Testicular Torsion
Torsion of the testis; Testicular ischemia; Testicular twisting
Testicular torsion is the twisting of the spermatic cord, which cuts off the blood supply to the testicle and surrounding structures within the scrotum.
Causes, incidence, and risk factors
Some men may be predisposed to testicular torsion because of inadequate connective tissue within the scrotum. However, the condition can result from trauma to the scrotum, particularly if significant swelling occurs. It may also occur after strenuous exercise or may not have an obvious cause.
The condition is more common during infancy (first year of life) and at the beginning of adolescence (puberty).
Symptoms
- Sudden onset of severe pain in one testicle, with or without a previous predisposing event
- Swelling within one side of the scrotum (scrotal swelling)
- Nausea or vomiting
- Light-headedness
- Additional symptoms that may be associated with this disease:
- Testicle lump
- Blood in the semen
Testicular torsion is a true urologic emergency and must be differentiated from other complaints of testicular pain because a delay in Testicular swelling and pain should be evaluated on an emergent basis. The evaluation is best done in an emergency room, where rapid imaging is available and there is quick access to surgical intervention. There is about a six-hour window for the testicle to be salvaged; surgical treatment within this period is associated with a 100% salvage rate for the testicle. After six hours, the salvage rate decreases, and if surgical repair is performed after twenty four hours, the testicle is no longer salvageable.
Care at home is inappropriate and will only result in the loss of the testicle.
The only treatment for testicular torsion is surgery.
On rare occasions, a physician may be able to manually untwist the testicle, but this is not common. The importance of having testicular pain evaluated immediately cannot be overemphasized.
If your doctor suspects torsion, a urologist will be notified. Depending on your history and physical, either you may be brought to the operating room or you may have imaging done. Occasionally a testicular torsion may be manually detorsed (untwisted by hand) by a physician.
Medications
In the emergency room, the patient with testicular torsion will probably receive morphine for pain relief.
Surgery
The goal of surgery is to salvage the testicle. If the testicle cannot be salvaged, the testicle is removed (a procedure known as orchiectomy). If the testicle is detorsed successfully, it will be sutured within the scrotum so that it can no longer twist (called orchiopexy). The other testicle will also undergo the same fixation to the scrotum.
Other Therapy
Patients who have a nonviable testicle may return for the insertion of a prosthetic testicle. This will be done only after the urologists feels that healing from the surgery is complete
Patients who have lost a testicle should be counseled on the potential dangers of contact sports, since there is the risk of injury to the one remaining testicle.
Prevention
Use precautions to avoid trauma to the scrotum. Many cases are not preventable.
Expectations (prognosis)
If the condition is diagnosed quickly and immediately corrected, the testicle may continue to function properly. After 6 hours of torsion (impaired blood flow), the likelihood that the testicle will need to be removed increases. However, even with less than 6 hours of torsion, the testicle may lose its ability to function.
Complications
If the blood supply is cut off to the testicle for a prolonged period, it may atrophy (shrink) and need to be surgically removed. Atrophy of the testicle may occur days-to-months after the torsion has been corrected. Severe infection of the testicle and scrotum is also possible if the blood flow is restricted for a prolonged period.
Cannabinoids and Testicular Torsion
The capacity of endogenous cannabinoids to modulate the protective responses of animals during in?ammation has led to the hypothesis that endogenous cannabinoids may be a component of the complex homeostatic system controlling the basal threshold of in?ammation. The membranes of endothelial cells, perivascular nerves or activated blood cells like platelets, leukocytes and macrophages may be potential
sources of endocannabinoids release and in?ammatory stimuli and mediators may determine the levels of endocannabinoids at the site of in?ammation.
Blood ?ow in both the ipsilateral and contra lateral spermatic arteries decreased after unilateral torsion and the long-term consequences of these changes may affect testicular function and ultimately fertility.
Anandamide released by the perivascular nerves or endothelial cells could act at cannabinoid receptors on the vascular smooth muscle to cause vasorelaxation. In addition, activation of cannabinoid receptors
may cause the inhibition of platelet aggregation, which could be another important mechanism to improve tissue reperfusion.
The endocannabinoid network is a naturally occurring system, ?rst identi?ed in the central nervous system and now found to be expressed throughout the body. The anti-in?ammatory properties of endocannabinoid have been demonstrated in different experiments. In addition to the brain, cannabinoid receptors have been found in vascular smooth muscle, endothelium and on immune cells like lymphocytes, macrophages and platelets, suggesting that they may play a role in in?ammatory responses.
Moreover, it has been demonstrated that perivascular nerves, endothelial cells, circulating leukocytes and platelets are potential sources of endocannabinoid release and they are to play a signi?cant role in both the regulation of vascular function and in?ammation threshold. In this regard, many studies have implicated the protective role of the cannabinoids against ischemia/reperfusion (IR) injury in the cardiac and neural cells. It has been demonstrated that cannabinoid receptors are operative in this protective phenomenon.
The capacity of endogenous cannabinoids to modulate the protective responses of animals during in?ammation has led to the hypothesis that endogenous cannabinoids may be a component of the complex homeostatic system controlling the basal threshold of in?ammation. The membranes of endothelial cells, perivascular nerves or activated blood cells like platelets, leukocytes and macrophages may be potential
sources of endocannabinoids release and in?ammatory stimuli and mediators may determine the levels of endocannabinoids at the site of in?ammation.
Cannabinoids are analgesics
Cannabinoids are anti-inflammatories
Cannabinoids are vascular dilators
Cannabinoids can help regulate the autonomic nervous system
Use liquid cannabinoid extracts made from Indica dominant hybrids.
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