Testicular Trauma Research Articles

Injury to the male external genitalia: a comprehensive review.

While rare, trauma and injury to the male external genitalia can result in significant consequences regarding function, appearance, psychological effects, and overall quality of life. Due to the relative paucity of literature regarding male external genitalia injuries, few standardized protocols exist. This review aims to outline common clinical causes of male external genitalia injuries by both anatomic location and etiology. Initial stabilization, long-term reconstruction, and coverage options are discussed in detail. Outcomes of complex grafts have favorable success rates of 90-100% in the hands of experienced surgeons. Outcomes of penile, testicular trauma also have favorable outcomes when managed appropriately. Attempts at reconstruction after initial injury stabilization should be undertaken at high-volume centers where a multidisciplinary approach can be employed. This manuscript will be an excellent reference and source that can provide direction for evaluation and management of these complex presentations.

Effect of Sildenafil in Protection of Contralateral Testis Following Unilateral Blunt Testicular Trauma in Mouse

Effect of Sildenafil in Protection of Contralateral Testis Following Unilateral Blunt Testicular Trauma in Mouse

Trends in Testicular Injury in Korea, 1986-2015.

The objectives of this study were to investigate patients treated for scrotal trauma at our institute for the last three decades to describe our experience with an emphasis on the etiologies and ultrasonographic findings in these patients. We reviewed medical records of patients who underwent scrotal ultrasonography for evaluation of testicular trauma at our institutes from 1986 to 2015. Trends regarding the etiology of scrotal trauma were evaluated during each decade. The echo pattern and contour definition of the testicular parenchyma and the pattern of hematoma development were recorded to evaluate radiographic findings of testicular injury. The correlation between ultrasonographic and intraoperative findings was assessed. A total of 115 patients were analyzed. Most patients (92.2%) presented with blunt trauma. The most common etiology of testicular trauma was assault during the first and second decades, while injury related to a fall was most common during the third decade. Of the 77 patients (67.0%) who underwent urgent exploration, 46 patients (59.7%) had testicular rupture. Loss of contour definition, heterogeneous echo pattern of the testicular parenchyma, and testicular hematoma showed a moderate to strong degree of correlation with testicular rupture (Spearman correlation co-efficient: 0.5–0.8). Over the past 30 years, the etiology of testicular injury changed from assault to falls or athletic injury and the severity of injury has decreased. Our findings demonstrate the importance of ultrasonography for determining an appropriate management strategy in scrotal trauma. Surgical exploration should be considered in patients with abnormal ultrasonographic findings.

Contrast enhanced harmonic ultrasonography for the evaluation of acute scrotal pathology. A pictorial essay.

Conventional ultrasonographic evaluation (grey scale and Doppler) represents the first line investigation in the acute pathology of the scrotum. Its diagnosis value in acute scrotal pathology is undoubted in regard with hypervascular lesions, but in the evaluation of isoechoic and hypo/avascular lesions i.v. contrast-enhanced harmonic ultrasonography (CEUS) is recommended in establishing a firm and certain diagnosis. Besides these, CEUS has an important role in the evaluation of the remaining viable testicular tissue in cases of testicular trauma, thus guiding a limited excision surgery. This paper aims to discuss the added diagnosis value of CEUS and to illustrate this through various ultrasonographic images suggestive for acute scrotum pathology.

The Epidemiology of Anti-Sperm Antibodies Among Couples with Unexplained Infertility in North West Bank, Palestine.

Anti sperm antibodies (ASA) can present in serum and semen and they may lead to impair the sperms function leading to infertility. The precise mechanism of generation of these antibodies is yet to be discovered. This study was performed to determine the prevalence of anti-sperm antibodies (ASA) in patients with unexplained infertility. The study was initiated also to explore the possible factors that may associate with ASA formation and how ASA status is associated with pregnancy rates after going with in vitro fertilization - intracytoplasmic sperm injection (IVF-ICSI). A cross-sectional study was conducted on 42 normal infertile couples consulting Razan Medical Center for Infertility & I.V.F. in Nablus, Palestine, from December 2012 - March 2013. Serum levels of immunoglobulins G (IgG) ASA were measured in participants (males and females) using enzyme-linked immunosorbent assay (ELISA). In addition, participants also filled a questionnaire about the presence of previous varicocele repair, inguinal hernia repair, orchitis, testicular trauma and vasectomy reversal among males and severe coitus bleeding and coitus during menses or puerperium among females. Couples were also asked about previous IVF-ICSI procedures and the outcome of the procedure in terms of either they got pregnant or not. Data was analysed using SPSS software. The prevalence of ASA was 14.3% (6/42) among all couples, 9.5% (4/42) among males and 4.8% (2/42) among females. There was no significant relationship between previous varicocele repair, previous inguinal hernia repair, or orchitis and formation of ASA (p value =0.64, 0.56, and 0.26 respectively). Previous trauma, vasovasostomy, severe coitus bleeding and coitus during menses or puerperium were not observed in any of the study sample. ASA did not seem to affect the outcome of IVF-ICSI (p-value =0.54). Prevalence of ASA in infertile couples in the north part of Palestine is similar to that obtained worldwide. ASA formation does not relate to any of the studied risk factors and does not seem to associate with pregnancy rate after IVF-ICSI. We recommend further studies using a larger sample size and including all parts of Palestine in order to generalize the obtained results.

Testicular trauma resulting in death due to shock and systemic inflammatory response syndrome (SIRS): A case report

Male genital trauma can occur by many different mechanisms with the clinical presentation being typically homogeneous, characterized by pain and swelling. This condition of Acute Scrotum is treated as a medical emergency with about 20% of the patient needing surgical exploration and rest of the cases are managed by conservative treatment. Any unnecessary delay in management can bring about irreversible damage to the testis making it important to identify the patients who do not need surgery by use of the appropriate diagnostic procedures. Few cases of acute scrotal pain might lead to Systemic Inflammatory Response Syndrome (SIRS), which is a life threatening condition. We report a case of an 18 year old boy who sustained testicular trauma while riding a bicycle and two months post trauma developed severe pain in left inguino-scrotal region, fever and subsequently died. The authors intend to report this unusual case as cases of testicular trauma resulting in shock and SIRS have been reported in literature but were unable to find cases of death occurring due to SIRS.

Is contrast-enhanced MRI efficient in testicular infarction mimicking testicular tumor on scrotal ultrasound?

A 4-year-old boy was admitted to emergency department of our institution with left testicular swelling and pain started 48 h ago. Physical examination revealed left sided erythema and tenderness in scrotum which was refractory to testicular elevation. The parents did not describe undescended testis, trauma or recent mumps history that may explain acute swelling of left scrotum. Immediately after the physical examination, a scrotal Doppler ultrasonography was performed using a high frequency linear transducer. Ultrasonographic evaluation showed heterogeneously enlarged left testis and edema in the left scrotum. Blood supply was decreased in left testis in comparison to the right, however, arterial waveforms were still preserved in the left epididymis. In addition to Doppler and gray scale ultrasonography features, a smooth contoured demarcation line in the left testis was also observed which simulated mass lesion in the left testis. Based on the ultrasonography findings a concurrent testicular neoplasia could not be ruled out completely and the patient was referred to contrast-enhanced magnetic resonance imaging (MRI) promptly after ultrasound examination. MRI revealed left testicular enlargement, scrotal edema, and heterogeneous hypointense areas in T2-weighted images, but there was no solid or cystic mass lesion within the left testis. The affected testis was observed to be prominently hypointense on T1-weighted images compared to right. At post-contrast and subtraction MRI sequences avid contrast enhancement was detected in left paratesticular tissue however, left testis was completely avascular at post-contrast MRI sequences (Fig. 1). Based on the MRI findings, the diagnosis of testicular torsion was made confidently. Emergency surgical exploration confirmed intravaginal testicular torsion but, unfortunately detorsion operation could not have been performed and left sided orchiectomy was required because left testis was observed to be totally necrotic during surgical intervention (Fig. 2). Fig. 1 Post-contrast subtraction axial MRI image reveals left testicular enlargement and left paratesticular enhancement. Note that the affected left testis is hypointense and no contrast enhancement is observed diagnostic for testicular torsion (arrows). However, ... Fig. 2 Photographic view of the left testis during operation shows left testicular necrosis. Intravaginal torsion accounts for most cases of testicular torsion. Most cases are spontaneous but, rarely intravaginal testicular torsion may result from testicular trauma.1 Since irreversible damage may occur within 4–6 h of symptom onset, early diagnosis and urgent surgical intervention are critical.2 In the early stage of torsion, the echogenicity and size of the affected testis may be normal. Later findings include testicular enlargement and increased parenchymal echogenicity. If left untreated, the torsion will eventually progress into infarction which is seen as decreased or absent blood flow in color Doppler ultrasonography.1 The latter is sometimes diagnostic challenge in ultrasonography since, demarcation line of the infarcted testis tissue may simulate tumor particularly in late testicular torsion.3 In the current case, as reported in the literature,4 a testicular tumor was accurately ruled out via emergency contrast-enhanced MRI. In conclusion, late testicular torsion may mimic testicular mass lesion in ultrasonography which may cause a diagnostic challenge in Emergency Medicine. Contrast-enhanced MRI is helpful in the diagnosis as well as in the differential diagnosis in such complex cases.

Primary testicular mucinous cystadenoma: Case report and literature review.

Testicular mucinous cystadenomas are rare in urological practice, and their histogenesis, course and management are debated. We report a primary testicular mucinous cystadenoma in a 54-year old male who presented with left testicular swelling and pain. He denied having a history of cryptorchidism, testicular trauma, infections, urinary complaints, or febrile illnesses. He did not have diabetes, but was on treatment for hypertension. The patient underwent a left inguinal radical orchiectomy, and histological examination of the resected tumour confirmed a primary testicular mucinous cystadenoma. The patient had an uneventful recovery, and is being followed up. Conclusively, urologists need to maintain a high index of suspicion of these tumours and their differentiation from metastatic tumours to ensure optimal therapeutic outcomes.

Lower genitourinary tract trauma

Lower genitourinary tract trauma comprises a substantial portion of the trauma burden in the USA. Some key trends and findings are described. Mortality is relatively high in patients with bladder trauma due to associated injuries. Urethral injuries should be suspected in patients presenting with the triad of blood at the urethral meatus, suprapubic fullness indicative of a full bladder, and urinary retention. Urethral injury is common in penetrating penile trauma, and stab wounds to the penis are more likely to involve the urethra than gunshot wounds. Penile fracture is largely a clinical diagnosis and suspicion of fracture requires urgent surgical exploration. Zipper injuries are the most common cause of presentation to the emergency department for penile trauma in adults. Toilet seat injuries are the leading cause of penile pediatric trauma presenting to the emergency department. In the setting of testicular trauma, rates of testicular salvage are excellent when exploration is prompt. Trauma in the form of animal or human bites requires treatment with broad-spectrum antibiotics in addition to repair of the injury. Military trauma has seen an increase in explosive injuries to the lower urinary tracts due to evolution of warfare tactics. Increasing awareness of presentation and context of lower genitourinary tract trauma can reduce delay of diagnosis and morbidity associated with such injuries.

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.

Changes in FABP1 and gastrin receptor expression in the testes of rats that have undergone electrical injury.

Testicular trauma may occur due to accidental electrical injury. The aim of this study was to investigate alterations in the levels of fatty acid-binding protein 1 (FABP1) and gastrin receptor (gastrin R) in the testes following electrical injury. Sprague-Dawley rats were divided into control, fatal electrocution (220 V, 50 Hz, 60 sec) and electrical injury (220 V, 50 Hz, 60 sec) groups (n=8 per group). The animals in the fatal electrocution and electrical injury groups were deeply anesthetized with sodium pentobarbital prior to each treatment, in which the current was delivered via an anode connected to the left foreleg and a cathode to the right hindleg. The rats that survived were subsequently sacrificed by cervical dislocation. Control animals received cervical dislocation alone. Immunohistochemical analysis was performed to evaluate the protein expression of FABP1 and gastrin R in the testes. Sections were evaluated by digital image analysis. The expression levels of FABP1 and gastrin R were significantly increased following electrical injury, supported by an increase in the integrated optical density (IOD) when compared with that in the control group (P<0.05). However, no significant difference was found in FABP1 and gastrin R expression levels between the fatal electrocution and control groups. In summary, the protein expression levels of FABP1 and gastrin R were found to be significantly altered by electrical injury, suggesting that these two proteins may be important in underlying mechanisms of testicular injury during electrical injury. The findings indicate that such alterations would be reflected in abnormal testicular function.

Sonographic appearances of torsion of the appendix testis and appendix epididymis in children.

The most common cause of acute scrotum in prepubertal boys is torsion of the testicular or epididymal appendages. The purpose of this retrospective study was to characterize the features of these lesions as viewed on sonographic (US) and color Doppler US examination. During a 220-week period, 527 male patients 0-17 years old had been referred from the pediatric emergency department for scrotal US evaluation. Torsion of the appendix testis or appendix epididymis had been diagnosed in 19 (3.6%) patients, 3-14 years old (mean, 9.4 years); those patients became our study cohort. The clinical diagnoses in 15 of those patients had been suspected testicular torsion (n = 7), trauma (n = 4), suspected epididymitis and/or orchitis (n = 3), and suspected hydrocele (n = 1). The remaining four patients had been referred owing to nonspecific pain. None of the 19 patients had had the "blue-dot sign" on physical examination. In the 19 patients diagnosed with torsion of the intrascrotal appendages, color Doppler US demonstrated a round or oval avascular lesion with heterogeneous echotexture (n = 18), posterior enhancement (n = 13), and hyperemia of the surrounding structures (n = 15). All lesions (appendages) were adjacent (n = 16) or in close proximity (n = 3) to the upper pole of the testis. Fifteen of the appendages were adjacent to both the testis and the epididymis, four were adjacent to the epididymis alone, and none were adjacent to the testis alone. Owing to the close proximity of the upper pole of the testis, the epididymis, and the appendage, differentiation between testicular and epididymal appendages was not possible. Torsion of the intrascrotal appendages has a typical appearance on color Doppler US; thus, we believe that it is the method of choice for diagnosing torsion of the scrotal appendages and safely ruling out other disorders as well as avoiding unwarranted surgical intervention or antibiotic treatment.

2091496 Multi-Parametric Ultrasonography of Testicular Hematomas: Features on Grey Scale, Color Doppler, Contrast Enhanced Sonography and Real-Time Tissue Elastography

ObjectivesTesticular trauma results in a variety of testicular complications including an intra-testicular hematoma. A focal intra-testicular lesion following trauma may be diagnostically difficult with a primary germ cell tumor a possibility. We investigate the appearances of a series of intra-testicular hematomas on multi-parametric ultrasonography.MethodsHematomas were identified from a database and retrospectively reviewed by experienced observers. All patients underwent testicular ultrasonography, by experienced sonographers, using high frequency transducers, employing standard techniques of multi-parametric ultrasonography combining grey-scale, color Doppler, and contrast enhanced ultrasound as well as real-time elastography to assess features of intra-testicular hematoma. Features recorded were; size, location, echogenicity, color Doppler signal, contrast-enhancement, elasticity score and strain ration. Follow-up was recorded.ResultsOver a three year period, 17 hematomas (right testis n=11, left testis n=6, maximum diameter range 5–28mm) in eight patients (mean age 31 years, range 25-43 years) were analysed. Blunt trauma (n=7) and surgery (n=1) were preceding events. Greyscale sonography demonstrated well-defined, oval or round, predominantly hypoechoic and heterogeneous, peripherally (n=13) or centrally located (n=4). Three demonstrated contrast-enhanced ultrasound enhancement of septations not seen on color Doppler and four peripheral rim enhancement. Sixteen lesions had real-time elastography performed; mean strain ratio was 1.49 (range 0.41–2.77), elasticity score ≤3 (n=12) and 5 (n= 4). All lesions were confirmed benign on follow-up sonography.ConclusionsMulti-parametric ultrasonography aids the interpretation of the benign nature of intra-testicular lesions thought to be hematoma formation allowing conservative management until resolution of appearances. ObjectivesTesticular trauma results in a variety of testicular complications including an intra-testicular hematoma. A focal intra-testicular lesion following trauma may be diagnostically difficult with a primary germ cell tumor a possibility. We investigate the appearances of a series of intra-testicular hematomas on multi-parametric ultrasonography. Testicular trauma results in a variety of testicular complications including an intra-testicular hematoma. A focal intra-testicular lesion following trauma may be diagnostically difficult with a primary germ cell tumor a possibility. We investigate the appearances of a series of intra-testicular hematomas on multi-parametric ultrasonography. MethodsHematomas were identified from a database and retrospectively reviewed by experienced observers. All patients underwent testicular ultrasonography, by experienced sonographers, using high frequency transducers, employing standard techniques of multi-parametric ultrasonography combining grey-scale, color Doppler, and contrast enhanced ultrasound as well as real-time elastography to assess features of intra-testicular hematoma. Features recorded were; size, location, echogenicity, color Doppler signal, contrast-enhancement, elasticity score and strain ration. Follow-up was recorded. Hematomas were identified from a database and retrospectively reviewed by experienced observers. All patients underwent testicular ultrasonography, by experienced sonographers, using high frequency transducers, employing standard techniques of multi-parametric ultrasonography combining grey-scale, color Doppler, and contrast enhanced ultrasound as well as real-time elastography to assess features of intra-testicular hematoma. Features recorded were; size, location, echogenicity, color Doppler signal, contrast-enhancement, elasticity score and strain ration. Follow-up was recorded. ResultsOver a three year period, 17 hematomas (right testis n=11, left testis n=6, maximum diameter range 5–28mm) in eight patients (mean age 31 years, range 25-43 years) were analysed. Blunt trauma (n=7) and surgery (n=1) were preceding events. Greyscale sonography demonstrated well-defined, oval or round, predominantly hypoechoic and heterogeneous, peripherally (n=13) or centrally located (n=4). Three demonstrated contrast-enhanced ultrasound enhancement of septations not seen on color Doppler and four peripheral rim enhancement. Sixteen lesions had real-time elastography performed; mean strain ratio was 1.49 (range 0.41–2.77), elasticity score ≤3 (n=12) and 5 (n= 4). All lesions were confirmed benign on follow-up sonography. Over a three year period, 17 hematomas (right testis n=11, left testis n=6, maximum diameter range 5–28mm) in eight patients (mean age 31 years, range 25-43 years) were analysed. Blunt trauma (n=7) and surgery (n=1) were preceding events. Greyscale sonography demonstrated well-defined, oval or round, predominantly hypoechoic and heterogeneous, peripherally (n=13) or centrally located (n=4). Three demonstrated contrast-enhanced ultrasound enhancement of septations not seen on color Doppler and four peripheral rim enhancement. Sixteen lesions had real-time elastography performed; mean strain ratio was 1.49 (range 0.41–2.77), elasticity score ≤3 (n=12) and 5 (n= 4). All lesions were confirmed benign on follow-up sonography. ConclusionsMulti-parametric ultrasonography aids the interpretation of the benign nature of intra-testicular lesions thought to be hematoma formation allowing conservative management until resolution of appearances. Multi-parametric ultrasonography aids the interpretation of the benign nature of intra-testicular lesions thought to be hematoma formation allowing conservative management until resolution of appearances.

Emergency ultrasound of acute scrotal pain.

Patients presenting with acute scrotal pain to the emergency department require a timely diagnosis. Although the differential diagnosis can be extensive and varies with age, there are a few conditions that are considered true surgical emergencies. These include torsion of the spermatic cord, incarcerated hernia with strangulation, testicular trauma leading to rupture or organ-threatening hematomas, and Fournier's gangrene. These are conditions that need to be kept in mind by the physician when approaching such patients. Other causes such as epididymitis or orchitis need to be distinguished, and although not requiring emergency surgery, still require urgent diagnosis and treatment. Diagnostic ultrasound can accurately diagnose many acute conditions of the scrotum, and emergency physicians have come to utilize it to advance their diagnostic acumen. This educational review article discusses the current literature and the use of emergency ultrasound in patients presenting with scrotal pain as well as scanning approaches and common sonographic findings.

Is it possible to distinguish testicular torsion from other causes of acute scrotum in patients who underwent scrotal exploration? A multi-center clinical trial.

IntroductionTo assess the clinical presentation of patients who underwent surgical exploration for acute scrotum and to investigate the potentially related factors for differential dignosis.Material and methodsWe retrospectively analyzed the medical records of 97 patients who underwent surgical exploration for acute scrotum between May 2007 and July 2013. The patients were divided into two groups as follows: Group1 included patients with testicular torsion (TT) and Group 2 contained patients with acute scrotal pathologies other than TT, including torsion of the testicular appendage, epididymo-orchitis, trauma and Henoch-Schönlein purpura. The physical examination findings, colour Doppler ultrasound (CDUS) and laboratory findings for the groups were compared.ResultsIn total, 97 scrotal explorations were carried out for acute scrotum. Group 1 included 72 patients (74.2%) and Group 2 included 25 patients (25.8%). Group 2 was comprised of patients with torsion of the testicular appendage (n = 13), epididymo-orchitis (n = 8), testicular trauma (n = 2) and Henoch-Schönlein purpura (n = 2). In Group 1, 32 cases (44.4%) presented to a hospital less than 6 hours after onset of pain. More than half (64%) of Group 2's cases presented more than 24 hours after pain onset. Fever and pyuria appeared more frequently in Group 2 than in Group 1 and the results reached statistical significance (p = 0.001 and p = 0.044, respectively). Group 1 had more testicular tenderness than Group 2 (p <0.001). Our testicular salvage rate was 59.7%, and 40.3% of patients underwent orchiectomy.ConclusionsCDUS predicted the diagnosis of TT (sensitivity 98.6%). Furthermore, clinical findings may also play a substantial role in the differential diagnosis of acute scrotum.

Trauma to the Male External Genitalia: Epidemiology, Diagnosis and Therapeutic Aspects at Yalgado Ouedraogo Teaching Hospital of Ouagadougou

Objective: To describe the epidemiology, diagnosis and therapeutic outcomes of trauma to the external genitalia trauma. Materials and Methods: This is a retrospective descriptive study over a period of six and a half years from January 1st, 2006 to June 30th, 2012. About 42 cases of trauma to the male external genitalia were received at the emergency department of General surgery and Urology of Yalgado Ouedraogo Teaching Hospital of Ouagadougou. Results: The average age of the patients was 31.7 years and the age groups most affected were those between 16 - 26 years. Our study population were mainly pupils and students with 40.5% of cases. Causes of trauma to the external genitalia were mainly highway accident with 19 cases (45.2% of cases). 85.7% of patients presented on the day of the trauma. Scrotum and its contents were more exposed to trauma (30 cases) than penis (12 cases). Treatment was most often surgical (78.6%). The postoperative course was uneventful in 75% of the cases of testicular trauma and 72.7% of the cases of penile trauma. Conclusion: External genitalia traumas affect young people. Complications can be important like erectile dysfunction. However, the prognosis is good if treatment is early.

Isolated Right Testicular PAN (Polyarthritis Nodosa) presenting as Right Testicular Pain

Patient is a 30 year old male with no significant past medical history who repeatedly sought medical attention for debilitating right testicular pain. Initially he was symptomatically treated with non-steroidal anti-inflammatory medications for presumptive diagnosis of testicular trauma. A few months later he went to different emergency department and was treated with antibiotics for presumptive diagnosis of epididymitis. Finally at his third presentation he was hospitalized. Three testicular biopsies were taken and only the biopsy sample from the middle area of the right testes revealed polyarthritis nodosa. The Patient had no other signs and symptoms and this was likely isolated PAN of his right testes which is a very rare occurrence.

Presumed testicular rupture during a college baseball game: a case report and review of the literature for on-field recognition and management.

Scrotal rupture during athletic competition is considered a rare occurrence; however, blunt trauma to the scrotum is relatively common. Protective athletic cups are strongly recommended for both children and adults engaging in contact sports as they likely limit the amount of serious injury to the scrotal contents. Nonetheless, should the on-field assessment by the athletic trainer, coach, or team physician indicate that the athlete has increased pain, ecchymosis, swelling, and tenderness to palpation after blunt trauma, testicular rupture should be suspected and prompt ultrasound and urologic assessment should be undertaken, as early operative intervention is necessary for testicular preservation. This report reviews testicular trauma during athletic competition.

Scrotal Exploration for Suspected Testicular Torsion: Can we Prevent Unnecessary Surgery?

Testicular pain is a common reason for seeking urgent urological advice and many patients with uncertain diagnosis undergo scrotal exploration. The role of ultrasound in triage of these patients is well recognised, but limited availability out-of-hours and inherent delays often make its use impractical. The aim of this study was to review local practices in relation to scrotal explorations and preoperative ultrasound and to highlight ways for improvement. We completed a retrospective study of 117 emergency scrotal explorations for suspected testicular torsion performed at our hospital in a four year period (2006-2010). Eleven patients (9.40%) had preoperative ultrasound. Analysis indicated that 32 patients (27%) had testicular torsion, 40 (34%) torsion of hydatid of Morgagni, 20 (17%) epididymo-orchitis, 1 (1%) testicular trauma and no cause for pain was found in 24 (21%) of cases. There were seven reported complications (5.98% rate). A significant proportion of patients undergoing scrotal exploration had pathology not requiring surgery. In cases where pain is of long duration (e.g. >12 hours) and clinical picture not suggestive of testicular torsion, ultrasound may be able to prevent unnecessary surgery by ruling out testicular torsion.

Role of ultrasound with color Doppler in acute scrotum management.

Background and Objective: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. Physical examination adds only a little information. Color Doppler ultrasound (US) is the modality of choice to differentiate testicular torsion from inflammatory conditions and can thus help in avoiding unnecessary surgical explorations.Subjects and Methods:A study on 50 patients was conducted who were referred with history of acute scrotal pain to our department between January 2013 and January 2014. Trauma and scrotal mass were excluded from the study. The clinical presentation, outcome, and US results were analyzed.Results:Color Doppler sonography yielded a positive and negative predictive value (PPV and NPV) of 100% each for torsion, whereas, 93.9 and 70.6% for epididymo-orchitis, respectively; a sensitivity and specificity of 100% for torsion, whereas, for epididymo-orchitis it was found to be 86.1 and 85.7%, respectively. In cases of incomplete or early torsion, some residual perfusion may be detected leading to false-negative results.Conclusion:We therefore conclude that color Doppler sonography can reliably rule out testicular torsion and can thus help in avoiding unnecessary surgical explorations. Hence, it can significantly improve outcome and decrease morbidity of patient. It is an accurate, rapid, nonexpensive, nonionizing, important adjunct to clinical assessment of scrotum.