TESTICULAR PAIN AND SERIOUS CONSEQUENCES!
The whole world is currently fighting against Coronavirus and so is India. Everywhere in the world the routine medical work has been kept on hold and priority has been given to the coronavirus cases. However, the emergencies do not wait for anyone or for any pandemics. I had a call from the parents of a 10 years old boy who had developed sudden onset of right testicular pain. I advised them to take their child to the emergency department and that I would be with them shortly. The parents had heard about me and were advised to call me directly for my assessment. They had followed my advice and were in the emergency department by the time I reached there. The boy was in severe pain, the parents were in distress and the staff were unable to console him. The testicular pain is a dire emergency as many might not know, and we tend to attend the patient straightway as there is a possibility of organ loss, that too a very important organ of male body. The moment I received a call from the distressed parents, I had called up the operation theatre, the Anaesthetist and prepared myself to leave for the hospital. Without wasting a single minute, I headed straight to the hospital, and my kind wife agreed to drive me to the hospital in Covid 19 situation. Police officers on the road understood the emergency situation and cooperated with me fully in my efforts to reach the hospital in time.
When I reached the emergency department, I saw a child in pain, parents distressed due to their child being in pain. I realised that the possibility of what my assumption was about the child’s condition was extremely likely. Testicular pain in young age group has to be taken extremely seriously as if ignored, it can lead to loss of that testicle. With good painkillers on board for the poor kid, I did quick history taking and assessment of his condition. Specially in children, as a doctor we have to treat three people, the child and the parents. It is very imperative to reassure the parents along with child and make parents comfortable. Upon examination the left testicle was normal, however the right testicle was abnormally positioned and extremely tender in absence of any features of infection. On clinical assessment I was sure that he had possible testicular torsion. Testicular torsion is an extremely acute condition where the testes twists around its long axis, which causes cutting off of the blood supply to the testes. If not operated within specific time the testicle can become infarcted (dead) and needs removal.
Obviously, I was very concerned about the child’s testicle and did not want to take any chances. In this situation there is no role of scan or any other investigations and the only diagnostic procedure as well as treatment is the scrotal exploration, which is operation on the scrotum and testes and looking at it on the operation table under anaesthesia. Every passing minute could be critical, hence without wasting anytime, I organised the child to be shifter to the operation theatre after explaining the parents, the child and after obtaining the consent from the parents. Luckily the parents had not wasted lot of time since the pain started and brought the child to the emergency within an hour of starting the pain. I managed to get the child on the operation table within half an hour. When I operated on the child, I found that his right testicle had done 720 degrees twist and was completely blue. He had a condition called testicular torsion (a torted or twisted testes). I then carefully untwisted the testicle, covered it with warm saline soaked gauze and requested my anaesthetist colleague to give the child 100% oxygen. After about 5 minutes of waiting and doing the above manoeuvring the testicle became pink again and the affected testicle regained its blood supply back. Luckily, I managed to save his testicle.
It is my evidence-based practice to fix the affected testicle as well as the normal testicle with non dissolvable stitches to prevent further twisting of the testicle on either side. Next day the child managed to go home, happy, without any pain and with happy parents. There are two peaks in the lifetime for this condition to happen. First peak is relatively smaller, which happens before 1 years of age and the next peak is between age group of 12 to 18 years. Even though my patient was not in this age group he still had the testicular torsion. The salvage rate (saving the testicle) directly correlates with the number of hours from the onset of pain. If operated within 4 hours of the start of pain the success rate of saving the testicle is from 90-100%. At 12 hours it goes down to 10% and at 24 hours it is only 2%.
It is very important that if someone has testicular pain or someone (son, brother or anyone) develops testicular pain, it should be taken very seriously, and urologist should be consulted urgently. As the hours from the onset of testicular pain increases the chances of saving the testicle becomes slimmer and slimmer. I have very low threshold for exploring scrotum to rule out the twisted testicle, especially in young patients when they present with sudden and acute pain in their testicle. The consequences of ignoring the pain, missing the testicular twisting could be extremely detrimental. The testicle not only can become dead, but also can develop life threatening infection. The consequences of losing testicle are also huge including psychological damage and infertility (inability to produce children).
Luckily my patient’s parents were sensible who didn’t waste any time and called me immediately as soon as he complained of testicular pain to them. They took the child directly to the hospital upon my advice. I managed to operate on him within those crucial hours and managed to save his testicle. One should always keep torsion on top of all the possibilities in case of sudden acute testicular pain and should seek timely medical help. Unfortunately, such conditions do not wait for coronavirus to go away and one has to attend the hospital immediately but for everyone else without any medical emergencies, please stay at home, please stay safe as together we will beat the coronavirus and prevent it from spreading.