Testicular torsion in the medicolegal perspective: Why is the diagnosis missing?

BACKGROUND By examining patients with testicular torsion (TT) that caused problems in medicolegal terms, the present study aims to define markers causing medical neglect or malpractice in similar conditions and perform a retrospective examination to characterize the medical aspects of patients with TT. METHODS In this study, 53 patients who underwent orchiectomy for TT following interventions made between 2004 and 2019 in different hospitals of Turkey and had satisfactory clinical findings in their files based on medicolegal inspections were included. RESULTS The median age of the patients was nine years. Twenty-three (43.4%) of the patients had TT on the left side, 29 (54.7%) had TT on the right side, and one (1,9%) patient had bilateral TT. It was noticed that 31 (58.5%) patients had epididymo-orchitis (EO), seven patients had (13.2%) urinary infection, five (9.4%) patients had a hydrocele, and four (7.5%) patients had renal colic, and the others had testicle contusion, gastroenteritis, inguinal hernia, and acute appendicitis as misdiagnoses. The mean time that passed between admission and TT diagnosis was detected as 59±11.2 hours. A statistically significant relation was detected between the branch of the physician who first evaluated the patients and the presence of performing scrotal examination and imaging during admission. The ratio of physical scrotal examinations by emergency service physicians was lower than with the urologists. Among the preliminary examiner allowed to be an advanced evaluation for the possibility of missing diagnosis by an independent specialist physicians, 25 (47.2%) were urologists, 22 (41.5%) were emergency service physicians, four (7.5%) were pediatricians, and two (3.8%) were radiologists. CONCLUSION Physicians should perform the required evaluations for a suitable diagnosis and treatment by putting aside their medicolegal concerns and prevent the problems by giving priority to patient health. For the correct diagnosis and proper management of TT, it is necessary to increase the information levels of physicians, and patients should be explored urgently in the event of any clinical suspicion.

[1]  M. Colaco,et al.  Malpractice Litigation and Testicular Torsion: A Legal Database Review. , 2015, The Journal of emergency medicine.

[2]  P. Metcalfe,et al.  Retrospective review of diagnosis and treatment in children presenting to the pediatric department with acute scrotum. , 2013, AJR. American journal of roentgenology.

[3]  E. Kulchavenya Best practice in the diagnosis and management of urogenital tuberculosis , 2013, Therapeutic advances in urology.

[4]  L. Mellick Torsion of the Testicle: It Is Time to Stop Tossing the Dice , 2012, Pediatric emergency care.

[5]  J. Meeks,et al.  Pediatric testicular torsion epidemiology using a national database: incidence, risk of orchiectomy and possible measures toward improving the quality of care. , 2011, The Journal of urology.

[6]  E. Kozer,et al.  Clinical predictors for testicular torsion as seen in the pediatric ED. , 2010, The American journal of emergency medicine.

[7]  T. Klatte,et al.  Color Doppler sonography reliably identifies testicular torsion in boys. , 2010, Urology.

[8]  S. Badaan,et al.  Role of Doppler Ultrasonography in the Triage of Acute Scrotum in the Emergency Department , 2010, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[9]  G. Charissis,et al.  Acute scrotum -etiology, clinical presentation and seasonal variation , 2009, Indian journal of pediatrics.

[10]  T. Lahdes-Vasama,et al.  A 19-Year Review of Paediatric Patients with Acute Scrotum , 2007, Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society.

[11]  G. Vaos,et al.  Multicenter assessment of ultrasound of the spermatic cord in children with acute scrotum. , 2007, The Journal of urology.

[12]  P. Forbes,et al.  Testicular torsion and risk factors for orchiectomy. , 2005, Archives of pediatrics & adolescent medicine.

[13]  S. Selbst,et al.  Epidemiology and etiology of malpractice lawsuits involving children in US emergency departments and urgent care centers. , 2005, Pediatric emergency care.

[14]  L. Kornreich,et al.  Clinical and sonographic criteria of acute scrotum in children: a retrospective study of 172 boys , 2005, Pediatric Radiology.

[15]  I. Mushtaq,et al.  Retrospective review of paediatric patients with acute scrotum. , 2003, ANZ journal of surgery.

[16]  M. Hanna,et al.  Medicolegal aspects of testicular torsion. , 2001, Urology.

[17]  A. Khairouni,et al.  Acute scrotal pain in children: results of 543 surgical explorations , 1999, Pediatric Surgery International.

[18]  R. Bolte,et al.  A Retrospective Review of Pediatric Patients With Epididymitis, Testicular Torsion, and Torsion of Testicular Appendages , 1998, Pediatrics.

[19]  M. Davenport ABC of General Surgery in Children: ACUTE PROBLEMS OF THE SCROTUM , 1996, BMJ.

[20]  M. Davenport ABC of General Surgery in Children: PROBLEMS WITH THE PENIS AND PREPUCE , 1996, BMJ.

[21]  A. Lewis,et al.  Evaluation of acute scrotum in the emergency department. , 1995, Journal of pediatric surgery.

[22]  J. Anderson,et al.  Testicular torsion in Bristol: A 25‐year review , 1988, The British journal of surgery.

[23]  A. Cass,et al.  Immediate exploration of the unilateral acute scrotum in young male subjects. , 1980, The Journal of urology.