Testicular torsion (twisted testicle)Testicular torsion (testicle ka mur jana)

Testicular torsion kya hai

Har testicle scrotum ke andar aik cord (spermatic cord) se latka hota hai. Yeh cord woh khoon pohanchati hai jo testicle ko zinda rakhta hai. Testicular torsion mein testicle ghoom jata hai aur cord mur jati hai, jaise bagh ka pipe mur jaye. Khoon ki faraahmi dab kar band ho jati hai, aur testicle ko nuqsan pohanchna shuru ho jata hai.

Yeh surgical emergency hai. Munh se li gayi koi cheez, malish aur koi gharelu nuskha is maror ko khol nahi sakta. Is ke liye doctor, aur aam tor par operation, jitni jaldi ho sake chahiye.

Testicle ka mur jana kisi ki galti nahi. Yeh kisi larke ya mard ke kiye hue kaam ki wajah se nahi hota, aur yeh kisi sharminda cheez ki nishani nahi. Yeh is baat ka mechanical masla hai ke testicle kaise jura hua hai.

Yeh kin ko hota hai

Torsion larkon aur jawan mardon, khaas tor par teen-agers, mein sab se aam hai, lekin yeh kisi bhi umar mein ho sakta hai, jis mein baligh mard aur nawzaaida bachay bhi shamil hain.

• Aksar yeh bina kisi chot ke hota hai. Yeh aaraam ke dauran, neend mein, ya warzish ke baad shuru ho sakta hai. Chot ya girna zaroori nahi.
• Kuch log scrotum ke andar dheeli jurawat ke saath paida hotay hain, jis se testicle jhool kar mur sakta hai. Yeh aksar dono taraf hoti hai, isi liye doosra testicle bhi aam tor par usi operation mein jama diya jata hai.
• Nawzaaida bachon ko bhi torsion ho sakta hai. Bachay mein scrotum soojha hua, sakht ya gehre rang ka lag sakta hai, aur bacha dard mein nazar na aaye. Jis bachay ka scrotum soojha ya gehra lage, usay fauran doctor ko dikhana chahiye.

Yeh guide "aap" se baat karti hai, lekin yeh larkon ke walidain ke liye bhi utni hi hai. Agar aap ka beta kehta hai ke us ke testicle mein dard hai, to meherbani kar ke is ko sanjeedgi se lein.

Aam alamaat

• Achanak, shadeed dard aik testicle mein ya scrotum ki aik taraf.
• Scrotum ki soojan aur surkhi, jo gehri rang ki bhi lag sakti hai.
• Matli aur ulti, aksar dard ke saath.
• Pait ke nichlay hissay ya jaangh mein dard testicle ke bajaye, khaas tor par larkon mein. Jis larke ko pait dard aur ulti ho, us ke testicles ki bhi jaanch honi chahiye.
• Testicle jo normal se oopar ho, ya ajeeb zaaviye par pari ho.
• Bohat nazuk testicle, jahan halka sa chhoona bhi dard kare, aur koi position jo dard kam na kare.
• Dard jo kuch ghanton baad ruk gaya ho. Agar testicle ko khoon milna band ho gaya ho to yeh bura ishara ho sakta hai, is liye is ka matlab yeh nahi ke intezar karna mehfooz hai.

Walidain ke liye aik note: larke aur teen-agers aksar "wahan" dard batane mein sharmate hain, aur sirf yeh keh saktay hain ke pait mein dard hai ya tabiyat kharab hai. Meherbani kar ke pursukoon aur seedhe tareeqay se poochein. Larka chahe to mard doctor ki darkhwast kar sakta hai taake woh khul kar bol sake, lekin us ka intezar na karein.

Har ghanta kyun ahem hai

Testicle muri hui cord ko sirf thori der bardasht kar sakta hai. Khoon ki faraahmi jitni der band rahe, nuqsan utna zyada hota hai, aur aik had ke baad nuqsan wapas nahi hota. Jab cord jaldi seedhi ki jaye to testicle aam tor par bach jata hai. Der hone par woh sikur sakta hai ya kaam karna band kar sakta hai, aur kabhi kabhi usay nikalna parta hai.

Isi liye:

• Aap ko dard shuru hote hi hospital jana chahiye, yeh dekhne ke liye intezar nahi karna ke dard thamta hai ya nahi.
• Doctor agar torsion ka shak karein to scan ka intezar kiye baghair seedha operation kar saktay hain.
• Kis hospital jana hai yeh bhi ahem hai, kyunke wahan aisa surgeon aur operation theatre chahiye jo jaldi istemal ho sakay (neechay "Sahi hospital tak pohanchna" dekhein).

Tashkhees kaise hoti hai

Tashkhees zyada tar doctor ke muaine se hoti hai. Doctor poochein ge ke dard kab shuru hua aur scrotum, testicles aur pait ka narmi se muaina karein ge. Aam qadam yeh hain:

• Muaina. Testicle ki position, soojan aur nazuki aksar torsion ki taraf ishara karti hai. Doctor ran (thigh) ka aik reflex bhi dekh saktay hain.
• Peshab ka test, infection dekhne ke liye, jo bhi testicle mein dard kar sakta hai. Normal peshab ka test torsion ko radd nahi karta.
• Khoon ke bahao wala ultrasound (Doppler), jahan jaldi dastiyab ho. Yeh dikha sakta hai ke testicle tak khoon pohanch raha hai ya nahi. Yeh madadgar hai, lekin agar doctor ko torsion ka shak ho to yeh operation mein kabhi der na kare.
• Surgical exploration. Agar torsion ka imkaan ho, to surgeon operation kar ke testicle ko seedha dekhte hain. Agar yeh torsion na nikle, tab bhi yeh mehfooz faisla hai. Maror ko nazar-andaz karne se exploration karna kaheen behtar hai.

Doosri beemariyan bhi aisi hi lag sakti hain, jaise testicle ya us ke peechay ki nali ka infection, testicle ke aik chhote hissay ka murna, hernia ya chot. Yeh faisla doctor ko karna chahiye, ghar ke kisi fard ko nahi. Ghar par yeh farz karna kabhi mehfooz nahi ke yeh "sirf infection" hai.

Ilaaj

Ilaaj aik emergency operation hai jo general anaesthetic mein hota hai.

• Cord ko seedha karna. Surgeon scrotum mein chhota cheera lagate hain, muri hui cord dhoond kar usay seedha karte hain.
• Testicle ko dekhna. Surgeon dekhte hain ke rang aur khoon ka bahao wapas aata hai ya nahi. Agar testicle theek ho jaye to usay rakha jata hai.
• Testicle ko apni jagah jama dena tanko se (jisay orchidopexy kehte hain), taake woh dobara na mure.
• Doosra testicle bhi jama dena. Chunke doosri taraf ki jurawat bhi aksar dheeli hoti hai, usay aam tor par usi operation mein jama diya jata hai taake aainda maror na ho.
• Agar testicle zinda na rahe kyunke maror bohat der rahi, to surgeon usay nikal dete hain (orchidectomy). Nuqsan-zada tissue ko chhorne ke muqable mein nikalna jism ke liye zyada mehfooz hai. Doosri taraf phir bhi jama di jati hai.

Kabhi kabhi emergency ka doctor jaldi ke pehle qadam ke taur par testicle ko jild ke zariye haath se seedha karne ki koshish karta hai. Is se thori madad mil sakti hai, lekin yeh operation ki jagah nahi leta, aur aap ko phir bhi operation chahiye. Meherbani kar ke ghar par kabhi yeh koshish na karein.

Agar kisi ko operation ki zaroorat ho sakti hai, to hospital khaane peene ke baare mein batayega. Aam usool ke taur par, jab tak doctor na dekh lein khana na dein, kyunke anaesthetic ki zaroorat ho sakti hai, lekin is ka intezam karne ke liye hospital jane mein der na karein.

Agar testicle nikalna pare, to chahein to baad mein ya abhi testicular implant lagaya ja sakta hai. Aap ke urologist is par baat kar saktay hain.

Operation ke baad aur follow-up

• Soojan, neel aur kuch dard kuch arsay tak aam hai. Hospital batayega ke dard ke liye kya istemal karna hai. Tang underwear ya scrotal support pehenna madadgar ho sakta hai.
• Zakhm ko saaf aur khushk rakhein, surgeon ki hidayat ke mutabiq. Tanke aksar aise hotay hain jo khud ghul jatay hain, lekin poochein zaroor.
• Aaraam karein, aur bhaari cheezein uthane, khel aur sakht mehnat se parhez karein jab tak surgeon na kahein ke theek hai. Woh batayein ge ke aap ke liye yeh kitni der ke liye hai.
• Follow-up appointment rakhein. Surgeon zakhm aur testicle ka muaina karte hain, aur aap se baat karte hain ke kya umeed rakhni hai.
• Bachaya hua testicle agle mahinon mein chhota ya naram ho sakta hai. Agar aap ko aisa mehsoos ho, ya koi musalsal dard ho, to apne urologist ko batayein.
• Zarkhaizi (fertility). Aik sehatmand testicle aam tor par normal hormones aur bachon ke baap banne ke liye kaafi hota hai. Torsion ke baad zarkhaizi mutasir ho sakti hai, chahe testicle bacha liya gaya ho. Agar yeh aap ke liye ahem hai, to aap ke urologist baad mein semen ka test karwa saktay hain.
• Usay khud jaanchna sikhayein. Jis teen-age larke ko torsion hua ho, usay pata hona chahiye ke agar dobara kabhi testicle mein dard ho to fauran batana hai.

Hospital wapas aayein agar bukhaar ho, zakhm ke aas paas surkhi phail rahi ho, paani ya peep nikal rahi ho, khoon aa raha ho, shadeed dard barh raha ho, ya soojan tezi se barh rahi ho.

Dard jo aata jata rehta hai

Kuch logon ko testicle mein shadeed dard ke daure partay hain jo minuton ya ghanton baad khud theek ho jatay hain. Yeh intermittent torsion ho sakta hai: cord mur jati hai, phir khud seedhi ho jati hai. Meherbani kar ke isay nazar-andaz na karein. Baad ka koi daura mukammal maror ban sakta hai jo seedha nahi hota.

• Agar shadeed dard ka daura jaldi theek na ho, to fauran emergency mein jayein.
• Agar daure baar baar aate jate rahein, to dard ke jane ke baad bhi jaldi urologist ko dikhayein. Testicles ko jagah par jamane ke liye mansooba-band operation tajweez ho sakta hai.

Sahi hospital tak pohanchna

Sahi hospital woh hai jahan surgeon aur operation theatre abhi dastiyab ho. Qareebi clinic ya chhota hospital jahan surgeon na ho qeemti waqt zaya kar sakta hai.

• Seedha aise hospital ki emergency mein jayein jo surgical emergencies sambhalta ho, sarkari ho ya nijji. Agar ho sake to pehle phone kar ke poochein: "Kya aap ke paas aisa surgeon hai jo abhi operation kar sake?" Agar nahi, to bina der kiye agle hospital jayein.
• Scan ki appointment ka intezar na karein, aur is ka bhi nahi ke pehle family doctor dekhe.
• Kisi baligh ke saath jayein. Agar mareez 18 saal se kam ho, to operation ki ijazat ke liye walid ya sarparast ka maujood hona zaroori hai.
• Malish, garam seak, dum, jari bootiyon ya hakeem ke liye na rukein. Yeh madad nahi karte aur testicle ki qeemat par ho saktay hain.
• Triage ke staff ko foran batayein: "achanak shadeed testicle ka dard, torsion ka shak". In alfaaz se staff ko jaldi ki ahmiyat samajhne mein madad milti hai.
• Jo dawaein ya kaghazat hon saath le jayein, lekin unhein dhoondne ki wajah se nikalne mein der na karein.

Aam sawalaat

What testicular torsion is

Each testicle hangs inside the scrotum from a cord (the spermatic cord). This cord carries the blood that keeps the testicle alive. In testicular torsion, the testicle rotates and the cord twists, like a kinked garden hose. The blood supply is squeezed shut, and the testicle starts to be damaged.

It is a surgical emergency. Nothing taken by mouth, no massage and no home remedy can undo the twist. It needs a doctor, and usually an operation, as quickly as possible.

A twisted testicle is nobody's fault. It is not caused by something a boy or man did, and it is not a sign of something shameful. It is a mechanical problem with how the testicle is attached.

Who it affects

Torsion is most common in boys and young men, especially teenagers, but it can happen at any age, including adult men and newborn babies.

• It often happens without any injury. It can start at rest, during sleep, or after exercise. A knock or a fall is not needed.
• Some people are born with a loose attachment inside the scrotum, which lets the testicle swing and twist. This often affects both sides, which is why the other testicle is usually fixed at the same operation.
• Newborn babies can have torsion too. In a baby, the scrotum may look swollen, hard or darker in colour, and the baby may not seem to be in pain. Any baby with a swollen or dark-looking scrotum should be seen by a doctor urgently.

This guide speaks to "you", but it is just as much for parents of boys. If your son says his testicle hurts, please take it seriously.

Common symptoms

• Sudden, severe pain in one testicle or one side of the scrotum.
• Swelling and redness of the scrotum, which may look darker.
• Nausea and vomiting, often together with the pain.
• Pain in the lower tummy or the groin rather than in the testicle itself, especially in boys. A boy with tummy pain and vomiting should have his testicles checked too.
• A testicle that sits higher than normal, or lies at an odd angle.
• A very tender testicle, where even a light touch hurts, and a position that does not ease the pain.
• Pain that has stopped after a few hours. This can be a bad sign if the testicle has stopped getting blood, so it does not mean it is safe to wait.

A note for parents: boys and teenagers are often too embarrassed to say they have pain "down there", and may say only that they have a tummy ache or feel sick. Please ask calmly and directly. A boy can ask for a male doctor if that helps him to speak up, but please do not wait for one.

Why every hour counts

The testicle can tolerate a twisted cord for only a short time. The longer the blood supply is cut off, the more damage is done, and after a certain point the damage cannot be reversed. When the cord is untwisted early, the testicle can usually be saved. With a delay, it may shrink or stop working, and sometimes it has to be removed.

This is why:

• You should go to hospital as soon as the pain starts, and not wait to see if it settles.
• Doctors may go straight to surgery if they think torsion is likely, rather than waiting for a scan.
• It matters which hospital you go to, because it needs a surgeon and an operating theatre that can be used quickly (see "Getting to the right hospital" below).

How it is diagnosed

The diagnosis is mostly made by a doctor's examination. The doctor will ask when the pain started and will gently examine the scrotum, the testicles and the tummy. The usual steps are:

• Examination. The position, swelling and tenderness of the testicle often point to torsion. Doctors may also check a reflex in the thigh.
• Urine test, to look for infection, which can cause a painful testicle too. A normal urine test does not rule torsion out.
• Ultrasound with blood flow (Doppler), where it is available quickly. It can show whether blood is reaching the testicle. It is useful, but it must never delay surgery if the doctor thinks torsion is likely.
• Surgical exploration. If torsion is likely, the surgeon will operate to look at the testicle directly. If it turns out not to be torsion, this is still a safe decision. It is far better to explore than to miss a twist.

Other conditions can look the same, such as an infection of the testicle or the tube behind it, a twisted tiny part of the testicle, a hernia or an injury. A doctor, not a family member, should decide which one it is. It is never safe to assume at home that it is "only an infection".

Treatment

The treatment is an emergency operation under general anaesthetic.

• Untwisting the cord. The surgeon makes a small cut in the scrotum, finds the twisted cord and untwists it.
• Checking the testicle. The surgeon watches whether the colour and blood flow come back. If the testicle recovers, it is kept.
• Fixing the testicle in place with stitches (called orchidopexy), so that it cannot twist again.
• Fixing the other testicle too. Because the other side often has the same loose attachment, it is usually fixed at the same operation to prevent a future twist.
• If the testicle is no longer alive because the twist went on too long, the surgeon removes it (orchidectomy). Removing it is also safer for the body than leaving damaged tissue. The other side is still fixed.

Sometimes a doctor in the emergency department tries to untwist the testicle by hand through the skin, as a quick first step. This can help a little, but it does not replace the operation, and you still need surgery. Please never try this at home.

If a person may need an operation, the hospital will tell you about food and drink. As a general rule, do not give food until a doctor has seen him, because an anaesthetic may be needed, but do not delay leaving for hospital to arrange this.

If a testicle has to be removed, a testicular implant can be placed later, now or in the future, if the person wishes. Your urologist can discuss this.

After surgery and follow-up

• Swelling, bruising and some pain are common for a while. The hospital will tell you which pain relief to use. Wearing close-fitting underwear or a scrotal support can help.
• Keep the wound clean and dry, following your surgeon's instructions. Stitches are often the type that dissolve, but ask.
• Rest, and avoid heavy lifting, sport and strenuous activity until your surgeon says it is safe. They will tell you how long this is for you.
• Keep your follow-up appointment. The surgeon checks the wound and the testicle, and talks to you about what to expect.
• A saved testicle may become smaller or softer over the following months. Tell your urologist if you notice this, or any ongoing pain.
• Fertility. One healthy testicle is usually enough for normal hormones and for fathering children. After torsion, fertility can be affected even when a testicle has been saved. If this matters to you, your urologist can arrange a semen test later.
• Teach him to check himself. A teenage boy who has had torsion should know to say at once if he ever has testicular pain again.

Come back to hospital if you have fever, spreading redness around the wound, discharge or pus, bleeding, severe pain that is getting worse, or rapidly increasing swelling.

Pain that comes and goes

Some people get attacks of severe testicular pain that settle on their own after minutes or hours. This can be intermittent torsion: the cord twists, then untwists by itself. Please do not ignore it. A later attack can become a full twist that does not untwist.

• If an attack of severe pain does not settle quickly, go to emergency straight away.
• If attacks keep coming and going, see a urologist soon, even when the pain has gone. A planned operation to fix the testicles in place may be advised.

Getting to the right hospital

The right hospital is one with a surgeon and an operating theatre available now. The closest clinic or a small hospital without a surgeon may waste valuable time.

• Go straight to a hospital emergency department that handles surgical emergencies, government or private. If you can, phone ahead and ask: "Do you have a surgeon who can operate now?" If not, go to the next hospital without delay.
• Do not wait for a scan appointment or for a family doctor to see him first.
• Go with an adult. If the patient is under 18, a parent or guardian must be there to give consent for surgery.
• Do not stop for massage, a hot compress, dum, herbal remedies or a hakeem. They do not help and can cost the testicle.
• Tell the triage staff straight away: "sudden severe testicle pain, possible torsion". These words help staff recognise the urgency.
• Bring any medicines or papers you have, but do not delay leaving to look for them.

Common questions