Fast Surgical Intervention Required For Testicular Torsion
The Law Of... seeking immediate medical attentionTesticular torsion, a condition caused by a twisting of the male genitalia, requires immediate medical attention if the testis is to be saved, a leading Medical Negligence expert has warned.Justin Glenister, Senior Associate at Simpson Millar
, explains the condition and outlines why immediate medical attention is required when this painful ailment is suffered.
Testicular torsion is a surgical emergency that can be developed at any age but is most common in children and teenagers.
There are no obvious predisposing causes for a testicle to become strangulated by the spermatic cord, which causes a loss of blood supply to the testicle. Testicular torsion presents with sudden, acute pain and the testicle feels very tender to touch.
Diagnosis is primarily a clinical one and a patient's history will be considered before palpation (examination) of the testis. The consequences of a delayed or missed torsion are so significant that, where there is any doubt, there should be an urgent surgical referral.
Immediate Surgical Intervention
If, on timely surgical exploration of the scrotum, it is discovered that the testicle is still viable, it can be untwisted and stitched to the inside of the scrotum to prevent re-torsion – this can be a horrific experience but at least there will be a full and speedy recovery.
However, unless that surgical intervention occurs within a matter of just a few hours, the testicle will become non-viable, tissue cells will start to die, and there will be need for the testicle to be removed (orchidectomy).
Early surgical exploration gives a greater chance of being able to salvage the torted testicle. It has become part of urological lore that, in order to salvage tort testis, scrotal exploration and de-torsion must be achieved within 6 hours of the onset of symptoms. However, empirical medical research supports a view that a viable testicle is still more likely than not (so a certainty in law) to be salvaged up to 16 hours from the onset of symptoms. Beyond 16 hours the chances of a viable testicle quickly dwindle to well below average.
A condition that may have a similar presentation to that of a torsion is epididymitis.
Whilst some of the symptoms, such as an inflammation in the affected area, are akin to testicular torsion, and whilst commonly found in men aged 14-35 years, epididymitis is often associated with sexually transmitted infections (such as chlamydia or gonorrhoea) or a urinary tract infection (UTI) and is treated at primary care with a course of antibiotics.
Therefore, an apyrexial (non-fevered), non-sexually active patient, is unlikely to warrant a firm diagnosis of epididymo-orchitis and torsion must therefore be considered a possibility. In view of the potentially catastrophic consequences of delayed treatment of torsion, even a potential diagnosis of torsion requires an immediate and urgent surgical referral.
Physical And Psychological Effects Of Testicular Torsion
Explaining how the loss of a testicle can have long lasting psychological effects on a patient and can seriously affect their quality of life, Justin said:"Suffering does not end with an extended period of undiagnosed pain, the death of a testicle, the stressful operation to remove it, or the post-operative recovery. Think of the 5 year old child already traumatised by this, now being teased and bullied about his condition; losing self-confidence and possibly being put off performing everyday activities, such as riding his bike or playing sport.""Thinking on further of the effect the condition may continue to have in the already difficult years of puberty and adolescence - the first intimate relations; consideration of a prosthetic; the prospect of further surgical procedures to fit it and the risk of failing to tolerate prosthesis and having it surgically removed.""Think on further still of the risk of damaged fertility - whilst one functioning testicle is often sufficient, a decline in fertility is still possible and can only be investigated once the patient reaches the age where a sperm sample can be produced and when he is mentally mature enough to produce it in a clinical setting.""In the meantime, the adolescent may be anxious about the future because of the possibility of damaged fertility, and there will almost certainly be loss and psychological injury if that possibility actually materialises.""All of these issues need to be carefully considered in a medical negligence claim for missed torsion, as must the effect upon the individual claimant, with due consideration to a provisional damages settlement and permission to, if necessary, return for further damages in future years for those cases involving the very young.""I have been assured that the accepted practices around the clinical diagnosis and referral for possible torsion are considered routine. I must therefore wonder why, in the last two years, I have I run several cases involving complete failures to make the referral or even consider torsion as a possible diagnosis."