Testicle, torsion of (torsio testis)

A disorder in which a testicle is turned around on its own axis, the epididymis possibly also being affected. The cause is too much mobility in the scrotum. It occurs most frequently during puberty and in young adults. The patient notices a sudden intense pain on one side of the groin or scrotum, often with a tendency to vomit and faint. Redness and swelling of the scrotum then occur. The condition must be detected quickly and distinguished from, for example, a strangulated inguinal hernia or epididymitis, both of which can give rise to the same symptoms. The torsion causes a strangulation of the vessels carrying blood to and from the testicle, the testicle is cut off from its oxygen supply, and the tissues may die as a result. The testicle must be turned back within 4 to 5 hours, otherwise the damage to its tissues is irreparable. This can be done externally by hand, or by an operation. An operation makes it easier to decide whether the testicle can be saved and if it can the surgeon will attach both testicles to the scrotum in order to prevent One or both testicles can be prevented from descending by a constriction in the inguinal canal. The cause of the testicle’s failure to descend is not always clear; hormones may play a part and mechanical obstacles, such as an inguinal hernia, can retard descent. If the scrotum is empty, the testicle may lie in the inguinal canal, in the area around the inguinal canal, or in the abdominal cavity. The descent of the testicle into the scrotum is essential for the production of hormones and sperm, because they can be produced only at below normal body temperature and the scrotum’s relatively exposed position provides this. When cryptorchism is suspected, the possibility of retractile testis must be excluded. A retractile testis is normally located in the scrotum, but can return into the inguinal canal due to the tightening of muscles in the wall of the scrotum (cremaster reflex); the retractile testis does not require treatment. Until a few years ago, it was thought that cryptorchism need not be treated until the boy was of primary-school age. However, research into fertility has shown that treatment ought to be carried out before the fourth year of life. When the testis is in the inguinal canal, hormone treatment (nasal spray)

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