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Testicular Injury

Injuries Testicular

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.


Presentation

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 [1]. 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 [1] [2] [3] [4] [5] [6]:

  • 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 [2] [6] [7]. Due to the higher anatomical location of the right testis, it is more frequently injured than the left [2]. Intentional injuries and motor vehicle accidents are other notable causes [1].
  • 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 [4]. 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 [2].

Regardless of the mode of trauma, hematomas, hydroceles, hematoceles, testicular fractures, dislocation, torsion and even testicular rupture in rare cases may be seen [1] [8]. 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 [1]. Additional injuries of the genitalia (the urethra and the penis) are often concomitantly present with symptoms of hematuria, penile swelling and ecchymoses [5] [6]. 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]
  • A person with a testicular injury may experience testicular pain or discomfort, testicular swelling, redness, tenderness of the testicle, lacerations or abrasions to the scrotum and bruises to the testicular.[firstaidservices.ca]
  • Signs and Symptoms of Testicular Trauma Testicular pain, scrotal hematoma, soft tissue injuries depending on the etiology of testicular trauma.[urology-textbook.com]
  • If you experience testicular pain even occasionally, talk to your doctor about it. Be aware of the risks of your sport or activity.[kidshealth.org]
  • Testicular pain and swelling Treatment for testicular pain and swelling will vary depending on the cause of the pain. Sometimes, it can be treated with simple measures like antibiotics and cold packs, and sometimes it will require surgery.[beaumont.org]
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]
  • 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]
  • PubMed Central View Article PubMed Google Scholar Koester MC: Initial evaluation and management of acute scrotal pain. J Athl Train. 2000, 35: 76-79.[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]
  • pain symptoms, and tenderness is obvious, but the disease is generally reusable scrotal or inguinal mass tumor history, and abdominal pain, Nausea, vomiting, no anus exhaust defecation and other symptoms, check the abdominal bowel sounds hyperthyroidism[healthfrom.com]
Swelling of the Scrotum
  • Testicular rupture, like testicular torsion and other serious injuries to the testicles, causes extreme pain, swelling in the scrotum, nausea, and vomiting. To fix the problem, surgery is necessary to repair the ruptured testicle.[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]
  • Testicular rupture causes extreme pain, swelling in the scrotum, nausea, and vomiting. Surgery is necessary to repair the ruptured testicle. If your son’s testicular injury pain doesn’t subside in less than an hour, we suggest seeing a professional.[wmuro.com]
  • You notice new or worse swelling in your scrotum. You have symptoms of a urinary problem, such as a urinary tract infection. These may include: Pain or burning when you urinate. A frequent need to urinate without being able to pass much urine.[myhealth.alberta.ca]
  • There is bruising or swelling of the scrotum or the scrotum fills with fluid. 5. You have difficulty urinating. 6. There is blood in your urine. 7. You have fever after an injury to the testicles. 8.[manipalfertility.com]
Testicular Mass
  • Orchiectomy – Testicular masses, if malignant, are usually removed along with the entire affected testicle.[wmuro.com]
  • mass; testicular torsion, the testicular elevation was transverse or epididymis in front of the testis, Thicker, scrotum and testicles, the pain is not reduced or aggravated.[healthfrom.com]
  • Other authors support the use of sonoelastography for the evaluation of testicular masses.[cancerimagingjournal.biomedcentral.com]
  • Ultrasound is extremely sensitive in the detection of testicular masses, but does not provide a histological diagnosis [ 2 ].[link.springer.com]
  • The use of contrast-enhanced US in testicular masses has been investigated with some qualitative (but not quantitative) reports ( 14 – 16 ).[pubs.rsna.org]
Scrotal Mass
  • 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]

Workup

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 [3] [8]. 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 [1] [2] [4] [6]. 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 [1] [2]. 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 [1] [3]. 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 [8].

Treatment

  • Zeeshan Hakim M.B.B.S., MS General Surgeon - Specializes in Treatment of Testicular Injury BHU Trauma Centre, Nagwa Samne Ghat Road, Lanka Lanka , Varanasi Jiva Ayurveda Bachelor of Ayurveda, Medicine and Surgery (BAMS) Ayurveda - Specializes in Treatment[lybrate.com]
  • 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]
  • Treatment Treatment of testicular injury treatment Department of Surgery: Surgical Urology Treatment: drug treatment rehabilitation Treatment cycle: 7-14 days Cure rate: 50-70% (A) treatment Testicular injury in the course of treatment as far as possible[healthfrom.com]
  • Melatonin pre-treatment significantly inhibited radiation-induced DNA strands breaks and lipid peroxidation.[ncbi.nlm.nih.gov]
  • 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]

Prognosis

  • (B) prognosis Many observations confirm that early surgical exploration, not only to remove the hematoma, to prevent infection.[healthfrom.com]
  • 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]
  • […] 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]

Etiology

  • 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]
  • Introduction Etiology Prevention Complication Symptom Examine Diagnosis Treatment Basic Nursing Introduction Introduction to testicular injury Scrotal soft tissue relaxation, testicular activity is large, but the scrotum content of tissue fragile, anti-damage[healthfrom.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]
  • […] 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]

Epidemiology

  • The authors review relevant pathophysiological background and epidemiology, recommend necessary diagnostic testing, and provide detailed medical, surgical, and endourological management approaches.[books.google.com]
Sex distribution
Age distribution

Pathophysiology

  • The authors review relevant pathophysiological background and epidemiology, recommend necessary diagnostic testing, and provide detailed medical, surgical, and endourological management approaches.[books.google.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]
  • 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]

Prevention

  • 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]
  • Prevention Testicular injury prevention 1, prevention mainly to avoid trauma. 2, early detection, early diagnosis, early treatment to prevent the disease is also important.[healthfrom.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]
  • Thus, it is of interest to note that vitamin A, acting as an antioxidant, stabilizes testicular membranes by reducing lipid peroxidation and prevents the alcohol-induced atrophy that occurs in animals not receiving vitamin-A-enriched diets.[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]

References

Article

  1. Deurdulian C, Mittelstaedt CA, Chong WK, Fielding JR. US of acute scrotal trauma: optimal technique, imaging findings, and management. Radiographics. 2007;27(2):357-369.
  2. Bhatt S, Dogra VS. Role of US in testicular and scrotal trauma. Radiographics. 2008;28(6):1617-1629.
  3. Rao MS, Arjun K. Sonography of scrotal trauma. Indian J Radiol Imaging. 2012;22(4):293-297.
  4. 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.
  5. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
  6. 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
  7. Bauer NJG. Case report: Traumatic unilateral testicular rupture. Int J Surg Case Rep. 2016;25:89-90.
  8. Aslam MZ, Thwaini A, Sundaram SK. Testicular dislocation: a rare consequence of blunt scrotal injury. Can Urol Assoc J.. 2009;3(3):E1-E3.

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Last updated: 2018-06-22 06:43