1
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Mora R, Nabhani J, Bakare T, Khouri R, Samplaski M. The effect of testicular trauma on male infertility. HUM FERTIL 2023; 26:1093-1098. [PMID: 36281974 DOI: 10.1080/14647273.2022.2135464] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/17/2022] [Indexed: 11/04/2022]
Abstract
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.
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Affiliation(s)
- Richard Mora
- University of Southern California Institute of Urology, Los Angeles, CA, USA
| | - Jamal Nabhani
- University of Southern California Institute of Urology, Los Angeles, CA, USA
| | | | | | - Mary Samplaski
- University of Southern California Institute of Urology, Los Angeles, CA, USA
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2
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Functional histology of human scrotal wall layers and their overlooked relation with infertility: a narrative review. Int J Impot Res 2022:10.1038/s41443-022-00573-5. [PMID: 35488082 DOI: 10.1038/s41443-022-00573-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 11/08/2022]
Abstract
Male infertility currently contributes to nearly half of the reported infertility cases. Scrotal wall layers play a cardinal role in regulating testicular physiology. However, few studies have focused on the functional histology of these layers and their relations with infertility in humans. The objective of the present narrative review is to collate novel insights into the functional histology of the human scrotal wall layers and their relation with infertility. The data was extracted from articles published between 1946 and 2021. The study was performed between January and December 2021. 71 original studies have been included in this review. Despite the fact that few studies have presented detailed functional histology of the human scrotal wall layers, this narrative review elucidates the possible influence of scrotal histology on infertility. Scrotal wall layers-associated pathologies may induce infertility by various mechanisms. They can impose mechanical forces that may affect the testicular histology and stimulate testicular inflammation. Moreover, they may induce testicular hyperthermia. Various unanswered clinical questions have been identified in this narrative review. More clinical studies are needed to assess the effect of alterations in the components of the scrotal wall layers on fertility (e.g., due to the exposure to metabolic and/or psychological stressors). In addition, testing the effectiveness of various pharmacological/surgical interventions to treat scrotal wall layers-associated pathologies will provide more insights into infertility treatment.
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3
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Ogbetere FE. Traumatic testicular torsion: A call to look beyond the obvious. Urol Ann 2021; 13:431-433. [PMID: 34759658 PMCID: PMC8525482 DOI: 10.4103/ua.ua_159_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 04/02/2021] [Indexed: 11/05/2022] Open
Abstract
Blunt scrotal trauma results in different forms of injuries such as hematoma, rupture of the testis, and testicular torsion. The diagnosis of trauma-induced testicular torsion in patients with blunt scrotal trauma requires a high index of suspicion. As early diagnosis and management of traumatic testicular torsion obviate testicular losses, an urgent testicular scan is necessary in cases of suspected traumatic torsion, and if not readily available or indeterminate, scrotal exploration is promptly indicated. Reported herein is a case of traumatic testicular torsion which was managed as a straightforward blunt scrotal trauma in a private health facility. He eventually had an orchidectomy when he presented to us 4 months later on account of a marked reduction in testicular volume. This case report reiterates the need to look beyond the obvious in patients with blunt scrotal trauma and the necessity of testicular scan and scrotal exploration in testicular salvage in suspected trauma-induced testicular torsion.
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Affiliation(s)
- Friday Emeakpor Ogbetere
- Department of Surgery, Edo University, Iyamho.,Department of Surgery, Edo Specialist Hospital, Benin City, Edo State, Nigeria
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4
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Testicular Rupture Following Blunt Scrotal Trauma. Case Rep Emerg Med 2020; 2019:7058728. [PMID: 31934468 PMCID: PMC6942712 DOI: 10.1155/2019/7058728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 10/04/2019] [Accepted: 11/09/2019] [Indexed: 11/17/2022] Open
Abstract
Testicular rupture after blunt scrotal trauma is characterized by rupture of the tunica albuginea and extrusion of seminiferous tubules. This is a serious injury and appropriate evaluation and management are necessary both for symptom control, but also for preservation of the testicle. Clinical examination of the scrotum following trauma is difficult and may result in incorrect triage of patients for surgical exploration. This case study describes the assessment and management of blunt testicular trauma in an adolescent lacrosse player.
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5
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Effects of Intratesticular Hematoma on Testis Microstructure, Spermatogenesis, and Testosterone Production: Defining a Cutoff Point for Significant Intratesticular Hematoma. Urology 2018; 118:80-86. [PMID: 29777790 DOI: 10.1016/j.urology.2018.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/17/2018] [Accepted: 05/01/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effects of different degrees of intratesticular hematoma (ITH), a major consequence of blunt testis trauma, on testis microstructure and function. We determined a cutoff point for significant vs nonsignificant ITH. METHODS Seventy male rats were divided into 7 equal groups. The control group remained intact. Sham groups consisted of rats given an intratesticular injection of normal saline in both testicles with volumes equivalent to 40% (group II), 30% (group III), and 10% (group IV) of testis volume. Bilateral ITH was created by the intratesticular injection of autologous blood equivalent to 40% (group V), 30% (group VI), and 10% (group VII) of testicular volume. After 60 days of recovery, testes volume, microstructure, semen parameters, and serum testosterone were recorded. RESULTS The most severe destructive effects were observed in groups V and VI. Testes, tubule, and epithelium volumes were reduced between 16.6% and 58.8%. The number of the spermatogenic, Sertoli, and Leydig cells was reduced between 47.5% and 73.1% in group V. Significant volume-dependent decreases in spermatozoa counts were seen in all groups except group IV after injection of different amounts of normal saline or blood. This reduction was most prominent after injections equivalent to 40% of testis volume (groups II and V). There was a nonsignificant trend toward lower testosterone level in groups V and VI. CONCLUSION ITH has significant volume-dependent detrimental effects on testis microstructure, semen parameters, and testosterone level. ITH equivalent to 10% of testis volume may be relatively well-tolerated, but the effects can be significant when ITH is ≥30% of testis volume.
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6
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Uçar M, Akkoç A. Nadir Bir Olgu; Testiküler Rüptür. ACTA MEDICA ALANYA 2017. [DOI: 10.30565/medalanya.338763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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7
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Sinasi M, Akoglu E, Akoglu H, Altinok AD, Onur OE, Kosargelir M. Traumatic Testis Dislocation: A Case Report and Review of the Literature. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791201900411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Dislocation of testis is a rare and underreported condition, commonly associated with delayed diagnosis and treatment in pelvic injuries. Delayed treatment may cause infertility due to elevated temperature exposure leading to a reduced sperm production. It is imperative to look for this entity during the secondary survey in the management of a polytrauma patient. We encountered dislocation of testis in a 26-year-old male motorcyclist involving in a road traffic crash. He complained of pelvic pain. A tender mass was felt in the left groin during physical examination. Abdominal computed tomography scan revealed a dislocated left testis. Closed reduction was performed and the patient recovered without any complications.
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Affiliation(s)
| | | | - H Akoglu
- Dr. Lutfi Kirdar Kartal Education and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | | | | | - M Kosargelir
- Haydarpasa Numune Education and Research Hospital, Emergency Medicine Clinic, Istanbul, Turkey
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8
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Starmer BZ, Baird A, Lucky MA. Considerations in fertility preservation in cases of testicular trauma. BJU Int 2017; 121:466-471. [DOI: 10.1111/bju.14084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Andrew Baird
- Aintree University Hospital NHS Foundation Trust; Liverpool UK
| | - Marc A. Lucky
- Aintree University Hospital NHS Foundation Trust; Liverpool UK
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9
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A Review of Imaging Modalities Used in the Diagnosis and Management of Scrotal Trauma. Curr Urol Rep 2017; 18:98. [DOI: 10.1007/s11934-017-0744-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Lee SH, Lee DG, Choi SK, Choi T, Yoo KH. Trends in Testicular Injury in Korea, 1986-2015. J Korean Med Sci 2017; 32:1669-1673. [PMID: 28875612 PMCID: PMC5592182 DOI: 10.3346/jkms.2017.32.10.1669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/09/2017] [Indexed: 11/27/2022] Open
Abstract
The objectives of this study were to investigate patients treated for scrotal trauma at our institute for the last three decades to describe our experience with an emphasis on the etiologies and ultrasonographic findings in these patients. We reviewed medical records of patients who underwent scrotal ultrasonography for evaluation of testicular trauma at our institutes from 1986 to 2015. Trends regarding the etiology of scrotal trauma were evaluated during each decade. The echo pattern and contour definition of the testicular parenchyma and the pattern of hematoma development were recorded to evaluate radiographic findings of testicular injury. The correlation between ultrasonographic and intraoperative findings was assessed. A total of 115 patients were analyzed. Most patients (92.2%) presented with blunt trauma. The most common etiology of testicular trauma was assault during the first and second decades, while injury related to a fall was most common during the third decade. Of the 77 patients (67.0%) who underwent urgent exploration, 46 patients (59.7%) had testicular rupture. Loss of contour definition, heterogeneous echo pattern of the testicular parenchyma, and testicular hematoma showed a moderate to strong degree of correlation with testicular rupture (Spearman correlation co-efficient: 0.5-0.8). Over the past 30 years, the etiology of testicular injury changed from assault to falls or athletic injury and the severity of injury has decreased. Our findings demonstrate the importance of ultrasonography for determining an appropriate management strategy in scrotal trauma. Surgical exploration should be considered in patients with abnormal ultrasonographic findings.
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Affiliation(s)
- Sang Hyub Lee
- Department of Urology, School of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul, Korea
| | - Dong Gi Lee
- Department of Urology, School of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul, Korea
| | - Seung Kwon Choi
- Department of Urology, School of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul, Korea
| | - Taesoo Choi
- Department of Urology, School of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul, Korea
| | - Koo Han Yoo
- Department of Urology, School of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul, Korea.
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11
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Abstract
Testicular trauma is a rare emergency. While penetrating injuries need surgical revision, blunt injuries may be treated conservatively. However, in case of testicular rupture early surgical intervention increases the chance of testicular preservation. Therefore, a meticulous urological diagnosis is important to avoid complications and to reduce rates of secondary orchiectomy.
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Affiliation(s)
- B Lyttwin
- Urologische Universitätsklinik, Anna-Seiler-Haus, Inselspital Bern, Freiburgstraße 10, 3010, Bern, Schweiz
| | - F Moltzahn
- Urologische Universitätsklinik, Anna-Seiler-Haus, Inselspital Bern, Freiburgstraße 10, 3010, Bern, Schweiz
| | - G N Thalmann
- Urologische Universitätsklinik, Anna-Seiler-Haus, Inselspital Bern, Freiburgstraße 10, 3010, Bern, Schweiz.
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12
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Wang Z, Yang JR, Huang YM, Wang L, Liu LF, Wei YB, Huang L, Zhu Q, Zeng MQ, Tang ZY. Diagnosis and management of testicular rupture after blunt scrotal trauma: a literature review. Int Urol Nephrol 2016; 48:1967-1976. [PMID: 27567912 DOI: 10.1007/s11255-016-1402-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 08/17/2016] [Indexed: 12/12/2022]
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13
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Dalton D, Davis N, O'Neill D, Brady C, Kiely E, O'Brien M. Aetiology, epidemiology and management strategies for blunt scrotal trauma. Surgeon 2016; 14:18-21. [PMID: 25151340 DOI: 10.1016/j.surge.2014.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/27/2014] [Accepted: 06/18/2014] [Indexed: 11/27/2022]
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14
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Bowen DK, Gonzalez CM. Intratesticular hematoma after blunt scrotal trauma: a case series and algorithm-based approach to management. Cent European J Urol 2014; 67:427-9. [PMID: 25667770 PMCID: PMC4310892 DOI: 10.5173/ceju.2014.04.art24] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 07/20/2014] [Accepted: 09/16/2014] [Indexed: 11/22/2022] Open
Abstract
We present our experience with intratesticular hematoma (ITH) without rupture of the tunica albuginea following blunt scrotal trauma and present an algorithm for management. We reviewed the charts of 3 patients who presented between 2006 and 2013 with this finding. Time from the incident to presentation ranged from 5 hours to 4 days. All patients underwent at least one scrotal ultrasound reviewed by the same urologist. Two patients underwent surgical exploration and all patients had resolution of pain within one to two days. Management of ITH should be centered on the patient's pain severity as well as serial ultrasound findings.
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Affiliation(s)
- Diana K Bowen
- Northwestern University, Department of Urology, Chicago, United States
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15
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Abstract
Serious blunt scrotal trauma in the pediatric population is rare and can pose significant danger to the viability of the testes. The following case describes an adolescent boy who presented with a single testis in his scrotum after low-impact perineal trauma, consistent with testicular dislocation. The literature regarding scrotal trauma includes few cases of testicular dislocation from low-impact perineal trauma. Included is a brief review of the most recent data including epidemiology, differential diagnosis, acute management, and complications pertinent to the pediatric emergency clinician.
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16
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Adlan T, Freeman SJ. Can ultrasound help to manage patients with scrotal trauma? ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2014; 22:205-12. [PMID: 27433221 DOI: 10.1177/1742271x14545911] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Traumatic injuries to the scrotum are uncommon but, when they do occur, frequently lead to serious complications. Early complications include testicular infarction, necrosis and abscess formation; in the longer-term trauma may result in testicular atrophy and subfertility. Early surgical intervention in patients with testicular rupture can significantly improve the clinical outcome and reduce the need for delayed orchidectomy. However, clinical examination of the scrotum following trauma is difficult and frequently inaccurate; this may result in incorrect triage of patients for surgical exploration. Scrotal ultrasound can reliably assess scrotal injuries and diagnose testicular rupture with a high level of accuracy. Additionally, ultrasound can provide important information regarding testicular perfusion, which can further inform decisions on surgical management. This article reviews the sonographic findings that may be encountered in patients with scrotal trauma, with an emphasis on blunt trauma. It describes the pivotal role that ultrasound can play in the accurate triage of these patients to surgical or conservative management.
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Affiliation(s)
- T Adlan
- Imaging Directorate, Derriford Hospital, Plymouth, UK
| | - S J Freeman
- Imaging Directorate, Derriford Hospital, Plymouth, UK
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17
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Abstract
Imaging of the genitourinary tract is essential in the workup of the majority of the conditions seen daily by urologists. The use of ultrasound in the office provides a safe, low cost, and efficient way for the clinician to evaluate the patient in real time. Ultrasound can allow for bedside diagnosis in many conditions and assist in treatment planning. This chapter covers the major applications of office ultrasound for the urologist as well as discusses future applications of ultrasound for the office setting.
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Affiliation(s)
- Etai Goldenberg
- Hofstra North Shore-LIJ School of Medicine, The Arthur Smith Institute for Urology, New Hyde Park, NY 11042, USA.
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18
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Cannis M, Mailhot T, Perera P. Bedside ultrasound in a case of blunt scrotal trauma. West J Emerg Med 2013; 14:127-9. [PMID: 23599846 PMCID: PMC3628458 DOI: 10.5811/westjem.2012.8.12630] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Accepted: 08/08/2012] [Indexed: 11/11/2022] Open
Abstract
This case study describes a patient who suffered blunt force trauma to the scrotum. Use of bedside emergency ultrasound facilitated early diagnosis of a ruptured testicle and allowed for prompt urological consultation and timely surgical repair. The utility of bedside emergency ultrasound in the evaluation of testicular trauma, as well as the outcome of our case, is discussed here.
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Affiliation(s)
- Mark Cannis
- Los Angeles County + University of Southern California Medical Center, Department of Emergency Medicine, Los Angeles, California
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19
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Bjurlin MA, Zhao LC, Goble SM, Hollowell CM. Race and Insurance Status are Risk Factors for Orchiectomy Due to Testicular Trauma. J Urol 2012; 187:931-5. [DOI: 10.1016/j.juro.2011.10.152] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Indexed: 10/14/2022]
Affiliation(s)
- Marc A. Bjurlin
- Division of Urology, Department of Surgery, Cook County Hospital, Cook County Health and Hospitals System, Chicago, Illinois
| | - Lee C. Zhao
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sandra M. Goble
- American College of Surgeons National Trauma Data Bank, Chicago, Illinois
| | - Courtney M.P. Hollowell
- Division of Urology, Department of Surgery, Cook County Hospital, Cook County Health and Hospitals System, Chicago, Illinois
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20
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Pogorelić Z, Jurić I, Biočić M, Furlan D, Budimir D, Todorić J, Milunović KP. Management of testicular rupture after blunt trauma in children. Pediatr Surg Int 2011; 27:885-9. [PMID: 21387107 DOI: 10.1007/s00383-011-2873-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Testicular rupture is a very rare entity in children and adolescents. The aim of this study was to evaluate the outcomes of surgical repair after testicular rupture in children. METHODS Between January 2000 and January 2010 seven patients were operated on because of testicular rupture. Mean age at the time of the accident was 15 years. In all patients, an emergency scrotal ultrasonography showed a rupture of the testicular capsule with a surrounding hematocele. Surgical exploration was performed to evacuate the hematocele and repair the ruptured testis. RESULTS Mean follow-up was 4.9 years. Average hospital stay was 2 days. Mean time between surgery and the initial trauma was 35 h. There were no major complications. Control ultrasound imaging showed that the tunica was repaired and Doppler signal confirmed vascularity in all patients. There were no significant differences in size between the right and left testes. There were no recorded cases of testicular atrophy. Semen analysis showed normospermia 6 months after surgery and anti-sperm antibodies count was within normal limits in all patients. CONCLUSION Prompt surgical intervention is crucial. Ruptured testis can be salvaged, with a high success rate, if surgical repair is performed within 72 h of testicular injury.
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, Split University School of Medicine, University Hospital Split, Spinčićeva 1, 21 000, Split, Croatia.
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21
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Valentino M, Bertolotto M, Derchi L, Bertaccini A, Pavlica P, Martorana G, Barozzi L. Role of contrast enhanced ultrasound in acute scrotal diseases. Eur Radiol 2011; 21:1831-40. [PMID: 21633826 DOI: 10.1007/s00330-010-2039-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 10/21/2010] [Accepted: 10/28/2010] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the efficacy of contrast-enhanced ultrasound (CEUS) in patients with acute scrotal pain not defined at ultrasound (US) with colour Doppler . METHODS CEUS was carried out in 50 patients with acute scrotal pain or scrotal trauma showing testicular lesion of undefined nature at US. The accuracy of US and CEUS findings versus definitive diagnosis (surgery or follow-up) was calculated. RESULTS Twenty-three patients had a final diagnosis of testicular tumour, three abscess, eight focal infarction, seven trauma, three testicular torsion, one haematoma. Five patients were negative. Thirty-five patients were operated (23 testicular tumours, six trauma, three testicular torsion, one abscess, one focal infarction, and one haematoma) and 15 underwent medical treatment or were discharged. US provided a definitive diagnosis in 34/50 as compared to the 48/50 patients diagnosed at CEUS. Sensitivity and specificity were 76% and 45% for US and 96% and 100% for CEUS respectively. CONCLUSIONS CEUS was more accurate in the final diagnosis compared to US, potentially reducing the need for further imaging. In particular CEUS can be proposed in emergency in cases where US diagnosis remains inconclusive, namely in infarction, and trauma, when testicular torsion cannot be ruled out, and in identifying testicular mass.
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Affiliation(s)
- Massimo Valentino
- Department of Diagnostic Imaging-Emergency Radiology Unit, University Hospital of Parma, Via Gramsci 14, 43100 Parma, Italy.
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22
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Molokwu CN, Doull RI, Townell NH. A novel technique for repair of testicular rupture after blunt trauma. Urology 2010; 76:1002-3. [PMID: 20932424 DOI: 10.1016/j.urology.2010.06.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Revised: 05/27/2010] [Accepted: 06/09/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To present a simple technique for the repair of a ruptured testis after blunt trauma when extruded but viable testicular tissue prevents closure of the testicular capsule during surgical exploration. Preservation of viable testicular tissue is important because the risk of impaired fertility and hormone function is minimized. METHODS A 25-year-old male sustained a ruptured right testis confirmed by ultrasound. Testicular exploration was performed and hematoma evacuated. Extruded but viable testicular tissue was identified and preserved. The free edges of parietal tunica vaginalis was used to create a "neocapsule" around the testis and extruded tissue. RESULTS There were no postoperative complications. Follow-up Doppler ultrasound scan at 3 months showed a viable testis with no atrophic changes. CONCLUSIONS This technique avoids the loss of extruded but viable testicular tissue and may reduce the risk of impaired fertility and hormone function, without compromising the goals of scrotal exploration.
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Affiliation(s)
- Chidi N Molokwu
- Department of Urology, Ninewells Hospital, Dundee, UK. chidi.molokwu@.nhs.met
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23
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Cubillos J, Reda EF, Gitlin J, Zelkovic P, Palmer LS. A Conservative Approach to Testicular Rupture in Adolescent Boys. J Urol 2010; 184:1733-8. [DOI: 10.1016/j.juro.2010.03.114] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Jimena Cubillos
- Divisions of Pediatric Urology, Cohen Children's Medical Center of New York-Long Island Jewish Health System, New Hyde Park and Westchester Medical Center (EFR, PZ), Valhalla, New York
| | - Edward F. Reda
- Divisions of Pediatric Urology, Cohen Children's Medical Center of New York-Long Island Jewish Health System, New Hyde Park and Westchester Medical Center (EFR, PZ), Valhalla, New York
| | - Jordan Gitlin
- Divisions of Pediatric Urology, Cohen Children's Medical Center of New York-Long Island Jewish Health System, New Hyde Park and Westchester Medical Center (EFR, PZ), Valhalla, New York
| | - Paul Zelkovic
- Divisions of Pediatric Urology, Cohen Children's Medical Center of New York-Long Island Jewish Health System, New Hyde Park and Westchester Medical Center (EFR, PZ), Valhalla, New York
| | - Lane S. Palmer
- Divisions of Pediatric Urology, Cohen Children's Medical Center of New York-Long Island Jewish Health System, New Hyde Park and Westchester Medical Center (EFR, PZ), Valhalla, New York
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Lardellier F, Varlet F, François M, Audry G, Buisson P, Dubois R, Galinier P, Geiss S, Gorduza D, Kalfa N, Lacreuse I, Leclair MD, Merrot T, Paye-Jaouen A, Ravasse P, Sapin E, Teklali Y, Valla JS, Diraduryan N, Guye E, Lopez M. Traumatisme du testicule chez l’enfant. Basic Clin Androl 2010. [DOI: 10.1007/s12610-010-0097-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Résumé
Introduction
Les traumatismes du testicule sont rares chez l’enfant, et la littérature est très pauvre sur ce sujet. Le but était de les analyser à partir d’une étude multicentrique rétrospective.
Matériel et méthodes
Un questionnaire sur les traumatismes du testicule survenus entre 2000 et 2009 a été envoyé dans les différents centres de chirurgie pédiatrique français. L’analyse a été effectuée à l’aide du questionnaire et du compte rendu opératoire, et n’ont été retenus que les dossiers de traumatisme vrai du testicule, excluant les plaies simples du scrotum, les traumatismes « révélateurs » d’une torsion de testicule ou d’hydatide, ou encore les dossiers incomplets.
Résultats
Quinze centres ont bien voulu nous transmettre leurs observations et parmi ceux-ci, deux ont répondu n’avoir opéré aucun cas; cette étude n’est pas exhaustive, car beaucoup d’équipes ont envoyé des dossiers d’enfants opérés et aucun cas de traumatisme bénin. Parmi les 60 observations reçues, 45 ont été retenues. L’âge moyen était de 12,3 ans (2 jours–18 ans). Les circonstances du traumatisme étaient 23 coups (pied, genou, poing), 13 chutes (vélo, banc, luge), quatre accidents de la voie publique, quatre traumatismes de nature inconnue et un traumatisme obstétrical. Le traumatisme était fermé 41 fois et ouvert quatre fois. L’échographie-doppler couleur a été réalisée dans 34 cas sur 45 (75,5 %); un diagnostic exact a été possible 30 fois, alors qu’il y a eu trois faux-positifs (deux fractures du testicule et un hématome intratesticulaire non confirmés à l’intervention) et un faux-négatif (contusion de l’épididyme non vue à l’échographie). Les lésions testiculaires étaient les suivantes: 15 fractures, huit hématomes intratesticulaires, six contusions testiculaires bénignes (dont une associée à une tumeur), six hématomes du cordon, six contusions de l’épididyme, trois hématocèles isolées et une avulsion. Le traitement a été chirurgical 33 fois et non opératoire 12 fois. Parmi les 15 fractures du testicule, 13 ont été opérées (huit sutures et cinq orchidectomies partielles) et deux ont été surveillées avec de bons résultats, sans atrophie secondaire. Pour les hématomes intratesticulaires, trois ont été surveillés et cinq opérés. Seuls 20 enfants ont été suivis au-delà de quatre mois, essentiellement les fractures testiculaires, et aucune atrophie secondaire n’a été constatée.
Conclusion
Les traumatismes du testicule chez l’enfant sont rares, mais leur pronostic est plutôt bon. L’échographie-doppler permet désormais de faire un diagnostic précis dans un grand nombre de cas, devant permettre d’éviter certaines explorations chirurgicales systématiques; mais l’intervention reste indispensable en cas de doute.
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Tolosa Eizaguirre E, Robles García J, Lorente Pérez J, Rincón Mayans A. Consulta diferida de un traumatismo escrotal. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2010.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
This review describes the clinical, grey-scale and colour Doppler US findings of different conditions that may be the cause of an acute scrotum. The US appearances of testicular torsion, torsion of the appendix testis, epididymoorchitis, incarcerated hernia and idiopathic scrotal oedema are described. Some of the major studies regarding the sensitivity and specificity of US in the diagnosis of these diseases are reviewed. Grey-scale and colour Doppler US demonstrate high accuracy in the aetiological diagnosis of an acute scrotum and can differentiate between diseases that require immediate surgical intervention and those that can be treated conservatively.
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Affiliation(s)
- Matteo Baldisserotto
- Radiology Department, Hospital Sao Lucas da Pontificia, Universidade Católica do Rio Grando do Sul, Porto Alegre, RS, Brazil.
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Ezra N, Afari A, Wong J. Pelvic and scrotal trauma: CT and triage of patients. ACTA ACUST UNITED AC 2008; 34:541-4. [DOI: 10.1007/s00261-008-9417-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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