Masturbation goes awry leading to torsion of testis in an adolescent, corrected at AINU

HYDERABAD: Adolescence could be confusing for young people as their bodies undergo change. Experimenting for fun could lead to irreparable damage.

Urologists at the Asian Institute of Nephrology & Urology (AINU) in Secunderabad rescued one such young student from the impending loss of one of his testicles due to testicular torsion, a form of a twisted testicle. A thorough background check revealed that masturbation triggered this incident.

Dr Raghavendra Kulkarni, Consultant Urologist and Dr Suraj Pinni, Urologist who have salvaged the testis of the young man said that irrespective of the cause, testicular torsion required immediate medical attention and surgical intervention in order to reduce the risk of testicular loss.

“This adolescent boy was brought to AINU because of mild left testicular pain with associated left groin pain. A medical examination was normal except for minimal tenderness. The scrotal doppler scan was normal. The boy and his accompanying mother were alerted of the possibility of, Intermittent Testicular Torsion (ITT) and advised to undergo surgical exploration”, Dr Raghavendra Kulkarni said.

Four days after the first consultation, in view of worsening testicular pain with the onset of testicular swelling, the boy was rushed back to AINU. Examination confirmed an enlarged painful left testis with fluid in the left-sided scrotum. A bedside scrotal scan showed fluid filled in the left-side scrotum with a normal color flow pattern of the left testis. This suggested testicular torsion with the impending loss of the blood supply. The boy was immediately taken up for the operation, he was relieved of the pain and the testis was successfully salvaged.

Testicular torsion could be due to a congenital abnormality making the testicle twist around its spermatic cord leading to ischemia and infarction of the testicle. It could occur at any age but it was prevalent in young men.

However, ITT was a very rare entity, the diagnosis of which required a high level of clinical acumen. Recurrent attacks of ITT or ITT that last too long could result in full-blown testicular torsion. False negativity of scrotal doppler might lead to a delay in surgery with possible testicular loss.

“From the very first visit, the possibility of ITT was discussed. Due to lack of consent from the patient and the patient’s mother, empirical antibiotics and analgesics were prescribed, as the way forward. In cases of ITT, the Urologist needs to be proactive in recommending elective scrotal exploration since the risk of testicular damage outweighs the morbidity of elective bilateral orchidopexy,” Dr Raghavendra Kulkarni said.

The urology team at AINU said that testicular torsion could occur spontaneously or precipitated by certain exertional activities like exercising, and cycling. Hence one must seek immediate medical attention because the first 4 – 6 hours were crucial beyond which the damage may become irreversible.