Testicular trauma

Ultrasound is mainstay of assessment

Indications for exploration:

• USS suggestive of rupture
• Severe pain non-responsive to management
• Increasing swelling

Testicular rupture (rupture of albuginea)

• Early exploration with debridement and repair of tubica albuginea is more likely to preserve useful testicular function - explore if USS is suggestive of breach
• Completely ruptured - orchidectomy
• Otherwise, evacuate the haematoma, debride, and loosely tack tunica albuginea together. Leave a small drain.

Scrotal wall haematomas - conservative

Other injuries without rupture - usually conservative

The pictures show blunt scrotal trauma with associated testicular rupture. Following blunt injury to the external genitalia, discoloration of the right hemiscrotum can be seen (A). Upon exploration, blood is visible within the tunica vaginalis (B). Testicular rupture is confirmed by demonstration of extruded seminiferous tubules (C; arrow). Following debridement of the extruded seminiferous tubules, the testicular tunica albuginea was closed primarily (D; arrow).