Scrotal Trauma Guidelines

Updated: Dec 27, 2021
  • Author: Robert A Mevorach, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Guidelines Summary

The American Urology Association (AUA) guidelines for diagnosis and management of genitourinary injuries were amended in 2017 and 2020 to reflect literature that was released since the original publication in 2014. Key recommendations for the genital trauma include the following [11] :

  • Clinicians must perform evaluation for concomitant urethral injury in patients with penile fracture or penetrating trauma who present with blood at the urethral meatus, gross hematuria, or inability to void. 
  • Clinicians should perform scrotal ultrasonography for most patients having physical findings suggestive of testicular rupture.
  • Surgeons should perform scrotal exploration and debridement with tunical closure (when possible) or orchiectomy (when non-salvagable) in patients with suspected testicular rupture.
  • For most penetrating injuries, clinicians should perform prompt surgical exploration with repair or orchiectomy (when non-salvageable). 
  • Surgeons should perform exploration and limited debridement of non-viable tissue in patients with extensive genital skin loss or injury from infection, shearing injuries, or burns (thermal, chemical, electrical).
  • Clinicians should initiate ancillary psychological, interpersonal, and/or reproductive counseling and therapy for patients with genital trauma when loss of sexual, urinary, and/or reproductive function is anticipated. 

The European Association of Urology guidelines for urological trauma were first published in 2003 and have undergone annual assessment of newly published literature in the field to guide updates. As of 2021, key recommendations include the following [12] :

  • Testicular rupture is associated with immediate pain, nausea, vomiting, and sometimes fainting. Upon physical examiniation, the hemiscrotum is tender, swollen, and ecchymotic. The testis may be difficult to palpate.
  • Scrotal ultrasound is the preferred imaging modality for the diagnosis of testicular trauma. If scrotal US is inconclusive, CT or MRI may be helpful but do not specifically increase the detection rates of testicular rupture.
  • Surgical exploration in patients with testicular trauma ensures preservation of viable tissue when possible. 
  • Explore the injured testis in all cases of testicular rupture and in those with inconclusive US findings.