Patient's question:
I have epididymitis, and my right testicle has shrunk overnight. I am very worried about whether it might lead to testicular necrosis. What are the symptoms of testicular necrosis?Doctor's answer:
Testicular torsion refers to the rotation of the testicle's position. When testicular torsion occurs, the spermatic cord, which supplies blood to the testicle, is also twisted, causing acute vascular obstruction and depriving the testicle of blood supply. If it is not repositioned promptly, it may lead to severe consequences such as testicular necrosis. Testicular torsion is not uncommon, but most people, including some medical professionals, have insufficient awareness of the condition, resulting in a high rate of misdiagnosis. It is often misdiagnosed as acute orchitis, acute epididymitis, or inguinal hernia, leading to delayed treatment. If one can master the following clinical characteristics of testicular torsion, early identification and prevention of severe outcomes can be achieved.1. Age and Occurrence: The condition can occur in adolescents and adults, but it is more common in infants and adolescents. In a study analyzing 718 cases, the average age of onset was 14.9 years. Therefore, parents and teachers should closely monitor children for related symptoms and avoid delaying treatment because they may not be able to describe their discomfort or feel embarrassed to speak up.
2. Timing of Onset: The condition can occur during both physical activity and rest. Approximately half of the patients develop it after intense exercise. When sleeping in a lateral position, the testicle is compressed between the legs, which is more pronounced than when standing, making it easier to twist.
3. Underlying Conditions: Certain congenital conditions can predispose individuals to testicular torsion, such as undescended testicles (especially inguinal cryptorchidism), testicular dysgenesis, or excessively long spermatic cords. These factors may trigger the condition.
4. Common Symptoms: Sudden scrotal (sharp pain) that radiates to the lower abdomen and causes difficulty straightening the back. The pain can be extremely severe, leading to arched posture, pale complexion, profuse sweating, and older children clutching their groin. Examination may reveal an enlarged, retracted testicle in a transverse position with (pronounced tenderness). Elevating the scrotum may relieve the pain. If the child is too young to describe their symptoms, parents and teachers should carefully examine these areas.
5. Ischemic Necrosis: Testicular torsion can lead to ischemic necrosis within 4-12 hours. Therefore, it is crucial to diagnose the condition immediately to avoid missing the ( is a repetition, so it should be "" once). After confirming the diagnosis, manual reduction may be attempted. Generally, the left testicle is rotated counterclockwise, and the right testicle is rotated clockwise, but this is not always consistent. If the pain decreases during rotation, the direction is correct; if the pain worsens, the direction is wrong, and the opposite direction should be tried. If the pain does not improve, the method fails, and immediate surgical exploration should be performed to save the testicle before it becomes necrotic.
6. Impact on Fertility: If one testicle is necrotic and removed, the contralateral testicle may also experience reduced blood flow during the episode, leading to retrograde degenerative changes in the testicular system and potentially affecting future fertility. Therefore, protective measures such as elevating the contralateral testicle, applying a towel, or massaging it, along with physical therapy, should be taken to preserve its fertility.
I’ve had this before too. After the examination, thankfully, it wasn’t the best, but I definitely didn’t have a sexually transmitted disease!