Prise en charge de la torsion du testicule par un chirurgien généraliste isolé en Afrique

Résumé

L’apparition d’une douleur scrotale brutale et intense pose plusieurs problèmes quand elle survient chez un homme jeune en Afrique. Parmi les étiologies possibles, la torsion testiculaire est l’urgence chirurgicale à écarter, car au-delà de 6 heures d’évolution le pronostic fonctionnel du testicule est engagé. L’évolution septique vers une fonte purulente, en cas de torsion dépassée, est aussi possible. D’incidence légèrement inférieure à celle des pays occidentaux, la méconnaissance de cette pathologie par les acteurs de santé de proximité, la précarité ou l’isolement sanitaire de certaines populations dans certaines régions sous-médicalisées, contribuent aux retards diagnostique et thérapeutique. Cela conduit souvent à une évolution péjorative, la perte du testicule étant directement corrélée au délai de prise en charge. La torsion testiculaire a ainsi été identifiée comme l’une des principales causes d’infertilité masculine en Afrique. Pourtant, le diagnostic clinique et le traitement chirurgical nécessitent peu de moyens et restent accessibles dans un milieu à faibles ressources ou en conditions précaires. Cet article reprend le tableau clinique de torsion du cordon spermatique et la technique d’orchidopexie.

Management of testicular torsion by a general surgeon isolated in Africa

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.