III. Vascular Disturbances
Objectives:
After completing this section you will
be able to:
- describe the common vascular disturbances that affect
the testis
- describe clinical features and importance of these lesions
- Torsion
The testis may become twisted on the spermatic cord. This results in venous
occlusion while arterial blood flow is maintained so that intense vascular
engorgement of the testis ensues leading to hemorrhagic infarction. The classic
presentation is that of a young child with excruciating testicular pain, often
after violent physical activity. Paradoxically, torsion may also occur during
sleep. In most cases, torsion is associated with congenital abnormalities
that increase the mobility of the testis within the scrotum e.g. high attachment
of the tunica vaginalis on the spermatic cord, absence of scrotal ligaments,
atrophy of the testis. In some cases, repeated, short-lived episodes of partial
vascular occlusion occur. If rapidly diagnosed, the testis may be saved, but
frequently it must be excised.
Depending on the duration of the torsion and completeness of vascular obstruction,
the organ will vary in appearance from diffuse congestion through widespread
interstitial hemorrhage to hemorrhagic infarction of the entire organ, which
then forms a sac of hemorrhagic, soft, necrotic tissue. If recurrent episodes
of torsion with incomplete venous obliteration occur, the testis becomes atrophic
and fibrotic.
Testicular torsion. Bisected organ shows diffuse hemorrhage and necrosis.
Question: Which other organs may undergo torsion and develop hemorrhagic
infarction?
- Varicocele
This is an abnormal enlargement of the venous plexus within the spermatic
cord. This fairly common finding may be associated with infertility. The abnormally
high blood flow through the venous plexus increases testicular temperature
leading to decreased spermatogenesis. The great majority of varicocele occurs
on the left side. The condition results in the formation of a swelling that
feels like a "bag of worms" and appears bluish through the skin of the scrotum.
It causes a constant pulling, dragging, or dull pain in the scrotum.
Question: What is the name of the venous plexus of the spermatic cord?
Question: Why is varicocele more common on the left than on the right
side?
Rarely, renal cell carcinoma of the left kidney extends along the left renal
vein and blocks the exit of the testicular vein. A rapidly developing left-sided
varicocele should therefore always prompt examination of the left kidney.
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