Testicular Pain Testicular Masses portal睾丸疼痛及睾丸肿块门户.lhup.pptVIP

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Testicular Pain Testicular Masses portal睾丸疼痛及睾丸肿块门户.lhup.ppt

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Testicular Pain Testicular Masses portal睾丸疼痛及睾丸肿块门户.lhup

* * * * * * * * Mechanism. In cases of testicular torsion, an anatomic deformity allows the spermatic cord to twist, resulting in occlusion of testicular blood flow. This anomaly is known as the bell-clapper deformity, in which the tunica vaginalis completely surrounds the testis. The deformity leads to inadequate posterior fixation of the testis to the epididymis and scrotal wall. An autopsy series1 found the incidence of bell-clapper deformity to be 12 percent among asymptomatic men. The free-floating testis is more likely to twist on its cord and strangulate its blood supply through intravaginal torsion. Initiating factors for torsion can include trauma or vigorous exercise, but symptoms may also occur during sleep. Many patients will recall a previous history of minor similar pain that resolved spontaneously. Such a history favors the diagnosis of torsion. Extravaginal torsion, which is far less common than intravaginal torsion, occurs exclusively in neonates. In this disorder, incomplete attachment of the gubernaculum and testicular tunics to dartos fascia causes the cord to twist above the level of the testis and tunica vaginalis. This twisting also obliterates the blood supply to the testis.2 An associated anatomic defect is usually not present on the contralateral side.3 Clinical Presentation. Intravaginal testicular torsion occurs most often in young men but can also affect middle-aged men. Patients with testicular torsion often present with sudden, severe, unilateral scrotal pain that is often associated with nausea and vomiting.4 Scrotal edema and erythema are typically present, and lower abdominal pain may also occur. Physical examination reveals a tender, firm affected testis that may appear retracted upward as a result of twisting of the spermatic cord. The torsed testis is often swollen and edematous, and it is difficult to distinguish normal anatomy. Normal positioning of the epididymis cannot rule out torsion, since the testis may have rotated 360