alexa Diagnosis and Management of Testicular Injuries | OMICS International
ISSN: 2168-9857
Medical & Surgical Urology
Like us on:
Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on
Medical, Pharma, Engineering, Science, Technology and Business

Diagnosis and Management of Testicular Injuries

Papoutsoglou N1,2* and Thiruchelvam N2

1Department of Urology and Pediatric Urology, Julius Maximilian University Medical School, Würzburg, Germany

2Department of Urology, University of Cambridge, Addenbrooke’s Hospital, Box 43, Cambridge CB2 0QQ, Cambridge, UK

*Corresponding Author:
Nikolaos Papoutsoglou
Department of Urology and Pediatric Urology
Julius Maximilian University Medical School
Würzburg, Germany
Tel: +49-93120138910
Fax: +49-93132009
E-mail: [email protected]

Received date May 28, 2013; Accepted date June 10, 2013; Published date June 13, 2013

Citation: Papoutsoglou N, Thiruchelvam N (2013) Diagnosis and Management of Testicular Injuries. Med Surg Urol 2:108. doi:10.4172/2168-9857.1000108

Copyright: © 2013 Papoutsoglou N, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Medical & Surgical Urology

Abstract

Testicular injuries are seldom because of the mobility of the testes and their anatomical position between the thighs, which offers them protection. They represent only a small percentage of traumatic injuries of the genitourinary tract. Etiologically we can categorize testicular trauma in blunt or penetrating. Treatment can be conservative or surgical. Significant haematocele indicates rupture of the tunica vaginalis testis and should be treated with surgical exploration and repair. Treatment decision can be made with the help of real time ultrasonography or sometimes MRI and CT-scans of the testes. Hormonal function remains in most of the cases normal but hormone status should be controlled in complicated cases, which affect fertility and could require hormone replacement.

Keywords

Testicular injuries; Vaginalis; Intratesticular; Orchidectomy

Introduction

Incidence and pathophysiology

Testicular injuries are seldom between the injuries of the genitourinary tract because of the protection offered to them by their anatomical position between the thighs and because of their mobility. Males between 15 and 40 years of age represent the most frequently affected group. According to the etiology testicular injuries are separated in blunt and penetrating, the first being the most common. Blunt testicular injuries can occur during sport activities especially full contact sports, assaults or traffic accidents mostly on bicycles and motorbikes. In most cases only the one of the testicles is involved with only 1.5% of blunt testicular injuries involving both testes [1].

Penetrating testicular injuries occur as a consequence of assaults with gunshots or knives, war injuries, especially bomb blasts; straddletype falls on sharp objects or in rare cases animal bites. They are in most of the cases associated with perineal, pelvic, or abdominal injuries [2].

The mechanism of injury in blunt trauma involves a blow forcing the testicle against the thigh or pubis with subsequent intraparenchymal bleeding. The rupture of the tunica albuginea which is the capsule in which the testicular parenchyma is situated, follows when the applied force exceeds 50 kg according to previous studies [3].

If the bleeding remains within the tunica vaginalis (another membranous structure surrounding the testicles) we speak about the formation of a haematocele. Breaking of the tunica vaginalis because of high intratesticular pressure and bleeding in scrotum forms a haematoma and an obvious enlargement of the affected testicle. Except blood there is also extravasation of testicular parenchyma in the scrotum.

Penetrating testicular injuries have a different mechanism as already mentioned and tetanus vaccination is mandatory with both active and passive immunization. Antibiotics should also be given for different periods of time depending on situation because of the risk of wound infection. Especially in case of animal bites (mostly dogs) vaccination against rabies must also be given [4,5].

Diagnosis

Patient history is alone enough to put the right diagnosis. Symptoms like pain, nausea, vomiting and sometimes fainting are the most common. Important is to remember that testicular trauma in minors could be an alarming sign of abusive assault (Figure 1).

medical-surgical-urology-bruised-enlarged-left

Figure 1: Photograph shows bruised enlarged left hemiscrotum of a 33-year old man presented 2 hours after being kicked whilst practicing a martial art.

On physical examination tenderness, swelling and ecchymosis of the hemiscrotum are always present. The testicles are not always easy to palpate especially in cases of big haematomas or in case of traumatic dislocation of the testicles for example in the inguinal region or rare in the abdominal cavity [6,7].

High resolution ultrasonographic evaluation (Figure 2) represents the first-line imaging modality in diagnosing suspected testicular ruptures with high specificity and sensitivity rates in cases of equivocal physical examinations. Characteristically features are the discontinuity of the echogenic tunica albuginea and heterogeneous echo pattern of the testicular parenchyma.

medical-surgical-urology-Ultrasound-left-testicle

Figure 2: (A) Ultrasound shows left testicle with no flow on colour Doppler and tunica albuginea rupture as compared to (B), a normal right testicle with an intact capsule and healthy blood supply.

Color flow and duplex Doppler imaging helps assessing the testicular viability and perfusion. If inconclusive, testicular MRI or CTscan may be helpful as second-line imaging modalities [8-13].

Although ultrasonography can distinguish various testicular injuries cannot be used alone for the diagnosis of testicular rupture [11]. In any case that imaging studies cannot definitively exclude testicular rupture and if clinically a tear of the tunica albuginea is suspected, surgical exploration is indicated [14,15].

Management

Insignificant testicular injuries without signs of haematocele or haematoma should be treated conservatively administrating nonsteroidal analgesics, local cooling with ice-packs and elevation of the affected testis in order to avoid pain and scrotal swelling [8]. Also in cases of blunt injuries with haematoceles smaller than three times the size of the contralateral testis, conservative management is recommended [16,17]. Every other injury should be treated with early surgical exploration and drainage of the haematoma or haematocele and excision of necrotic tissues [1] (Figure 3).

medical-surgical-urology-Intraoperative-split-capsule

Figure 3: Intraoperative photograph shows split capsule with extruding haematoma.

The closure of the tunica vaginalis is mandatory in every case of rupture. In cases of extended destruction of the tunica albuginea new technics describe the use of free tunica vaginalis flaps for testicular closure and preservation of the testicular parenchyma [18].

If traumatic dislocation of the testis occurs should be treated with manual replacement and orchidopexy in one or two stages (Figure 4).

medical-surgical-urology-healthy-bleeding-tissue

Figure 4: Intraoperative photograph shows debrided haematoma back to healthy bleeding tissue.

Penetrating testicular injuries are more severe and often associated with injuries of other organs and structures necessitating more aggressive approaches. Surgical exploration with debridement of necrotic tissue or even orchidectomy, if the testis is no more viable are indicated. Antibiotics are recommended and tetanus prophylaxis is for penetrating injuries mandatory [6,19].

A delayed surgical management can lead to infection, chronic pain, testicular atrophy and impairment of hormonal function as long as in increased orchidectomy rates [8] (Figure 5).

medical-surgical-urology-capsular-closure

Figure 5: Intraoperative photograph shows capsular closure.

Fertility impairment after testicular injuries is seen only in bilateral orchidectomies where testosterone substitution must be offered to the patients for life. In any other cases of unilateral orchidectomy fertility should not represent a problem in the future as long as the endocrinological function of the contralateral testis proves to be normal. If testosterone deficiency is suspected because of suggestive symptoms as low libido, decreased muscle mass and strength, gynecomasty and sometimes erectile dysfunction, semen analysis and hormonal determinations for testosterone, FSH and LH should be performed [20,21].

References

Select your language of interest to view the total content in your interested language
Post your comment

Share This Article

Relevant Topics

Recommended Conferences

  • 7th International Conference on Clinical and Medical Case Reports June 01-02, 2018 Osaka, Japan Theme: Focusing the breakthroughs of case reports in Clinical & Medical Research
    June 01-02, 2018 Osaka, Japan
  • 7th International Conference and Exhibition on Surgery June 21-23, 2018 Dublin, Ireland Theme: Advancements and Endeavours in the Field of Surgery
    June 21-23, 2018 Dublin, Ireland Dublin, Ireland
  • World Summit on Trauma and Reconstructive Surgery Sep 10-11, 2018 Singapore Theme: Expanding new horizons in Trauma and Surgery
    Sep 10-11, 2018 Singapore City, Singapore
  • International Conference on Reproduction and Fertility October 18-19, 2018 Abu Dhabi, UAE
    October 18-19, 2018 Abu Dhabi, UAE
  • 11th International Conference on Clinical and Medical Case Reports October 22-23, 2018 Turkey
    October 22-23, 2018 Istanbul, Turkey

Article Usage

  • Total views: 12043
  • [From(publication date):
    September-2013 - Dec 15, 2017]
  • Breakdown by view type
  • HTML page views : 8246
  • PDF downloads : 3797
 

Post your comment

captcha   Reload  Can't read the image? click here to refresh

Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri & Aquaculture Journals

Dr. Krish

[email protected]

1-702-714-7001Extn: 9040

Biochemistry Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

[email protected]

1-702-714-7001Extn: 9042

Chemistry Journals

Gabriel Shaw

[email protected]

1-702-714-7001Extn: 9040

Clinical Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Engineering Journals

James Franklin

[email protected]

1-702-714-7001Extn: 9042

Food & Nutrition Journals

Katie Wilson

[email protected]

1-702-714-7001Extn: 9042

General Science

Andrea Jason

[email protected]

1-702-714-7001Extn: 9043

Genetics & Molecular Biology Journals

Anna Melissa

[email protected]

1-702-714-7001Extn: 9006

Immunology & Microbiology Journals

David Gorantl

[email protected]

1-702-714-7001Extn: 9014

Materials Science Journals

Rachle Green

[email protected]

1-702-714-7001Extn: 9039

Nursing & Health Care Journals

Stephanie Skinner

[email protected]

1-702-714-7001Extn: 9039

Medical Journals

Nimmi Anna

[email protected]

1-702-714-7001Extn: 9038

Neuroscience & Psychology Journals

Nathan T

[email protected]

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

Ann Jose

[email protected]

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

[email protected]

1-702-714-7001Extn: 9042

 
© 2008- 2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version