Testicular Trauma Research Articles

A Hidden Testicular Mass at Ultrasound

A 20-year-old young man was referred to our department for a self-detected palpable, painless testicular mass. The patient reported a steroid-resistant nephrotic syndrome and ulcerative colitis since 2003 treated with Azathioprine and Infliximab and denied any history of testicular infection or trauma. Exam showed a well circumscribed, non-tender, soft mass on the right testicle. Scrotal ultrasonography (US) showed a homogeneous testis with normal echogenicity and of normal volume with the exception of a focal buldging (Fig.

P-034 Rate of testicular histology failure in predicting successful testicular sperm extraction in Non-Obstructive Azoospermia

Abstract Study question Does testicular histology predict successful or unsuccessful TEsticular Sperm Extraction (TESE) in Non-Obstructive Azoospermia (NOA) patients? Summary answer Testicular histology failed to predict successful TESE in 1 of 3 NOA patients. What is known already The management of patients with Non-Obstructive Azoospermia (NOA) involves TEsticular Sperm Extraction (TESE) combined with IntraCytoplasmic Sperm Injection (ICSI). Sperm retrieval is successful in up to 50% of men with NOA; however, there is no single clinical finding or investigation that can accurately predict a positive outcome. Previous studies have concluded that testicular histology is the best predictor of a successful or unsuccessful TESE. Study design, size, duration This is a retrospective study of 525 patients who underwent TESE between January 2018 and December 2020 in Humanitas Fertility Center. Participants/materials, setting, methods The cohort was dived in five groups: 287 NOA, 95 necrozoospermia, 18 anejaculation, 1 testicular trauma and 124 Obstructive Azoospermia (OA) patients. Main results and the role of chance Sperm was retrieved and cryopreserved in 218/287 patients with NOA (75,95%), 55/95 in necrozoospermia (57,89%), 18/18 anejaculation (100%), 1/1 testicular trauma (100%) and 120/124 in OA patients (96,77%). Interesting that, when we compare sperm recovery data through TESE with the histological assessment (HA) of corresponding testicular biopsy, we found discordance against HA. In particular we retrieved spermatozoa in 218 NOA patients but in 74 of them HA failed to detect them (33,94%). Moreover HA failed to detect spermatozoa in 8/55 (14,54%) in case of necrozoospermia, 1/18 (5,55%) in anejaculation and 10/120 (8,33%) in OA patients. Limitations, reasons for caution Testis's heterogeneity is a limitation of the study. Wider implications of the findings We found a discordance when HA is compared with sperm recovery data of corresponding testicular biopsy. This data suggest that in case of testicular diagnostics histology in 33,94% of NOA cases there is a wrong diagnosis and 1 of 3 patients it doesn’t retrieve and cryopreserve spermatozoa when it could. Trial registration number N A

AB162. SOH22ABS173. Case report: unexpected unilateral testicular rupture

Background: Acute scrotal pain is a urological emergency. While clinical recommendations regarding testicular torsion and acute epididymitis are well known, little is known about the causes of the low incidence of acute scrotal pain. Our aim is to identify and characterize the rare differential diagnosis of acute scrotal pain in order to provide diagnostic and therapeutic recommendations. Testicular trauma can be categorized as blunt, penetrating. While every case of penetrating trauma is subject to surgical treatment, a decision must be made between surgery and conservative treatment for each blunt injury case. Here we present a case report.

Multiple Lesions in Scrotal Tunica Vaginalis

A 37-year-old man, taxi driver by profession, presented with a 1-year history of a painless lump in the right testicle, which had grown rapidly in the last few months. The patient did not have any relevant medical history, except for a testicular trauma several years earlier while playing football. Physical examination of right testicle revealed subcentimeter nonmobile nodules. Alpha fetoprotein, beta-HCG, and lactate dehydrogenase were all within normal limits. Scrotal ultrasound revealed a normal right testicle with multiple hypoechoic paratesticular nodules, all smaller than 1 cm and connected to both the visceral and parietal layers of the tunica vaginalis.

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.

Enhancing men's awareness of testicular diseases (E-MAT) feasibility trial: Protocol for a mixed method process evaluation.

Background: Testicular cancer (TC) is the most common malignancy in men under 50 years. Athletes are particularly at risk of testicular trauma and diseases. Experiencing negative testicular symptoms does not necessarily imply that men seek help. Men's awareness of testicular diseases is often lacking and their intention to seek help for testicular symptoms is sub-optimal. The use of virtual reality (VR) may be effective in promoting men's awareness of testicular diseases. The Enhancing Men's Awareness of Testicular diseases (E-MAT) feasibility trial aims to test the effect of E-MAT VR (intervention; interactive experience using virtual reality [VR]) compared to information delivered Electronically E-MAT E (control; same information as E-MAT VR delivered as plain text and images) on testicular knowledge, and testicular self-examination among male athletes affiliated with a national sports organisation. The overall aim of this mixed method process evaluation will be to describe (i) the experiences of participants and key stakeholders (e.g., researchers); (ii) the perceived effectiveness of intervention components; (iii) acceptability of the feasibility trial and intervention procedures; (iv) the relationship between implementation, mechanisms, and context; and (v) the barriers and facilitators to support effective conduct of a future definitive trial. Methods: This mixed method process evaluation will use a descriptive realist evaluation. Quantitative data will be gathered using a usability and satisfaction survey, in addition to fidelity checks during intervention delivery. Quantitative data will be analysed using descriptive and inferential statistics. Qualitative data will be gathered from semi-structured interviews and focus groups with participants and key stakeholders to investigate their experiences of E-MAT VR and E-MAT E, and explore areas for improvement. Thematic analysis of transcripts will be conducted. Conclusions: This process evaluation will provide an in-depth understanding of how the interventions worked within this cohort and lessons for a future definitive trial.

Unclassified testicular sex cord-stromal tumors in children

We report a case of 12-year-old boy diagnosed with an unclassified sex cord stromal testicular tumor after a mild testicular trauma and the unclear ultrasound finding of a testicular mass. Physical examination was significant for a mass in the right testis. Scrotal magnetic resonance revealed an 8 millimeters nodular lesion suggestive of a Leydig cell tumor. Tumor markers were negative. The patient underwent a right radical orchiectomy plus implantation of a testicular prosthesis. Tumor cells expressed inhibin, WT 1, CD 56, CD99, vimentin and actin. Pathological diagnosis was unclassified sex cord stromal tumor confined to the testis. Metastatic workup by CT was negative. Unclassified sex cord-stromal tumors are infrequent and show an indeterminate differentiation of tumor cells that cannot be characterized with light microscopy towards Leydig, Sertoli, granulosa or theca cells. Immunohistochemistry helps in the differential diagnosis.Due to the risk of malignancy, local recurrence and uncertain biological behavior, radical orchiectomy is recommended, and a metastatic workup should be performed. Keywords: children; orchiectomy; sex cord-stromal tumor; scrotal ultrasound; testicular tumor

Non-invasive molecular biomarkers for predicting outcomes of micro-TESE in patients with idiopathic non-obstructive azoospermia.

Non-obstructive azoospermia (NOA), the most severe type of male infertility, affects approximately 1% of men worldwide. However, the aetiology of most NOA cases is not definite, that is defined as idiopathic NOA (INOA), posing a clinical conundrum worldwide. Most of these patients must receive donor sperm treatment until the emergence of microdissection testicular sperm extraction (micro-TESE). Although this procedure has recently become a promising treatment for INOA, the low sperm retrieval rate and testicular trauma have prompted us to explore appropriate non-invasive molecular biomarkers to predict the outcomes of sperm recovery preoperatively. Previous studies have identified a spectrum of biomarkers to address this challenging issue at various levels in different tissues, such as DNAs, RNAs, protein and steroid levels in the blood and seminal fluid. To better understand and assess the predictive values of diverse molecular biomarkers from different tissues on the outcome of sperm retrieval by micro-TESE in patients with INOA, we summarised recent findings and discussed the potential applications of these methods. The ultimate goal of this study was to provide references for further studies and clinical management.

Various Intratesticular Hypoechoic Lesions on Scrotal Sonography.

Sonography with a high-frequency transducer is the modality of choice for imaging the scrotum. Most intratesticular lesions are hypoechoic. Differentiation of intratesticular hypoechoic lesions as either malignant or benign is important because the treatment of these lesions vary. In this paper, we review the sonographic features of different types of intratesticular hypoechoic lesions, such as testicular cysts, testicular tumors, testicular inflammatory lesions, segmental testicular infarction, and testicular trauma.

Adrenal gland hematoma presenting as an acute scrotum in a neonate

The acute scrotum in a neonatal patients is an emergency. Its'etiology is variable, mostly represented by testicular torsion, trauma or adrenal hemorrhage. Previously, immediate scrotal exploration was considered imperative for diagnosis and treatment. With good imaging studies, some patients are conservatively managed. We report two cases of neonatal adrenal hemorrhage presenting as acute scrotum misguiding the clinician to rule out a local scrotal pathology. As the clinical examination is not reliable in a new-born, it definitely requires an imaging evaluation to establish the diagnosis. This case report tries to outline the importance of the correlation between acute adrenal hemorrhage and acute scrotum and the role of ultrasonography as a useful tool for differential diagnosis. A well performed ultrasound examination helps to identify an abdominal pathology as the cause of an acute scrotum and to specifically diagnose an adrenal hemorrhage in order to avoid unnecessary surgical exploration.

SONOGRAPHIC IMAGING OF ACUTE SCROTAL PAIN

Background: An acute scrotum is defined as acute pain with or without scrotal swelling, may be accompanied by local signs or general symptoms. Acute scrotal pain is a medical emergency. Depending on cause, the management is entirely different. Torsion of testis and strangulated hernia are surgical emergency; whereas, epididymo-orchitis is treated by medicines. Testicular trauma and obstructed hernia can be differentiated by taking history from patient. Clinical /Physical examination adds only a little information. Color Doppler ultrasound is the modality of choice to differentiate testicular torsion from inflammatory conditions.
 Aim of Study: The aim of this study is to observe the epidemiology of acute scrotum and their presentation, there by facilitating a systematic approach in identifying those patients who need early intervention to decrease associated morbidity and mortality.
 Conclusion: Acute scrotum is a common case seen in the today's scenario with considerable mortality and morbidity. In our study acute epididymo-orchitis was the commonest cause followed by torsion of testis the primary objective of management of acute scrotum is to avoid testicular loss. Acute scrotal swellings are common in younger & middle age individuals with variable symptoms. These cases need careful examination, proper evaluation and prompt treatment. The likelihood of testicular salvage in torsion depends on the interval between onset of pain and surgical intervention. Routine clinical examination gives only a little information. Doppler ultrasound assessment of patients at intermediate clinical risk of testicular torsion significantly reduced the frequency of negative surgical explorations without increased rate of missed testicular torsions.(1) In the imaging algorithm for testicular torsion in childhood, we differentiate between the two main entities, the peri- and neonatal torsion and torsions in children and infants older than 1 month. Imaging should not cause any delay in diagnosis but contribute to increase the specificity of diagnosis of testicular torsion in order to avoid unnecessary surgical explorations. (2)
 Keywords: Sonographic Imaging in Acute Scrotal Pain.

Acute Testicular Torsion in Children: A Tertiary Hospital Experience in a Developing Country

Background: Testicular torsion is a urological emergency in which there is a race against time to salvage the testis. The aim of this study was to evaluate our experience in the management of children who presented with acute testicular torsion. Materials and Methods: This was a retrospective study of children aged 15 years and below who had surgery for acute testicular torsion between January 2013 and December 2017 at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. Results: Sixty-four children were managed during the study period. The ages of the patients ranged from 2 months to 14 years with a median of 6 years. The right testis was mostly affected and the mean duration from the onset of symptom to presentation was 4 hours. All the patients presented with testicular pain and half of the patients had a prior history of intermittent testicular pain. Four (6.3%) patients had a history of trauma precipitating the testicular torsion and 3 (4.7%) patients had undescended testis. Detorsion and Orchidopexy was the most performed surgical procedure and wound infection was the most common post-operative complication. There was no mortality. Conclusion: Testicular torsion is not uncommon in children and may be associated with testicular loss. The right testis is mostly involved in children. Prior history of intermittent testicular pain, trauma and undescended testis are important considerations. Prompt detorsion and orchidopexy remains the cornerstone of treatment.

Impact of Sexual Activity on the Risk of Male Genital Tumors: A Systematic Review of the Literature.

Most cancers are related to lifestyle and environmental risk factors, including smoking, alcohol consumption, dietary habits, and environment (occupational exposures). A growing interest in the association between sexual activity (SA) and the development of different types of tumors in both men and women has been recorded in recent years. The aim of the present systematic review is to describe and critically discuss the current evidence regarding the association between SA and male genital cancers (prostatic, penile, and testicular), and to analyze the different theories and biological mechanisms reported in the literature. A comprehensive bibliographic search in the MEDLINE, Scopus, and Web of Science databases was performed in July 2021. Papers in the English language without chronological restrictions were selected. Retrospective and prospective primary clinical studies, in addition to previous systematic reviews and meta-analyses, were included. A total of 19 studies, including 953,704 patients were selected. Case reports, conference abstracts, and editorial comments were excluded. Men with more than 20 sexual partners in their lifetime, and those reporting more than 21 ejaculations per month, reported a decreased risk of overall and less aggressive prostate cancer (PCa). About 40% of penile cancers (PCs) were HPV-associated, with HPV 16 being the dominant genotype. Data regarding the risk of HPV in circumcised patients are conflicting, although circumcision appears to have a protective role against PC. Viral infections and epididymo-orchitis are among the main sex-related risk factors studied for testicular cancer (TC); however, data in the literature are limited. Testicular trauma can allow the identification of pre-existing TC. SA is closely associated with the development of PC through high-risk HPV transmission; in this context, phimosis appears to be a favoring factor. Sexual behaviors appear to play a significant role in PCa pathogenesis, probably through inflammatory mechanisms; however, protective sexual habits have also been described. A direct correlation between SA and TC has not yet been proven, although infections remain the most studied sex-related factor.

A Man With Testicular Pain

An 86-year-old male with a history of diabetes presented to the emergency department (ED) with left testicular pain for 2 days. Physical examination demonstrated an uncircumcised male with a normal testicular lie, left testicle enlargement, erythema, and tenderness to palpation. The patient was afebrile, with a WBC count of 9,000 cells/uL, and urinalysis revealed leukocytes. ED point-of-care ultrasonography was obtained (Figures 1 and 2).Figure 2Sonographic image of the left testicle in the sagittal plane obtained with a high frequency linear transducer demonstrated a hypoechoic structure (arrow) with increased surrounding vascular flow demonstrating inflammatory changes (star) within the testicle. Scrotal wall thickening was seen (asterisk).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Testicular abscess. Testicular abscess on ultrasonography is typically spherical or elliptical, with a focal area of mixed echogenicity due to necrotic cellular debris.1Gaillard F. Testicular abscess: radiology reference article.https://radiopaedia.org/articles/testicular-abscess?lang=usDate accessed: December 12, 2020Google Scholar,2O’Rourke K. Kibbee N. Stubbs A. Ultrasound for the evaluation of skin and soft tissue infections.Mo Med. 2015; 112: 202-205PubMed Google Scholar Testicular abscess may also demonstrate enlargement of the affected testicle and a reactive hydrocele. Testicular abscess is rare and typically results from untreated or severe epididymo-orchitis. In sexually active patients, common pathogens include Neisseria gonorrhea and Chlamydia trachomatis. However, those who are not sexually active can have other gram-negative and gram-positive organisms.1Gaillard F. Testicular abscess: radiology reference article.https://radiopaedia.org/articles/testicular-abscess?lang=usDate accessed: December 12, 2020Google Scholar,3Mevorach R.A. Lerner R.M. Dvoretsky P.M. et al.Testicular abscess: diagnosis by ultrasonography.J Urol. 1986; 136: 1213-1216Crossref PubMed Google Scholar,4Hackett B. Sletten Z. Bridwell R.E. Testicular abscess and ischemia secondary to epididymo-orchitis.Cureus. 2020; 12e8991PubMed Google Scholar Typically, patients will report testicular pain, swelling, and fever. The differential diagnosis includes testicular torsion, epididyomo-orchitis, epididymal abscess, testicular cancer, and testicular trauma. Ultrasound is the initial imaging modality needed to differentiate testicular abscess from other similarly presenting diagnoses. Treatment depends on the size of the testicular abscess and clinical parameters. Minor cases (those in patients who have normal WBC counts, are afebrile, are able to urinate, and do not have signs of necrotizing fasciitis) can be treated with antibiotics, while more severe cases may require surgical debridement or orchiectomy. ED treatment includes initiation of antibiotic therapy and urology consultation.

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.

Reconstrucción testicular con toma y aplicación de injerto autólogo de túnica albugínea contralateral por trauma penetrante de testículo por proyectil de arma de fuego. Reporte de caso y revisión de la literatura

Antecedentes:
 El trauma testicular y escrotal ocurre principalmente en jóvenes entre 15 y 40 años.
 El 50% de las heridas testiculares por arma de fuego terminan en orquiectomía.
 La presentación clínica es con dolor, edema, equimosis y hematoma; laceración de piel o exposición de tejido. El diagnóstico es clínico. La evidencia o sospecha de una ruptura testicular es una urgencia y requiere exploración quirúrgica inmediata. El manejo quirúrgico recomendado es con cierre primario de la túnica albugínea cuando es posible y orquiectomía cuando no es posible.
 Caso clínico:
 Presentamos el caso de un masculino de 20 años con trauma testicular por arma de fuego; condicionándole trauma izquierdo grado V y derecho grado IV. Se realizó orquiectomía simple izquierda y orquiectomía parcial derecha con reconstrucción testicular por medio de injerto de túnica albugínea contralateral. El paciente cursó con una evolución satisfactoria; al estudio ultrasonográfico Doppler de control se observó vascularidad conservada y hormonalmente niveles de testosterona en aumento.
 Discusión:
 La meta en el tratamiento del trauma testicular es preservar el tejido viable y reparar el testículo. El cierre primario está descrito ante una laceración de la túnica albugínea con bordes fácilmente identificables, lo cual no fue posible en este caso. Dentro de las reparaciones descritas existen injertos de túnica vaginalis, mallas de material reabsorbible y biológicas con resultados no concluyentes.
 El uso de túnica albugínea como reparación y protección del testículo contralateral, permitió una reconstrucción óptima; evitando el aumento de presión que se produce al usar la túnica ipsilateral y permitiendo la preservación del parénquima y fisiología testicular.

The Potential of Nano Curcumin in Preventing the Formation of Artificial Antisperm Antibody in Wistar Rats through Inflammatory Pathway Regulation

BACKGROUND: Immunological mechanisms of infertility are still poorly understood and controversial, both the cause and treatment. Inflammation, immunology, cell proliferation, cell differentiation, and cell survival are influenced by several proteins, including nuclear factor kappa-B (NFĸB), tumor necrosis factor-α (TNF-α), and interleukin-10 (IL-10).
 AIM: This study aimed to explore the potential of nano curcumin to prevent anti-sperm antibodies (ASA) formation due to the testes’ inflammatory process in Wistar rats.
 METHODS: This research is an experimental study with a pre-post-test approach with control group. The research subjects were rats (Rattus norvegicus) of the Wistar strain. The induced animals were grouped into three groups: Group 1 received nano curcumin 1 × 80 mg/kg BW orally, Group 2 received dexamethasone 1 × 0.3 mg/kg BW, and Group 3 received placebo aquadest 1 × 1 mL orally. TNF-α, NF-kB, and IL10 levels in serum were examined with enzyme-linked immunosorbent assay.
 RESULTS: The nano curcumin treatment showed the ability to reduce the pro-inflammatory cytokine protein TNF-α expression (47.3 ± 2.32) more optimally than dexamethasone treatment (54.4 ± 3.22). Nano curcumin has also shown the ability to reduce the pro-inflammatory cytokine transcription factor, NF-kB (32.5 ± 2.76) more optimally than treatment with dexamethasone (44.6 ± 2.43).
 CONCLUSION: Nano curcumin can prevent the formation of ASA in testicular trauma through inhibition of the inflammatory response.

Microlitiasis testicular una patología rara y poco conocida. Reporte de casos y revisión de literatura

Objetivo: El objetivo del presente trabajo es hacer una revisión de los casos reportados por ultrasonido de microlitiasis testicular y hacer una revisión de la literatura.
 Diseño: Se realizó una revisión de los ultrasonidos testiculares en los que se reportó microlitiasis testicular en el periodo comprendido del 2011 a 2018 en el Hospital “Dr. Manuel Gea González”, las variables que se analizaron fueron: edad, motivo del estudio, lado afectado y otros hallazgos.
 Resultados: Fueron 21 ultrasonidos con microlitiasis testicular con rango de edad de 6 a 24 años con promedio de 16 años. En el 81% afecto a ambos testículos, y en el 29% afecto el lado izquierdo. En el motivo del estudio el dolor testicular se encontró en el 33 % (7 casos), 14 % por tumor testicular (3 casos), torsión testicular 10% (2 casos), otras causas fueron varicocele, absceso y trauma testiculares.
 Limitaciones del estudio: Al tratarse de un estudio observacional retrospectivo, las conclusiones obtenidas son relativas.
 Originalidad: La microlitiasis tiene una prevalencia informada entre el 2.4% y el 3.8% en niños, se asocia a neoplasias testiculares y puede causar infertilidad. Se considera como posible etiología algunas nanobacterias que inducen las calcificaciones testiculares por lo tanto el estudio de esta patología podría modificar su tratamiento y prevenir su aparición. 
 Conclusiones: La microlitiasis testicular es una patología rara y poco conocida que puede estar asociada a cáncer e infertilidad y al parecer su etiología puede ser infecciosa ocasionada por nanobacterias. Es una patología abierta a la investigación.

Testicular microlithiasis, a rare and little-known disease: Case reports and a literature review

Objective: The aim of the present work was to review the cases of testicular microlithiasis revealed by ultrasound and carry out a review of the literature.
 Design: Testicular ultrasounds that identified testicular microlithiasis in patients seen at the Hospital “Dr. Manuel Gea González”, within the time frame of 2011 and 2018, were reviewed. Age, study indication, and laterality were among the variables analyzed.
 Results: Twenty-one ultrasounds revealed testicular microlithiasis in patients ranging from 6 to 24 years of age, with a mean of 16 years. Both testes were affected in 81% of the patients, and the left testis was affected in 29%. The indication for ultrasound was testicular pain in 33% (7 cases), testicular tumor in 14% (3 cases), and testicular torsion in 10% (2 cases). Other causes were varicocele, testicular abscess, and testicular trauma.
 Study limitations: The conclusions were relative, given the study’s retrospective, observational design. 
 Originality: Microlithiasis has a reported prevalence of 2.4% to 3.8% in children. It is associated with testicular tumors and can cause infertility. A possible cause is nanobacteria that induce testicular calcifications. The study of the disease could modify its treatment and prevent its appearance. 
 Conclusions: Testicular microlithiasis is a rare and little-known disease that can be associated with cancer and infertility. Its etiology appears to be nanobacterial infection. More research on the disease should be carried out.

Spermatic cord hematoma in an adult patient with testicular trauma: Sonological appearances of a rare entity

Acute scrotal injuries with resultant testicular contusions, testicular torsion, testicular infarction, and testicular rupture have been well documented in the literature. Spermatic cord hematoma has been rarely reported, and this case report describes the sonological appearances of the above-mentioned entity in an 18-year-old male.