Blunt Scrotal Trauma Research Articles

Rare Diagnosis in the Emergency Department: Traumatic Testicular Dislocation

Abstract: Introduction: Traumatic Testicular Dislocation (TTD) is a rare form of scrotal trauma, involving the displacement of the scrotum directly towards the surrounding tissues due to direct compression, often occurring towards the inguinal area. In this report, we present a case of TTD in an adult patient involved in a motor vehicle accident and provide a brief review of this rare condition. Case Report: An 18-year-old male patient was brought to our emergency department following a motorcycle accident. The patient reported a new swelling in his left groin. On physical examination, the left side of the scrotum was found to be empty, without the presence of hematoma. A swelling in the described area was palpated in the left inguinal region. A CT scan, conducted due to trauma, did not reveal the left testis in its normal position; instead, the testis was identified in the left inguinal region. Scrotal Doppler ultrasound was performed. The left testis was manually manipulated and descended into the left scrotum by Urologist. Conclusion: Testicular dislocation is a rare complication of blunt scrotal trauma. Even in the presence of multiple injuries, a thorough examination of the testicles is always recommended. Ultrasound (USG) and Doppler USG are the most useful diagnostic tools for TTD, but CT can also be helpful in cases of complex trauma. While TTD is not a life-threatening condition, a careful plan is recommended for the repositioning of the testis.

Testicular rupture in a young patient: diagnostic value of contrast-enhanced ultrasonography

Testicular rupture after a blunt scrotal trauma is characterized by tearing of the tunica albuginea that result in the extrusion of the seminiferous tubules.
 Imaging, particularly ultrasonography, plays a crucial role in the assessment of scrotal trauma and directs patient management toward conservative or surgical treatment. Conventional B-mode and color Doppler ultrasonography are the main imaging techniques in the evaluation of the testicle in trauma but may underestimate the extent of injury. The most important information for the surgeon is the integrity or interruption of the tunica albuginea and the extent of vital testicular tissue. The latter is often difficult to assess with conventional ultrasonography because the injured testicle is often hypovascular even in vital regions due to testicular edema that compromises vascular flow. The selective use of advanced techniques such as contrast-enhanced ultrasonography is important in identifying testicular viability when color Doppler ultrasonography is equivocal.
 This case report describes the evaluation and management of a blunt testicular trauma in a 15-year-old football player.

Trauma-Induced Testicular Torsion Successfully Salvaged Five Days After Blunt Scrotal Trauma: A Case Report

Trauma-Induced Testicular Torsion Successfully Salvaged Five Days After Blunt Scrotal Trauma: A Case Report

Use of contrast enhanced ultrasound in testicular diseases: A comprehensive review.

BackgroundContrast‐enhanced ultrasound (CEUS) is a sonographic technique that increases the diagnostic accuracy of ultrasound and color Doppler ultrasound (CDUS) when studying testicular abnormalities. However, its role in clinical practice is still debatable because there are no accepted standards regarding how and when this technique should be used for patients with testicular disease.ObjectivesTo perform a nonsystematic review of the current literature to highlight the strength and flaws of performing CEUS and to provide a critical overview of current research evidence on this topic.Materials and methodsA thorough search of published peer‐reviewed studies in PubMed was performed using proper keywords.ResultsStrong enhancement of neoplastic lesions (both benign and malignant) during CEUS aids in differential diagnosis with non‐neoplastic lesions, which usually appears either nonenhanced or enhanced in a manner similar to that of the surrounding parenchyma. CEUS enhancement has a high predictive value in the identification of neoplastic lesions, whereas a similar or complete absence of enhancement may be interpreted as strong evidence of benignity, although there are exceptions. Literature on quantitative analysis is still scarce, though promising, particularly in distinguishing benign from malignant neoplasms. Furthermore, CEUS may be useful in many emergency situations, such as acute scrotum, blunt scrotal trauma, and focal infarction of the testis. Finally, CEUS can help increase the probability of sperm recovery in azoospermic males.Discussion and conclusionCEUS is a safe, easy‐to‐perform, and cost‐effective diagnostic tool that can provide a more accurate diagnosis in testicular lesions and acute scrotal disease. However, further studies with larger cohorts are required to refine the differential diagnosis between benign and malignant neoplasms. Finally, these preliminary results can instigate the development of innovative research on pre‐testicular sperm extraction to increase the chances of sperm recovery.

English

Hematocele with blunt scrotal trauma is an uncommon cause of the testicular pain. Elastography is the new recent advance in the field of ultrasound. USG and elastography findings of the acute hematocele is described in this aricle. Testicular trauma is the third most common cause of acute scrotal pain,1 and high-frequency ultrasonography (USG) with a linear array transducer is the first preferred modality for testicular trauma evaluation. Extra testicular haematoceles or blood collections inside the tunica vaginalis are the most common findings in the scrotum after blunt injury.2 On clinical assessment, haematocele appears as a hard mass like swelling and causes pain in the scrotum. In the majority of cases, spontaneous resolution occurs with the support of conservative therapy,3 even if treated conservatively, may result in infection, discomfort, or atrophy in undiagnosed broad hematoceles and testicular hematomas over time.4 A testis with its coverings, epididymis, and spermatic cord are all contained in each hemiscrotum. A typical testis is 5 x 3 x 2 cm in diameter and has an intermediate echogenicity. The tunica albuginea is a fibrous covering that protects the testis from damage from the external injuries. It is located on top of the tunica vasculosa, which is made up of capsular arteries. A testis with its coverings, epididymis, and spermatic cord are all contained in each hemiscrotum. With its high tensile strength, the tunica albuginea plays an important role in shielding the testis from trauma. It can withstand a force of up to 50 kg without bursting. The testicular parenchyma is made up of several lobules, each of which is made up of several seminiferous tubules that lead to dilated spaces inside the mediastinum called the rete testis through the tubuli recti. The epididymis is made up of a head, neck, and tail that protects the superolateral part of the testis. The epididymis' tail ends in the spermatic cord as the vas deferens. The epididymal head is a 5 – 12 mm pyramidal structure that sits atop the testis' superior pole. The head is almost isoechoic to the testis. The epididymis has a 2 – 4 mm thick body.5 The patient lies in a supine position with the scrotum covered by a towel positioned between the thighs during scrotal ultrasound. A high-frequency lineararray transducer with a frequency range of 7 – 14 MHz is preferred. The scrotum is always soft to the touch after trauma, making scanning difficult. It should be attempted to examine both the testes and the epididymis in their entirety, as well as any extra testicular lesions. The testes are assessed in two planes: longitudinal and transverse. Each testis and epididymis should be compared to the contralateral testis and epididymis in terms of size and echogenicity. Transverse scrotal imaging is important for depicting both testes and comparing their gray-scale and colour Doppler appearances.

How common are traumatic injuries to the epididymis? A study of prevalence, imaging appearance, and management implications.

To evaluate the prevalence of epididymal injuries with scrotal trauma, review imaging appearance, clinical management, and outcomes. In this retrospective study, the radiology report database was queried for scrotal ultrasounds containing keywords pertaining to trauma, from 1998 to 2019. Exams with no clinically documented trauma, exams with trauma > 1year ago, and duplicate exams were excluded. Chart review was conducted for age, trauma mechanism, time interval between trauma and ultrasound, signs of infection, and clinical management. Reports were reviewed to record the presence of scrotal injury, traumatic epididymitis, or epididymal hematoma. Cases with epididymal injury underwent image review. Descriptive statistics, Fisher's exact test, and Mann-Whitney's U test were performed to evaluate for associations between clinical parameters and epididymal injury. Initial search yielded 385 exams. A total of 103 exams met inclusion criteria. Trauma mechanisms included straddle injury (35%), blunt scrotal trauma by ball or other object (29%), assault (28%), penetrating injury (4%), and fall (3%). Sixty-eight patients (66%) had scrotal injury on imaging. Twenty-six (25%) had epididymal injury. Thirteen were isolated to the epididymis, and 13 had associated testicular or extra-testicular findings. There were 12 cases of traumatic epididymitis and 14 epididymal hematomas. All epididymal injuries were managed non-operatively. A total of 7 were prescribed antibiotics, including 1 subject who otherwise had no evidence of infection. Epididymal injury is encountered in 25% of scrotal ultrasounds for trauma evaluation. Traumatic epididymitis can be seen in 12%. It is important for radiologists to recognize this entity, as it can be mistaken for infection.

MP04-05 SCROTAL ULTRASOUND REDUCES UNNECESSARY SCROTAL EXPLORATION IN BLUNT SCROTAL TRAUMA

INTRODUCTION AND OBJECTIVES:Scrotal ultrasound (US) use in the setting of blunt scrotal trauma (BST) has been controversial despite multiple studies demonstrating excellent sensitivity in this cont...

Scrotal trauma: A case report and review of the literature.

Genitourinary (GU) injury is present in approximately 10% of cases of abdominal trauma.1 Of those GU injuries, up to 67% involve the external genitalia.2,3 GU trauma is more common in males, especially in the instance of genital injury. This increased incidence in males is secondary to both anatomical considerations and increased participation in activities such as contact sports, violent interaction, and war activities.2 The lower urinary tract is susceptible to traumatic injury by way of various mechanisms. These injuries, and their sequelae, can affect patients of any age or background. Though lower urinary tract trauma rarely results in life-threating pathology, appropriate management of these injuries is pivotal in decreasing long-term morbidity.4 Although the external genitalia in males are at high risk of injury in trauma because of their extracorporeal location, the scrotum and testes are relatively well-protected from severe damage for the following reasons: 1) the testes are inherently mobile within the scrotum; 2) the scrotal skin provides reasonable elasticity allowing for internal structures to slip away from the point of contact in blunt trauma; 3) the cremasteric reflex offers a protective reflex mechanism; and 4) the tunica albuginea serves as a tough fibrous physical defense with its tensile strength.4–6 Resultantly, the incidence of scrotal or testicular injury in a trauma activation is generally considered to be less than one percent. However, the associated morbidity to the patient (including psychological effects of testicular injury or loss) and health system costs associated with these injuries warrant special attention.5,7–9 In general, there are two broad domains to consider when evaluating scrotal trauma: blunt vs. penetrating injury. Historically, blunt injury has been thought to comprise the significant majority (i.e., 75–80%) of genital trauma.2,4 A recent analysis of the National Trauma Data Bank in the U.S. described a more balanced distribution of penetrating vs. blunt scrotal trauma, with both representing nearly half of all injuries.5 However, this significant difference in reported mechanism may be attributable to input biases and geopolitical determinants (e.g., increased incidence of gunshot wound [penetrating] injuries in the U.S. compared to other nations). The importance of categorizing these these types of injuries into broad classes lies in the special diagnostic and management considerations for each type of injury (Fig. 2). For example, while just 1.5% of blunt testicular injury involves the gonads bilaterally, approximately 30% of penetrating scrotal injury will involve both testes. Additionally, penetrating injury occurs with associated injuries in approximately 70% of patients, decreasing the threshold of suspicion of damage to neighboring structures, such as the penis, bladder, urethra, and femoral vessels.2,4 However, workup for associated injury should not be neglected in the setting of blunt trauma either, and nearby structures should be appropriately investigated when clinical suspicion is present (e.g., blood at the urethral meatus suggesting urethral injury).4 Other domains of scrotal trauma, including thermal and degloving/scrotal wall avulsion injuries, are described in the literature as well and will be discussed here briefly. Open in a separate window Fig. 2 Simplified diagnostic and management pathway in blunt and penetrating scrotal trauma.

The dangers of hurling-genital injuries arising in the modern game.

To assess the proportion of penoscrotal injuries arising from the sport of hurling and to assess work-up and management of each injury. Using Hospital In-Patient Enquiry data, all penoscrotal injuries occurring over a 10-year period between 2007 and 2017 were identified and assessed. Chart review, imaging reports, operative notes and discharge summaries were used to identify the aetiology of each injury and those occurring due to hurling were selected for analysis. Investigations and management of each case were reviewed. Seventy patients presented to our institution over a 10-year period with penoscrotal injuries and, of these, ten patients (14%) presented with injuries arising due to blunt scrotal trauma whilst playing hurling. The average age of these patients was 24.3years, and the right testicle was injured six times, compared with the left testicle twice and isolated scrotal injuries twice also. One hundred percent of patients underwent diagnostic ultrasonography with Doppler flow assessment with 90% (n = 9) having positive findings. Three patients (33%) required operative management with only one patient (10%) requiring an orchidectomy. There were no delayed or interval procedures. Hurling is a physical sport with a notable proportion of blunt scrotal trauma arising due to the sport. Prompt physical examination and diagnostic ultrasonography are essential in investigations of injuries, and surgical exploration should be considered in all cases with concerns of testicular survival. Groin protection should be recommended to all players and in particular to those at high risk such as single testis or prior injury.

Blunt testicular trauma - is surgical exploration necessary?

EAU and AUA guidelines recommend urgent surgical exploration in cases of suspected testicular rupture. However, the management of rupture to other encapsulated organs (e.g. kidney) is primarily non-operative. The aim of this study was to evaluate the conservative management of blunt scrotal trauma. Standard practice in our Level II trauma centre is to manage all blunt scrotal injuries conservatively with analgesia, antibiotics and scrotal support. Ultrasonography is performed where testicular injury or haematocoele is suspected clinically. All patients are offered a 3month follow-up appointment. A retrospective chart review was performed on all patients who underwent ultrasonography for blunt scrotal trauma between 1998 and 2014. Each patient was contacted by telephone to assess for testicular atrophy. Thirty-seven consecutive patients were identified for inclusion in the study. Twenty-three patients (62%) were diagnosed with significant testicular injury (rupture of tunica albuginea or large haematocele). All were managed conservatively regardless of ultrasound findings. Four patients had evidence of testicular atrophy at their three month follow up appointment. None reported chronic pain or required delayed orchidectomy. Four patients later underwent repair of an asymptomatic post-traumatic hydrocoele. Our experience shows that blunt scrotal trauma can be safely managed conservatively and may reduce the risk of atrophy compared to case series where the testis was surgically explored.

Usefulness of Preoperative Ultrasound for the Evaluation of Testicular Rupture in the Setting of Scrotal Gunshot Wounds

A scrotal gunshot wound may result in testicular injury, necessitating urgent scrotal exploration and attempted testicular salvage. Scrotal ultrasound is highly sensitive and specific for testicular rupture in the setting of blunt scrotal trauma but it has been poorly studied in the setting of scrotal gunshot wounds. Our objective was to determine the accuracy of scrotal ultrasound to identify testicular rupture following a scrotal gunshot wound. We retrospectively reviewed the records of patients with a scrotal gunshot wound from 2003 to 2014 in whom preoperative ultrasound was done prior to scrotal exploration. A heterogeneous echo pattern of testicular parenchyma with contour loss was considered a positive examination for testicular rupture. Patients underwent scrotal exploration within 24 hours of presentation. The sensitivity and specificity of ultrasound were estimated and compared to operative findings. ROC curve analysis was done. Of 75 patients who sustained a scrotal gunshot wound ultrasound was positive in 30 and negative in 45. No ultrasound revealed bilateral injuries. Scrotal exploration demonstrated a total of 40 testicular ruptures in 35 patients, of which 30 testicles were salvaged. Ten orchiectomies were performed. The sensitivity and specificity of ultrasound were 60% and 95%, respectively, with 16 missed injuries and 6 false-positive findings. Positive predictive value was 80% and negative predictive value was 87%. The ROC AUC was 0.79. In 6 of the 16 missed injuries there was an ipsilateral hematocele or hematoma. The sensitivity of scrotal ultrasound is limited for evaluating testicular rupture after a scrotal gunshot wound. Large coincident hematoceles or hematomas may obscure the diagnosis of testicular rupture. Negative ultrasound should not preclude scrotal exploration after a scrotal gunshot wound is sustained.

A Review of Imaging Modalities Used in the Diagnosis and Management of Scrotal Trauma.

Genitourinary tract injuries account for 3 to 10% of trauma patients, and scrotal trauma is particularly prevalent in males 10 to 30years of age. Prompt diagnosis and timely surgical intervention are essential to prevent future complications of infertility, delayed orchiectomy, infection, and testicular atrophy. While clinical examination provides valuable information, it may be inconclusive due to soft tissue swelling and difficult to perform due to testicular pain with palpation. Conversely, testicular rupture does not always present with pain or tenderness. Imaging can contribute additional support for surgical evaluation in scrotal trauma. Current AUA guidelines support ultrasound in blunt scrotal trauma to confirm testicular rupture while recommending early exploration in penetrating injuries due to the high incidence of testicular rupture. This review discusses the existing literature on the use of various imaging modalities in assessment of blunt and penetrating scrotal trauma and common imaging findings.

Blunt Scrotal Trauma in Soldiers-Epidemiology and Outcome.

Blunt scrotal trauma (BST) is common among soldiers but its incidence and outcome are unknown. The purpose of this study was to estimate the incidence, clinical findings, and outcome of BST in soldiers referred to a primary care field physician. The medical records of soldiers in their military services who sustained BST and were evaluated by primary care field doctors over a 10-year period were reviewed. Anamnestic data, physical findings, primary care physician decisions, hospitalization, and surgery rates as well as final outcomes were analyzed. The medical records of 382,036 soldiers were reviewed and 668 cases (0.175%) of BST were identified. All patients complained of scrotal pain and 10% of dysuria. The most common physical findings included: scrotal tenderness (71.7%), scrotal edema (16.2%), and scrotal hematoma (4.8%). In 11.8% of the visits microhematuria was found in urine dip stick. A total of 243 patients (36.4%) were referred to emergency department, but only 9 (3.7%) were hospitalized. Of these, 3 patients underwent surgical exploration due to suspected testicular rupture in ultrasonography. Finally, testicular rupture was found only in 1 patient. This testis was sutured. In another patient testicular torsion was found and orchiectomy done. 168 patients (25.1%) developed prolonged scrotal pain lasting for more than 2 weeks after the trauma. Blunt testicular trauma is not an uncommon phenomenon among soldiers. Surgical intervention is rarely needed and in 99.6% of cases seen by general practitioners supportive management is suffice. The phenomenon of prolonged post-traumatic testicular pain, developing in a quarter of the patients after BST pain deserves more research.

688 - Blunt scrotal trauma in adults: A multi-institution experience evaluating the American Association for the Surgery of Trauma organ injury grading scale about 107 cases

The authors evaluated the usefulness of the American Association for the Surgery of Trauma (AAST) testis injury scale based on preoperative scrotal ultrasonography (US) and physical examination compared to peroperative findings. A retrospective review was performed on 107 patients (mean age=29,2±5.8 years) with a testis blunt trauma treated between January 2005 and August 2015. All patients underwent surgical scrotal exploration. Preoperative US was performed in all cases. Testis trauma was classified according to the AAST organ injury scale, preoperatively based on physical examination and scrotal US and then compared to peroperative definitif grading scale. Of the included patients, 14 were found to have abnormal testis contours on US, 25 had a rupture of the tunica albuginea, with a sensitivity of 70,8% and a specificity of 71,2%. Orchidectomy was performed in 12 cases, partial orchidectomy in 32 and tunica albuginea repair in 35 patients. Through this series, US was not a specific and sensitive exam to really precise the severity grade of testis trauma. Pre- and preoperative findings were significantly different. Thus, we continue to support history and clinical findings and we encourage surgical exploration when testis lesion is suspected.

Blunt scrotal trauma resulting in unilateral ruptured testicle

We present a case of testicular rupture after blunt scrotal trauma requiring surgical exploration and repair with salvage of the injured testicle. Testicular rupture is a true urological emergency and early diagnosis and surgical exploration maximized testicular salvage. Ultrasonography proves useful in evaluating the scrotal contents and allowing for early diagnosis of testicular injury.

Diagnosis and management of testicular rupture after blunt scrotal trauma: a literature review.

Testicular rupture, one of the most common complications in blunt scrotal trauma, is the rupture of tunica albuginea and extrusion of seminiferous tubules. Testicular rupture is more inclined to young men, and injury mechanisms are associated with sports and motor accidents. After history taking and essential physical examination, scrotal ultrasound is the first-line auxiliary examination. MRI is also one of the vital complementary examinations to evaluate testicular rupture after blunt scrotal trauma. Surgical exploration and repair may be necessary when the diagnosis of testicular rupture is definite or suspicious. Postoperative follow-up is to monitor the relief of local symptoms and changes of testicular functions. This review sums up the literatures about testicular rupture after blunt scrotal trauma in recent 16years and also refers some new advantages and perspectives on diagnosis and management of testicular rupture.

Sonography of pediatric blunt scrotal trauma: what the pediatric urologist wants to know.

Pediatric blunt scrotal trauma is most often the consequence of sports injury and presents a diagnostic challenge because swelling and pain make a scrotal physical exam difficult. US with color flow and duplex Doppler is the first-line imaging modality with the goal of accurate and timely diagnosis of injury requiring surgery to preserve fertility and hormonal function. US imaging findings following blunt scrotal trauma include hydrocele, hematocele, testicular hematoma, testicular fracture, testicular rupture, compromised perfusion/testicular torsion and testicular dislocation. Importantly, several of these findings may coexist. Our goal is to present the pertinent intrascrotal anatomy, US imaging findings for each testicular injury, and contemporary management for each, with emphasis on what our pediatric urology colleagues need to know for optimal patient care.

MP59-07 UTILITY OF PREOPERATIVE ULTRASOUND FOR THE EVALUATION OF TESTICULAR RUPTURE IN THE SETTING OF PENETRATING SCROTAL TRAUMA

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma1 Apr 2016MP59-07 UTILITY OF PREOPERATIVE ULTRASOUND FOR THE EVALUATION OF TESTICULAR RUPTURE IN THE SETTING OF PENETRATING SCROTAL TRAUMA Stephen Hurley, Edward Park, Ryan Powers, Patricia Vidal, Sarah Psutka, and Courtney Hollowell Stephen HurleyStephen Hurley More articles by this author , Edward ParkEdward Park More articles by this author , Ryan PowersRyan Powers More articles by this author , Patricia VidalPatricia Vidal More articles by this author , Sarah PsutkaSarah Psutka More articles by this author , and Courtney HollowellCourtney Hollowell More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.826AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Penetrating trauma to the scrotum results in testicular injury in up to 60% of cases. Delayed repair of a ruptured testis will often result in complications; namely infection, atrophy, persistent pain, and delayed orchiectomy. At the time of initial presentation, physical examination is often limited by patient discomfort as well as the presence of a hematocele and/or hematoma. Ultrasonography (US) has been found to be highly sensitive and specific for testicular rupture in the setting of blunt scrotal trauma. The purpose of this study was to determine the accuracy of scrotal US to identify testicular rupture in patients who have sustained a scrotal gunshot wound (GSW). METHODS We performed a retrospective review of patients presenting with a penetrating scrotal GSW from 2003-14. Each patient had preoperative scrotal US to evaluate for evidence of testicular rupture. An US depicting a heterogeneous echo pattern of the testicular parenchyma with loss of contour definition of the testicle was considered a positive examination. Patients underwent scrotal exploration within 24 hours of presentation. The sensitivity and specificity of US were determined in comparison to operative findings. Area under the curve (AUC) was calculated from the graphed receiver operating characteristic curve. RESULTS In total, 75 patients sustained penetrating GSWs to the scrotum. 31 (41%) patients had positive US findings, while 44 (59%) patients had negative examinations. No US revealed bilateral testicular injuries. At surgery, we observed 42 testicular ruptures in 37 (49%) of the 75 patients (5 patients with bilateral injuries). 32 (76%) testicles were salvaged, while 10 (24%) orchiectomies were performed. The sensitivity and specificity of preoperative US were 58% and 89% respectively, with 16 missed diagnoses, and 4 false positives. US had a positive predictive value of 84.6% and negative predictive value of 67.4% for identifying testicular rupture. AUC was 0.74. In 5 of the 16 missed injuries, ultrasound revealed a hematocele or hematoma in the ipsilateral hemiscrotum. CONCLUSIONS The utility of scrotal US for the evaluation of testicular rupture in the setting of penetrating scrotal trauma is limited. Concurrent scrotal pathology such as hematomas and hematoceles may limit the sensitivity of scrotal ultrasonography leading to false-negative examinations. A negative US exam should not deter the clinician from performing a scrotal exploration if physical exam findings are concerning for a testicular injury. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e786-e787 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Stephen Hurley More articles by this author Edward Park More articles by this author Ryan Powers More articles by this author Patricia Vidal More articles by this author Sarah Psutka More articles by this author Courtney Hollowell More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Isolated epididymal injury after blunt scrotal trauma from high velocity paintball round.

Isolated epididymal injury without associated underlying scrotal or testicular injury in the setting of blunt trauma is exceedingly rare. We present a case of an isolated epididymal injury incurred after scrotal trauma from a high velocity paintball round. Ultrasound demonstrated an enlarged, hypoechoic left epididymis with no evidence of underlying testicular injury. This case highlights the importance of obtaining imaging to evaluate for signs of testicular rupture, potentially obviating the need for surgery. It also reinforces the need for appropriate protective gear when participating in activities with potential for high velocity scrotal trauma.

MP18-18 COMPARISON OF POLYPROPYLENE MESH AND PRIMARY REPAIR IN THE TREATMENT OF BLUNT TESTICULAR RUPTURE

This study aimed to show the applicability of Polypropylene mesh (PM) grafting in blunt testicular ruptures.Data of 16 patients treated for testicular rupture following blunt scrotal trauma between March 2007 and April 2015 were analyzed retrospectively. Eight primary repairs and eight PM graftings were performed to repair the tunica albuginea (TA). Postoperatively, patients underwent Doppler ultrasonography at 3 weeks and then at 3, 6, and 12 months, followed by annual scans. The measurement of plasma testosterone levels was performed 12 months after the surgery.The average follow-up time was 24.8 (range 12-48) and 42.8 (range 14-75) months for patients treated with PM grafting and primary repair, respectively. Differences in testicular size between treatment groups were only significant at 12 months postoperatively with the value of 26.5 mL (range 24-28) and 22.8 mL (range 13-27) in patients treated with a PM graft and primary repair, respectively (P = .045). There were no complications for those patients treated with the PM graft. Two patients who underwent primary repair developed testicular atrophy within 1 year postoperatively.PM grafting is a safe alternative to primary closure of a TA defect following blunt testicular trauma.&nbsp.