Testicular trauma
Key points
Management approach
Check and treat other injuries - full primary and secondary surveys
Get USS to look for intracapsular haematoma/breaches
Controversial as to whether all testicular injuries require surgical exploration
Acceptable to manage conservatively even if capsular breach and extruded seminiferous tubules
If operating (see Statpearls reference):
Protruding seminiferous tubules are debrided to enable closure of the tunica albuginea
Extensive capsular loss may require removal of additional parenchyma or creation of a tunica albuginea flap using the tunica vaginalis
Large intracapsular haematomas may need to be explored and drained to prevent compartment syndrome
Penetrating injuries to the testis should be surgically explored following the same repair principles as blunt injuries
Vas deferens injuries occur in up to 10% of penetrating trauma cases and should be treated with suture ligation
Delayed reconstruction of the vas deferens is an option if required
The unaffected testis should be examined based on the path of the penetrating injury
References
Tullington JE, Blecker N. Lower Genitourinary Trauma. [Updated 2023 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557527/