National award for research helping avoid emergency surgery for suspected testicular torsion | News

A project which has decreased the number of men and boys having unnecessary emergency surgery for suspected testicular torsion has won an award at a national conference of urological surgeons.

Testicular torsion happens when a testicle twists, cutting off the blood supply and can happen at any age (including before birth in a few boys) but is most common between the ages of 10 and 25.

Testicular torsion may happen during exercise or during sleep, and after a trauma or injury. 

It is a time-critical surgical emergency, with survival of the testis almost certain if is treated within a critical 6-hour window.

It can be difficult to diagnose as torsion isn’t the only case of testicular pain, and this has meant some patients having surgery unnecessarily, as the testis was found to be untwisted.

Maidstone and Tunbridge Wells NHS Trust was one of the first trusts in the UK to introduce a pathway for testicular torsion incorporating TWIST scores and rapid ultrasound scanning - which can accurately identify torsion - in selected patients.

TWIST (Testicular Workup for Ischaemia and Suspected Torsion) is a clinical score tool for emergencies where testicular torsion is suspected.

It puts patients into low, intermediate, and high-risk groups based on their symptoms and examination findings, to determine whether they need to go directly to emergency surgery.

An audit was conducted of patients on this pathway over a three year period, and the results were presented by Urology Registrar, Miss Amy Wombwell at the British Association of Urological Surgeons' Annual Scientific Meeting in London.

The results showed an improved negative exploration rate, meaning fewer patients had surgery where no twisting was found, and patients needing surgery were taken to theatre more quickly.

This helps patients avoid unnecessary anaesthesia and surgery, improves the chance of saving the testis, and means emergency theatres and surgical teams are available for other patients who need them.

The project was selected by the chairs as the best poster in the “Management, governance, education and quality improvement” category.