Testicular and Scrotal Injuries

The mobility of the testicle, cremaster muscle contraction, and the tough capsule of the testis (tunica albuginea) are responsible for the infrequent rate of injury to the testis. A direct blow to the testis impinging it against the symphysis pubis is the primary cause of blunt testicular injury. Blunt testicular injuries are either contusions or ruptures. Rarely, traumatic dislocation of the testicle to the inguinal canal has been reported. In testicular contusions or ruptures, the tunica vaginalis sac fills with blood (hematocele) and appears as a large, blue, tender scrotal mass. Penetrating injuries to the scrotum through the tunica vaginalis require exploration. Bilateral testicular injuries are often seen in penetrating trauma. Testicular ultrasound studies with colored Doppler studies can help delineate the extent of testicular trauma and are quite reliable in diagnosing ruptured testes.

Early exploration, evacuation of blood clots, and repair of testicular rupture tend to result in an earlier return to normal activity, decreased hematoma infection, and less testicular atrophy than does conservative management. Testicular salvage following penetrating trauma is on the order of 35 percent. 23

Scrotal skin avulsion is managed by housing the testicle in the remaining scrotal skin even though the reconstruction places the skin under tension. Usually the scrotum returns to nearly normal size within a few months. In complete scrotal skin loss, the testicles are placed in pouches in the inner thighs.

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