The mobility of the scrotum, the reflex activity of the cremaster muscle, and the protective tunica albuginea provide relatively good protection for the testicles. However, severe impacts, sports injuries, and traffic accidents can still result in testicular contusion, rupture of the tunica albuginea, hematoma formation, displacement, or torsion.
Etiology
Blunt trauma accounts for approximately 75% of cases of testicular injury, with the remainder caused by penetrating injuries, such as those resulting from firearms, explosions, or sharp object wounds. Only about 1.5% of patients with blunt trauma experience bilateral testicular involvement, whereas scrotal penetrating injuries result in bilateral testicular damage in approximately 30% of cases.
Clinical Manifestations
Common manifestations include:
- Severe pain in the testicles following trauma, with the pain radiating to the lower abdomen, lumbar region, or upper abdomen. Swelling or hematomas may be present in the scrotal skin. In certain cases, pain may not be severe and may instead manifest primarily as scrotal distention and discomfort.
- Nausea, vomiting, or even painful shock.
- Enlargement of the testicles, with the borders difficult to discern upon palpation.
- Thickening of the spermatic cord in cases of testicular torsion.
- Displacement of the testicle may lead patients to report a hollow sensation in the scrotum at the site of the original testicle, with palpable lumps resembling the testicle located elsewhere.
Diagnosis
Medical History and Physical Examination
Scrotal trauma warrants consideration of potential testicular injury. Patients typically present with complaints of severe scrotal pain and nausea. The severity of scrotal swelling, bruising, and hematoma does not correlate strongly with the extent of testicular injury, as unruptured testicular contusions may still exhibit significant bleeding.
Ultrasound Examination
Ultrasound imaging facilitates the assessment of testicular integrity and blood supply. Heterogeneous echogenicity in testicular parenchymal tissue and disruptions in the continuity of the tunica albuginea may suggest testicular rupture.
MRI Examination
Magnetic resonance imaging effectively identifies the integrity of the testicles, aiding in diagnosis.
Treatment
The primary objectives of treatment involve removing devitalized testicular tissue, closing the testicular capsule (tunica albuginea), and repairing the scrotum.
Conservative Management
Mild testicular contusions may benefit from management strategies such as cold compresses, elevation of the scrotum, and pain relief measures.
Surgical Management
Surgical exploration and repair aim to preserve testicular function, prevent infection, control bleeding, and shorten recovery time. In most cases, a transverse incision of the scrotum may be necessary, followed by removal of necrotic tissue and extruded seminiferous tubules, with closure of the tunica albuginea using fine absorbable sutures. Even in cases of unruptured testicles, extensive intra-testicular hematomas should undergo prompt surgical exploration and drainage to prevent elevated pressure leading to necrosis and atrophy. Early surgical exploration is recommended for scrotal penetrating injuries.