Our Summary

This research paper describes a study conducted between November 2011 and November 2014, where the researchers performed a specific type of surgery on 5 out of 15 patients suffering from a condition called testicular torsion. Testicular torsion is a painful condition caused by the twisting of the spermatic cord, which can lead to loss of blood flow and severe damage to the testicle.

The 15 patients were divided into three groups. Group A consisted of 7 patients who underwent a procedure called orchidopexy, which involves fixing the testicle inside the scrotum to prevent further twisting. Group B consisted of 5 patients who underwent a different procedure called “tunica albuginea incision with tunica vaginalis flap coverage” (TAI＋TVFC), which is designed to restore blood flow to the testicle. Group C consisted of 3 patients who underwent a procedure called orchidectomy, which involves the removal of one or both testicles.

The researchers found that the TAI＋TVFC procedure helped to immediately improve the tension and color of the testes in all 5 patients in Group B, indicating improved blood flow. However, two patients in this group still experienced shrinkage of the testicle after surgery. This was likely due to a delay of 8 or more hours between the onset of the condition and the surgery.

Overall, the study suggests that the TAI＋TVFC procedure can be effective in restoring blood flow after surgery for testicular torsion. However, the timing of the surgery is crucial and delays can lead to poorer outcomes.

FAQs

  1. What is the TAI+TVFC procedure mentioned in the study and how does it help in cases of testicular torsion?
  2. Based on the study, what is the impact of the ‘Golden time’ in surgery for testicular torsion?
  3. How does the study measure the success of the operations performed on the 15 patients with testicular torsion?

Doctor’s Tip

A doctor may tell a patient undergoing testicular surgery to seek immediate medical attention in case of any sudden onset of pain or swelling in the testicles, as prompt treatment is crucial for salvaging the testicle. They may also advise the patient to follow post-operative care instructions carefully, including rest, pain management, and avoiding strenuous activities until fully recovered. Regular follow-up appointments and ultrasound monitoring may also be recommended to ensure proper healing and function of the testicle.

Suitable For

Patients who are typically recommended testicular surgery include those with testicular torsion, which is a medical emergency that occurs when the spermatic cord becomes twisted, cutting off blood flow to the testicle. Testicular torsion most commonly affects young males, with peak incidence during adolescence. Surgery is necessary to untwist the spermatic cord and restore blood flow to the testicle, as prolonged torsion can result in permanent damage or loss of the testicle. In cases where the testicle cannot be salvaged, an orchidectomy procedure may be necessary. Testicular surgery may also be recommended for other conditions such as testicular cancer, trauma to the testicle, or congenital abnormalities.

Timeline

Before testicular surgery:

  • Patient presents with sudden onset of severe testicular pain, swelling, and possible nausea or vomiting
  • Patient is evaluated by a healthcare provider who performs a physical examination and may order imaging tests such as ultrasound
  • Diagnosis of testicular torsion is confirmed, and surgical intervention is recommended
  • Patient undergoes pre-operative evaluations and consents for surgery

After testicular surgery:

  • Patient undergoes tunica albuginea incision with tunica vaginalis flap coverage (TAI＋TVFC) or other appropriate surgical procedure
  • Immediate improvement in tension and testis color is noted in patients who undergo TAI＋TVFC
  • Blood perfusion is improved after surgery
  • Follow-up examinations are performed to monitor testicular volume and blood flow
  • Testicular atrophy may occur in some patients, especially if there is a delay in surgery
  • Salvage of the testicle is considered successful if testicular volume is preserved at greater than 50% on the contralateral side
  • Overall, TAI＋TVFC is found to be useful in restoring blood flow after surgery for testicular torsion, but the timing of surgery is crucial for successful outcomes.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with testicular surgery?

  2. How long will the recovery period be and what can I expect during the recovery process?

  3. Will the surgery affect my fertility or sexual function in any way?

  4. What type of anesthesia will be used during the surgery and what are the side effects or risks associated with it?

  5. How soon after the surgery can I resume normal activities, such as work or exercise?

  6. Will I need to take any medications or follow any specific post-operative care instructions?

  7. What are the chances of the surgery being successful in preserving the affected testicle?

  8. Are there any alternative treatment options to surgery that I should consider?

  9. How often will I need to follow up with you after the surgery for monitoring and evaluation?

  10. Are there any long-term effects or considerations I should be aware of following testicular surgery?

Reference

Authors: Nagasawa S, Kanematsu A, Shinkai Y, Shimatani K, Hashimoto T, Togo Y, Suzuki T, Go S, Nojima M, Yamamoto S. Journal: Hinyokika Kiyo. 2017 Nov;63(11):455-459. doi: 10.14989/ActaUrolJap_63_11_455. PMID: 29232795