The soft tissue of the scrotum is loose and the testis is more mobile, but the contents of the scrotum are brittle and tender, and the resistance to injury is poor. Therefore, damage to the scrotum and its contents is not uncommon in clinical practice. Usually occurs in young adults. Injuries to the testis, sheath, spermatic cord, and scrotal wall often occur at the same time, and the most common cause of injury is direct violence.
What causes testicular damage?
The cause of the disease
The testicles are superficially exposed and are not easily injured due to the well-protected structure of the scrotum and its freedom of movement. Injury types are divided into open and closed. The injury was caused by direct violence or indirect injury.
1. Trauma In the injury caused by bullets, there are often multiple combined injuries. In the case of shrapnel injury, the testicles will be partially, mostly, or completely damaged. Direct puncture injury, because the testicular mobility is large, the possibility of injuring the testis is small.
2. Contusions caused by kicking, falling, or riding.
Pathogenesis
When the testicular tunica albuginea is damaged, the testicular tissue bulges and becomes a hernia. If the main artery of the testis is injured, the testis will atrophy, and in severe cases, the testis will be necrotic. When the testis is torsion, the testis will begin to be hemorrhagic infarction, and gradually there will be exudation of fluid in the sheath. At first, it is serious and then becomes bloody. When the torsion still cannot be lifted, the arterial atresia will stop, the blood supply will stop, and the testis will be necrotic and atrophic.
What are the symptoms of testicular injury and how is it diagnosed?
1. There is a history of trauma to the scrotum.
2. Local severe pain can radiate to the lower abdomen, waist, or upper abdomen, and even painful shock may occur. The pain may also be accompanied by nausea and vomiting.
3. The examination showed swelling of the scrotum, bruising, and congestion of the skin, and the testis on the affected side was swollen and hard, with obvious tenderness. Often accompanied by scrotal hematoma, hydrocele or hemocoel, and so on. In the later stage of testicular ischemia atrophy, the testis is small and soft.
4. When the testis is ruptured, the testicular boundary is unclear; when the testis is dislocated, the scrotum is empty, and testicular masses are often palpated in the lower abdomen and perineum; when the testis is torsion, the testis is elevated in a transverse position or the epididymis is located in front of the testis, and the spermatic cord changes. When the scrotum and testicles are raised, the pain is not relieved or worsened.
After the scrotal injury, the diagnosis is not difficult due to clinical manifestations such as scrotal swelling, pain, and ecchymosis. It is important to determine whether the testis is damaged. If it is delayed, it often leads to the formation of hematoma, followed by infection or compression of the testis, ischemia, and eventually testicular atrophy, affecting the sexual function and fertility of the patient. For this reason, many scholars believe that B-ultrasound is of great benefit to determine whether the testis is damaged or not. Experts examined 28 patients with scrotal closure injury by B- ultrasound, and 12 had abnormal testicular changes: 4 had testicular enlargement. There were single or multiple hypoechoic areas with ill-defined boundaries (hematoma); 5 cases had testicular contour interruption (albuginea rupture); 3 cases lost the normal shape of the testis, the broken ends were separated from each other, and the section was irregular (testis rupture), 10 of them were confirmed by surgery. In addition, in the testicular injury without hematoma, the choice of treatment method is quite difficult.
Diagnosis of testicular damage?
B-ultrasound and Doppler examination have certain value in judging testicular rupture and testicular blood supply reduction. When the testis is ruptured, a hypoechoic area of the testis may appear; when the testis is entangled, the blood oxygenation of the injured testis may be reduced. If the diagnosis is not clear, surgical exploration can be performed.
