1
|
LONG-DEPAQUIT T, CHIRON P, BOURGOUIN S, HARDY J, DELEDALLE FX, LAROCHE J, MOLIMARD B, SAVOIE PH. [Management of testicular torsion by a general surgeon isolated in Africa]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2022; 2:mtsi.v2i2.2022.230. [PMID: 35685303 PMCID: PMC9128443 DOI: 10.48327/mtsi.v2i2.2022.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/02/2022] [Indexed: 06/15/2023]
Abstract
The onset of sudden and intense scrotal pain exposes to several problems when it occurs in a young man in Africa. Among the possible etiologies, testicular torsion is the surgical emergency to rule out, because beyond 6 hours of evolution the functional prognosis of the testicle is concerned. The septic evolution towards a purulent melting, in case of exceeded torsion, is also possible. Of slightly lower incidence than in Western countries, lack of awareness of this pathology by local health actors, the precariousness or health isolation of certain populations in certain under-medicalized regions, contribute to diagnostic and therapeutic delays. This often leads to a pejorative development, loss of the testicle being directly correlated with the delay in treatment. Testicular torsion has thus been identified as one of the main causes of male infertility in Africa. However, clinical diagnosis and surgical treatment require few resources and remain accessible in an environment with low resources or in precarious conditions. Indeed, despite the contribution of ultrasound in certain situations, the clinical picture is at the center of the diagnosis and therapeutic decision making. At the slightest doubt, surgical exploration is necessary. The multi-tunic anatomy of the testicle facilitates its surgical fixation in the event of conservation, ideally by triangulation of single-strand non-absorbable thread. Simultaneous fixation of the contralateral testicle is currently the subject of debate in the literature. In Africa, the benefit/risk balance, taking into account in particular the difficulty of subsequent access to care, justifies, from our point of view, performing contralateral orchidopexy at the same time. Depending on the appearance of the testicle and, to a lesser extent, the duration of the evolution of the symptoms, orchidectomy may be necessary. This article describes the clinical picture of spermatic cord torsion and the orchidopexy technique.
Collapse
Affiliation(s)
- Thibaut LONG-DEPAQUIT
- Service d’urologie, Hôpital d’instruction des armées Sainte-Anne, 2 boulevard Sainte Anne, BP 600, 83000 Toulon, France
| | - Paul CHIRON
- Service d’urologie, Hôpital d’instruction des armées Bégin, 69 avenue de Paris, 94160 Saint-Mandé, France
| | - Stéphane BOURGOUIN
- Service de chirurgie viscérale, Hôpital d’instruction des armées Sainte-Anne, 2 boulevard Sainte Anne, BP 600, 83000 Toulon, France
| | - Julie HARDY
- Service d’urologie, Hôpital d’instruction des armées Sainte-Anne, 2 boulevard Sainte Anne, BP 600, 83000 Toulon, France
| | - François-Xavier DELEDALLE
- Service d’urologie, Hôpital d’instruction des armées Sainte-Anne, 2 boulevard Sainte Anne, BP 600, 83000 Toulon, France
| | - Julien LAROCHE
- Service d’urologie, Hôpital d’instruction des armées Sainte-Anne, 2 boulevard Sainte Anne, BP 600, 83000 Toulon, France
| | - Benoit MOLIMARD
- Service d’urologie, Hôpital d’instruction des armées Sainte-Anne, 2 boulevard Sainte Anne, BP 600, 83000 Toulon, France
| | - Pierre-Henri SAVOIE
- Service d’urologie, Hôpital d’instruction des armées Sainte-Anne, 2 boulevard Sainte Anne, BP 600, 83000 Toulon, France
| |
Collapse
|