Testicular trauma

Background

Scrotal anatomy

Testicular anatomy

1. Epididymis 2. Head of epididymis 3. Lobules of epididymis 4. Body of epididymis 5. Tail of epididymis 6. Duct of epididymis 7. Deferent duct (ductus deferens or vas deferens)

Clinical Features

Blunt trauma due to impingement against symphysis pubis
- Will have contusion or rupture based on whether tunica albuginea is disrupted
- Large, blue, tender scrotal mass (hematocele)
Testicular dislocation
- Absent testicle

Differential Diagnosis

Genitourinary Trauma

Urinary system
Genital
Other
- Child abuse
- Pelvic fracture (often accompanies)
- Sexual assault

Evaluation

Images of the for testicular trauma: normal anatomy, testicular rupture, hematoma, and torsion.

Sagittal ultrasound demonstrating a boundary between the subcapsular hematoma and testicle (white arrows). There is a loss of the clear tunica vaginalis along the right portion of the image, which is concerning for testicular rupture (orange arrow), compared with the intact tunica vaginalis (blue arrow).

Scrotal ultrasound required for all blunt testicular injuries
- Reliable in diagnosing ruptured testes^[1]

Management

Most testicular injuries are managed conservatively
- Analgesia, ice, elevation, scrotal support, urology follow up
Consult Urology for urgent operative care
- Testicular rupture
- Testicular dislocation (absence)

Disposition

See above. Depends on underlying diagnosis identified.

External Links

References

↑ Buckley JC, McAninch JW. Use of ultrasonography for the diagnosis of testicular injuries in blunt scrotal trauma. J Urol 2006;175:175-8.

Authors:

[1] Buckley JC, McAninch JW. Use of ultrasonography for the diagnosis of testicular injuries in blunt scrotal trauma. J Urol 2006;175:175-8.

[1]