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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. Half of the direct, blunt injury leads to testicular rupture (tearing of the tunica albuginea). Swelling and intratesticular bleeding may cause progressive testicular ischemia with later atrophy if the tunica albuginea does not rupture. Less common are penetrating or degloving injury patterns.

Signs and Symptoms of Testicular Trauma

Testicular pain, scrotal hematoma, and soft tissue injuries depend 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].
• Evaluate the testicular blood flow with Doppler sonography.
• The extent of injury is easily underestimated with testicular ultrasound imaging (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-day-old testicular rupture: an intact tunica albuginea with regular testicular tissue is seen on the right half of the image. On the left side, the tunica is not visible; the prolapsing testicular tissue appears inhomogeneous.

Ultrasound imaging of complete testicular rupture. See also fig. surgical repair of a complete testicular rupture for intraoperative findings.

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 or decreased blood flow of the testis. Conservative treatment consists of analgesics, elevation of the scrotum, local cooling, and bed rest. Testicular ischemia or rupture due to swelling or bleeding may occur later in the course, regular follow-up is necessary.

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, and suture of the tunica albuginea. Orchiectomy is necessary for patients with complete testicular destruction.

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

N. D. Kitrey, F. Campos-Juanatey, P. Hallscheidt, E. Serafetinidis, and D. M. Sharma, “EAU Guidelines: Urological Trauma,” 2022. [Online]. Available: https://uroweb.org/guidelines/urological-trauma/.

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