A Urological Expert’s View:
Although it should never happen nowadays, young men lose salvageable testicles on most weeks in the NHS. Broadly, if a man is taken to surgery within six hours of the torsion occurring the great majority of testicles will survive. A delay of over twelve hours is usually fatal to the testicle. A delay of 6-12 hours may lead to a salvageable testis.
There is NO diagnostic test to exclude testicular torsion. In departments with very experienced ultrasound doctors, a number of conditions may be diagnosed which can mimic torsion. However even in this situation there should be no delay to surgery if an absolute diagnosis cannot be made – the ultrasound should be done on the way to the operating theatre. If there remains any doubt, emergency surgical exploration should be carried out.
National and international guidelines are unanimous in advising this management pathway.
Thus there were two clear breaches here.
The first was misdiagnosis in the face of a classical presentation of torsion. The second was to delay further the surgical exploration waiting for an unnecessary test. On the balance of probabilities the testis would have survived had these errors not been made.
Once the decision had been made to remove the dead testis, the surgery itself was of an acceptable standard and the fixation of the remaining testis (to avoid that side torting) was entirely correct. Deferred insertion of a testicular prosthesis is what most specialists would recommend in the presence of testicular loss due to torsion.