Various forms of blunt, penetrating, or degloving testicular injury are recognized in the literature. Sports-related trauma and motor vehicle accidents are the two most common modes, and in the majority of cases, unilateral scrotal pain is the main clinical presentation. The diagnosis is made after conducting a detailed patient history and a physical examination, followed by ultrasonography of the testes.
Despite the fact that testicular injuries comprise less than 1% of all trauma-related injuries, early recognition of this condition is vital in order to reduce potential complications . The most common, and often the only symptom of testicular injury, is a scrotal pain, which may be sometimes accompanied by swelling, and appears after one of the recognized forms of trauma      :
- Blunt injuries - Sport-related activities are responsible for up to 50% of all testicular trauma, for eg. during contact sports (kicking in the groin area), ice hockey and baseball, during which the testes are crushed between the thighs or the symphysis pubis   . Due to the higher anatomical location of the right testis, it is more frequently injured than the left . Intentional injuries and motor vehicle accidents are other notable causes .
- Penetrating trauma - Animal bites, injuries from sharp objects (e.g. knife) and gunshot wounds, considered as the most common penetrating form of injury, are possible causes of penetrating testicular injury . This type, unlike blunt trauma, more commonly involves both testes.
- Iatrogenic injury - Complications during inguinal and scrotal surgery (spermatic cord transection, nerve injury, infection, etc.) can result in testicular injury and the appearance of bleeding, the formation of hematomas and progressive testicular swelling .
Regardless of the mode of trauma, hematomas, hydroceles, hematoceles, testicular fractures, dislocation, torsion and even testicular rupture in rare cases may be seen  . Moreover, subsequent infection (epididymis and epididymo-orchitis) is a known complication, while up to 15% of testicular tumors are incidentally discovered during evaluation of testicular injury . Additional injuries of the genitalia (the urethra and the penis) are often concomitantly present with symptoms of hematuria, penile swelling and ecchymoses  . For this reason, a comprehensive workup is necessary.
- Testicular Pain
Any sudden onset of severe testicular pain is a cause for concern and careful monitoring. [auanet.mediaroom.com]
While most testicular pain is temporary, it can persist days, weeks, months and even years. Doctors classify testicular pain as chronic if it last 3 months or longer. [dontcookyourballs.com]
[…] may include: Testicular pain and discomfort Testicular swelling Testicular bruising Testicular tenderness Scrotum pain Scrotum bruising Scrotum swelling Groin pain Abrasions to the person’s scrotum Lacerations to the person’s scrotum Bruises to the scrotum [firstaidservices.ca]
- Scrotal Pain
Sports-related trauma and motor vehicle accidents are the two most common modes, and in the majority of cases, unilateral scrotal pain is the main clinical presentation. [symptoma.com]
On the fifth day post-trauma the patient remained febrile with progressing scrotal swelling and pain. [casesjournal.biomedcentral.com]
Initially patients with acute scrotal pain are told to look for signs of injury and infection, but they should also be aware of the signs of sepsis and SIRS. [snopes.com]
Testicular trauma is the third most-common cause of acute scrotal pain and may result in various degree of damage to the testes. Testicular rupture and testicular ischemia/infarct are two severe complications which need to be ruled out. [radiopaedia.org]
In this case, pain and swelling involve both the scrotal contents and the groin area. [auanet.org]
- Testicular Mass
Orchiectomy – Testicular masses, if malignant, are usually removed along with the entire affected testicle. [wmuro.com]
Testicular sparing surgery in small testis masses: A multinstitutional experience. Galosi AB, Fulvi P, Fabiani A, Servi L, Filosa A, Leone L, Marronaro A, Caraceni E, Montironi R. Galosi AB, et al. [pubmed.ncbi.nlm.nih.gov]
Other authors support the use of sonoelastography for the evaluation of testicular masses. [cancerimagingjournal.biomedcentral.com]
For many years, the identification of a hypoechoic testicular lesion in a young man with a painless palpable mass was considered virtually diagnostic of testicular cancer. [ajronline.org]
Ultrasound is extremely sensitive in the detection of testicular masses, but does not provide a histological diagnosis [ 2 ]. [link.springer.com]
- Swelling of the Scrotum
You notice a change in how your testicles look or are positioned in your scrotum. You notice new or worse swelling in your scrotum. You have symptoms of a urinary problem, such as a urinary tract infection. [myhealth.alberta.ca]
In addition, the doctor will look at your scrotum for swelling, color, and damage to the skin and examine the testicle itself. [kidshealth.org]
Other symptoms can include: Nausea (especially common with testicular torsion) Bruising or discoloration of the scrotum Swelling of the scrotum Blood in the urine Difficulty urinating Fever Diagnosing Testicular Injuries It's important to see your doctor [webmd.com]
Schedule a visit if your son is experiencing the following: Pain that doesn’t subside or your son experiences extreme pain lasting longer than an hour Swelling or bruising of the scrotum or a puncture of the scrotum or testicles Nausea and vomiting that [wmuro.com]
The injury happened directly on the scrotum. 2. Pain doesn’t ease up after an hour. 3. You continue to feel nauseous or continue to vomit. 4. There is bruising or swelling of the scrotum or the scrotum fills with fluid. 5. [manipalfertility.com]
- Scrotal Mass
A scrotal mass is a lump or bulge that can be felt in the scrotum, and may result from a variety of factors There are several kinds of scrotal masses: Hydrocele (non-cancerous): A mass or swelling caused by a buildup of fluid around the testicle. [urologygroup.com]
Most scrotal masses are due to far more common problems, such as: Infection of the epididymis Testicular torsion We will determine a mass from these more common conditions by how it feels and if light shines through it. [wmuro.com]
Differential diagnosis of scrotal masses by ultrasound. Eur Radiol 1997;7(5):668–679. Crossref, Medline, Google Scholar 52. Bertolotto M, Derchi LE, Sidhu PS, et al. [pubs.rsna.org]
Evaluation of scrotal masses. Crawford P1, Crop JA1. [dontcookyourballs.com]
Having in mind the numerous types of injuries that stem from testicular trauma, a rapid but thorough diagnostic workup is necessary. A detailed patient history needs to be conducted, during which the mode of injury and the presence of symptoms are assessed, and together with a careful physical examination (since patients experience profound discomfort due to pain) that will confirm testicular involvement, a presumptive diagnosis can be made  . However, imaging studies are mandatory for determination of the exact type of injury and selection of appropriate therapy. Currently, ultrasonography (US), both standard and color doppler, are considered as the gold standard    . Focal, or sometimes multifocal hyperechoic lesions suggest acute bleeding, anechoic fluid collections point to hydroceles, whereas a linear hypoechoic band is a hallmark of a testicular fracture  . In addition, hemorrhage and extrusion of testes into the scrotal sac are highly indicative of a testicular rupture, and a range of other findings on ultrasonography can be encountered, further strengthening its role in the diagnosis of testicular injury  . In rare cases of testicular dislocation, but also in polytraumatic patients, computed tomography (CT) of the perineum and lower abdomen is highly useful to identify the location of the testicle and assess additional organ trauma .
Treatment of Testicular Trauma Conservative treatment of testicular injury: Conservative treatment of testicular trauma is indicated for mild hematoma without tear of the tunica albuginea and without decreased blood flow of the testis. [urology-textbook.com]
If that treatment fails, surgery may be necessary. [wmuro.com]
Disclaimer: the material posted on this blog on testicular injury and associated causes, signs, symptoms, complications and treatment is for learning purposes only. [firstaidservices.ca]
Spermatocele Most of the time, spermatocele won't require treatment. However, in rare cases, treatment may be necessary. If your spermatocele is causing pain or is quite large, your doctor may recommend treatment. [beaumont.org]
However, spermatogenesis spontaneously recovered without any treatment or without undergoing orchiectomy 6 months after the testicular injury. [ncbi.nlm.nih.gov]
Torsion of testicular appendage: Testicular appendage has an excellent prognosis. Testicular tumor : The prognosis depends upon the type of tumor and the extent of the disease at the time of diagnosis. [emedicinehealth.com]
[…] ischemia or infarct ultrasound imaging features are similar to testicular torsion but the pathogenesis is different; post-traumatic infarct is due to increased intra-testicular pressure resulting in venous obstruction and venous infarction Treatment and prognosis [radiopaedia.org]
She said my prognosis was good because my cancer was 'stage one', meaning it had been confined to the testicle. I then faced a choice. [dailymail.co.uk]
Human chorionic gonadotropin is produced and high levels indicate a poor prognosis. [openaccessjournals.com]
Trends regarding the etiology of scrotal trauma were evaluated during each decade. [ncbi.nlm.nih.gov]
Signs and Symptoms of Testicular Trauma Testicular pain, scrotal hematoma, soft tissue injuries depending on the etiology of testicular trauma. [urology-textbook.com]
[…] injury, perhaps from the pain, resulted in a vasovagal response which may have lowered his blood pressure and exacerbated a cardiac etiology,” Bjurlin said. [snopes.com]
Other injuries that can occur include 1 : testicular fracture testicular dislocation testicular torsion intratesticular hematoma intratesticular pseudoaneurysm Etiology Testicular trauma can be blunt or penetrating in cause. [radiopaedia.org]
Less common etiologies include motor vehicle accidents, falls, and straddle injuries. [emedicine.medscape.com]
Mittal Abstract Testicular anatomy and embryology are reviewed, along with the risk factors, epidemiology, differential diagnosis, staging, and management of testicular cancer. [pubs.rsna.org]
Epidemiology Frequency Testicular trauma is relatively uncommon. Blunt trauma accounts for approximately 85% of cases, and penetrating trauma accounts for 15%. [emedicine.medscape.com]
Because of its pathophysiology, a hydrocele in a child is quite different from that in an adult. Hydroceles in children are congenital. [clinicaladvisor.com]
View Article PubMed Google Scholar Matsuda N, Hattori Y: Systemic inflammatory response syndrome (SIRS): molecular pathophysiology and gene therapy. J Pharmacol Sci. 2006, 100: 189-198. 10.1254/jphs.CRJ06010X. [casesjournal.biomedcentral.com]
Pathophysiology The testis is enveloped by layers of white fibrous connective tissue called the tunica vaginalis and the tunica albuginea. [emedicine.medscape.com]
An important characteristic of a tissue is its inherent elasticity, which may be altered by the pathophysiological processes associated with ageing, inflammation, and the presence of tumours. [cancerimagingjournal.biomedcentral.com]
The aetiology, pathophysiology and management of chronic orchialgia. Masarani M1, Cox R. Am Fam Physician. 2009 Apr 1;79(7):583-7. Epididymitis and orchitis: an overview. Trojian TH1, Lishnak TS, Heiman D. [dontcookyourballs.com]
We advocate and educate to empower physicians and the public to progress toward the highest quality prevention, detection and treatment of urologic diseases. [auanet.mediaroom.com]
Furthermore, some of the recent studies have shed lights on potential therapeutic or preventive approaches that can be developed in future studies by blocking or minimizing the destructive effects of Cd to testicular function in men. [ncbi.nlm.nih.gov]
Preventing Testicular Injuries You can't always prevent a testicle injury, but these steps will help protect you: Wear a jockstrap when you're playing sports. [webmd.com]
Here’s a look at the types, symptoms, causes and prevention methods against testicular trauma. Types: The testicles are made of different types of tissue, and the scrotum contains other structures attached to the testicles. [reverehealth.com]
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- Bhatt S, Dogra VS. Role of US in testicular and scrotal trauma. Radiographics. 2008;28(6):1617-1629.
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- Bjurlin MA, Kim DY, Zhao LC, et al. Clinical characteristics and surgical outcomes of penetrating external genital injuries. J Trauma Acute Care Surg. 2013;74(3):839-844.
- Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
- Okonkwo KC, Wong KG, Cho CT, Gilmer L. Testicular trauma resulting in shock and systemic inflammatory response syndrome: a case report. Cases J. 2008;1:4
- Bauer NJG. Case report: Traumatic unilateral testicular rupture. Int J Surg Case Rep. 2016;25:89-90.
- Aslam MZ, Thwaini A, Sundaram SK. Testicular dislocation: a rare consequence of blunt scrotal injury. Can Urol Assoc J.. 2009;3(3):E1-E3.