درد و تورم ناگهانی بیضه در کودک : پیچ خوردگی بیضه و یک اورژانس واقعی دکتر علیرضا سینا ارولوژی کودکان

Sudden testicular pain and swelling in a child or adolescent should not be ignored in the hope of spontaneous recovery. These symptoms may be due to testicular torsion; a true emergency in which blood flow to the testicle is reduced or interrupted, and delaying treatment can lead to permanent damage or loss of the testicle. In this program from the Erfan Niayesh Hospital Medical Talk Series, Dr. Alireza Sina explains the symptoms of testicular torsion, the importance of the golden time for treatment, the method of diagnosis, and the necessity of immediate surgery. What is testicular torsion? In testicular torsion, the testicle and spermatic cord rotate around their axis. The blood vessels of the testicle pass through this cord; therefore, its twisting can disrupt blood supply and damage the testicular tissue in a short time. This problem can occur at any age, but is most common during puberty and adolescence. Torsion can begin during sleep, exercise, or for no apparent reason. Important symptoms of testicular torsion Sudden, severe pain on one side of the scrotum Swelling or rapid redness of the scrotum One testicle higher than the other Change in the angle or position of the testicle Nausea and vomiting with pain Pain in the groin or lower abdomen Severe tenderness of the testicle when touched Sometimes, a young boy will complain of abdominal pain, vomiting, or restlessness instead of testicular pain. For this reason, boys with sudden lower abdominal pain should also be evaluated for testicular torsion. Why is this a real emergency? When the testicle cord is twisted, blood supply is reduced. The sooner treatment is given, the greater the chance of saving the testicle. The best results are usually achieved when surgery is performed within the first few hours after the onset of pain. Even if it has been a few hours since the onset of pain, the child should be taken to the emergency room immediately to assess the possibility of saving the testicle. What to do if there is sudden testicular pain? Take the child or adolescent to the emergency room of a hospital that has a urological or surgical evaluation without delay. It is best not to give the child heavy food or drink until the examination, as anesthesia and immediate surgery may be required. Taking painkillers should not delay the visit. Massaging, warming the area, or family attempts to rotate the testicle can also be dangerous. What if the pain resolves spontaneously? Sudden resolution of pain does not always mean that the danger is gone. The testicle may have been twisted for a while and then untwisted on its own. This condition is called “intermittent torsion,” and there is a risk of recurrence and subsequent injury. Any sudden, severe attack of testicular pain, even if it has resolved, should be reported to a doctor. How is the diagnosis made? The history and examination are key. The doctor will review the time of onset of the pain, its suddenness, the presence of nausea and vomiting, and any history of trauma and previous attacks. A Doppler ultrasound can show blood flow to the testicle, but if the symptoms and examination strongly suggest torsion, an ultrasound should not delay surgery. Is all testicular pain torsion? No. Inflammation of the testicle or epididymis, torsion of the epididymis, trauma, incarcerated hernia, and other problems can also cause pain and swelling. However, the family may not be able to tell the difference at home. In sudden testicular pain, the most dangerous torsion must be ruled out quickly. What is the treatment for testicular torsion? The main treatment is immediate surgery. The surgeon opens the torsion and checks the blood supply to the testicle. If the testicle can be saved, it is fixed so that it does not twist again. The opposite testicle is usually fixed in the same operation, because it may have a similar cause for the torsion. If the blood supply is cut off for a long time and the testicular tissue cannot be saved, it may be necessary to remove the affected testicle. Does this problem affect puberty and fertility? If treated quickly and the testicle is saved, many patients will have normal function. Even if a testicle is lost, the healthy opposite testicle can produce enough male hormones and sperm in many people. The outcome for each patient depends on the duration of the blood supply interruption, the severity of the torsion, and the health of the opposite testicle. When should you go to the emergency room immediately? Sudden, severe pain in a testicle Rapid swelling or redness of the scrotum Pain with nausea or vomiting Elevation or change in position of a testicle Sudden lower abdominal or groin pain in a child Testicular pain after an injury that persists A severe attack of pain that resolves on its own This video answers the following questions: How does testicular torsion occur? How important are the first few hours of treatment? Does relief of pain mean th...