Testicular Torsion – A Shift in Medical Opinion.

Testicular torsion is a serious condition and should be treated as a medical emergency. It occurs when the testicle twists, cutting off the blood supply. Whilst a torsion can occur at any age, it is more common in teenagers and young adults and occurs in around one in 1,000 males between the age of 10 and 20.

In cases where testicular torsion is suspected, time really is critical as the earlier a diagnosis is made, the greater the chance of the testicle being saved.

Common symptoms of a 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

Usually, testicular torsion should be diagnosed and treated within six hours of the onset of symptoms. A surgical de-torsion, to untwist the spermatic cord and testicle, is required as soon as possible as irreversible ischaemic injury can begin within four hours. Generally, after six hours, the lack of blood to the testicle can cause permanent, irreversible damage meaning that the affected testicle would need to be removed.

Due to the short timeframe for successfully treating a torsion, we often see cases related to delays in diagnosis and treatment. Commonly, a testicular torsion can often be misdiagnosed as an infection or epididymitis (an inflammation at the back of the testicle). Delays may also be a result of not attending hospital immediately, and pressures on A&E departments meaning that patients are not seen within that critical window.

In a bid to reduce delays, a pathway was introduced nationally for best practice in the management of numerous conditions, including acute testicular pain. The pathway notes that there should be a low threshold for immediate referral for children with acute testicular pain to a hospital where scrotal exploration can be performed on site. It also notes that there needs to be a timely evaluation by a surgical clinician within 60 minutes of arrival in an emergency department.

More information on the pathway can be found here.

In previous years, the general medical view was that the removal of a testicle due to a testicle torsion did not have any adverse effects on future fertility. However, we have recently seen a shift in medical opinion, with many experts now wanting to fully investigate a patient’s fertility following the removal of a testicle, before being able to comment on future prospects of successfully conceiving a child.

If it can be proven, on the balance of probabilities, that there has been an impact on a man’s fertility, as a result of a negligent delay in diagnosis/ treatment of testicular torsion, then it is possible for a claimant to claim the costs of any required future treatment. This could include IVF, sperm freezing and/or testosterone replacement therapy in order to safeguard the possibility that the claimant would wish to be able to start a family of his own one day in the future.

In a recent case, a claimant underwent fertility testing as part of our investigations and was found to have a pre-existing varicocoele. This was entirely unrelated to the defendant’s negligence. However, it was our expert’s view that in time, the varicocoele would grow and negatively impact the claimant’s sperm motility. This would not have caused an issue had the claimant’s other testicle not been removed. We were therefore able to claim for the costs of the requisite treatment, thereby safeguarding the claimant’s future family plans.

It is also important not to underestimate the potential psychological impact of losing a testicle due to negligence. During our investigations into the same case, it became evident that the claimant had developed anxiety in relation to the possibility of injury to his remaining testicle. He therefore stopped activities he had once enjoyed, such as combat sports and cycling. As part of the claim, we were able to claim for associated counselling and therapy costs to give the claimant the means to seek professional psychiatric help. We are also generally able to claim the costs of a testicular prosthesis, in order to address cosmetic concerns.

If you think you or a loved one have been affected by a delayed or missed diagnosis, please do reach out to our dedicated team to discuss your enquiry.