Testicular Pain: Time Is Critical

Testicular Pain: Time Is Critical

Written by Suzanne Condron, M.D. on Feb 18, 2015 9:00:00 AM

Let me start with reader triage. If you’ve stumbled upon this post because your son is having testicular pain, and you Googled “Is pain in the testicle an emergency” here is your answer: Yes!  It is an emergency. Stop reading and go to the Emergency Room.  Seriously, go to the ER.

Word has gotten out that chest pain is an emergency. Stroke symptoms are on our radar, too, thanks in part to the “Time is Brain” stroke campaign. We generally hustle to the ER for severe abdominal pain, shortness of breath or dehydration. Scrotal pain, however, is another story.

Denial Comes at a Cost

Testicular torsion is just what it sounds like: The testicle rotates on its axis, twisting the spermatic cord and blood vessels, cutting off its blood supply.  It happens to approximately 1 out of 4,000 males under age 25, peaking between ages 12 and 16.[1] [2] The pain is excruciating, but somehow boys or their parents try to ignore it.  That denial comes at a cost, though, because testicular torsion is a surgical emergency. From the time of torsion, there is a four- to six-hour window to operate and untwist the testicle.  After that, the risk increases dramatically that the testicle will die and have to be removed, potentially decreasing later fertility.[1] Simply put, time is testicle.

docs_with_a_clock

A Serious, Urgent problem

Research has shown that most of the delays in treatment happen because patients or their parents don’t realize scrotal pain is a serious, urgent problem.[3] [4] Once someone finally seeks help for his awful pain, he is generally granted a fast pass through the ER. He is handed off to a urologist for an ultrasound exam, then straight to the operating room if it turns out to be testicular torsion.

So who waits? Adolescent males, that’s who. One study showed that the average delay in going to the ER was age-related.[5]  Males 18 and older generally waited four hours.  Males under 18 waited 20 hours. Another study broke down the outcomes of the younger males and found that the risk of losing a testicle increased 8 percent for every year of age.[6]  It’s unclear if the youngest patients sought help earlier or if the oldest patients had more severe cases, but the bottom line is clear: If you have scrotal pain, “do not pass Go, do not collect $200,” just go to the ER.

The Clock Is Ticking

Maybe it’s awkward to discuss genital anatomy with preteen and teenage boys, but they need to know the vocabulary – testicles/testes, scrotum – and they need to know that pain there is an emergency. Then maybe they won’t keep a private problem to themselves. The clock is ticking.

Your questions are welcomed! Please leave a comment.

 

Suzanne-Condron-blog

Dr. Condron is a board-certified pediatrician at Kelsey-Seybold Clinic – Fort Bend Medical and Diagnostic Center whose clinical interests include obesity, nutrition, allergies, asthma, childhood development, literacy, infectious diseases and preventive medicine.

 

 

[1] Ringdahl E and Teague L. Testicular Torsion. Am Fam Physician. 2006 Nov 15; 74 (10): 1739-1743.

[2] Kadish HA,Bolte RG. A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of the testicular appendages. Pediatrics.1998;102;73.

[3] Rampaul MS, Hosking SW. Testicular torsion: most delay occurs outside hospital. Ann R Coll Surg Engl. 1998; 80:169-172.

[4] UbeeS, Hopkinson V, Srirangam S. Parental perception of acute scrotal pain in children. AnnR Coll SurgEngl. 2014 Nov; 96(8):618-20.

[5] Barada JH, WeingartenJL, Cromie WJ. Testicular salvage and age-related delay in the presentation of testicular torsion. J Urol.1989 Sep; 142 (3):746-8.

[6] Mansbach JM, Forbes P, Peters C. Testicular torsion and risk factors for orchiectomy. Arch PediatrAdolesc Med.2005 Dec; 159 (12)1167-71.

 

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Topics: testicular pain, adolescent males, scrotal pain, testicular torsion

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