Speaker 1: Now Health Matters with Daniel Martin. Welcome into Health Matters
Speaker 1: right here on CN 8938. Many of you, many of
Speaker 1: you have been sharing this article and leaving comments of
Speaker 1: concern and wondering about the medical condition known as testicular torsion.
Speaker 1: You would have read about the doctor suspended after misdiagnosing.
Speaker 1: Um the condition in a young boy initially treating what
Speaker 1: the doctor thought was maybe an infection.
Speaker 1: And then it resulted in the fact that this boy
Speaker 1: had to undergo surgery to remove his left testes and
Speaker 1: this was after this delayed diagnosis of testicular torsion. It's
Speaker 1: an emergency condition.
Speaker 1: I want to learn more about it
Speaker 1: who it could affect how you can figure out for
Speaker 1: yourself and whether like this one, like I, I need
Speaker 1: a second opinion here. I don't think this doctor is right.
Speaker 1: I'm pretty sure it could be something like testicular torsion.
Speaker 1: Let's discuss the health matter itself. Dr Jay Lim is
Speaker 1: back on the show. He is a urologist at a
Speaker 1: Pan Asia Surgery Group. Dr Lim, thank you so much
Speaker 1: for coming back.
Speaker 2: No worries, Daniel. Always great to be back here again.
Speaker 1: I
Speaker 1: understand you recently had some experience with this, didn't you?
Speaker 2: I actually do because in fact, it's actually quite a
Speaker 2: quite common occurrence. It's one of these things that neurologists
Speaker 2: must look out for and we constantly think about it
Speaker 2: any time. And every time we see a young gentleman
Speaker 2: that comes in complaining of pain in the
Speaker 2: scrotum region, that's always what we worry about. And in fact,
Speaker 2: there are some characteristics that we look at it and
Speaker 2: the recent case that I actually got involved in generally
Speaker 2: happens at where testicular caution most commonly happened. And which
Speaker 2: is basically two main periods. The first period actually is
Speaker 2: actually when you just born, that's actually the most common
Speaker 2: cause is you actually see testicular torsion.
Speaker 2: The other peak that we commonly see is just around
Speaker 2: after the age of puberty. So any young gentleman that
Speaker 2: comes in below the age of 20 or even 20
Speaker 2: in their twenties, I would actually think about whether this
Speaker 2: is a torsion, the numbers are out there. About one
Speaker 2: in 4000 male can actually have a torsion. It is
Speaker 2: not as common as appendicitis for sure.
Speaker 2: But if you are a young teenage boy that comes
Speaker 2: into my clinic, in fact, it's probably one of the
Speaker 2: first things that we are trained to actually think of,
Speaker 2: which is whether this is a case of torsion, we
Speaker 2: are dealing with what
Speaker 1: is happening exactly what's getting twisted and why is it
Speaker 1: a medical emergency?
Speaker 2: Right. So what you can think about portion. Um The
Speaker 2: way to look at it is basically test, this is
Speaker 2: like any organ in the body. You need blood supply,
Speaker 2: you need good blood supply. And imagine basically if I
Speaker 2: take my finger out here and I put in a very,
Speaker 2: very tight rubber band and I ask you to hold
Speaker 2: a rubber band for around 4 to 6 hours. It
Speaker 2: need
Speaker 2: actually the 1st 5, 10 minutes might be bearable. But
Speaker 2: as condition as they go by the blood flow gets
Speaker 2: a bit impinged and you start turning blue. And after that,
Speaker 2: it starts looking very tender and it gets swollen and
Speaker 2: all that stuff. That's essentially what's happening to the test
Speaker 2: is because the test is only got one major blood
Speaker 2: vessel that goes in
Speaker 2: when you torsion. A test is what you're doing is
Speaker 2: basically twisting the torsion within the scrotum bit more and more.
Speaker 2: And we talk about 360 to degrees torsion or even
Speaker 2: 580 degrees to or whatever many rounds that you can get.
Speaker 2: So imagine basically having an organ that's basically
Speaker 2: wheeze out his blood supply. That's what's to and how
Speaker 2: basically it can present as an immense pain usually. Um,
Speaker 2: so bad that he actually induces a bit of nausea
Speaker 2: and vomiting. So it's a very, very, not uncommon to
Speaker 2: actually see them coming in. We're looking very, very sick
Speaker 2: in a huge amount of pain.
Speaker 2: The key to this diagnosis is that you need to
Speaker 2: make sure you got diagnosis within 4 to 8 hours
Speaker 2: depending on what age group you are. That's right. Imagine
Speaker 2: if you basically cross the line of 6 to 8
Speaker 2: hours for male or even 4 to 6 hours in
Speaker 2: younger boys, then there is not much I can do
Speaker 2: to reverse the damage that's already done
Speaker 1: because of that blood loss, because of the torture that
Speaker 1: results in a blood loss. The organ is loss,
Speaker 2: right? Yes, the organ is lost and it's irreversible damage.
Speaker 2: Of course, you can come to a hospital in certain cases,
Speaker 2: they come to hospital too late and we can always
Speaker 2: try to say for selfish to test this. But as
Speaker 2: times go by, you can imagine that the salvage weight
Speaker 2: becomes less and less and less and less as they,
Speaker 2: as the hours go by. Obviously,
Speaker 1: pain has been endured. It's very uncomfortable, it's painful and,
Speaker 1: and to go through that is one thing and, and
Speaker 1: let's say you have to go through the loss and
Speaker 1: the removal of one testee. What is the health implication
Speaker 1: of
Speaker 1: that
Speaker 2: in? I suppose the good way to look at it
Speaker 2: is there's always an implication, nobody likes to lose an
Speaker 2: organ regardless of the situation.
Speaker 2: Um But it depends on what age group that you
Speaker 2: are we are talking about. Uh if it's basically a
Speaker 2: young boy before the marriage, age of marriage, then the
Speaker 2: issue of fertility will come into play. But the good
Speaker 2: thing about how we are made, God actually gave us
Speaker 2: a spare. So technically, with only one functioning test, this
Speaker 2: is actually enough
Speaker 2: to actually give us enough hormones to actually go on
Speaker 2: with life because the test is itself uh needs to
Speaker 2: basically come up with testosterone, which is the male hormone.
Speaker 2: So one test is enough to actually generate enough testosterone
Speaker 2: and is actually good enough to actually uh produce enough
Speaker 2: sperm for reproduction in
Speaker 2: future. But you can imagine the psychological impact of a
Speaker 2: young boy or young teenager walking around. Basically, they knew
Speaker 2: what happened. They might have a lot of stress or
Speaker 2: mental disturbances from, you know, walking around with one less organ. Now, naturally,
Speaker 2: if you are in the age whereby you are trying
Speaker 2: to start a family,
Speaker 2: then the implications are somewhat different. And the the fertility,
Speaker 2: if the remaining test is is normal, then great, the
Speaker 2: chances of you conceiving probably is not that badly damaged.
Speaker 2: But let's say if you had a previous accident on
Speaker 2: the remaining test is before or you have some previous
Speaker 2: conditions that affect the facility, then naturally that
Speaker 2: person's chances of having a baby would go down as
Speaker 2: a result of that damage. And of course, if you're
Speaker 2: in your fifties and sixties, which yes, they occur in
Speaker 2: that age group do very, very rare, right in the
Speaker 2: older generation. And obviously, the impact may not be that
Speaker 2: bad as long as the hormonal functions can be taken
Speaker 2: up by the remaining testes,
Speaker 1: that's good to know, at least in that regard. But
Speaker 1: like you said, the psychological impact is worth bearing in
Speaker 1: mind as well that I've heard about, I mean, other
Speaker 1: implants that exist.
Speaker 2: So in the unfortunate situation that you have to have
Speaker 2: one test is removed and in
Speaker 2: situations like trauma or accidents or torsion, you lost one
Speaker 2: test is they are actually implants that we can actually
Speaker 2: put into, um, back into the quater. And if you
Speaker 2: were to look on the website and that's basically an architect,
Speaker 2: architect do meter, what it does is that basically it,
Speaker 2: there's a whole string of implants and you can look
Speaker 2: at what is the appropriate size. I know one funny
Speaker 2: thing aside as boys, basically, everybody wants to go for
Speaker 2: the bigger size
Speaker 1: you should go for that matches
Speaker 1: folks.
Speaker 2: That is absolutely right. So we try to match up
Speaker 2: the contralateral side of the remaining test is and we
Speaker 2: figure out what size works best for you and in surgery,
Speaker 2: we actually replace it so that it's basically giving
Speaker 2: the patients or in this case, the young gentleman a
Speaker 2: bit of a psychological support.
Speaker 1: It's an implant that helps in terms of the appearance factor,
Speaker 1: but it doesn't replace the functional aspects in
Speaker 1: any way,
Speaker 2: doesn't it just a plastic model that's long lasting and
Speaker 2: it's appropriate sized.
Speaker 1: Got it, I think just as we end off. I
Speaker 1: think it goes to question what caused the torsion to
Speaker 1: happen and how do we prevent this?
Speaker 2: In many cases, torsion occurs because of some uh congenital
Speaker 2: uh anatomical abnormalities. Um As I mentioned to you just now,
Speaker 2: there are two periods as torsion is still can occur
Speaker 2: in um young babies. We call it the prenatal or
Speaker 2: perinatal ages. It's basically due to uh extra virginal torsion
Speaker 2: that happens when the test is actually gets got into
Speaker 2: the scrotum just as it was better get into the
Speaker 2: scrotum
Speaker 2: and it torch and the whole blood vessel is torn.
Speaker 2: Um That is actually the most common reason as to
Speaker 2: why it taught in babies. But for young teenagers, it's
Speaker 2: mostly an extra or intra virginal torsion caused by an
Speaker 2: anatomical variation called the vow clapper uh anatomy. So what
Speaker 2: happens is imagine having a t uh attack
Speaker 2: is supposed to be fixed on about 3 to 4
Speaker 2: parts of the uh of the of the scrotum is
Speaker 2: supposed to be fixed to it so that it actually
Speaker 2: prevents turning in a bell clapper deformity. The test itself
Speaker 2: actually are allowed to move a bit more than usual. Therefore,
Speaker 2: in situations where they suddenly undergo puberty, they start twisting
Speaker 2: and turning and you get into the
Speaker 2: this situation. So it will be fairly different depending on
Speaker 2: what kind of age group. But the treatment is all
Speaker 2: the same. It is a surgical emergency. You need to
Speaker 2: get to the hospital as soon as you can. In
Speaker 2: the last situation that I had. This young gentleman, young boy,
Speaker 2: 12 years old came in, he was woken up in
Speaker 2: the middle of the night mom got him into emergency very,
Speaker 2: very quickly. And by 8 a.m.
Speaker 2: he came in through around 4 a.m. by 8 a.m.
Speaker 2: operations already done and he got immediately better because the
Speaker 2: blood flow has been restored.
Speaker 1: My gosh, so it's not due to trauma, sporting activity,
Speaker 1: tight underwear. None of that,
Speaker 2: none of that. None of that is just an anatomical
Speaker 2: variation abnormality that can
Speaker 2: occur.
Speaker 1: That's good to know as well. So really time is
Speaker 1: of the essence here.
Speaker 1: Yes, it is. In fact. So the minute you feel
Speaker 1: that very strong pain and it's centered in the scroll term,
Speaker 1: you will feel it centered
Speaker 1: there.
Speaker 2: Yes, it's so painful that you want to basically feel
Speaker 2: like vomiting. You feel nauseous. You can't stand up no
Speaker 2: matter what you do points to the right spot. And
Speaker 2: if that's the case, if in doubt, I will also
Speaker 2: suggest you get seek help at the first possible time
Speaker 2: so that you can have it looked at and
Speaker 1: this is definitely an A&E kind of situation.
Speaker 2: Oh, it's
Speaker 2: definitely an A&E you've got time is of essence here.
Speaker 2: We're talking about 4 to 8 hours. You want to
Speaker 2: be able to get into the problem and taught it
Speaker 2: as soon as you can. So this is one of
Speaker 2: those few medical emergencies that you see me jumping around in,
Speaker 2: in emergency department. Usually I'm quite chill and everything's gonna
Speaker 2: take a while and so on and so forth. Except
Speaker 2: for torsion, I really would want to get into theaters
Speaker 2: as soon as I can
Speaker 2: so much so that I even start pushing the patients
Speaker 2: to the, to the operating theater myself that has happened before.
Speaker 2: And it is this situation that you can really make
Speaker 2: a difference if you get there on time at the
Speaker 2: right place.
Speaker 1: Valuable
Speaker 1: valuable advice. Doctor Lim could have done it without you.
Speaker 1: Thank you so much for coming on the show. No
Speaker 2: problem, Daniel. Always a pleasure. Doctor
Speaker 1: J Lim there who's a urologist out of Pan Asia
Speaker 1: surgery group. I'm Daniel Martin and this is health matters
Speaker 1: before making any decisions based on the information in our program.
Speaker 1: Please consult a medical professional.