Legal Aspects of Men's Genitourinary Health

J. Henning; S. Waxman

Disclosures

Int J Impot Res. 2009;21(3):165–170 

In This Article

Testicular Torsion

Testicular torsion is one of the more litigious areas of urologic practice. It is a surgical emergency that often requires swift exploration to avoid loss of the involved testis. Although acute onset of testicular pain in a young male is torsion until proven otherwise, most cases of scrotal-related pain in the office and emergency department are non-surgical conditions.[41] The physical exam can sometimes be challenging with a young male in severe discomfort. Most clinicians diagnose and treat patients with 'classic' onset of symptoms without difficulty. One should consider the diagnosis of torsion even when the patient age, history or physical findings are atypical. Atypical patient presentations are more likely to lead to misdiagnosis, testis loss and potential claims.

There are some common pitfalls related to torsion claims. First, failure to timely see and obtain radiographic studies when torsion is suspected.[42] The sensitivity and specificity of high-resolution ultrasound and color Doppler sonography has been reported as 97.3 and 99%, respectively.[43] Despite these reassuring numbers, a false-negative exam is possible. High-resolution ultrasound/color Doppler sonography reproducibility and reliability requires a skilled sonographer. Furthermore, high-resolution ultrasound and color Doppler sonography are not recognized as a 'gold standard' for diagnosing torsion.[44] History, physical exam and clinical suspicion trump questionable objective radiographic findings.[45]

Second, if torsion is discovered, (in all but neonatal torsion) a contralateral orchidopexy is indicated and considered standard of care. Many males who develop torsion have considerably elongated spermatic cords in the scrotum (bell clapper deformity). Also, earlier orchidopexy or other earlier scrotal surgery do not rule out the possibility of a testicular torsion.[45]

Third, attempts to save an obviously necrotic testis are ill advised. Claims have been filed for subsequent abscess formation, need for debridement and atrophy and even loss of the contralateral testis when this type of salvage has been attempted.[42]

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