Doctors warn of increased cases of testicle torsion in the cold

Pediatric surgeons and urologists have warned of an increase in testicular torsion in adolescents or young adults, a problem that can lead to the loss of the organ that is responsible for producing male hormones, such as testosterone, and sperm.

In a recent statement, the Brazilian Association of Pediatric Surgery expresses its concern about the discharge and reports frequent situations in which young people arrive at the emergency room with a “dead” testicle that needs to be removed due to the delay in diagnosis and surgery that reverses the problem.

“We can’t take long to take the child to emergency care. In cases like this, it’s not a good idea to wait for the day to dawn or give a painkiller and wait for an improvement to seek care”, says the note from the entity.

According to pediatric surgeon Sylvio Ávila, from Hospital Pequeno Príncipe, in Curitiba (PR), every year there is an expected number of cases, but in recent weeks, the number has skyrocketed, especially in the south of the country.

“There are hospitals that have two, three cases a day. Just yesterday [na última terça, 27], we had two cases. It’s a lot of twisted testicles, I’ve never seen that amount,” says Ávila.

There are no updated national data on the increase in occurrence. A 2010 study estimated that there are at least 1,000 sprains a year in the country. In Pequeno Príncipe, the number of cases from the beginning of the year to this Thursday (29) had already exceeded the whole of last year —49 against 41.

The suspicion is that the increase is related to low temperatures, a situation that favors testicular torsion in young people who have an anatomical “defect” in the attachment of the testicles to the scrotum.

In the cold, the testicles move more and there is a greater risk that they will rotate on their axis, causing torsion. When this happens, there is a closing of the blood vessels that nourish the organ, causing a “heart attack” due to lack of oxygen. If not distorted in time, it “dies” and needs to be excised.

“When it’s cold, the cremaster muscle [que se insere no escroto e age suspendendo o testículo] contracts and brings the testicle closer to the body. When it’s hot, it relaxes and the testicle descends”, explains urologist Roni Fernandes, vice president of the Brazilian Society of Urology.

“The cold front comes and, in the following days, the cases begin to arrive”, reports urologist Marcos Broglio, who works at Santa Casa de São Paulo. This year, the institution treated at least 28 cases of sprain.

According to doctors, there is no way to predict or diagnose the problem early. Testicular torsion happens acutely and suddenly, causing very intense pain, often accompanied by nausea or vomiting and abdominal pain.

They reinforce that, in the face of acute pain in the region, the boy needs to be taken immediately to a hospital to be operated on because there is a time limit for the testicle to be saved. Up to six hours after the twist, the chances of keeping the organ are more than 90%. If it takes 12 hours, they drop to 50%, and 24 hours late, 90% lose their testicles.

One of the factors that contribute to the delay in seeking medical help is the shame that adolescents have to report to their parents that they have testicle pain. “As they are unaware of the problem, they think it might be some silly thing they did [masturbação] and don’t tell their parents. Some boys report that they felt pain after nighttime erections with erotic dreams,” says surgeon Ávila.

According to Broglio, 80% of cases occur between the ages of 9 and 20, and the circumstances in which sprains occur vary widely. These include intense physical activity and small bumps on the testicle. “In half the cases I see, they say [a torção] happens at night, sleeping.”

That’s what happened to a 14-year-old teenager from Curitiba last Tuesday (27). The mother, who asked not to be named so as not to expose her son, says the boy woke up with a lot of pain in his testicle at 6:30 am and asked his parents for help. An hour later, they were already in the hospital’s emergency room.

According to her, as she sought quick care, it was possible to put the testicle back in place and fix it to avoid a new torsion. Her mother reports that she had never heard that this could happen in her sleep.

Roni Fernandes, from SBU, recalls that torsion can also occur during ejaculation because the muscle moves. “But it can happen in many circumstances. For example, the boy is with his friends and he jumps into a cold swimming pool. If the testicle is not well fixed, he can twist.”

Another major obstacle that prevents surgery in time to save the twisted testicle is the delay in accessing public hospitals. The patient needs to look for a health unit, which will trigger the bed regulation system, which will search the network for a place with surgical capacity. This usually takes more than 20 hours.

“Sometimes, some services still end up transferring the patient to other places where they have urologists, which delays the surgery even more. There is no need for this, a general surgeon can approach the case”, says Broglio.

In Roni Fernandes’ opinion, although it is a low-complexity surgery, which can be performed in any hospital, it is necessary that patients, parents, the regulatory system and hospitals understand the urgency of the case. “You even have to get past appendicitis.”

He states that in 60% of cases this testis malformation is bilateral. That is, when one testicle twists and is operated on, the other healthy testicle also needs to be fixed preventively so that it does not twist in the future. “We have already received two patients where this was not done and they lost the second one as well.”

Even with one testicle, a man preserves fertility and hormone production, but if he loses both, he becomes infertile and without male hormones, which will lead to muscle and bone loss and impaired sexual performance.

“The most serious consequence is aesthetics, this weighs heavily on men’s self-esteem. Unfortunately, the SUS does not offer testicular prosthesis. Only private and insured patients have this benefit”, says Sylvio Ávila, from Pequeno Príncipe Hospital.