Irish doctors have warned the public not to ignore symptoms of a serious condition that has resulted in 15 men losing their testicles at a Dublin hospital.
A total of 180 males have had testicles removed at the Mater Miscordiae University Hospital during the past 10 years, according to a new study.
Some 15 of these were suffering from testicular torsion twisting that cuts off blood supply to a testicle, resulting in necrosis and requiring surgical removal known as an orchidectomy.
A number of these patients waited for up to four days before presenting at the hospital's emergency department with severe scrotal and abdominal pain, and the authors of the study said early intervention is crucial in order to avoid losing testicles.
They said testicular torsion is an "acute surgical emergency" that requires prompt diagnosis and surgical intervention if an affected testicle is to be saved. Intervention within six hours of diagnosis is associated with a high rate of "testicular salvage".
"Delay in presentation and diagnosis can result in testicle loss, therefore increased awareness of testicular torsion is needed among the general population to reduce the time to hospital attendance," they wrote.
The authors doctors from the Mater's Department of Urology and the Department of Surgery at UCD also noted that misdiagnosis and delayed diagnosis of the condition was a major source of litigation.
"Failure to perform a genital exam for a young male with abdominal pain has been cited as grounds for litigation in medical malpractice cases with large financial settlements awarded to the injured parties," they added.
The study, which was published in the latest issue of the Irish Medical Journal, noted that scrotal pain was the most common symptom of testicular torsion, but around 20 per cent of patients present with abdominal pain.
Other possible symptoms include swelling of the scrotum, nausea, vomiting, frequent urination, fever, and a testicle that is positioned higher than normal or at an unusual angle.
The study stated that the condition is more common in younger men, and the authors warned that there is a need to consider a diagnosis of testicular torsion in cases of abdominal pain.
There was a median delay of 72 hours from the time that symptoms were noticed to the time that the patients presented at the Mater. Two were immediately found to have a "non-salvagable testis".
Another six underwent ultrasounds that revealed an absence of blood flow to a testicle, and they were scheduled for orchidectomies within 24 hours.
"Testicular torsion is a common and important cause of scrotal and abdominal pain in men, and delayed diagnosis can result in testicular necrosis necessitating orchidectomy," wrote the authors.
"Delayed presentation remains a significant issue in the Irish health service."
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