Testicular Trauma Workup

Updated: Sep 18, 2019
  • Author: Ryan P Terlecki, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Workup

Laboratory Studies

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

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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]

 

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