Chapter 32 · Acute lower urinary tract conditions
Scrotal and testicular trauma
General principles
Scrotal trauma may be blunt, penetrating, or involve traumatic testicular dislocation.
Goals of emergency care: assess testicular integrity and preserve fertility.
Clinical assessment
- Scrotal pain, swelling, hematoma.
- Inability to palpate the testis (in dislocation or rupture).
- Hematuria (with urethral or bladder injury).
Diagnosis
- Doppler ultrasonography assesses tunica albuginea integrity and blood flow.
- Surgical exploration if rupture is suspected.
Emergency management
- For hematocele and testicular rupture: surgical exploration, repair of the defect, and orchiectomy if nonviable.
- For traumatic dislocation: closed or open reduction with orchiopexy.
- For hematoma without rupture: conservative treatment (cold application, rest, anti-inflammatory medication).
Algorithm
| Step | Action |
|---|---|
| 1 | Assess injury severity |
| 2 | Doppler ultrasonography |
| 3 | Rupture → surgical exploration |
| 4 | Dislocation → reduction + orchiopexy |
| 5 | Hematoma without rupture → conservative treatment |