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Exploration of the scrotum for suspected torsion of the testis

Patient information

What is the evidence base for this information?

This leaflet includes advice from consensus panels, the British Association of Urological Surgeons, the Department of Health and evidence based sources; it is, therefore, a reflection of best practice in the UK. It is intended to supplement any advice you may already have been given by your urologist or nurse specialist as well as the surgical team at Addenbrookes. Alternative treatments are outlined below and can be discussed in more detail with your urologist or specialist nurse.

What does the procedure involve?

This involves examination of the testis via a scrotal incision, untwisting of the affected testis and fixation of both testes in the scrotum, to prevent twisting in the future. If the testicle is not twisted, the scrotum will be closed. If the twisted testicle is dead, it will be removed. The scrotal skin will be closed with stitches.

What are the alternatives to this procedure?

Observation with pain-killers to relieve the pain risks loss of the testis. An ultrasound scan is sometimes used to confirm the diagnosis, but cannot completely rule out a twisted testicle.

8068
Twisted testicle

What should I expect before the procedure?

This procedure is usually performed following an emergency admission and is best carried out within four hours of the onset of symptoms.

You will be asked not to eat or drink before surgery and, immediately before the operation.

Please be sure to inform your urologist in advance of your surgery if you have any of the following:

  • an artificial heart valve
  • a coronary artery stent
  • a heart pacemaker or defibrillator
  • an artificial joint
  • an artificial blood vessel graft
  • a neurosurgical shunt
  • any other implanted foreign body
  • a prescription for warfarin, aspirin, rivaroxaban, dabigatran, apixaban, edoxaban or clopidogrel, ticagrelor or blood thinning medication
  • a previous or current MRSA infection

high risk of variant CJD (if you have received a corneal transplant, a neurosurgical dural transplant or previous injections of human derived growth hormone).

What happens during the procedure?

You may experience discomfort for a few days after the procedure. You should take simple painkillers that you can buy from the shops. Absorbable stitches are normally used which do not require removal. You will be discharged from hospital the same day, or if your surgery occurs at night, the following day.

Are there any side effects?

Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.

Please use the check boxes to tick off individual items when you are happy that they have been discussed to your satisfaction:

Common (greater than one in 10)

Fixation of both testes if torsion is discovered

It may be necessary to remove the affected testis during surgery, if the damage caused by twisting is thought to be irreversible (if the affected testicle is dead)

Most people undergoing this operation have not previously fathered children, so we can give no guarantee of fertility in the future

Occasional (between one in 10 and one in 50)

It may be possible through the skin to feel the stitch used to fix the testis

Blood collection around the testes which resolves slowly or requires surgical removal

Possible infection of the incision or the testis requiring further treatment

Long-term discomfort in the scrotum

Rare (less than one in 50)

Loss of testicular size or atrophy in future, even if the testis is saved

Long-term, debilitating pain in the scrotum

What should I expect when I get home?

When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.

The groin and scrotum may be uncomfortable for seven to 10 days. Simple painkillers will usually relieve this discomfort.

You are advised to take a week off school or work and to refrain from vigorous exercise (including sport) for two weeks.

What else should I look out for?

If you develop a temperature, increased redness, throbbing or drainage at the site of the operation, please contact your GP.

Are there any other important points?

A follow-up outpatient appointment will not normally be arranged unless there are post operative problems.

Driving after surgery

It is your responsibility to ensure that you only drive if you hold a valid licence and are fit to drive following your surgery.

You do not normally need to notify the DVLA unless you have a medical condition that will last for longer than three months after your surgery and may affect your ability to drive. You should, however, check with your insurance company before returning to driving. Your doctors will be happy to provide you with advice on request.

Privacy & Dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high tech equipment and/or specialist one to one care is required.

Hair removal before an operation

For most operations, you do not need to have the hair around the site of the operation removed. However, sometimes the healthcare team need to see or reach your skin and if this is necessary they will use an electric hair clipper with a single-use disposable head, on the day of the surgery. Please do not shave the hair yourself or use a razor to remove hair, as this can increase the risk of infection. Your healthcare team will be happy to discuss this with you.

References

NICE clinical guideline No 74: Surgical site infection (October 2008); Department of Health: High Impact Intervention No 4: Care bundle to preventing surgical site infection (August 2007)

Is there any research being carried out in this field at Addenbrooke’s Hospital?

There is no specific research in this area at the moment but all operative procedures performed in the department are subject to rigorous audit at a monthly audit and clinical governance meeting.

Who can I contact for more help or information?

Oncology nurses

Uro-oncology nurse specialist

01223 586748

Bladder cancer nurse practitioner (haematuria, chemotherapy and BCG)

01223 274608

Prostate cancer nurse practitioner

01223 274608 or 216897 or bleep 154-548

Surgical care practitioner

01223 348590 or 256157 or bleep 154-351

Non-oncology nurses

Urology nurse practitioner (incontinence, urodynamics, catheter patients)

01223 274608 or 586748 or bleep 157-237

Urology nurse practitioner (stoma care)

01223 349800

Urology nurse practitioner (stone disease)

01223 349800 or bleep 152-879

Patient Advice and Liaison Centre (PALS)

Telephone:

+44 (0)1223 216756

PatientLine: *801 (from patient bedside telephones only)

E mail: pals@addenbrookes.nhs.uk

Mail: PALS, Box No 53

Addenbrooke's Hospital

Hills Road, Cambridge, CB2 2QQ

Chaplaincy and multi faith community

Telephone: +44 (0)1223 217769

E mail: chaplaincy@addenbrookes.nhs.uk

Mail: The Chaplaincy, Box No 105

Addenbrooke's Hospital

Hills Road, Cambridge, CB2 2QQ

MINICOM System ("type" system for the hard of hearing)

Telephone: +44 (0)1223 217589

Access office (travel, parking and security information)

Telephone: +44 (0)1223 596060

What should I do with this leaflet?

Thank you for taking the trouble to read this patient information leaflet. If you wish to sign it and retain a copy for your own records, please do so below.

If you would like a copy of this leaflet to be filed in your hospital records for future reference, please let your urologist or specialist nurse know. If you do, however, decide to proceed with the scheduled procedure, you will be asked to sign a separate consent form which will be filed in your hospital notes and you will, in addition, be provided with a copy of the form if you wish.

I have read this patient information leaflet and I accept the information it provides.

Signature……………………………….……………Date…………….………………….

We are smoke-free

Smoking is not allowed anywhere on the hospital campus. For advice and support in quitting, contact your GP or the free NHS stop smoking helpline on 0800 169 0 169.

Other formats

Help accessing this information in other formats is available. To find out more about the services we provide, please visit our patient information help page (see link below) or telephone 01223 256998. www.cuh.nhs.uk/contact-us/accessible-information/

Contact us

Cambridge University Hospitals
NHS Foundation Trust
Hills Road, Cambridge
CB2 0QQ

Telephone +44 (0)1223 245151
https://www.cuh.nhs.uk/contact-us/contact-enquiries/