Now Health Matters with Daniel Martin. Welcome into Health Matters right here on CN 8938. Many of you, many of you have been sharing this article and leaving comments of concern and wondering about the medical condition known as testicular torsion. You would have read about the doctor suspended after misdiagnosing. Um the condition in a young boy initially treating what the doctor thought was maybe an infection.
And then it resulted in the fact that this boy had to undergo surgery to remove his left testes and this was after this delayed diagnosis of testicular torsion. It's an emergency condition. I want to learn more about it who it could affect how you can figure out for yourself and whether like this one, like I, I need a second opinion here. I don't think this doctor is right. I'm pretty sure it could be something like testicular torsion. Let's discuss the health matter itself. Dr Jay Lim is
back on the show. He is a urologist at a Pan Asia Surgery Group. Dr Lim, thank you so much for coming back.
No worries, Daniel. Always great to be back here again.
I understand you recently had some experience with this, didn't you?
I actually do because in fact, it's actually quite a quite common occurrence. It's one of these things that neurologists must look out for and we constantly think about it any time. And every time we see a young gentleman that comes in complaining of pain in the scrotum region, that's always what we worry about. And in fact, there are some characteristics that we look at it and the recent case that I actually got involved in generally
happens at where testicular caution most commonly happened. And which is basically two main periods. The first period actually is actually when you just born, that's actually the most common cause is you actually see testicular torsion. The other peak that we commonly see is just around after the age of puberty. So any young gentleman that comes in below the age of 20 or even 20 in their twenties, I would actually think about whether this is a torsion, the numbers are out there. About one
in 4000 male can actually have a torsion. It is not as common as appendicitis for sure. But if you are a young teenage boy that comes into my clinic, in fact, it's probably one of the first things that we are trained to actually think of, which is whether this is a case of torsion, we are dealing with what
is happening exactly what's getting twisted and why is it a medical emergency?
Right. So what you can think about portion. Um The way to look at it is basically test, this is like any organ in the body. You need blood supply, you need good blood supply. And imagine basically if I take my finger out here and I put in a very, very tight rubber band and I ask you to hold a rubber band for around 4 to 6 hours. It need actually the 1st 5, 10 minutes might be bearable. But as condition as they go by the blood flow gets
a bit impinged and you start turning blue. And after that, it starts looking very tender and it gets swollen and all that stuff. That's essentially what's happening to the test is because the test is only got one major blood vessel that goes in when you torsion. A test is what you're doing is basically twisting the torsion within the scrotum bit more and more. And we talk about 360 to degrees torsion or even 580 degrees to or whatever many rounds that you can get.
So imagine basically having an organ that's basically wheeze out his blood supply. That's what's to and how basically it can present as an immense pain usually. Um, so bad that he actually induces a bit of nausea and vomiting. So it's a very, very, not uncommon to actually see them coming in. We're looking very, very sick in a huge amount of pain. The key to this diagnosis is that you need to make sure you got diagnosis within 4 to 8 hours
depending on what age group you are. That's right. Imagine if you basically cross the line of 6 to 8 hours for male or even 4 to 6 hours in younger boys, then there is not much I can do to reverse the damage that's already done
because of that blood loss, because of the torture that results in a blood loss. The organ is loss,
right? Yes, the organ is lost and it's irreversible damage. Of course, you can come to a hospital in certain cases, they come to hospital too late and we can always try to say for selfish to test this. But as times go by, you can imagine that the salvage weight becomes less and less and less and less as they, as the hours go by. Obviously,
pain has been endured. It's very uncomfortable, it's painful and, and to go through that is one thing and, and let's say you have to go through the loss and the removal of one testee. What is the health implication of that
in? I suppose the good way to look at it is there's always an implication, nobody likes to lose an organ regardless of the situation. Um But it depends on what age group that you are we are talking about. Uh if it's basically a young boy before the marriage, age of marriage, then the issue of fertility will come into play. But the good thing about how we are made, God actually gave us
a spare. So technically, with only one functioning test, this is actually enough to actually give us enough hormones to actually go on with life because the test is itself uh needs to basically come up with testosterone, which is the male hormone. So one test is enough to actually generate enough testosterone and is actually good enough to actually uh produce enough sperm for reproduction in future. But you can imagine the psychological impact of a
young boy or young teenager walking around. Basically, they knew what happened. They might have a lot of stress or mental disturbances from, you know, walking around with one less organ. Now, naturally, if you are in the age whereby you are trying to start a family, then the implications are somewhat different. And the the fertility, if the remaining test is is normal, then great, the chances of you conceiving probably is not that badly damaged.
But let's say if you had a previous accident on the remaining test is before or you have some previous conditions that affect the facility, then naturally that person's chances of having a baby would go down as a result of that damage. And of course, if you're in your fifties and sixties, which yes, they occur in that age group do very, very rare, right in the
older generation. And obviously, the impact may not be that bad as long as the hormonal functions can be taken up by the remaining testes,
that's good to know, at least in that regard. But like you said, the psychological impact is worth bearing in mind as well that I've heard about, I mean, other implants that exist.
So in the unfortunate situation that you have to have one test is removed and in situations like trauma or accidents or torsion, you lost one test is they are actually implants that we can actually put into, um, back into the quater. And if you were to look on the website and that's basically an architect, architect do meter, what it does is that basically it, there's a whole string of implants and you can look
at what is the appropriate size. I know one funny thing aside as boys, basically, everybody wants to go for the bigger size
you should go for that matches folks.
That is absolutely right. So we try to match up the contralateral side of the remaining test is and we figure out what size works best for you and in surgery, we actually replace it so that it's basically giving the patients or in this case, the young gentleman a bit of a psychological support.
It's an implant that helps in terms of the appearance factor, but it doesn't replace the functional aspects in any way,
doesn't it just a plastic model that's long lasting and it's appropriate sized.
Got it, I think just as we end off. I think it goes to question what caused the torsion to happen and how do we prevent this?
In many cases, torsion occurs because of some uh congenital uh anatomical abnormalities. Um As I mentioned to you just now, there are two periods as torsion is still can occur in um young babies. We call it the prenatal or perinatal ages. It's basically due to uh extra virginal torsion that happens when the test is actually gets got into the scrotum just as it was better get into the scrotum and it torch and the whole blood vessel is torn. Um That is actually the most common reason as to
why it taught in babies. But for young teenagers, it's mostly an extra or intra virginal torsion caused by an anatomical variation called the vow clapper uh anatomy. So what happens is imagine having a t uh attack is supposed to be fixed on about 3 to 4 parts of the uh of the of the scrotum is supposed to be fixed to it so that it actually prevents turning in a bell clapper deformity. The test itself
actually are allowed to move a bit more than usual. Therefore, in situations where they suddenly undergo puberty, they start twisting and turning and you get into the this situation. So it will be fairly different depending on what kind of age group. But the treatment is all the same. It is a surgical emergency. You need to get to the hospital as soon as you can. In
the last situation that I had. This young gentleman, young boy, 12 years old came in, he was woken up in the middle of the night mom got him into emergency very, very quickly. And by 8 a.m. he came in through around 4 a.m. by 8 a.m. operations already done and he got immediately better because the blood flow has been restored.
My gosh, so it's not due to trauma, sporting activity, tight underwear. None of that,
none of that. None of that is just an anatomical variation abnormality that can occur.
That's good to know as well. So really time is of the essence here. Yes, it is. In fact. So the minute you feel that very strong pain and it's centered in the scroll term, you will feel it centered there.
Yes, it's so painful that you want to basically feel like vomiting. You feel nauseous. You can't stand up no matter what you do points to the right spot. And if that's the case, if in doubt, I will also suggest you get seek help at the first possible time so that you can have it looked at and
this is definitely an A&;E kind of situation.
Oh, it's definitely an A&;E you've got time is of essence here. We're talking about 4 to 8 hours. You want to be able to get into the problem and taught it as soon as you can. So this is one of those few medical emergencies that you see me jumping around in, in emergency department. Usually I'm quite chill and everything's gonna
take a while and so on and so forth. Except for torsion, I really would want to get into theaters as soon as I can so much so that I even start pushing the patients to the, to the operating theater myself that has happened before. And it is this situation that you can really make a difference if you get there on time at the right place.
Valuable valuable advice. Doctor Lim could have done it without you. Thank you so much for coming on the show. No
problem, Daniel. Always a pleasure. Doctor
J Lim there who's a urologist out of Pan Asia surgery group. I'm Daniel Martin and this is health matters before making any decisions based on the information in our program. Please consult a medical professional.