Pediatric testicular rupture is rare, and detailed descriptions of its ultrasonographic (US) findings with operative correlation remain limited. This paper reviews the characteristic ultrasonographic findings of pediatric testicular rupture and correlates them with operative findings and postoperative outcomes. Among 27 male patients who underwent US for suspected testicular trauma over a 23-year period, four cases with surgically confirmed testicular rupture were retrospectively reviewed. Clinical presentation, physical examination findings, timing of presentation and surgery, preoperative US findings, operative findings, and postoperative outcomes were evaluated. The patients ranged in age from 11 to 14years, with two right-sided and two left-sided injuries. Mechanisms of injury included sports-related trauma (n = 2) and physical assault (n = 2). Presenting symptoms included scrotal swelling, scrotal/lower abdominal pain, and vomiting. Physical examination demonstrated scrotal tenderness in all patients, scrotal swelling in three, and erythema in one. The interval from injury to presentation ranged from 2 to 60h (median, 34h), and the interval from injury to surgery ranged from 28 to 130h (median, 54h). All patients demonstrated characteristic US findings suggestive of testicular rupture, including discontinuity of the tunica albuginea, poorly defined testicular margins, heterogeneous echotexture of the extruded testicular parenchyma, and decreased blood flow in the extruded area. Associated findings included intratesticular or scrotal hematoma and scrotal wall thickening. Operative findings confirmed rupture of the tunica albuginea in all cases and correlated well with preoperative US findings. During follow-up (mean, 9months), ipsilateral testicular atrophy developed in three patients, whereas one patient showed preserved testicular volume without abnormal US findings. Pediatric testicular rupture demonstrates characteristic ultrasonographic findings that correlate well with operative findings. Recognition of these findings may facilitate early diagnosis and prompt surgical consultation. Because postoperative testicular atrophy may occur despite testicular preservation, continued ultrasonographic follow-up is important.

Diagnostic potential of contrast-enhanced ultrasound in scrotal pathology.

Introduction: Acute scrotum is defined as the sudden onset of scrotal pain and swelling and encompasses a wide range of etiologies. Although numerous conditions may present as an acute scrotum, prompt recognition of those requiring urgent surgical intervention is crucial. Methods: Representative clinical images of two causes of acute scrotum - Fournier's gangrene and traumatic testicular rupture are presented, accompanied by brief diagnostic and management comments. Results: Fournier's gangrene presents with severe scrotal swelling, erythema, skin necrosis, crepitus, and systemic toxicity, requiring immediate broad-spectrum antibiotics and urgent surgical debridement. Traumatic testicular rupture most commonly follows blunt scrotal trauma, presenting with painful swelling and hematoma, and mandates emergency surgical exploration to salvage the testis. Conclusion: Every case of acute scrotum should be considered a surgical emergency until testicular torsion, Fournier's gangrene, and severe testicular trauma are excluded. Visual recognition of characteristic findings supports rapid clinical decision-making and prompt intervention.

To evaluate the diagnostic accuracy and reliability of point-of-care ultrasound (POCUS) in pediatric acute scrotal emergencies and assess its impact on clinical decision-making for differentiating surgical from non-surgical conditions. This prospective study conducted at a tertiary care center between March 2023 and October 2024, included 294 pediatric patients (age 1-17.9 years) presenting to the pediatric emergency department with acute scrotal pain. POCUS examinations were performed using B-mode and color Doppler imaging. Diagnoses were confirmed through surgical intervention (n = 102), clinical follow-up (n = 58), or imaging follow-up (n = 134). Statistical analyses included diagnostic accuracy metrics, logistic regression for identifying predictors of surgical emergencies, and inter-examiner agreement using Cohen's kappa. POCUS demonstrated 100% diagnostic accuracy in our sample for inflammatory conditions, testicular trauma, infarction, and scrotal abscess. For testicular torsion, sensitivity and specificity were 89.5% and 100%, while for appendiceal torsion, they were 94% and 97.5%, respectively. Multivariate analysis identified six significant predictors of surgical emergencies, with the strongest being scrotal tenderness (OR = 4.48, p < 0.001), reduced/absent Doppler vascularization (OR = 3.67, p < 0.001), and scrotal skin changes (OR = 3.32, p < 0.001). Inter-examiner agreement was almost perfect for hydrocele (κ = 0.91), testicular torsion (κ = 0.90), hematocele (κ = 0.86), and skin thickening (κ = 0.81). POCUS offers high diagnostic accuracy for most pediatric scrotal conditions, though with relatively lower sensitivity for testicular torsion, requiring careful clinical correlation. When combined with clinical assessment, POCUS effectively differentiates surgical from non-surgical emergencies, potentially reducing unnecessary surgical interventions.

Disclosure: R. Atodaria: None. R. Abdelmasih: None.Background: AZF gene microdeletions are the second most common genetic cause of male infertility and are seen in 1 out of every 4000 males. The frequency of these deletions is at least 2-10% in males with azoospermia or oligozoospermia. Sperm retrieval procedures can have suboptimal success rates. Case Presentation A 32-year-old male with prior testicular trauma during childhood presented for an inability to have kids for 3 years. He was previously seen by Urology who found azoospermia, small bilateral hydroceles, and a left varicocele. They suggested repair of the varicocele to address his infertility. His initial labs showed decreased testosterone (263 ng/dL, ref 300-1080 ng/dL), increased prolactin (25.3 ng/mL, ref 2.6 – 13.1 ng/mL), increased follicle-stimulating hormone (26.4 mIU/mL, ref 1.7 – 2.6 mIU/mL), and increased luteinizing hormone (14.3 mIU/mL, ref 1.2 to 7.8 mIU/mL) levels. Repeat testosterone was 204 ng/dL. Pituitary MRI was normal. Chromosome analysis showed an AZFb+c microdeletion. Intervention options for sperm injection and retrieval were discussed. The patient elected to re-discuss surgical repair of the varicocele with Urology in light of these genetic findings before making a decision about pursuing sperm retrieval procedures. A referral to genetics was sent to discuss the potential risk of passing on Y chromosome microdeletions to his male offspring. Discussion: We present a case of male infertility due to azoospermia from an AZFb+c microdeletion. In general, AZF microdeletions are rare yet can convey a significant burden onto affected patients. Diagnosis is crucial because of its prognostic value. For instance, AZFc deletions are the most common subtype and have the least severe phenotype, with up to 50% of azoospermic patients successfully undergoing testicular sperm extraction. On the other hand, AZFa and AZFb deletions are associated with poor chance of sperm retrieval due to a complete lack of germ cells or maturation arrest of germ cells, respectively. As such, sperm injection and sperm extraction procedures are typically contraindicated in patients with AZFa or AZFb microdeletions due to very high failure rates. With less severe microdeletions, such as the AZFb+c deletion seen in our patient, affected patients frequently develop hypospermatogenesis which can leave a reasonable chance of successful sperm retrieval if done in a timely manner. Thus, physicians should maintain low thresholds for ordering chromosome microarrays in infertile males since earlier diagnosis may lead to earlier intervention with higher chance of success.Presentation: Saturday, July 12, 2025

This study systematically reviews the literature to explore the potential causes of anti-sperm antibody (ASA) production among infertile men. A comprehensive search of PubMed was conducted in December 2024, utilizing keywords such as “anti-sperm antibody,” “immunologic infertility,” and related terms. The search yielded 2215 studies, which were screened by title and abstract, excluding 1857 studies. A total of 358 full-text articles were assessed for eligibility, and finally, 51 studies were included. Twenty-three thousand one hundred eight patients were involved in the included studies; 22,702 patients were infertile, and 406 were fertile controls. Infectious disease were the most commonly investigated causes of ASA production including chlamydia trachomatis infection with 9 studies. History of vasectomy and vasectomy reversal with 9 studies, varicocele (7), cryptorchidism (5), Inguinal hernia repair and other genital or inguinal surgeries (5), HPV infection (4), and seminal bacterial community and culture (4) were other potential investigated causes. Adeno-associated virus, mumps, congenital absence of vasa, testicular microlithiasis, testicular sperm extraction, testicular torsion, and testicular trauma were other causes that their correlation with ASA was explored. Vasectomy emerged as the most frequently studied factor significantly correlated with ASA production. Other conditions, like psychogenic anejaculation, prostatitis, and Buerger’s disease, were also associated, though findings on some factors remain controversial. This study highlights the diverse potential causes of ASA production in infertile males, categorized into infectious, autoimmune, inflammatory, and anatomical conditions. However, the variability in results underscores the need for further research with larger populations to clarify the underlying causes of ASA production in male infertility.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12865-025-00740-5.

Acute scrotum poses diagnostic challenges due to its diverse etiology and potential severity. Multiparametric ultrasound has proven to be a fundamental and valuable imaging modality in this context, improving early-phase sensitivity through various techniques, including B-Mode, color Doppler, power Doppler, pulsed Doppler, microflow studies, and elastography. In this context, Contrast-Enhanced Ultrasound (CEUS) emerges as a rapid, safe, and valuable tool in enhancing diagnostic accuracy and therapeutic decisions for acute scrotal conditions. This study involves a detailed analysis of various ultrasound imaging techniques and investigates the optimal circumstances and methods for employing CEUS in emergency situations to improve diagnostic accuracy and therapeutic decisions. Multiparametric ultrasound plays a crucial role in diagnosing various pathologies, including testicular torsion, appendage torsion, inflammation, ischemia/infarction, and trauma. CEUS provides real-time assessment of vascular perfusion, aiding in early diagnosis and accurate characterization of scrotal pathologies and significantly reducing the need for unnecessary surgical interventions, especially in trauma cases. Its role in differentiating between various pathologies and guiding therapeutic decisions underscores its importance in clinical practice, contributing significantly to improve patient outcomes.

It is difficult to quickly assess the degree of testicular injury in patients with blunt testicular trauma, and accurate and rapid assessment of the degree of injury is related to clinical decision-making and treatment outcomes. This study explored the sonographic characteristics of patients with different degrees of blunt testicular trauma via contrast-enhanced ultrasound (CEUS), as well as biomarkers of oxidative stress and vascular endothelial cell injury, to further evaluate the diagnostic value of these parameters in blunt testicular trauma. New Zealand male rabbits were used to establish blunt testicular trauma models of different degrees, including contusion, hematoma, rupture, and control models. Routine ultrasound and CEUS were performed immediately, 2, 4, and 6 h after modeling, and pathological examination was used to confirm the modeling results further. The levels of von Willebrand factor (vWF), endothelin-1 (ET-1), reactive oxygen species (ROS), and nitric oxide (NO) in the serum were analyzed. According to the CEUS results, the arrival time (AT) (F = 35.159, P < .001), time to peak intensity (TTP) (F = 122.434; P < .001), and area under the curve (AUC) (F = 47.444; P < .001) of the time-intensity curves showed significant differences among the groups. There was no significant difference between Hematoma Trauma (HT) (F = 0.178; P = .91) and Peak Intensity (PI) (F = 0.172; P = .92). For biomarkers, there were significant differences in vWF (F = 40.61; P < .001), ROS (F = 106.3; P < .001), NO (F = 79.3; P < .001), and ET-1 (F = 61.94; P < .001) levels among the groups. For blunt testicular trauma, the AT, TTP, and AUC indices of CEUS can more accurately distinguish the degree of testicular injury. Oxidative stress and endothelial cell damage may also be used as biomarkers for evaluating the degree of testicular injury.

Drainage of varicose veins during subinguinal microscopic varicocelectomy (vein milking): Does it affect pain, cosmetic appearance, and spermiogram?

To perform a scoping review of the literature pertaining to paediatric scrotal trauma and to contrast operative with conservative management in this cohort of patients using available data. A search of Cochrane, SCOPUS, and EMBASE databases was performed using methods pre-published on PROSPERO. Reporting followed Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Eligible studies were articles or abstracts published in English describing the management of paediatric scrotal trauma, which reported at least one secondary outcome. The intended primary analysis is to report the management of paediatric scrotal trauma and the outcome based on management. Thirty-six studies were identified, totaling 253 patients. Then, 91.7% of cases presented with unilateral testicular injury and 94.5% of cases resulted from blunt trauma. Then, 86% of patients presenting with scrotal trauma underwent ultrasound imaging of the scrotum. One hundred twenty-three cases underwent conservative management, 116 cases underwent acute surgical management, and 14 underwent delayed surgical management, with a mean time to an intervention of 3days. Thirty patients were found to have testicular atrophy, with a mean follow-up of 14months, of these 30 patients, 63% (n = 19) were conservatively managed, 20% (n = 6) were managed with acute surgical repair, and 17% (n = 5) were managed with delayed surgical repair. Paediatric testicular trauma is a rare presentation. A high level of suspicion is mandatory when testicular rupture is suspected. Early exploration is warranted in the setting of high risk and provides an excellent chance of testicular salvage.

Background/Objectives: Male infertility is a complex, multifactorial condition influenced by infectious, inflammatory, and autoimmune components. Immunological factors, though implicated in reproduction, remain poorly understood. This study aims to deepen the understanding of infections, inflammation, and autoimmune factors in male infertility, with a focus on immune-related disorders affecting the testes and epididymis—immunologically privileged but vulnerable sites. These factors can impair sperm quality through oxidative stress (ROS) and antisperm antibodies (ASA), further compromising fertility. Methods: A narrative review was conducted by analyzing scientific literature from the past 10 years conducted on PubMed using keywords such as “male infertility”, “autoimmunity”, and “inflammatory disease”. Studies focusing on testicular and epididymal disorders, immunological impacts, and therapeutic approaches were included. Results: Our research highlights that conditions like epididymitis, vasectomy, testicular trauma, and previous surgeries can trigger inflammatory responses, leading to ASA formation and oxidative stress. ASA, particularly sperm-immobilizing antibodies, inhibits sperm motility and migration in the female reproductive tract. Infections caused by sexually transmitted bacteria or urinary pathogens frequently induce epididymo-orchitis, a primary contributor to male infertility. While standardized methodologies for ASA testing remain elusive, assisted reproductive treatments such as intracytoplasmic sperm injection (ICSI), in vitro fertilization (IVF), and intrauterine insemination (IUI) show promise in overcoming immune-mediated infertility. Conclusions: This review underscores the critical role of infection, inflammation, and autoimmune responses in male infertility. It highlights the necessity of improving diagnostic methods, understanding immune-pathological mechanisms, and addressing medicolegal issues associated with male infertility. This knowledge could pave the way for innovative therapies, ultimately enhancing fertility outcomes, and mitigating the societal and legal repercussions of infertility.

Testicular trauma is a cause of morbidity in patients of all age groups, especially among young people. The Paraíba Valley Regional Hospital (PVRH) is a reference in the care of polytraumatized patients and because it is located in a strategic region being cut by major highways. A retrospective analysis of the medical records of patients submitted to unilateral orchiectomy, bilateral orchiectomy and scrotum exploration was performed at the PVRH in a period of 4 years. Within this database, 11 patients submitted to these procedures due to traumatic etiology were found. Orchiectomy was the predominant treatment in the case series reported here (72.7%). The therapeutic approach adopted in this study differs from that reported in the literature, due to the time taken from the trauma until the therapeutic conduct was long, only 36.4% with treatment within 24 hours, thus making more conservative or even more reparative conducts unfeasible, as well as the severity of the injuries involved with the trauma with motorcycles Thus, studies that lead to the detailing of patients victims of testicular trauma in other institutions may contribute to a positive evolution in the quality of pre- and in-hospital care.

Abstract Disclosure: R. Cannarella: None. A. Crafa: None. S. Sapienza: None. M.M. Caruso: None. A.E. Calogero: None. Background: We have previously reported that treatment with recombinant human growth hormone (rhGH) can influence testicular growth and puberty onset in children with GH deficiency (GHD), and suggested GH as a determinant of testicular growth in childhood (doi: 10.3389/fendo.2021.619895). Limited evidence is available on testicular function in post-pubertal GHD patients. Objective: This prospective controlled study was undertaken to evaluate testicular function in young GHD adults previously undergone to GH treatment. Patients and Methods: Post-pubertal patients with non-syndromic GHD (&amp;gt;18 years), in whom GH therapy was discontinued after reaching the therapeutic goal, were required to have a complete evaluation of testicular function. Those who agreed were enrolled in our study. Age-matched healthy men older than 18 years served as controls. Exclusion criteria were: the presence of varicocele, urogenital infections, cryptorchidism, hypospadias, hypogonadism, testicular trauma or torsion, and other congenital or acquired disorders capable of interfering with testicular function. The study outcomes were: serum gonadotropins and total testosterone (TT), conventional sperm parameters, and testicular volume (TV) measured by ultrasound examination. Between-group analysis was performed using the Student’s t-test for independent samples or the Mann-Whitney test, for normally or non-normally distributed variables, respectively. Data were reported as mean±standard deviation for non-skewed data and median (interquartile range) for skewed data. Results: 26 patients with GHD and 25 age-matched controls (18.8±3.3 years vs. 20.1±3.6 years; p=0.18) were enrolled. Patients and controls did not differ for serum luteinizing hormone [2.6 (1.5-4.9) IU/L vs. 3.5 (2.8-4.8) IU/L); p=0.2], follicle-stimulating hormone [3.4 (2.2-4.3) IU/L vs. 3.1 (2.3-4.3) IU/L); p=1.0], and TT [5.7 (4.7-6.8) ng/dL vs. 6.0 (5.1-7.4) ng/dL); p=0.4] levels. At semen analysis, GHD patients had lower semen volume (2.1±1.4 mL vs. 3.5±1.5 mL; p=0.002), total sperm count [135.0 miL/ejaculate (54.3-229.0) vs. 231.3 miL/ejaculate (124.8-285.0); p=0.03], progressive motility [25.5% (15.0-34.0%) vs. 32.0% (30.0-36.5); p=0.02], and total motility [56.0% (49.0-62.0) vs. 66.5% (62.5-70.0); p=0.0001] compared to controls. No difference was found in sperm concentration [73.0 miL/mL (45.0-92.0) vs. 68.0 miL/mL (39.0-90.0); p=1.0] and normal morphology [8.5% (7.0-12.0) % vs. 10.0% (7.5-14.0); p=0.3]. Importantly, GHD patients had lower right (13.3±3.4 mL vs. 16.9±4.1 mL; p=0.001) and left (12.5±3.4 mL vs. 16.3±3.8 mL; p=0.0005) TV. Conclusion: This study provides the first evidence of lower TV and slightly worse semen parameters in patients with GHD compared to healthy controls. Serum GH levels during growth may be important for achieving normal testicular volume and spermatogenesis in adulthood. Presentation: 6/2/2024

Abstract Disclosure: R. Cannarella: None. A. Crafa: None. R. Curto: None. G. Costanza: None. D. Lo Presti: None. S. La Vignera: None. M.C. Caruso: None. A.E. Calogero: None. Background: The impact of type 1 diabetes mellitus (T1DM) and glycemic control on testicular growth in childhood and adolescence is unknown. Understanding this is important as impaired testicular growth during childhood could negatively influence reproductive potential in adulthood. Objective: This retrospective cross-sectional study was undertaken to evaluate the impact of T1DM and glucose control on testicular volume (TV) in prepubertal (&amp;lt;9 years), peri-pubertal (9-14 years), and post-pubertal (14-16 years) ages. Patients and Methods: We recruited children and adolescents aged between 2 and 18 years, referred to the Unit of Pediatric Endocrinology, University of Catania, for T1DM. Data on TV, age, and glycated hemoglobin (HbA1c) were collected. A cohort of healthy normal-weight children/adolescents in whom TV data were available served as controls. Exclusion criteria were: genetic abnormalities, drug intake (except for insulin in the patient group), radiotherapy, chemotherapy, head or testicular trauma, systemic disorders (i.e., kidney and/or liver diseases), endocrine disorders such as hypogonadism, hyperprolactinemia, Cushing syndrome, acromegaly, hypopituitarism, hypostaturalism, and puberty disorders. The primary outcome was TV (measured with the Prader orchidometer by the same operator), which was analyzed in age-matched subgroups (age &amp;lt;9 years, 9 years ≤ age &amp;lt; 14 years, and age ≥14 years). Between-group analysis was performed using the Student’s t-test for independent samples or the Mann-Whitney test for normally or non-normally distributed variables, respectively. To further understand the impact of glycemic control on testicular growth, TV was analyzed by HbA1c value (≥7% or &amp;lt;7%) among age-related patient subgroups, with one-way analysis of variance or Kruskal-Wallis tests, for normally or non-normally distributed variables, respectively. Results: Seventy-three T1DM patients (11.2±4.2 years) and 95 age-matched controls (9.7±3.3 years) were recruited. Patients showed a mean HbA1c of 8.2±2.0%. TV was not significantly different between patients and controls in the &amp;lt;9 years subgroup (2.3±0.8 mL vs. 2.0±0.6 mL; p=0.07), as well as in the 9-to-14-year (6.6±5.5 mL vs. 7.8±5.5 mL; p=0.12), and ≥14-year (18.7±2.6 mL vs. 15.0±5.6 mL; p=0.09) subgroups. HbA1c values were found to influence testicular growth of patients younger than 9 years, with significantly lower TV for HbA1c values &amp;gt;7% compared to those ≤7% (1.8±0.6 mL vs. 2.8±0.6 mL; p=0.003). No differences were found in the other age subgroups. Conclusion: This study provides the first evidence of the effects of T1DM on testicular growth in childhood and adolescence. Poor glucose control appears to negatively influence testicular growth in prepubertal children with T1DM, in line with preclinical evidence showing the effect of insulin on the proliferation of immature Sertoli cells. Presentation: 6/2/2024

Abstract Disclosure: R. Cannarella: None. A. Crafa: None. S. Sapienza: None. M.M. Caruso: None. A.E. Calogero: None. Background: We have previously reported that treatment with recombinant human growth hormone (rhGH) can influence testicular growth and puberty onset in children with GH deficiency (GHD), and suggested GH as a determinant of testicular growth in childhood (doi: 10.3389/fendo.2021.619895). Limited evidence is available on testicular function in post-pubertal GHD patients. Objective: This prospective controlled study was undertaken to evaluate testicular function in young GHD adults previously undergone to GH treatment. Patients and Methods: Post-pubertal patients with non-syndromic GHD (&amp;gt;18 years), in whom GH therapy was discontinued after reaching the therapeutic goal, were required to have a complete evaluation of testicular function. Those who agreed were enrolled in our study. Age-matched healthy men older than 18 years served as controls. Exclusion criteria were: the presence of varicocele, urogenital infections, cryptorchidism, hypospadias, hypogonadism, testicular trauma or torsion, and other congenital or acquired disorders capable of interfering with testicular function. The study outcomes were: serum gonadotropins and total testosterone (TT), conventional sperm parameters, and testicular volume (TV) measured by ultrasound examination. Between-group analysis was performed using the Student’s t-test for independent samples or the Mann-Whitney test, for normally or non-normally distributed variables, respectively. Data were reported as mean±standard deviation for non-skewed data and median (interquartile range) for skewed data. Results: 26 patients with GHD and 25 age-matched controls (18.8±3.3 years vs. 20.1±3.6 years; p=0.18) were enrolled. Patients and controls did not differ for serum luteinizing hormone [2.6 (1.5-4.9) IU/L vs. 3.5 (2.8-4.8) IU/L); p=0.2], follicle-stimulating hormone [3.4 (2.2-4.3) IU/L vs. 3.1 (2.3-4.3) IU/L); p=1.0], and TT [5.7 (4.7-6.8) ng/dL vs. 6.0 (5.1-7.4) ng/dL); p=0.4] levels. At semen analysis, GHD patients had lower semen volume (2.1±1.4 mL vs. 3.5±1.5 mL; p=0.002), total sperm count [135.0 miL/ejaculate (54.3-229.0) vs. 231.3 miL/ejaculate (124.8-285.0); p=0.03], progressive motility [25.5% (15.0-34.0%) vs. 32.0% (30.0-36.5); p=0.02], and total motility [56.0% (49.0-62.0) vs. 66.5% (62.5-70.0); p=0.0001] compared to controls. No difference was found in sperm concentration [73.0 miL/mL (45.0-92.0) vs. 68.0 miL/mL (39.0-90.0); p=1.0] and normal morphology [8.5% (7.0-12.0) % vs. 10.0% (7.5-14.0); p=0.3]. Importantly, GHD patients had lower right (13.3±3.4 mL vs. 16.9±4.1 mL; p=0.001) and left (12.5±3.4 mL vs. 16.3±3.8 mL; p=0.0005) TV. Conclusion: This study provides the first evidence of lower TV and slightly worse semen parameters in patients with GHD compared to healthy controls. Serum GH levels during growth may be important for achieving normal testicular volume and spermatogenesis in adulthood. Presentation: 6/2/2024

Case series -Atypical animal-induced scrotal traumas 2 © 2024 Canadian Urological Association caused by dogs, although cases of human bites have also been reported. 9, 10 Bite injuries are often minor traumas, typically managed with irrigation, debridement, and antibiotic prophylaxis. 4 Although rarely reported, animals can induce injury in mechanisms other than biting. Herein, we report on three cases of unique animal-induced scrotal traumas. Specific non-relevant patient details have been altered to preserve patient privacy. This 51 y.o. patient had been camping at a remote location when a black bear approached his camp in the early morning. The bear was not deterred and attacked the patient, leaving the patient with injuries to the right scrotum and gluteal region. Unfortunately, due to the severalhour hike to return to his vehicle, the patient had a significant delay in his presentation to the hospital. On presentation to the emergency department (ED), external puncture wounds were noted in the scrotum, with a non-palpable right testicle (Figure 1 ). An US was ordered, showing a small right hematocele, but the irregular borders of the tunica albuginea, and a heterogenous appearance within the testicle suggested hematomas within the testicle. Urology was immediately consulted, and the patient was taken urgently to the operative room. The scrotum was explored through a median-raphe midline incision. The right testicle was determined to be extensively damaged with no viable tissue to repair, and a subsequent orchiectomy was performed. The left side was not explored, as it appeared normal on the preoperative US and intact on palpation. The patient recovered uneventfully, and his pathology ultimately showed no concerning findings. Case series -Atypical animal-induced scrotal traumas 4 © 2024 Canadian Urological Association three cases underscore the importance of considering the possibility of cancer when dealing with injuries to the scrotum. Urologists treating testicular trauma should similarly consider cancer when proposing treatment for their patients, performing an inguinal approach for orchiectomies when possible. It is imperative that all specimens be sent to pathology, with proper follow-up. In cases where malignancy is diagnosed following a scrotal orchiectomy, adjuvant treatments are recommended. 13 Patients with low-stage seminomas undergoing radiation should have their radiation extended to include ipsilateral and scrotum. In patients with low-stage nonseminoma germ cell tumours, the scrotal scar and spermatic cord remnants should be widely excised during the retroperitoneal lymph node dissection (RPLND). Patients who had received platinum-based chemotherapy should also have the cord stump removed at the time of RPLND.

Genitourinary (GU) trauma resulting from combat and the treatment of these injuries is an inadequately explored subject. While historically accounting for 2 to 5% of combat-related injuries, GU-related injuries escalated considerably during U.S. involvements in Iraq and Afghanistan due to improvised explosive devices (IEDs). Advanced body armor increased survivability while altering injury patterns, with a shift toward bladder and external genitalia injuries. Forward-deployed surgeons and military medics manage treatment, with Role 2 facilities addressing damage control resuscitation and surgery, including GU-specific procedures. The review aims to provide an overview of GU trauma and enhance medical readiness for battlefield scenarios. This review examined urologic trauma management in combat, searching PubMed, Cochrane Central, Scopus, and Web of Science databases with search terms "wounds" OR "injuries" OR "hemorrhage" AND "trauma" AND "penile" OR "genital" AND "combat." Records were then screened for inclusion of combat-related urologic trauma in conflicts after 2001 and which were English-based publications. No limits based on year of publication, study design, or additional patient-specific demographics were implemented in this review. Ultimately, 33 articles that met the inclusion criteria were included. Included texts were narrowed to focus on the management of renal injuries, ureteral trauma, bladder injuries, penile amputations, urethral injuries, testicular trauma, Central nervous system (CNS) injuries, and female GU injuries. In modern conflicts, treatment of GU trauma at the point of injury should be secondary to Advanced Trauma Life Support (ATLS) care in addition to competing non-medical priorities. This review highlights the increasing severity of GU trauma due to explosive use, especially dismounted IEDs. Concealed morbidity and fertility issues underscore the importance of protection measures. Military medics play a crucial role in evaluating and managing GU injuries. Adherence to tactical guidelines and trained personnel is vital for effective management, and GU trauma's integration into broader polytrauma care is essential. Adequate preparation should address challenges for deploying health care providers, prioritizing lifesaving and quality-of-life care for casualties affected by GU injuries.

Epidemiology of Testicular Trauma in Sports: Analysis of the National Electronic Injury Surveillance System Database

BACKGROUND: Satisfaction with the results is a complex and poorly studied aspect of testicular prosthetics, which currently has no comprehensive consecration in the literature. There are no works that are based on a comprehensive view of the problem, from a subjective analysis of the local physical characteristics of the implant itself and the aesthetic perception of one’s body to assessing the impact of prosthetics on the patient’s sex life and socialization. AIM: The aim of this study is to evaluate the results of testicular prosthetics using an original questionnaire reflecting satisfaction with the physical characteristics of the implant, sexual behavior characteristics and the socio-psychological status of the patient. MATERIALS AND METHODS: Questionnaires of 236 patients were analyzed — 112 adults 1 year after prosthetics and 124 adolescents after reaching 18 years of age with a period after surgery from 1 to 8 years. The survey was carried out using an original questionnaire that included 15 questions reflecting various aspects of the patient’s attitude to the results of prosthetics. RESULTS: Overall satisfaction with prosthetics was more than 90% in both groups, prevailing in patients operated on in adolescence. The greatest satisfaction with prosthetics was noted in patients after testicular torsion and trauma, less satisfaction in patients with cryptorchidism, testicular hypoplasia, and monorchidism. When analyzing the patient’s interest in this procedure depending on the period before prosthetics, it was noted that satisfaction does not tend to decrease over time, up to a 10-year interval between the loss of the gonad and prosthetics. Requirements for the final result of prosthetics tend to increase in more educated patients. The results of the survey demonstrate the greatest demands for prosthetics in patients in the age group of 21–30 years as the most sexually active age category. CONCLUSIONS: Patient satisfaction with modern implant prosthetics is quite high — at least 90%. However, these values are not maximum and leave room for further optimization of this method, which follows from the lack of a maximum assessment of satisfaction with the results of prosthetics — for all criteria the indicators do not exceed 95%.

&#x0D; Objective: Urogenital injuries (UGIs) are present in approximately 10% of adult and less than 3% of pediatric trauma patients. To date, no reports have been published regarding urogenital injuries in Somalia, a sub-Saharan African country. We aimed to analyze the data of urogenital trauma patients who presented to the emergency department of the only tertiary care center in Somalia.&#x0D; &#x0D; &#x0D; Materials and Methods: Patients who presented to the emergency department of our institution following trauma between January 2019 and December 2022 and were admitted with the diagnosis of UGI constituted the target population. The collected data included demographic characteristics, type of trauma, involved urogenital organ, admission site, patient management type, and survival. &#x0D; &#x0D; &#x0D; Results: Overall, 2426 trauma patients presented to the emergency department. Among these patients, 116 (4.8%) had UGI. The mean patient age was 28.31±5.2 [1-73]. Most (83.6%, n=97) patients were male. Kidneys were the most commonly injured organs (41.4%, n=48), followed by the urinary bladder (17.2%, n=20) and testis (13.7%, n=16). Nine patients with renal trauma underwent nephrectomy. Among 20 patients with bladder injury, half underwent surgical repair. Ten of 16 patients with testicular trauma underwent orchiectomy due to severe rupture. All 12 patients with penile injuries underwent primary repair. Among 10 (8.6%) patients with urethral injuries, 4 underwent immediate primary repair, 3 underwent endoscopic realignment, while the remaining 3 needed cystostomy and delayed urethroplasty. The mortality rate was 10.3% (n=12). &#x0D; &#x0D; &#x0D; Conclusions: Surgical exploration was commonly performed due to the severity of the traumas and the presence of adjacent organ injuries. This finding arises from the fact that Somalia is a country affected by terrorism and low-density war.&#x0D;