Testicular Trauma: Injury of the Testes
Definition and Etiology of Testicular Trauma
Testicular trauma is an injury of the testes, usually caused by blunt force impact due to traffic accidents, fights or sports injuries. Penetrating or degloving trauma is also possible (Buckley and McAninsh, 2006).
Signs and Symptoms of Testicular Trauma
Testicular pain, scrotal hematoma, soft tissue injuries depending on the etiology of testicular trauma.
Diagnostic Work-Up in Testicular Trauma
Ultrasonography of the Testes:
- Important is the localization of the hematoma, which can be scrotal, in the cavum serosum testis or within the testicular parenchyma [fig. intratesticular hematoma].
- The next important step in ultrasonography is the detection of a testicular rupture (tearing of the tunica albuginea) [fig. testicular rupture].
- Detection of decreased blood flow with Doppler ultrasonography.
- The extent of injury can be easily underestimated with ultrasonography (Bhatt and Dogra, 2008). Inhomogeneities in the testicular parenchyma and evidence of a hematoma within the cavum serosum testis are signs of a rupture of the tunica albuginea, even if it appears intact.
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fig. ultrasonography of a testicular hematoma after blunt testicular trauma. By courtesy, Prof. Dr. R. Harzmann, Augsburg. |
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Ultrasonography of a three-days old testicular rupture: on the right side, an intact tunica albuginea is seen, the testicular tissue appears homogeneous there. On the left side, the tunica cannot longer be seen, the prolapsing testicular tissue appears inhomogeneous. |
Treatment of Testicular Trauma
Conservative treatment of testicular injury:
Conservative treatment of testicular trauma is indicated for mild hematoma without tear of the tunica albuginea and without decreased blood flow of the testis. A testicular rupture may occur later in the course of convervative treatment. Conservative treatment consists of analgesics, elevation of the scrotum, local cooling and bed rest.
Surgical Treatment of testicular injury:
The scrotal management is necessary for a pronounced hematoma (hematocele), for suspected testicular rupture and for a decreased testicular blood flow. Surgical treatment depends on the intraoperative findings: detorsion of the testis, removal of hematoma or nonviable tissue, suture of the tunica albuginea. Orchiectomy is necessary in complete testicular destruction.
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References
- Bhatt, S. & Dogra, V. S.
- Role of US in
testicular and scrotal trauma.
Radiographics, 2008, 28, 1617-1629 - Buckley, J. C. & McAninch, J. W.
- Diagnosis and
management of testicular ruptures.
Urol Clin North Am, 2006, 33, 111-6, vii
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