This is a report by the Healthcare Safety Investigation Branch (HSIB) around testicular torsion. Testicular torsion is a condition where the testicle twists, cuts off the blood supply and results in significant pain. If not treated in time it can result in the loss of a testicle.
Testicular torsion can affect males at any age, but young adults aged between 12 and 18 years are at greater risk of torsion than other age groups. Since 2016, across England there have been more 3500 admissions each year with suspected testicular torsion and a proportion of these suffered complications due to misdiagnosis and delay.
The HSIB investigation reviewed the diagnostic and treatment pathway for testicular torsion. There was a predominant focus on delays and the human factors associated with the pathway. The investigation identified system-wide recommendations designed to prevent delays to the identification and treatment of testicular torsion happening in the future.
- There is a risk of incorrect interpretation of the symptoms, diagnosis and treatment of testicular torsion due to issues relating to the accuracy and accessibility of national guidance on the condition.
- There are multiple sources of guidance for GPs on testicular torsion, which do not all state the same information.
- The arrangement of urological surgical services in relation to acute testicular pain had not been considered in the NHS England/Improvement ‘Getting It Right First Time’ programme for urology area networks, which are voluntary agreements between trusts in the same geographical area establishing comprehensive urology services.
- The NHS 111 service genital problems clinical pathway had been amended to upgrade the default urgency for treatment advice given to patients with acute testicular pain within the 16-25 age group.
- The lack of principles or guidance for GP services setting up and running primary care advice/triage by telephone consultation is likely to be contributing to variation in the quality and safety of these services across the country.
- It is recommended that the National Institute for Health and Care Excellence revises the content and accessibility of its Clinical Knowledge Summary on testicular torsion.
- It is recommended that the NHS England/ Improvement ‘Getting It Right First Time’ programme ensures that testicular torsion/acute testicular pain is included on the checklist of emergency pathways to be considered by the newly established Urology Area Networks across England.
- It is recommended that NHS England/Improvement works with relevant stakeholders to develop guidance for handling telephone advice/triage in primary medical care settings.
There are multiple sources of guidance for general practitioners on testicular torsion. It would be beneficial to review whether this guidance is accurate and whether it reflects the information contained in the revised clinical knowledge summary to be issued by the National Institute for Health and Care Excellence.
NHS Digital has amended all clinical pathways where testicular pain is assessed in Version 16 of NHS Pathways, to increase the detection of testicular torsion in people over the age of 16 and up to 25.