TESTICULAR INJURIES
Category: Urology
Abstract : Testicular injuries : Testicular injuries are uncommon. Mechanisms Blunt
or penetrating. Most in civilian practice are blunt, a blow forcing the testicle
against the pubis or the thigh. Bleeding occurs into the parenchyma of the
testis, and if sufficient force is applied, the tunica albuginea of the testis
(the tough fibrous coat surrounding the parenchyma) ruptures, allowing extrusi
Testicular injuries : Testicular injuries are uncommon.
Mechanisms
Blunt
or penetrating. Most in civilian practice are blunt, a blow forcing the testicle
against the pubis or the thigh. Bleeding occurs into the parenchyma of the
testis, and if sufficient force is applied, the tunica albuginea of the testis
(the tough fibrous coat surrounding the parenchyma) ruptures, allowing extrusion
of seminiferous tubules.
Penetrating injuries occur as a consequence of
gunshot and knife wounds and from bomb blasts; associated limb (e.g. femoral
vessel), perineal (penis, urethra, rectum), pelvic, abdominal, and chest wounds
may occur.
Where bleeding is confined by the tunica vaginalis, a haematocele
is said to exist. Intraparenchymal (intratesticular) haemorrhage and bleeding
beneath the parietal layer of tunica vaginalis will cause the testis to enlarge
slightly. The testis may be under great pressure as a consequence of the
intra-testicular haemorrhage confined by the tunica vaginalis. This can lead to
ischaemia, necrosis, and atrophy of the testis.
The force is usually
sufficient to rupture the tunica albuginea and the tunica vaginalis, and
seminiferous tubules and blood extrude into the layers of the scrotum. This is a
haematoma.
History and examination
Severe pain is common, as are
nausea and vomiting. If the testis is surrounded by haematoma it will not be
palpable. If it is possible to palpate the testis, it is usually very tender.
The resulting scrotal haematoma can be very large and the bruising and swelling
so caused may spread into the inguinal region and lower
abdomen.
Testicular ultrasound in cases of blunt trauma
A normal
parenchymal echo pattern suggests there is no significant testicular injury
(i.e. no testicular rupture). Hypoechoic areas within the testis (indicating
intraparenchymal haemorrhage) suggests testicular rupture.
Indications
for exploration in scrotal trauma
- Testicular rupture. Exploration allows
evacuation of the haematoma, excision of extruded seminiferous tubules, and
repair of the tear in the tunica albuginea.
- Penetrating trauma. Exploration
allows repair to damaged structures (e.g. the vas deferens may have been severed
and can be repaired).
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