This urologic emergency requires prompt diagnosis, immediate urologic consultation, and rapid definitive operative treatment for salvage of the testicle. A salvage rate of 90-100% is found in patients who undergo detorsion within 6 hours of pain; the viability rate fell to between 20% and 50% after 12 hours; and 0 to 10% viability if detorsion is delayed greater than 24 hours

[Doctor_Shovan مهمان]

Age

Testicular torsion most often is observed in males younger than 30 years, with most aged 12-18 years. The peak age is 14 years, although a smaller peak also occurs during the first year of life

[Doctor_Shovan مهمان]

Clinical

 

History

 

 

• History includes a sudden onset of severe unilateral scrotal pain

  
  

• Onset of pain can occur more slowly, but this is an uncommon presentation of torsion

  
  

• Torsion can occur with activity, can be related to trauma in 4-8% of cases,or can develop during sleep

  
  

• The historical features suggestive of testicular torsion

  
  

• include the following

  
  

• :

  
  

• 
  

  • Acute onset of unilateral scrotal pain

    
    

  • Scrotal swelling

    
    

  • Nausea and vomiting: In the pediatric population, nausea and vomiting more commonly accompany acute testicular torsion and have a positive predictive value of greater than 96%

    
    

  • Abdominal pain.20-30%

    
    

  • Fever 16%

    
    

  • Urinary frequency 4%

    
    

  [*]

  Many patients have a history of recurrent scrotal pain

  [*]

  that has resolved spontaneously. This history is highly

  [*]

  suggestive of intermittent torsion and detorsion of the testicle.

  [*]

  Patients who complain of what sounds like torsion-detorsion should be referred promptly to a urologist since patients with symptoms of intermittent torsion who electively have surgical exploration are less likely to develop subsequent torsion and loss of the testicle. Creagh et al reported that acute torsion developed in 10% of patients with intermittent torsion while they waited for surgery

[Doctor_Shovan مهمان]

Physical

 

 

• The physical examination is useful, but imperfect, in diagnosing acute testicular torsion
  

• The physical examination, moreover, may be difficult to perform, as the testicle is typically very tender and patients are often in significant discomfort

  
  

• The involved testicle is painful and is frequently elevated in position when compared with the other side

  
  

• Horizontal lie of the testicle - While abnormal lie can help diagnose testicular torsion, fewer than 50% of cases demonstrated true horizontal lie

  
  

• Enlargement and edema of the testicle; edema involving the entire scrotum

  
  

• Scrotal erythema

  
  

• Ipsilateral loss of the cremasteric reflex - The cremasteric reflex is almost always absent in patients with testicular torsion, and its presence may help to distinguish other causes of acute scrotal pain from testicular torsion. Case reports, however, have noted the opposite to be true

  
  

• Usually, no relief of pain upon elevation of scrotum elevation may improve the pain in

  epididymitis .Prehn signFever uncommon

  
  

[Doctor_Shovan مهمان]

Causes

 

 

• Congenital anomaly; bell clapper deformity
  

  
  

• Undescended testicle
  
Sexual arousal and/or activity

• 
  

• Trauma

  
  

• Testicular tumor

  
  

• Exercise

  
  

[Doctor_Shovan مهمان]

علايم شايع

درد ناگهاني يك بيضه

تورم ، قرمزي و حساسيت به لمس بيضه دان

تهوع و استفراغ

تعريق

ضربان قلب سريع در صورت شديد بودن علل

 

علل

معمولاً ناشناخته . گاهي در هنگام تولد وجود دارد يا ممكن است به ندرت در اثر انقباض شديد عضلات متصل به بيضه و طناب اسپرماتيك ايجادشود.عوامل افزايش دهنده خطر

عوامل افزايش دهنده خطر

ناشناخته

 

[Doctor_Shovan مهمان]

پيشگيري

در هنگام شركت در ورزش هاي تماسي براي پيشگيري از آسيب تناسلي از بيضه بند استفاده كنيد.

عواقب مورد انتظار

گاهي پيچ خوردگي خود به خود تصحيح مي شود؛ علايم از بين مي روند و درماني لازم نيست . البته بيضه ي بدون ترميم معمولاً آسيب مي بيند مگر اين كه جراحي در عرض 4-3 ساعت پس از شروع علايم انجام شود. اگر قرار باشد يك بيضه برداشته شود، بايد براي بلوغ طبيعي ، زندگي جنسي و توليدمثل طبيعي ، هورمون هاي كافي براي بيضه سالم باقي مانده فراهم شود.

[Doctor_Shovan مهمان]

عوارض احتمالي

مرگ سلول هاي بيضه در اثر كاهش يا انسداد جريان خون . بيضه آسيب ديده و طناب اسپرماتيك در اين حالت بايد برداشته شوند.

درمان اصول كلي

معمولاً تشخيص تنها با معاينه فيزيكي گذاشته مي شود ولي سونوگرافي نيز ممكن است انجام شود.

جراحي براي رفع پيچش طناب اسپرماتيك پيچ خورده و اتصال بيضه آسيب ديده به سطح داخلي جدار بيضه دان كه مانع عود مي گردد. جراحي براي پيشگيري از پيچ خوردگي ، احتمالاً برروي بيضه غيرمبتلا نيز انجام خواهد شد.

پس از جراحي ، از كيسه يخ براي تسكين درد و تورم استفاده كنيد.

يخ را در پلاستيك بگذاريد. آن را در طرف آسيب ديده بگذاريد و با يك پارچه يخ را از پوست جدا كنيد. هر بار 10-5 دقيقه يخ را روي موضع قرار دهيد. در صورت لزوم اين كار را تكرار كنيد.

داروها

بعد از جراحي ، ممكن است مسكن ها تجويز گردند.

 

[Doctor_Shovan مهمان]

فعاليت

بعد از جراحي به تدريج فعاليت هاي طبيعي خود را از سر بگيريد.

رژيم غذايي

رژيم غذايي خاصي ندارد.

در اين شرايط به پزشك خود مراجعه نماييد

اگر شما يا يكي از اعضاي خانواده تان علايم پيچ خوردگي بيضه را داشته باشيد. اين ، يك اورژانس است !

اگر علايم عفونت پس از جراحي آغاز شوند. اين علايم عبارتند از تب ، لرز، درد عضلاني ، سردرد، سرگيجه و احساس ناخوشي عمومي

اگر خونريزي بيش از حد در محل جراحي رخ دهد.

منابع

emedicine.medscape

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wordpress