Testicular injuries
From Medical-Wiki
Testicular trauma is not as common as might be expected. Indeed, the fact that the testicles are dangling and exposed may offer them protection because as they rest in the scrotum, they are quite mobile. However, because of their role in fertility, any testicular injury must be given appropriate attention.
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Types of injuries
Injuries fall into one of three categories: blunt trauma, penetrating trauma, and degloving trauma. The age group most commonly involved in this trauma is 15 to 40 years.
- Blunt trauma may be caused by a variety of sources. Athletics cause a significant proportion of such injuries, e.g. catchers being nipped by foul balls, soccer players being kicked, and boxers receiving a low blow. There are also new forms of trauma, e.g. such as paint ball injuries and the chronic trauma experienced by mountain bikers.
- Penetrating trauma is most typically seen with gunshot and knife wounds.
- Degloving injuries are the least common of the three types of injuries. In this type injury, the scrotal skin is sheared off, e.g. after having been caught in some type of machinery.
- Genital self-mutilation is technically a fourth class of injury although it may involve elements of the first three as well as more severe injuries such as auto-castration performed by desperate transsexuals. [1]
Testicular rupture occurs in about half the cases of major blunt trauma. Recognizing this circumstance is difficult because scrotal swelling, guarding, and hematoma make testicles and epididymis difficult to differentiate. Epididimyl rupture is rare, however, transection of the vas deferens is not uncommon.
Diagnosis
Radiological findings
Doppler ultrasonography has become crucial to the evaluation of scrotal injuries. If it is available, it should be used immediately to evaluate not only the anatomy but also the integrity of blood supply of the testes and their supporting structures.
Surgical exploration
If there is still a question regarding the nature of injuries, immediate surgical exploration should be pursued by a urologist. It is well established that early surgical intervention is superior to medical management and possible delayed exploration. This is true for both length of hospitalization and orchiectomy rates. [2]
