Laboratory Studies

Screening urinalysis is an important adjunct to the physical examination to rule out urinary tract infection or epididymo-orchitis.

Imaging Studies

Scrotal ultrasound is the preferred imaging modality for the diagnosis of testicular trauma according to the European Association of Urology guidelines on testicular trauma.^[4]

Scrotal ultrasonography with Doppler studies (performed by an experienced ultrasonographer or radiologist) is valuable for diagnosing and staging testicular injuries. A normal parenchymal echo pattern, with normal blood flow in cases of blunt trauma, can safely exclude significant injury. Acute bleeding or contusion of the testicular parenchyma typically appears as a hyperechoic area, whereas old blood appears as a hypoechoic lesion.

The presence of a disrupted tunica albuginea is pathognomonic for testicular rupture. A scrotal hematoma often has associated scrotal skin thickening.

Acute and chronic hematoceles are observed as mixed hypoechoic and hyperechoic areas confined by the tunica vaginalis. The most specific finding for testicular rupture is a discrete fracture plane, but this is seen in only 17% of cases. Characterization seems to be further improved by the use of contrast-enhanced ultrasound, which may allow for more informed surgical decision-making.^[22]

Perform Doppler studies during the scrotal ultrasonography. Doppler studies provide information on the vascular status of the testes. Blood flow to the testis indicates that the vascular pedicle is intact. Absence of flow implies that a torsion or devascularizing injury has occurred to the spermatic cord.

Other imaging studies, such as nuclear imaging or magnetic resonance imaging (MRI), have been used to obtain additional information in equivocal cases. An animal-based study by Srinivas et al demonstrated that MRI after blunt testicular trauma could assist in stratifying the extent of injury and provide information regarding prognosis.^[23]

Treatment & Management

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Media Gallery

This scrotal sonogram shows a healthy testis.
This scrotal sonogram shows a fractured testis with a disrupted tunica albuginea and testicular contents surrounded by tunica vaginalis.
This scrotal sonogram shows intratesticular hematoma in a fractured testis.

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Author

Ryan P Terlecki, MD Director, Men's Health Clinic, Director, Fellowship in Urologic Reconstruction, Prosthetic Urology, and Infertility, Director, Medical Student Education, Associate Professor of Urology, Wake Forest Baptist Health

Ryan P Terlecki, MD is a member of the following medical societies: American Medical Association, American Urological Association, Phi Beta Kappa

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Boston Scientific<br/>Received research grant from: Boston Scientific; Department of Defense.

Coauthor(s)

Richard A Santucci, MD, FACS Senior Surgeon, Crane Surgical Services

Richard A Santucci, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, International Society of Urology

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.

Shlomo Raz, MD Professor, Department of Surgery, Division of Urology, University of California, Los Angeles, David Geffen School of Medicine

Shlomo Raz, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, California Medical Association

Disclosure: Nothing to disclose.

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, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, Society of University Urologists

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Endourological Society Board of Directors; President Elect North Central Section of the American Urological Association<br/>Serve(d) as a speaker or a member of a speakers bureau for: Cook Medical.

Additional Contributors

Gamal Mostafa Ghoniem, MD, FACS Professor and Vice Chair of Urology, Chief, Division of Female Urology, Pelvic Reconstructive Surgery, and Voiding Dysfunction, Department of Urology, University of California, Irvine, School of Medicine

Gamal Mostafa Ghoniem, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urogynecologic Society, American Urological Association, International Continence Society, International Urogynaecology Association, Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Astellas<br/>Received research grant from: Uroplasty/Cogentix, Astellas, Allergen.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Jong M Choe, MD, FACS, and previous coauthor, Benjamin S Battino, MD, to the development and writing of this article.

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