A report published today (12 September ) sets out a number of safety recommendations to improve the diagnosis and treatment of testicular torsion, a time critical-condition that mainly affects young boys and teenagers.

Serious impact on patients

Testicular torsion is a condition where the testicle twists, cuts off the blood supply and results in significant pain. If not treated in time it can result in the loss of a testicle.

As well as the extreme pain from the torsion itself, the risk of losing a testicle is high, if the torsion isn’t rectified quickly, often within hours. This can have further physical effects on men, as well as impacting on mental health and wellbeing.

Our investigation focuses on the case of Ryan, a 20-year-old student, who suffered a testicular torsion and, due to a delay in diagnosis and treatment lost his right testicle. He shared his thoughts and feelings about his experience with us:

“Experiencing testicular torsion and then having an operation to remove my testicle has had a big impact on my life. At the time, I felt really distressed at the intense pain and not knowing what was wrong. After the operation, I was frustrated that there had been delays in my care and that I had to miss so much of my university studies. I now worry about the future – the effect it could have on my fertility and asking myself if I want to go through another surgery to have a prosthetic fitted.

“This is my personal experience, but I think that torsion itself and then losing a testicle could affect a man’s wellbeing in so many ways. I was really glad HSIB looked at my case in depth. I had the opportunity to tell my story and have been involved all the way through the investigation. I hope that the recommendations made by HSIB will ensure better outcomes for young men going through the pain and distress of a testicular torsion.”

Making it easier to diagnose

The investigation identified that testicular torsion needs more recognition within the clinical environment and there is a risk of incorrectly interpreting the symptoms because of lack of guidance and multiple sources of information.

In our report, ‘the management of acute onset testicular pain’, we set out how improvements can be made in national guidance for GPs and for hospital triage specialists to ensure information is more standardised.

When Ryan’s case was being investigated (2017), NHS 111 clinical pathways were not sufficiently adequate for spotting testicular torsion and these have now been amended to increase detection in men up to the age of 25.

Expert view

Dr Stephen Drage, HSIB Director of Investigations and NHS Consultant said: “‘Testicular torsion is a time critical condition where rapid surgery can prevent significant complications. Torsion may also mimic other conditions making it difficult for health professionals to tell between different causes of testicular pain. Our investigation makes recommendations that will help health professionals to make the right decision at the right time to ensure access to rapid surgery where necessary.”

Professor James Green, Consultant Urological Surgeon (Barts Health NHS Trust) and expert on testicular torsion says:

“This report is extremely welcome. It reiterates the fact that testicular torsion is an emergency. It is painful and needs to be treated quickly if we are to have a good chance of saving the testicle. This detailed report identifies a number of areas that can be improved to minimise delay, and if the recommendations in this report are implemented fewer men will lose a testicle needlessly.”

Safety recommendations

Read the safety recommendations in full on the management of acute onset testicular pain

Responses to the recommendations will be published on the HSIB website later this year.

Read the report

Download and read the ‘management of acute onset testicular pain’ investigation report.