Urology Awareness Month: The Case of Testicular Torsion.

Every September, Urology Awareness Month aims to increase public understanding of urological health and the various conditions that affect the urinary system and male reproductive organs.

Organised by the Urology Foundation, this month-long event focuses on raising awareness about the importance of promoting early detection and treatment of urological conditions, and supporting ongoing research in the field. It is a time for healthcare professionals, patients, and the public to come together to improve urological care and reduce the stigma associated with these conditions.

In this blog, we will focus on one urological condition, namely: testicular torsion.

What is testicular torsion?

Testicular torsion occurs when a testicle twists, cutting off the blood supply and causing sudden scrotal pain. It can happen at any age, but is most common in teenagers and young adults. Testicular torsion occurs in around 1 in 1,000 boys between the age of 10 and 20.

It is important that all men are aware of the symptoms of testicular torsion as the earlier it is diagnosed, the more likely it is the affected testicle can be saved. Common symptoms of testicular torsion are as follows:-

• Abdominal pain
• Pain in the testes/scrotum – pain is often severe and comes on suddenly
• Swelling on one side of the scrotum
• Nausea and vomiting
• A testicle which is positioned higher than normal or at an unusual angle
• Frequent urination
• Fever

Time is of the Essence

Testicular torsion is a urological emergency and time is of the essence. Usually, it should be diagnosed and treated within six hours of the onset of symptoms. Surgical de-torsion (to untwist the spermatic cord and testicle) is required as soon as possible as irreversible ischaemic (lack of blood) injury can begin within four hours, and after six hours permanent damage is likely to occur and the testicle is unlikely to be salvageable.

For this reason, it is important that patients presenting with symptoms of testicular torsion receive appropriate and timely medical attention.

The issues: delay in diagnosis

Unfortunately, due to the tight timeline to get patients into surgery, we often see cases of delays in diagnosis of testicular torsion, resulting in the avoidable loss of a teste.

The reason for such delays is often as follows:

• Patients not attending A&E immediately – some patients (or their parents) don’t realise that scrotal/testicular pain is an urgent problem. One study found that males under 18 waited up to 20 hours before heading to A&E.
• A&E waiting times - a busy A&E department may prevent patients being seen within a timely manner and getting into surgery within the six hour timeline.
• Misdiagnosis – the symptoms of testicular torsion are often misdiagnosed as epididymitis (where a tube at the back of the testicles becomes swollen and painful).
• Raising awareness is needed - there are still many hurdles to improving the speed of diagnosis and treatment for testicular torsion.

Getting it Right First Time (GIRFT) Children and Young People: Testicular Torsion pathway

A new pathway aiming to reduce delays and prevent more boys and young men losing a testicle as a result of testicular torsion has been developed by the NHS’s GIRFT programme.

GIRFT has brought together a multi-disciplinary group of more than 50 NHS colleagues to build a national consensus pathway for best practice in the management of numerous conditions, one of which is acute testicular pain.

Among the 28 consensus statements which form the GIRFT pathway are:

• NHS 111 algorithms and primary care should have a low threshold for immediate referral for children with acute testicular pain to a hospital where scrotal exploration can be performed on site for that child.
• Referral pathways should minimise the number of transfers a patient undergoes, aiming for a maximum of one transfer between healthcare providers (including transfer from primary to secondary care).
• Timely evaluation by a surgical decision maker means review within 60 minutes of a child or young person with testicular pain arriving at the emergency department.
• Surgeons and anaesthetists caring for children with acute testicular pain should maintain their skills and competency to ensure they can assess and operate on young patients without delay.

GIRFT has also recognised that the time between the onset of pain and contact with a healthcare practitioner can often be delayed because of the private and sensitive nature of the condition. A consensus statement within the pathway states that education about testicular torsion should be delivered by schools, so that boys experiencing acute testicular pain recognise the signs of torsion and the importance of acting quickly, and feel confident in reporting it to an adult.

Get in Touch

At Lanyon Bowdler, we understand the devastating impact that a delay or missed diagnosis can have for a patient and their family. If you have suffered due to poor care, our dedicated team are ready to provide the legal support you need and guide you through the process.