Blunt Scrotal Trauma Research Articles

Use of Ultrasonography for the Diagnosis of Testicular Injuries in Blunt Scrotal Trauma

We determined the use of scrotal ultrasonography in the initial diagnosis and management of testicular injuries due to blunt scrotal trauma. We performed a retrospective review of 65 patients presenting to our Emergency Department with blunt scrotal trauma in the last 25 years. In 47 patients an inconclusive clinical examination prompted scrotal ultrasonography. A heterogeneous echo pattern of the testicular parenchyma with loss of contour definition was the basis for diagnosis of testicular rupture. The sensitivity and specificity of scrotal ultrasonography were determined by comparing this radiographic criterion with definitive intraoperative findings and the need for delayed orchiectomy due to undiagnosed testicular rupture. Of the 65 patients sustaining blunt scrotal trauma 44 (68%) underwent scrotal exploration, and 30 (46%) of these injuries involved rupture of the tunica albuginea. Among the 47 scrotal ultrasounds performed to supplement a nondiagnostic clinic examination, there were 32 suspected testicular ruptures. Thus, the 2 false-positives resulted in a specificity of 93.5% in those patients explored. No delayed orchiectomies were performed for missed testicular ruptures, resulting in 100% sensitivity. The majority of testicular ruptures were salvaged (83%), with only 5 of the 30 (17%) requiring orchiectomy (4 of these patients had delayed presentation greater than 48 hours). Scrotal ultrasonography, with the single radiographic finding of a heterogeneous echo pattern of the testicular parenchyma with loss of contour definition, is highly sensitive and specific in the diagnosis of testicular rupture in an otherwise equivocal scrotal examination. Accurate diagnosis and prompt repair led to a salvage rate for testicular rupture specifically of 83% and overall of 92%, with preservation of the testicular parenchyma and hormonal function, and avoidance of the delayed complications of chronic pain, atrophy and orchiectomy associated with missed testicular rupture.

An Unusual Well-Circumscribed Intratesticular Traumatic Hematoma

High-resolution scrotal sonography has become the imaging modality of choice not only for differential diagnosis of a variety of pathologic processes with similar clinical manifestations (such as pain, swelling, and presence of a mass) but also for diagnosis and monitoring of blunt scrotal trauma. 1 , 2 , 3 We present an unusual case of a well-circumscribed intratesticular hematoma mimicking on sonography a testicular mass. It was conservatively treated and monitored until its resolution.

Dislocación testicular traumática. aportación de un caso

AbstractTesticular dislocation after blunt scrotal trauma is a rare event. This injure must be recognized and treated promptly to maximize the likelihood of testicular salvage.We describe a new case of unnoticed traumatic testicular dislocation with secondary testicular lost. We discuss the chain of events leading toward the correct diagnosis and treatment based on a review of published reports.

Ultrasound features of blunt testicular injury

This is a retrospective study of ultrasound examination for patients with blunt scrotal trauma. Fifteen patients were examined over an 18-month period. The purpose of the study was to discover the ultrasonic features of blunt testicular trauma and to distinguish less severe from more severe injury with testicular rupture requiring surgery. Three had ultrasonic findings of acute testicular rupture and this was confirmed by surgery. The ultrasound features of testicular trauma with rupture are irregularity of testicular outline and inhomogeneity of testicular texture. The value of ultrasound in diagnosing patients with testicular rupture and, therefore, requiring urgent surgery is discussed. In our limited study, irregularity of testicular outline was the distinguishing feature of rupture.

Traumatic testicular dislocation: a case report and review of published reports

Testicular dislocation after blunt scrotal trauma is a rare event. Its diagnosis depends on the awareness of the physician of its possible occurrence. It is usually a late finding during treatment of a motorcyclist brought to the emergency room because of multitrauma injury and is sometimes demonstrated in an abdominal computed tomography scan. We describe a typical case and discuss the chain of events leading toward the correct diagnosis and treatment based on a review of published reports.

Scrotal trauma: a cause of testicular atrophy

Scrotal trauma is often mentioned as a cause of testicular atrophy yet there have been few studies documenting the effect of scrotal trauma on testicular size months or years following injury. We performed clinical and sonographic examinations in 10 patients who had suffered blunt scrotal trauma. A significant reduction in volume of the injured testis was observed in 5 10 cases at follow-up sonography. In two cases the affected testis was heterogeneous and colour flow Doppler examination showed reduced flow. In three cases the testis was homogeneous but reduced in volume and in the remaining five cases the affected testis appeared normal. We conclude that testicular atrophy is a sequel of scrotal trauma and occurred in 50% of patients in this study.

The value of ultrasound in the evaluation of patients with blunt scrotal trauma

Twenty-one men with blunt scrotal trauma managed in the Urology Department of Riyadh Central Hospital are presented. The decision for surgical exploration was strengthened by ultrasonic findings in six patients — four men with haematocoele and ruptured testicles and two with expanding extratesticular haematoma and normal testes. In addition, sonography revealed unsuspected intratesticular haematoma and disrupted tunica albuginea (without haematocoele) in two other cases. One case managed non-operatively developed a testicular abscess detected by ultrasound. Surgery confirmed the diagnoses in all nine cases that were explored. Thirteen patients were managed non-operatively, including six cases in whom sonography revealed contused testes. Hence, the value of ultrasound scanning in evaluating patients after blunt scrotal trauma was established. It complemented clinical findings and detected unsuspected testicular injury.

Accuracy of Ultrasound Diagnosis after Blunt Testicular Trauma

The aim of this study is to determine the value of ultrasound evaluation for the diagnosis of testis rupture due to blunt scrotal trauma. We reviewed 16 operated cases of blunt scrotal trauma with hematocele, which were evaluated by ultrasound preoperatively. In 2 cases a tunica albuginea rupture was correctly diagnosed by ultrasonography but there were 2 false-positive and 5 falsenegative diagnoses of rupture. Systematic exploration of the 16 cases revealed testicular rupture in 7, simple hematocele in 7 and hematocele associated with spermatic cord injury in 2. In 2 cases orchiectomy was necessary. From our experience the accuracy rate of ultrasound evaluation of blunt scrotal trauma was 56%, with a 58% negative predictive value. Considering these results, ultrasound examination of blunt scrotal trauma with hematocele is not sufficiently accurate to eliminate surgical exploration and, therefore, we recommend early surgical exploration as primary therapy in these cases.

Evaluation of the Acute Scrotum by Color-Coded Doppler Ultrasonography

Color-coded Doppler ultrasonography is a combination of real-time sonography and duplex sonography for noninvasive imaging of arterial and venous blood vessels. In 40 patients with acute onset of scrotal pain this diagnostic procedure was correlated with the findings at surgical exploration: 11 had testicular torsion, 4 hydatid torsion, 13 spontaneous detorsion, 2 blunt scrotal trauma and 10 epididymitis. For testicular torsion color-coded Doppler ultrasonography had a sensitivity of 82% and a specificity of 100%, and for epididymitis the sensitivity was 70% and specificity was 88%. Color-coded ultrasonography readily demonstrates testicular perfusion. In cases of incomplete or early torsion some residual perfusion may be detected leading to false-negative results. Despite this fact, color-coded Doppler ultrasonography currently is the most valuable diagnostic modality in the evaluation of the acute scrotum.

Ultrasound evaluation of blunt scrotal trauma

Eighty patients with blunt scrotal trauma underwent real-time sonography with high-frequency transducers. Sonography showed testicular rupture in 14 patients, testicular hematoma in 8 patients, lesions of the epididymis in 17 cases, and hematocele without an associated lesion of the testicle or the epididymis in 28 patients; 13 examinations were normal. The diagnosis was confirmed at operation in 18 cases and by clinical and sonographical follow-up in 62 cases. Sonography was able not only to distinguish reliably testicular rupture from uncomplicated testicular hematoma (accuracy rate 100%). Characteristic findings in testicular rupture included inhomogeneity of the parenchymal pattern, contour abnormalities, poorly defined margins, and obvious disruption of the echogenic tunica albuginea or fragmentation of the testicle.

Value of testicular ultrasound in the evaluation of blunt scrotal trauma without haematocele.

The value of ultrasound in testicular trauma with haematocele has been questioned inasmuch as the injured testis should always be explored surgically. Ultrasonography, however, plays an important role in the diagnosis and follow-up of patients with blunt scrotal trauma without haematocele. We have evaluated 17 such patients with real-time ultrasound. In 9 cases the testis and epididymis were normal to palpation, although in 6 of them parenchymal lesions, mainly subcapsular haematomas and parenchymal contusions not amenable to surgical intervention, were detected with ultrasonography. Seven patients presented with changes in the testicular or epididymal morphology at palpation and in 1 case the testes were not palpable. Ultrasonography was of great value, indicating surgery in 6 of these patients where physical examination alone was not sufficient to establish the need for surgical exploration.

Die Wertigkeit der Sonographie beim Skrotaltrauma

65 patients with penetrating or blunt scrotal trauma underwent scrotal ultrasound. High-resolution real-time sonography was able to differentiate testicular from extratesticular lesions in all cases. Lesions of the epididymis were diagnosed in 14 cases. In epididymal haematoma sonography revealed an hyperechoic enlarged epididymis whereas posttraumatic epididymitis was demonstrable as hypoechoic swelling. 14 testicular ruptures and 6 testicular haematomas without disruption of the tunica albuginea were correctly diagnosed. Diagnosis could be confirmed at operation in 12 cases and by clinical and sonographic follow-up in 8 cases. A heterogeneous parenchymal pattern, contour abnormalities, poorly defined margins and obvious fragmentation of the testicle strongly suggest testicular rupture.

Has Ultrasound Influenced the Therapy Concept of Blunt Scrotal Trauma?

We present the ultrasonic diagnoses and treatment of 44 patients with blunt scrotal trauma (rupture of the testis, hematocele, intratesticular hematoma and hematoma of the scrotal layers). Purely intratesticular hematoma without any other accompanying injury also can be detected sonographically. When massive scrotal swelling is present ultrasound is valuable to determine the status of the underlying testis even if discrete fracture planes of the tunica cannot always be detected. To achieve best long-term results early surgical intervention should be performed in cases of rupture of the testicle and hematocele, while hematoma of the scrotal layers and purely intratesticular hematoma can be treated conservatively. (J. Urol., 142:1243-1246, 1989)

Ultrasonography of scrotal trauma.

Ultrasound has emerged as the diagnostic imaging modality of choice in the evaluation of patients with scrotal trauma. Most studies of testicular rupture show great accuracy with virtually no instances of false-positive or false-negative diagnoses. Ultrasonography is capable of differentiating between scrotal hematoma, extratesticular fluid collections, posttraumatic torsion testis, posttraumatic epididymitis, epididymal hematoma, as well as testicular rupture. The differentiation of hematocele from pyocele or exudative hydrocele is generally not possible. In patients with suspected testicular rupture, an accurate diagnosis followed by prompt surgical repair is the key to preservation of testicular function. Ultrasound is an extremely useful adjunct to the physical examination in cases of blunt scrotal trauma both for the differential diagnosis of the enlarged scrotum and for determining the necessity for emergency surgery.

Traumatic Torsion of the Testis

Torsion of the testis is a common urological emergency. Blunt scrotal trauma also may precipitate an emergency. We recently treated 2 adolescent boys in whom blunt scrotal trauma induced testicular torsion. A retrospective review of the charts of 138 patients explored for acute scrotal pain at our hospital revealed a history of scrotal trauma in 3 of 57 patients (5 per cent) with testicular torsion and 7 of 73 (10 per cent) with torsion of the testicular appendages. The possibility of torsion must be considered in cases of scrotal trauma.

Ultrasonography for the Diagnosis and Staging of Blunt Scrotal Trauma

Of 19 patients with blunt testicular trauma diagnosed and staged correctly by physical examination and ultrasonography 10 were explored surgically and 9 were managed nonoperatively (treatment was supported by ultrasonography). Fractured testicles occurred in 5 of the 10 explored patients and were repaired surgically, and in 2 of the 9 conservatively managed patients. These 2 patients refused an operation.Ultrasonography can show disruption of the testicle as evidenced by intratesticular lucencies representing hematoma, extruded testicular parenchyma or a fragmented testicle. The tunica albuginea is too thin to be defined consistently and, thus, it could not be used as a parameter for disruption in the 10 patients who were explored surgically.Ultrasonography used in conjunction with a thorough physical examination is highly accurate, readily available, noninvasive and gives minimal discomfort. This modality can be used to follow nonoperative scrotal injury to resolution. With the availability of high resolution real-time ultrasonography more rapid and reliable screening of the scrotum is possible.

Testicular Rupture in Blunt Scrotal Trauma: Review of 15 Cases with Recent Application of Testicular Scanning

Review of records between 1960 and 1981 revealed 15 cases of testicular rupture secondary to blunt scrotal trauma. Because of delay in presentation testicular salvage was accomplished in only 20 per cent of the cases. In 5 cases in which the patient was evaluated with radionuclide testicular imaging using 99mtechnetium pertechnetate the diagnosis of testicular rupture was made preoperatively.

Injuries to scrotal contents by blunt trauma

Three unusual injuries to the scrotal contents following blunt trauma are reported. Early surgical exploration is recommended when significant ecchymosis or a hydrocele follows blunt scrotal trauma.

Rupture of the Testicle: The Importance of early Surgical Treatment

No AccessJournal of Urology1 Feb 1969Rupture of the Testicle: The Importance of early Surgical Treatment Melvin Gross Melvin GrossMelvin Gross Present address: Urology Service, Brooke General Hospital, Fort Sam Houston, Texas 78234. More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)62310-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Rupture of the Testicle: The Importance of early Surgical Treatment." The Journal of Urology, 101(2), pp. 196–197 © 1969 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByPowers R, Hurley S, Park E, McArdle B, Vidal P, Psutka S and Hollowell C (2018) Usefulness of Preoperative Ultrasound for the Evaluation of Testicular Rupture in the Setting of Scrotal Gunshot WoundsJournal of Urology, VOL. 199, NO. 6, (1546-1551), Online publication date: 1-Jun-2018.Buckley J and McAninch J (2018) Use of Ultrasonography for the Diagnosis of Testicular Injuries in Blunt Scrotal TraumaJournal of Urology, VOL. 175, NO. 1, (175-178), Online publication date: 1-Jan-2006.Corrales J, Corbel L, Cipolla B, Staerman F, Darnault P, Guille F and Lobel B (2018) Accuracy of Ultrasound Diagnosis after Blunt Testicular TraumaJournal of Urology, VOL. 150, NO. 6, (1834-1836), Online publication date: 1-Dec-1993.Kratzik C, Hainz A, Kuber W, Donner G, Lunglmayr G, Frick J and Schmoller H (2018) Has Ultrasound Influenced the Therapy Concept of Blunt Scrotal Trauma?Journal of Urology, VOL. 142, NO. 5, (1243-1246), Online publication date: 1-Nov-1989.Cass A and Luxenberg M (2018) Value of Early Operation in Blunt Testicular Contusion with HematoceleJournal of Urology, VOL. 139, NO. 4, (746-747), Online publication date: 1-Apr-1988.Vaccaro J, Davis R, Belville W and Kiesling V (2018) Traumatic Hematocele: Association with Rupture of the TesticleJournal of Urology, VOL. 136, NO. 6, (1217-1218), Online publication date: 1-Dec-1986.Cass A (2018) Testicular TraumaJournal of Urology, VOL. 129, NO. 2, (299-300), Online publication date: 1-Feb-1983.Martin D (2018) Editorial CommentJournal of Urology, VOL. 129, NO. 2, (300-300), Online publication date: 1-Feb-1983.McConnell J, Peters P and Lewis S (2018) Testicular Rupture in Blunt Scrotal Trauma: Review of 15 Cases with Recent Application of Testicular ScanningJournal of Urology, VOL. 128, NO. 2, (309-311), Online publication date: 1-Aug-1982.Schuster G (2018) Traumatic Rupture of the Testicle and a Review of the LiteratureJournal of Urology, VOL. 127, NO. 6, (1194-1196), Online publication date: 1-Jun-1982.Edson M (2018) Editorial CommentJournal of Urology, VOL. 127, NO. 6, (1196-1196), Online publication date: 1-Jun-1982.Friedman S, Rose J and Winston M (2018) Ultrasound and Nuclear Medicine Evaluation in Acute Testicular TraumaJournal of Urology, VOL. 125, NO. 5, (748-749), Online publication date: 1-May-1981.Edson M and Meek J (2018) Bilateral Testicular Dislocation with Unilateral RuptureJournal of Urology, VOL. 122, NO. 3, (419-420), Online publication date: 1-Sep-1979.Warden S and Schellhammer P (2018) Bilateral Testicular Rupture: Report of a Case With an Unusual PresentationJournal of Urology, VOL. 120, NO. 2, (257-258), Online publication date: 1-Aug-1978. Volume 101Issue 2February 1969Page: 196-197 Advertisement Copyright & Permissions© 1969 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Melvin Gross Present address: Urology Service, Brooke General Hospital, Fort Sam Houston, Texas 78234. More articles by this author Expand All Advertisement PDF DownloadLoading ...