Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Scrotal Trauma Workup

  • Author: Robert A Mevorach, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
 
Updated: Nov 21, 2015
 

Laboratory Studies

See the list below:

  • Perform wound cultures for aerobic, anaerobic, and fungal organisms from all avulsing or penetrating injuries. Cultures allow broad-spectrum coverage (which is based partially upon mechanism or geographic site of injury) to begin, while isolates allow directed treatment for completion of care.
  • A Gram stain of chronic wounds may allow directed therapy when an accurate history cannot be obtained to aid in appropriate coverage.
  • Urinalysis to assess for hematuria may be the only indication of urinary tract and possible urethral injury when symptoms are absent or history is not attainable.
  • Urine culture may aid in therapy, particularly with penetrating and contaminated wounds, even if drainage is not present.
Next

Imaging Studies

See the list below:

  • Color Doppler ultrasound imaging, with or without contrast[3]
    • Isolated blunt injuries are managed best with a thorough knowledge of the internal anatomy and testicular perfusion.
    • Hematomas, intratesticular and extratesticular, are expected.
    • A completely intact tunica albuginea is the only finding that can preclude scrotal exploration in the face of abnormal physical examination findings and evidence of hematocele on ultrasonography.
    • The incidence of testis rupture or epididymal disruption in this scenario is at least 80%.
    • Nonperfusion of the testis may indicate testicular torsion, vascular avulsion, or cord thrombosis and should be immediately explored.
      Transverse scrotal ultrasound image shows left intTransverse scrotal ultrasound image shows left intratesticular hematoma and hematocele consistent with testis rupture. Increased testis size on left is a soft sign, as hematoma alone could result in this finding.
      Longitudinal image of left testis showing discontiLongitudinal image of left testis showing discontinuity of tunica albuginea. This finding mandates scrotal exploration.
      This longitudinal Doppler image shows perfused tesThis longitudinal Doppler image shows perfused testicular tissue exuding through disrupted tunica albuginea, eliminating any doubt regarding the diagnosis of testicular rupture.
  • Retrograde urethrography: This study is warranted in suspected urethral injury, based upon mechanism of injury, findings of hematuria, or rectal examination that demonstrates hematoma or an abnormal prostate (eg, high-riding prostate, impalpable prostate).
  • CT scan
    • In multisystem trauma, the abdominopelvic CT scan may be extended to the upper thigh, which provides information regarding testis dislocation, anatomy of intratesticular structures, and some indication of perfusion.
    • For cases in which short time to the operating room becomes important, this precludes ultrasound examination.
Previous
 
 
Contributor Information and Disclosures
Author

Robert A Mevorach, MD Associate Professor, Departments of Urology and Pediatrics, University of Rochester School of Medicine

Robert A Mevorach, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, Society of Laparoendoscopic Surgeons, Society of University Urologists, Association of Military Osteopathic Physicians and Surgeons, American Urological Association, Endourological Society

Disclosure: Nothing to disclose.

Additional Contributors

Edmund S Sabanegh, Jr, MD Chairman, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation

Edmund S Sabanegh, Jr, MD is a member of the following medical societies: American Medical Association, American Society of Andrology, Society of Reproductive Surgeons, Society for the Study of Male Reproduction, American Society for Reproductive Medicine, American Urological Association, SWOG

Disclosure: Nothing to disclose.

References
  1. Güneş M, Umul M, Altok M, Akyüz M, İşoğlu CS, Uruç F, et al. Is it possible to distinguish testicular torsion from other causes of acute scrotum in patients who underwent scrotal exploration? A multi-center clinical trial. Cent European J Urol. 2015. 68 (2):252-6. [Medline].

  2. Dagrosa LM, McMenaman KS, Pais VM Jr. Tension Hydrocele: An Unusual Cause of Acute Scrotal Pain. Pediatr Emerg Care. 2015 Aug. 31 (8):584-5. [Medline].

  3. Mohammed WM, Davis NF, O'Connor KM, Kiely EA. Re-evaluating the role of Doppler ultrasonography in patients presenting with scrotal pain. Ir J Med Sci. 2015 Aug 7. [Medline].

  4. Whelan C, Stewart J, Schwartz BF. Mechanics of wound healing and importance of Vacuum Assisted Closure in urology. J Urol. 2005 May. 173(5):1463-70. [Medline].

  5. Bandi G, Santucci RA. Controversies in the management of male external genitourinary trauma. J Trauma. 2004 Jun. 56(6):1362-70. [Medline].

  6. Catalano O, Lobianco R, Sandomenico F, et al. Real-time, contrast-enhanced sonographic imaging in emergency radiology. Radiol Med (Torino). 2004 Nov-Dec. 108(5-6):454-69. [Medline].

  7. Jankowski JT, Spirnak JP. Current recommendations for imaging in the management of urologic traumas. Urol Clin North Am. 2006 Aug. 33(3):365-76. [Medline].

  8. Kerins M, Greene S, O'Connor N. A human bite to the scrotum: a case report and review of the literature. Eur J Emerg Med. 2004 Aug. 11(4):223-4. [Medline].

  9. Ko SF, Ng SH, Wan YL, et al. Testicular dislocation: an uncommon and easily overlooked complication of blunt abdominal trauma. Ann Emerg Med. 2004 Mar. 43(3):371-5. [Medline].

  10. Morey AF, Metro MJ, Carney KJ, et al. Consensus on genitourinary trauma: external genitalia. BJU Int. 2004 Sep. 94(4):507-15. [Medline].

Previous
Next
 
Transverse scrotal ultrasound image shows left intratesticular hematoma and hematocele consistent with testis rupture. Increased testis size on left is a soft sign, as hematoma alone could result in this finding.
Longitudinal image of left testis showing discontinuity of tunica albuginea. This finding mandates scrotal exploration.
This longitudinal Doppler image shows perfused testicular tissue exuding through disrupted tunica albuginea, eliminating any doubt regarding the diagnosis of testicular rupture.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.