Traumatic bilateral testicular dislocation: a recovery of spermatogenesis by orchiopexy 15 years after the onset

The effect of testicular trauma on male infertility

We aim to evaluate the effect of testicular trauma on male reproductive outcomes. The electronic medical record was retrospectively searched using diagnosis codes for testicular trauma and procedure codes for testicular trauma repairs, at Los Angeles County and Parkland Hospitals, for males aged 18-55 years. Charts were reviewed for trauma details, reproductive hormones, and semen analyses. Men were contacted by phone for a fertility and sexual performance survey. Fifty-six patients were identified as having testicular trauma. Twelve were reached by telephone, of which 33.3% had blunt and 66.7% had penetrating traumas. The mean duration since trauma was 41 months. One quarter reported new-onset erectile dysfunction post-trauma, 16.7% endorsed new-onset dysuria, 8.3% endorsed long-term testicular pain. Only two males (16.7%) attempted paternity post-trauma, both with primary infertility. One patient (8.3%) was attempting paternity post-trauma and experiencing primary infertility for 42 months. Two patients (16.7%) had undergone semen analysis testing, both patient-reported as 'normal'. None of the 12 patients we reached were under the care of a urologist. Both short and long-term urologic follow-up is crucial for testicular trauma patients. Despite some experiencing lasting consequences, none of these men were under the care of a urologist.

A Rare and Easily Overlooked Case of Bilateral Traumatic Testicular Dislocation and an Alternative Viewpoint on Delayed Management

The incidence of traumatic testicular dislocation is rare, and it is usually overlooked in an initial diagnosis. We present a case of bilateral dislocated testes after a traffic accident that was treated via orchidopexy one week later. No testicular complications had occurred by the time of the follow-up visit. Generally, surgery is often postponed owing to a late diagnosis or another major organ injury, and the adequate timing of surgery is still under debate. We performed a review of past cases, which showed similar testicular outcomes irrespective of surgical timing. Delayed intervention may be a feasible decision after a patient's hemodynamic status is stable for surgery. To prevent delayed diagnosis, scrotal examination should not be overlooked in any patients presenting with pelvic trauma to the emergency department.

Traumatic testicular dislocation: A case report and literature review

INTRODUCTION

Traumatic testicular dislocation is an uncommon complication of blunt scrotal injury and is easily overlooked because of the presence of other severe accompanying injuries. In most cases, an operation is needed for the prevention of malignant change or infertility.

PATIENT CONCERNS AND DIAGNOSIS

We report a case of traumatic testicular dislocation with pelvic fracture and internal bleeding in a 27-year-old male with testis rupture after a motorcycle collision.

INTERVENTIONS AND OUTCOMES

He received emergent right radical orchiectomy, and a series of operations for femoral and pelvic fractures were performed after his condition stabilized in the intensive care unit. After 1 month postsurgery, no obvious genitourinary complications were noted.

CONCLUSION

We suggest scrotum examination in all trauma patients, particularly if a pelvic injury is suspected or in case of a high risk of a motorcycle collision, to avoid missing the diagnosis and prevent severe complications.

Delayed Diagnosis and Treatment of Traumatic Testicular Dislocation: A Case Report and Literature Review

Traumatic testicular dislocation is a rare complication secondary to different kinds of accidents. A 61-year-old man, who was injured by wall collapse and was diagnosed as pelvic fracture and posterior urethral rupture 5 months ago, came to the urologic department to seek urethral reconstruction. However, thorough physical examination and imaging examination confirmed a round mass in the right inguinal region and an empty right scrotum, which support diagnosis of testicular dislocation. The patient did not take the initiative to complain about that because he thought the right testis had been destroyed by the accident already. So the patient underwent fiber cystourethroscopy, urethral reconstruction, and orchiopexy. No testicular atrophy was confirmed at follow-up. We reviewed previous reports about traumatic testicular dislocation and analyzed the cause of delayed diagnosis.

Pelvic Fracture Associated with Intrapelvic Dislocation of Testis

Introduction

Intrapelvic testicular dislocation is rare injury with the possibility of missed or delayed diagnosis. Timely diagnosis of intrapelvic testicular dislocation can prevent iatrogenic testicular injury during surgery and its long-term sequel.

Case Report

A 30-year-old male after motorbike accident presented with a pelvic injury with intrapelvic dislocation of testis. Timely and appropriate diagnosis of injuries, specially intrapelvic dislocation of testis, required early orchidopexy and open reduction and internal fixation of the anterior column, leading to excellent outcome.

Conclusion

In cases of polytrauma and pelvic injuries specially motorbike accidents, testicular dislocation should be ruled out before definitive surgery. Adequate communication and co-ordination between orthopedic surgeon, radiologist, and urologist can lead to excellent outcomes.

Managing traumatic testicular dislocations: what we know after two centuries

Traumatic testicular dislocation (TTD) is a rare consequence of blunt scrotal trauma. A 21-year old gentleman presented with inguinal pain following a motorcycle accident and physical examination revealed absence of both testes within a well-formed scrotal sac with bilateral inguinal swellings. Ultrasonography confirmed viability and location of the testes at the superficial inguinal pouch. He underwent emergent surgical reduction with orchidopexy and was discharged the next day. No evidence of testicular dysfunction or atrophy was noted at follow-up. We reviewed reports of TTDs reported in English over the last two centuries and discuss its occurrence, evolution and management.

Testicular Dislocation After Pelvic Ring Injury: A Report of 2 Cases

CASES

We present 2 cases of traumatic testicular dislocation associated with a pelvic ring injury after a motorcycle collision. Case 1 describes bilateral testicular dislocation discovered intraoperatively. Urology was consulted, and the testicles were manually reduced under general anesthesia. Case 2 describes unilateral testicular dislocation discovered at the 1-month follow-up after pelvic ring fixation. Concern for infarction prompted urology to take the patient for surgical reduction. Both cases resolved uneventfully without genitourinary complaints at the follow-up.

CONCLUSIONS

Testicular dislocation is rare but should be considered in the setting of pelvic injury due to a motorcycle collision. Detection warrants urgent urologic consultation.

Bilateral Traumatic Testicular Dislocation

Traumatic testis dislocation is an uncommon condition and usually occurs after direct impact on the scrotum. We present an uncommon case of bilateral testicular dislocation caused by an automotive accident, which is the most frequently associated cause described in literature today. Although the fact that diagnosis can be made either by physical examination or with the use of basic exams such as Doppler ultrasound, it is not uncommon for cases to go undetected and diagnosed late. In this case, there was a late diagnosis, almost one year after the motorcycle accident. Despite this, studies describe preservation of spermatogenesis even after delayed surgical correction. The treatment can be made by manual reduction, but most of the cases need surgical correction. Therefore, it is always necessary to perform the complete physical examination of the polytrauma patient on the first medical exam, in order to avoid the risk of fertility loss, endocrine dysfunction, and future malignancy.

Bilateral testicular dislocation with pelvic ring fracture: a case report and literature review

We report a case of a bilateral testicular dislocation with B1-1 pelvic-ring fracture according to the modified Tile AO classification, in a patient of 62 years. The mechanism of injury was impaction on the tank of a motorcycle. Symphyseal plate fixation using a Pfannenstiel approach was associated to bilateral orchidopexy through scrotal approach. The posterior pelvic ring was stabilized by iliosacral screwing because the left sacroiliac joint was open. The outcome was favorable without disorders of gonadal function. Systematic testicular palpation and careful CT analysis of the genital organs enabled identification and effective management of these rare urinary tract lesions.

Traumatic ectopic dislocation of testis

Traumatic ectopic dislocation of testis is a rare occurrence and usually occurs following a motorcycle collision, in what is referred to as “fuel tank injury”. Early identification and subsequent surgical management is of utmost importance to maintain normal spermatogenesis in the dislocated testis. In appropriate clinical setting, scrotal ultrasound examination with gray-scale and color flow Doppler imaging is the method of choice for diagnosis. Computed tomography of the abdomen is a useful adjunct procedure. We report a case of traumatic testicular dislocation with partial testicular torsion following a motorcycle collision, diagnosed with imaging, and subsequently confirmed on surgery.