Scrotal trauma may cause the rupture of the tunica albuginea of the testicles and thus represents a severe clinical condition requiring prompt clinical evaluation and possibly surgical exploration.
Diagnosis
Physical examination and anamnestic report should guide the diagnosis of scrotal trauma. Patients usually present with significant scrotal swelling and discomfort. Scrotal ultrasound can reliably diagnose testicular rupture with a high level of accuracy, which should prompt exploration and attempt at repair. The most specific findings on ultrasonography are loss of testicular contour and heterogeneous echotexture of parenchyma.
Surgical exploration
Penetrating injuries to the scrotum should undergo surgical exploration as over 50% will have testicular rupture. Prompt surgical exploration is indicated with sonographic findings of testicular rupture, equivocal imaging, large hematoma, or clear physical findings of testicular rupture. Patient goes under spinal or general anaesthesia. Vertical medial incision, laterally to the scrotal raphe, is taken. Repair of the ruptured testis is performed by debriding non-viable tissue and closing the tunica albuginea. Early exploration and repair may prevent complications, such as ischemic atrophy of the testis and infection. Skin graft or flap can be harvested to ensure the closure of the scrotal skin.
