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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. Swelling may cause progressive testicular ischemia with later atrophy, if the tunica albuginea did not rupture. 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 Workup 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.

Ultrasound imaging of intratesticular hematoma after blunt trauma. With kind permission, Prof. Dr. R. Harzmann, Augsburg.

Ultrasound imaging of a three-days old testicular rupture: on the right side, an intact tunica albuginea with regular testicular tissue is seen. On the left side, the tunica is not visible, 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:

Scrotal exploration is necessary for patients with significant hematoma (hematocele), with suspected testicular rupture or if a decreased testicular blood flow is seen. Surgical treatment depends on the intraoperative findings: detorsion of the testis, removal of hematoma and nonviable tissue, suture of the tunica albuginea. Orchiectomy is necessary for patients with complete testicular destruction.

References

  Deutsche Version: Hodenverletzung