Testicular Embolism Special Procedure requiring Special Sensitivity on the part of the Radiology Department and Attending Physicians

Testicular patients dying through ignorance," proclaimed a 2002 article in Life Extension Daily News. Researchers from Nijmegen's University Medical Center St. Radboud warned that a treatment delay of more than three months for testicular carcinoma was associated with a "significantly decreased" five-year survival rate. The most commonly cited reason for this critical diagnostic delay was not monetary issues. Instead, the delay was often due to patients fear and embarrassment of the condition and the location of the condition in the body. (Health Media Ltd., 2002) One way to prevent the spread of testicular carcinoma is speedy detection and treatment. Patients must conduct self-examinations on a regular basis, of course, and take responsibility for their own health. However, after detection has been made of a suspicious testicular mass, the next step often is the procedure of testicular embolism, as performed by a hospital's radiology department.

The other frequently cited reason for poor detection of testicular was ignorance of the condition of the cancer at all, much less the need to provide appropriate self-screening. This ignorance was attributed to doctor's own unwillingness to bring up such a potentially embarrassing complaint with a patient. (Health Media Ltd., 2002) "Some men with large testicular lumps continue to evade the medical profession despite all efforts. Medical professionals and the general population, especially men, need to be educated to recognize that testicular lumps are a medical emergency," added Dr. Jeremy Steel, of London's St. Bartholomew's Hospital in The Lancet. Not only is the procedure feared as a threat to male fertility, there is fear that simply discussing the condition or procedures relating to the condition may somehow threaten a man's masculinity.

Given this state of medical affairs, it is critical that a specialist in the Radiologist Department of any hospital become abreast of the ways to screen for testicular abnormalities in a patient, and to have a healthy and open attitude to discussing the procedure of testicular embolisms. Dr. Steel added it was essential that medical students were trained in examination of the "external genitalia," as part of the regular examination of the abdominal system. (Health Media Ltd., 2002)

However, even when a patient is fully aware of the need for self-screening, there can be no doubt that the issue is a difficult one. "On Monday morning, May 12, 1997, I noticed in the shower that my right testicle seemed larger than my left. Having a million things to do, I promptly forgot it, and went about my hectic schedule. By Wednesday morning, however, the affected testicle seemed to have grown even larger, and was now about twice the size of the other. I knew this condition was not normal, so I went to the College Health Services that day to have it examined," noted John Callavaro, an M.B.A. student at the Amos Tuck School of Business at Dartmouth University.

Luckily, Callavaro was treated by a physician at this prestigious university's student health services department who knew exactly what to do when confronted by the sight of such a suspicious mass, even in a patient as young and as healthy as Callavaro. When the attending urologist saw his testicle, she knew it was not a hydrocele, or a benign mass. Callavaro had a scrotal ultrasound immediately. This ultrasound sadly confirmed a heterogeneous or cancerous mass. The urologist told the patient that the testicle needed to come out at once, and that the tumor was most likely malignant. (Callavaro, 2002)

This patient's first reaction is indicative and instructive of the reactions a physician might encounter when discussing any radiology procedure regarding testicular cancer. "My first reaction was shock: How could this be happening? Then terror: Oh God, tell me this is not happening. Then disbelief: How could they be so sure? How would I live with only one testicle?" The attending physician must be aware of these possible reactions and also other concerns, such as taking time off from school, as in Callavaro's case, and paying for the procedures through the patient's current health insurance. (Callavaro, 2002)

Blood was drawn to determine Callavaro's baseline tumor marker levels. He was then informed of the different steps of the procedures he would be confronted with, the first of which was a testicular embolism. Once in the hospital, he was provided with anti-embolism stockings and an IV was inserted. One thing that gave the patient a state of empowerment about these procedures was the way that...

They explained to him that soon as he recovered from the anesthesia, he could go home. "I awoke in recovery with a small scar on my bikini line. The nurses gave me Percocet for the pain. By evening I was home and spent the next day or so just resting. By Monday, I was feeling good enough to drive myself to my CT scan appointment at the hospital. We needed to find out how far the disease had spread, and determine my course of future treatment." (Callavaro, 2002)
Understanding what he or she must do to facilitate the process of the conscious sedation or limited sedation, if possible, before the procedure is critical. Callavaro's conscious sedation, as with any sedation for such a procedure was administered to the patient by a specially trained radiology nurse. The patient undergoing sedation should be told that the purpose of the sedation is to relax his muscles and to relax him psychologically during the procedure and to reduce any discomfort that he might experience in body or mind.

He "may" or may not be "drowsy," depending on his individual reaction to sedation. The patient should be able to remain conscious and able to speak and follow instructions by the radiologist throughout the procedure. Rather than being "put to sleep," the patient should be assured that he is in control of the procedure. ("Conscious Sedation," FAQs about Vascular Procedures, 2003)

The most frequently used medication given for conscious sedation is Fentanyl and Midazolam. A patient should be comfortable enough with the physician to tell the physician about any allergies he might have to either of these medications, which would be given to the patient with an IV prior to the procedure. Also, the patient must discontinue any medications with contraindications to these medications beforehand. ("Conscious Sedation," FAQs about Vascular Procedures, 2003)

Other things to stress to the patient are that he cannot eat solid foods for six hours before the testicular embolism procedure, although he may have clear water, black coffee or tea, or apple, cranberry, grape juices, Jell-O and broth, two hours beforehand. He may take all of his routine medications with clear liquids up to two hour before the procedure. If the patient a diabetic on insulin, he must consult with his doctor regarding insulin dosages during fasting on the morning of your procedure. A nurse from radiology should call the patient and verbally review all of these instructions, and also remind him that he must have a responsible adult driver to escort him home from the hospital, in case he might still be groggy from the sedation. ("Conscious Sedation," FAQs about Vascular Procedures, 2003)

During the procedure, the patient will lie on an x-ray table. The technologist will prepare the skin over the groin by cleaning it with an antiseptic solution and place sterile drapes and towels over to create a sterile workspace. Lidocaine local anesthesia or another form of anesthesia of comparable chemical components will be injected into the skin overlying the patient's exposed groin. A catheter is then placed into the artery and contrast dye is injected to allow visualization of the arteries that supply the region of the tumor or vascular malformation to the physicians and individuals observing the procedure. ("What Happens During the Procedure," FAQs about Vascular Procedures, 2003)

Once the blood supply the region in question has been adequately defined, a catheter is directed as close to the area as possible. Additional contrast is injected to ensure against embolization of unintended regions. Depending on the nature of the embolization, particles, coils or chemotherapeutic drugs, are then injected. Following embolization, contrast dye is reinjected to be certain that the entire area of interest is embolized. The catheter is removed and pressure is applied to the groin until there is no bleeding (approximately fifteen minutes.) This procedure typically requires approximately one and a half to three hours from the physician's point-of-view. ("What Happens During the Procedure," FAQs about Vascular Procedures, 2003)

The procedure is relatively unobtrusive. But because conscious sedation medicine has been administered and the femoral artery has been punctured, the patient may be required to stay to recover for five to six hours after the end of the procedure. Although the patient should not be alarmed, he should be alerted to the possibility that different…