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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.

Inguinal Lymphadenopathy
  • lymphadenopathy – swollen glands in the groin Fever of 101 degrees F or above Worsening swelling of the groin Worsening testicular swelling Worsening testicular tenderness Worsening swelling and redness of the scrotum Worsening swelling and redness of[firstaidservices.ca]
Disability
  • Mookie Betts hits three home runs and makes insane catch Caleb Joseph was hit in the groin by a foul ball on Monday and placed on the disabled list on Tuesday.[nydailynews.com]
  • BALTIMORE — The Baltimore Orioles have placed catcher Welington Castillo on the 10-day disabled list with a testicular injury.[sportsnet.ca]
  • Castillo was on the disabled list earlier this month with right shoulder tendinitis. Caleb Joseph received most of the starts behind the plate during that time. Joseph started Wednesday night against New York.[nbcsports.com]
  • May 31, 2017 Luke Jones BALTIMORE — The Orioles have placed starting catcher Welington Castillo on the 10-day disabled list with a testicular injury after he took a foul ball to the groin in Tuesday’s loss to the New York Yankees.[wnst.net]
  • As minimal, the blood-clot from the tunica vaginalis sac should be evacuated, which would relieve disability and hasten recovery. Article / Publication Details[karger.com]
Animal Bite
  • 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.[symptoma.com]
  • Animal bites can also cause infections in the scrotum. Degloving. In this type of injury, the scrotum is torn away, like removing a glove from a hand.[webmd.com]
  • Causes Causes of testicular injury may include: Altercations Automobile accidents Animal bites Sports activities such as martial arts, wrestling, gymnastics and biking Occupational injury Testicular injury symptoms Signs and symptoms of testicular injury[firstaidservices.ca]
  • Infections: Commonly caused by animal bites to the scrotum. Degloving: This is an injury where the scrotum is torn away, similar to the removal of a glove from a hand.[reverehealth.com]
  • The most common cause of penetrating testicular injuries is a gunshot wound to the genital area. [13] Other causes include stab wounds, self-mutilation, animal bites (usually dog), and emasculation.[emedicine.medscape.com]
Internal Bleeding
  • A testicle can be bruised from a blunt trauma to the area; there could be internal bleeding in the scrotum, testicular fracture, or even testicular rupture. Slapstick comedy may make groin injuries seem amusing, but they are no laughing matter.[auanet.mediaroom.com]
Chills
  • Signs and symptoms of orchitis may include: Testicular and/or scrotal tenderness, swelling or redness Fever and chills Headache Body aches Nausea Fatigue Parotid gland inflammation (parotitis) in cases of mumps Trauma and injury causes, symptoms, and[medicinenet.com]
Lower Abdominal Pain
  • abdominal pain – right or left Treatment Treatment for testicular injury may include the following: Bed rest Scrotal support – keeping the scrotum elevated to reduce movement Cold compresses – for 20 minutes, 2-3 times a day Reduced activity Rinsing[firstaidservices.ca]
Alopecia
  • An acquaintance with alopecia universalis has bat houses on her property. It’s known to cause delusions, wild mood swings, and hallucinations.[dontcookyourballs.com]
Screaming
  • Yes, I screamed like a baby. So did I... Just now. Oct 4, 2005 during an african safari, a liger tore off both my testacles and ate them Oct 4, 2005 I got hit in the balls with a tenis racket. My balls were bruised for a few weeks.[forums.anandtech.com]
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]
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]
  • 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]
  • 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]
  • Case Study: Scrotal Pain in a Young Man [pdf] This document was amended in July 2016 to reflect literature that was released since the original publication of this content in May 2012.[auanet.org]
Testicular Mass
  • Orchiectomy – Testicular masses, if malignant, are usually removed along with the entire affected testicle.[wmuro.com]
  • Other authors support the use of sonoelastography for the evaluation of testicular masses.[cancerimagingjournal.biomedcentral.com]
  • In this series, several factors supported our consideration of conservative treatment, including a prior history of testicular sperm extraction or aspiration (even if performed 1 year previously), the absence of a palpable testicular mass or signs of[ajronline.org]
  • Ultrasound is extremely sensitive in the detection of testicular masses, but does not provide a histological diagnosis [ 2 ].[link.springer.com]
  • Traditionally, B-mode ultrasound is extremely sensitive in the detection of testicular masses, but does not provide histological diagnosis.[birpublications.org]
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]
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]
  • Evaluation of scrotal masses. Crawford P1, Crop JA1.[dontcookyourballs.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

  • 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]
  • ) Ayurveda - Specializes in Treatment of Testicular Injury Jas Maa Complex, D 58/12, A 2, Gandhi Nagar, Sigra Sigra, Varanasi 7 Recently consulted for: Acne Treatment, Hair Loss, Flu Book appointment and get 125 LybrateCash (Lybrate Wallet) after your[lybrate.com]
  • If that treatment fails, surgery may be necessary.[wmuro.com]
  • However, spermatogenesis spontaneously recovered without any treatment or without undergoing orchiectomy 6 months after the testicular injury.[ncbi.nlm.nih.gov]

Prognosis

  • 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]
  • 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]
  • Human chorionic gonadotropin is produced and high levels indicate a poor prognosis.[openaccessjournals.com]

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]
  • […] 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]
  • The etiology of this condition remains unclear. Treatment consists of bed rest and scrotal elevation. Analgesics are rarely needed.[aafp.org]

Epidemiology

  • Epidemiology Frequency Testicular trauma is relatively uncommon. Blunt trauma accounts for approximately 85% of cases, and penetrating trauma accounts for 15%.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • 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]

Prevention

  • 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]

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: 2019-07-11 21:37