Introduction
In men and boys, the testicles are organs placed outside the body in the scrotum. The scrotum is a pouch of skin that helps in holding the testicles. It helps in the protection of the testicles as well. Testicular torsion is a type of testicular trauma that is a medical emergency that, if delayed, may result in the loss of a testicle.
What Is Testicular Trauma?
Testicles are organs that help in the production of sperm and hormones. Any damage to the testicles is called testicular trauma. Testicles are located outside the body, due to which they are prone to trauma. The tissue of the scrotum covers the testicles. The scrotum is the only protection for the testicles as it lacks protection from the bones and muscles. In most cases, the testicles act as shock absorbers and can withstand serious injuries. However, intense trauma can tear the protective layer of the scrotum and may lead to injury of the testicles. Testicular trauma, if not treated at the right time, can lead to loss of blood supply or infertility as they help in sperm production. 85 % of the cases are due to blunt injury, which is caused by:
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Individuals get kicked in the genital area.
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Motorcycle accident
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Bicycle accidents or other forms of road accidents.
What Are the Types of Testicular Trauma?
Testicular trauma involves:
1) Contusion: It is caused by a bruise or a hematoma that results in injury to the blood vessels leading to an accumulation of blood beneath the tissues. Symptoms include swelling, bruising, and bleeding.
2) Testicular Torsion: Testicular torsion occurs when the tissues around the testis are loosely attached, which causes rotation of the testis. The spermatic cord is responsible for transporting blood to the scrotum, and testicular torsion causes the twisting of the spermatic cord to lose blood flow. It is common in younger age groups between twelve and eighteen. Testicular torsion can be seen in cases before birth and requires emergency treatment due to blood loss. In addition, there may be permanent damage to the testis, which may have to be surgically removed.
3) Rupture: Injuries or trauma lead to the tearing of the protective covering of the testicles. A fracture can also cause a rupture. This can cause the spilling of the testicular contents due to a lack of protective cover.
4) Degloving: This is similar to removing the glove hence the term. The protective layer is degloved due to an accident causing trauma.
5) Dislocation: This is due to the change in location or dislocation of the testicle because of an accident or trauma. The sites where the testicles can dislocate are near the pubic bone, abdomen, or places adjacent to the scrotum. For example, dislocation is often seen in cases of motorcycle accidents because of the collision of the testicles with the gas tank.
6) Detaching: The testicles get detached in some individuals.
7) Infections: Animal bites can lead to infection of the scrotum.
8) Epididymitis: Epididymis is a coiled tube that helps to store and transport sperm. It is located behind the testicles. Inflammation in the epididymis is called epididymitis.
9) Hematoceles: A collection of blood under the scrotum or the protective layer leads to the formation of hematoceles.
What Are the Symptoms of Testicular Trauma?
The symptoms involve:
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Intense pain in the scrotum.
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Bruising of the scrotum.
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Swelling of the scrotum.
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Discomfort and pain in the lower abdomen.
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Vomiting or nausea.
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Individuals may experience fever after injury.
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Hematuria (blood in urine).
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Dysuria (pain while passing urine).
What Are the Causes of Testicular Trauma?
The causes involve:
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Penetrative injuries are caused by gunshots and knives.
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Punches or kicks cause blunt injuries or anything that can be thrown.
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Animal bites.
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Injuries caused by machines.
These causes lead to severe injuries, such as the pooling of blood and loss of the protective layer.
How Is Testicular Trauma Diagnosed?
The first step of diagnosis involves detailed history taking and is followed by a physical examination. A physical examination of the epididymis is done and checked for any injury to it or the surrounding structures. The health care provider informs the person if the findings are normal.
If the healthcare provider suspects any problem, they may order the following tests:
Ultrasound: This imaging test is a painless procedure where the testicles are viewed on the screen with the help of sound waves that help create the image.
Magnetic Resonance Imaging (MRI): This technique helps assess the scrotum and provides a detailed image of the scrotum and the testicles.
Exploratory Surgery: Surgery is performed to look for the abnormalities caused by the injury and, if possible, provide treatment during the procedure. Surgery is often performed in severe cases or cases that have not shown any improvement within forty-eight hours.
What Is the Treatment for Testicular Trauma?
Treatment Involves:
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In mild cases, the doctor may suggest resting and prescribe pain medication for pain. It is also advised to place an ice pack and support the affected area. If needed, the health care provider may also prescribe antibiotics. If there is no improvement even after forty-eight hours, the individual should reach out to the health care provider.
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Problems that involve penetration injuries to the scrotum and testicles, loss of a huge amount of skin, or the protective layer, loss of blood supply, and twisting of the testicles need immediate medical care as they can lead to permanent complications such as infertility.
Surgical Approaches Involve:
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Bring the testicle back to its original position by untwisting the testicles and preventing it from future dislocation.
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In cases of rupture and degloving (detachment of the skin or protective layer), bring the layer back to its original position and suture it.
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Washing the area of the wound to reduce infection.
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Reattachment of a detached testicle.
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In cases of degloving, skin grafts can be used.
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The last option involves orchiectomy, which is the removal of the injured testicle, which can be saved. In removing both testes, the healthcare provider may suggest sperm freezing.
What Are the Complications of Testicular Trauma?
The Complications Involve:
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Decreased testosterone levels.
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Urologic abnormalities.
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Infection.
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Infertility.
Conclusion
Testicles are located outside the body, due to which they are prone to trauma. Any damage to the testicles is called testicular trauma. The most common causes are penetration injuries and blunt trauma. If the symptoms do not resolve after forty-eight hours, the individual requires immediate medical attention.
