Ask the experts

What is Testicular Torsion? 

Testicular torsion is a condition that can occur when the tissues around the testicle are not normally attached, potentially causing the testicle to twist around the spermatic cord. When this happens, the torsion of the cord cuts off the blood flow to the testicle. It typically produces pain and swelling, and if left untreated for a prolonged period of time (more than 6 to 10 hours), it will permanently damage the testicle. This condition is always an emergency.

Many hospitals have plans in place to emergently take care of patients with torsion to minimize the possible loss of testicles. We’ve learned from many patients who delayed in seeking care for torsion, they had never heard of this condition before. Too many patients are not aware that testicular pain may be caused by torsion, and that prompt aid is needed to save the testicle.

Many young men feel insecure or ashamed when they experience testicular pain. If they’re unaware of how dire this condition is, they will try to “wait it out.” This decision could lead to the loss of the testicle.

We’ve come up with the phrase, “the patient is the gatekeeper for testicular torsion.” If the young man is aware of the condition of torsion, he is more likely to seek medical attention early after the onset of pain. Spreading awareness of testicular torsion should take place during medical office visits with adolescent males, at schools, sports teams and social media. These efforts to increase awareness of the condition could raise the chances to save testicles.

T. Ernesto Figueroa, MD is Division Chief of Pediatric Urology at the Nemours Children’s Health System in Wilmington, Del. 

How Do I Know If I Have a Urinary Tract Infection (UTI)? 

Each year, urinary tract infections (UTIs) account for close to 10 million doctor visits. A UTI can occur when bacteria gets into your urine and settles in your bladder. Women are four times more likely than men to get a UTI, and the summertime may bring with it an increased risk to get one.

Signs of a UTI may include:

  • Pain or burning when you urinate
  • Frequent urination
  • A strong sense of urgency to urinate
  • Pain in your back or side near the ribs
  • Pressure in your lower belly
  • Urine that is cloudy, bloody or has a strong odor sensation that you are unable to completely empty your bladder
  • Fever or chills

Consider the following facts as you look to prevent UTIs:

  • Urinating after sex may help flush out bacteria that might have gotten into the urinary tract during intercourse.
  • Certain forms of birth control, such as spermicidal foam and diaphragms, can increase the risk of UTI in some women. Talk to your health care provider about your options.
  • Don’t put off urinating when you need to and don’t rush to finish. Incomplete bladder emptying can increase your risk of UTI.
  • After urinating, wipe from front to back to keep from sweeping bacteria from the rectum or anus toward the vagina and urethra.

Kathleen Kobashi, MD is a urologist at Virginia Mason Medical Center in Seattle, Wash. 

Is Deflux an Effective way to Treat my Child’s VUR? 

Deflux is a gel that may be used to treat vesicoureteral reflux (VUR). VUR is a common pediatric urology condition. 

Normally, urine flows one way, down from the kidneys, through tubes called ureters, to the bladder. VUR is when urine flows from the bladder back into the ureters. VUR can lead to serious issues for children. 

Often reflux will go away with time. The lower the grade of reflux, the more likely it is to go away. The goal of medical or non-surgical treatment is to prevent UTI and kidney damage while the child grows. Reflux improves in many children because the junction between the bladder and the ureter gets longer with age. 

VUR is not contagious and affects roughly 10 percent of children. As a way to treat VUR, the use of Deflux gel may be an option. The gel is injected into the child’s bladder near the opening of the ureter. This forms a bulge that helps block and prevent the urine from flowing in the wrong direction into the ureter. 

General anesthesia will need to be given during this procedure and the health care provider will need to use a cystoscope when injecting the gel. It will take roughly 30 minutes and the child’s bladder and urethra may be irritated for up to two days afterwards. 

Other side effects are also associated with this treatment option for VUR and it is likely the child will need to be on antibiotics for a few months to prevent infections. Your provider will review tips with you for how to ensure your child’s recovery is as smooth as possible. 

Stacy Tanaka, MD is a pediatric urologist at Vanderbilt University Medical Center in Nashville, Tenn.  |  SUMMER 2019  |  UROLOGYHEALTH extra