The Clinical Research On Testicular Torsion

Testicular torsion is the spermatic cord torsion because of congential anomaly or activity of testis and spermatic cord.It will stop the blood circulation in spermatic cord,cause the testis to ischemic injure and necrose.this disease has a high incidence,and a high misdiagosis rate,and becomes one of emergencies in urology department.But it is difficult to give a fine diagnosis to testicular in the early stage.There are 36 patients in China-Japan unit hospital of Jilin university from Jan 2000 to Nov 2008. The clinical datas of these patients were analyzed retrospectively.To improve the diagnosis and treatment level of testicular torsion.In this research,there are 36 patients,the clinical datas about their signs,exciting causes,treatments,results were analysed retrospectively.We found something in this research.The exciting causes of testiculat torsion are:(1)age,most of the patients are in puberty,in a sexually active stage.(2)the temperature of environment.Testicular torsion always happens in November to February,this may have something with the activity of testis in cold environment.(3)posture.testicular torsion has something with sleep,heavy exercises and sex activity.most of the patients have the disease during or after sleep;the position of the testis is changed during heavy exercise,this may cause the cremaster muscle to constrict;the cremaster muscle's high activity and erection of penis make the testis change position during intercourse.(4)trauma.Ringdahl E considered it may be testicular torsion if it was still painful 1 hour after trauma of scrotum.(5) With other diseases.For example oblique inguinal hernia,when hernia content enters into the scrotum,the position of testis is changed.The clinical manifestations of testicular torsion contain 3 aspects.(1) Accidental pain of unilateral testis,always in left.It is just vague pain in early stage.it will become intense in advanced stage,it happens all the time or sometime.(2)The pain always irradiates to inguen or hypogastric region homolateral.(3)Some patients feel nausea and vomiting,little have low grade fever.The skin of scrotum is red and swelling in medical examination.The haphalgesia is obvious,and the position of testis is upward or horizontal.some spermatic cords are torsional,become shorter and thicker.Prehn's sign is always positive.Someone's cremasteric reflects disappear,someone's contralateral cremasteric reflect become more active.There is a block in scrotum,the testis becomes swelling,hard,and transmitted light test is negative in child's testicular torsion.Radionuclide scrotum imaging with ⁹⁹technetium Pertechnetate is considered golden stander for testicular torsion.But it needs a lot of Time,money,needs special equipment,and it has radiolesion,so it is not popular in clinical.Color Doppler becomes first-use examine for its real-time,quickness,non-invasion,accuracy,cheap,repeatability.blood flow is the crucial information.In the early stage(3～6 hours after torsion),the echo of testis was homogeneous;(6～12 hours after torsion),the testis becomes swell,the echo becomes inhomogeneous,the blood flow reduces.in advanced stage(24 or longer after torsion),the level of echo becomes lower,the blood flow disappoints.It is difficult to diagnose the testicular torsion in the early stage.analyzing all the clinical datas is very necessary.A right diagnosis could be give by clinical datas for classical form,but for atypical form,it is necessary for inquiring incidences carefully,evacuating other diseases.But it is very difficult to diagnose the testicular torsion quickly and accurately.There are some reasons for it.(1)Some patients are ashame of speaking the pathogenetic situation.They are reluctant to go to the hospital when it begin.When the symptoms are obvious,they lost the chance to save testis. (2)lack realizations of the testicular torsion.Testicular torsion can not be seen in gengeal medical book.Most doctors are not familiar to this disease,and consider acute epididymitis of first choice.(3)Inquiring incidences and medical examine are not accurate.The pain always irradiates to inguen or hypogastric region homolateral,some one with nausea,vomiting.It is very confusing with thest situations.(4)No iconography examie promptly.It is necessary to give an iconography examine,but there is no this kind of equipment,or recognization.It is not a good idea to have manual reduction,the recommended method is operation.The operation should be done within 6 hours after torsion to avoid the testis ischemic necrosis.Operation is also necessary to patient 24 hours after torsion,orchiectomy is done if necessary.Now it is a good method to dicide operational way by pathological examine and Arde's scoring system.Give one piece of medullar testis tissue pathological examine,then examine the bleeding time.â… grade:bleed immediately;â…¡grade:bleed within 10 minutes;â…¢grade:bleed out of 10 minutes.â… ,â…¡grade should be given orchiorrhaphy.â…¢grade should be given orchiectomy.Orchiorrhaphy unilateral and contralateral will not affect sexual function.Some researchs reported that some will happen orchiatrophy after orchiorrhaphy.Some researchs reported that about 50-68%patients will happen Semen abnormality.Some foreign researchs reported that about 25%patients will happen infertility.Accurate diagnosis and treatment should be given to testicular torsion with 6 hours.The best treatment method for testicular torsion is operation.If the operation is not done in time,the results are severe:orchiectomy,have orchiatrophy after Orchiorrhaphy.