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Scrotal Trauma - Emergency Management

General Information

General InformationGeneral Information


  • Traumatic injury to the scrotum and testicles by blunt force or penetrating mechanism


  • Scrotum
    • Composed of skin and the dartos muscular fascia, which is just deep to the skin
    • Divided by a septum into 2 chambers, which contain the testicles
  • Testicle
    • Surrounded by tunica albuginea and composed of coiled seminiferous tubules


  • More commonly caused by blunt rather than penetrating trauma


  • Genitourinary tract injuries account for 3%-10% of patients with trauma1
  • Blunt trauma
    • Comprises up to 85% of testicular trauma2
    • May occur from motor vehicle collisions, sports injuries, falls, kicks, and strikes by thrown objects3
    • Of the blunt scrotal trauma injuries that present to the hospital, > 40% will have associated testicular rupture4
  • Penetrating trauma to the genitalia2,5,6
    • Overall rare
    • Gunshot wounds are much more common than all other penetrating injuries
      • 10% of gunshot victims have associated genitourinary system trauma7
  • Other mechanisms of injury: animal and human bites, burns, and scrotal degloving injuries



General references used

  1. Wang A, Stormont I, Siddiqui MM. A Review of Imaging Modalities Used in the Diagnosis and Management of Scrotal Trauma. Curr Urol Rep. 2017 Oct 28;18(12):98
  2. McGeady JB, Breyer BN. Current epidemiology of genitourinary trauma. Urol Clin North Am. 2013 Aug;40(3):323-34full-text
  3. Adams RJ, Attia M, Cronan K. Report of 4 cases of testicular rupture in adolescent boys secondary to sports-related trauma. Pediatr Emerg Care. 2008 Dec;24(12):847-8
  4. Buckley JC, McAninch JW. Diagnosis and management of testicular ruptures. Urol Clin North Am. 2006 Feb;33(1):111-6, vii
  5. Bjurlin MA, Kim DY, Zhao LC, et al. Clinical characteristics and surgical outcomes of penetrating external genital injuries. J Trauma Acute Care Surg. 2013 Mar;74(3):839-44
  6. Brandes SB, Buckman RF, Chelsky MJ, Hanno PM. External genitalia gunshot wounds: a ten-year experience with fifty-six cases. J Trauma. 1995 Aug;39(2):266-71
  7. Najibi S, Tannast M, Latini JM. Civilian gunshot wounds to the genitourinary tract: incidence, anatomic distribution, associated injuries, and outcomes. Urology. 2010 Oct;76(4):977-81
  8. Boudissa M, Ruatti S, Maisse N, et al. Bilateral testicular dislocation with pelvic ring fracture: a case report and literature review. Orthop Traumatol Surg Res. 2013 Jun;99(4):485-7full-text
  9. Micallef M, Ahmad I, Ramesh N, Hurley M, McInerney D. Ultrasound features of blunt testicular injury. Injury. 2001 Jan;32(1):23-6
  10. Ko SF, Ng SH, Wan YL, et al. Testicular dislocation: an uncommon and easily overlooked complication of blunt abdominal trauma. Ann Emerg Med. 2004 Mar;43(3):371-5
  11. Bhatt S, Dogra VS. Role of US in testicular and scrotal trauma. Radiographics. 2008 Oct;28(6):1617-29
  12. Simhan J, Rothman J, Canter D, et al. Gunshot wounds to the scrotum: a large single-institutional 20-year experience. BJU Int. 2012 Jun;109(11):1704-7PDF
  13. Lynch TH, Martínez-Piñeiro L, Plas E, et al; European Association of Urology (EAU). EAU guidelines on urological trauma. Eur Urol. 2005 Jan;47(1):1-15
  14. D'Andrea A, Coppolino F, Cesarano E, et al. US in the assessment of acute scrotum. Crit Ultrasound J. 2013 Jul 15;5 Suppl 1:S8full-text
  15. Vijayaraghavan SB. Sonographic differential diagnosis of acute scrotum: real-time whirlpool sign, a key sign of torsion. J Ultrasound Med. 2006 May;25(5):563-74
  16. Guichard G, El Ammari J, Del Coro C, et al. Accuracy of ultrasonography in diagnosis of testicular rupture after blunt scrotal trauma. Urology. 2008 Jan;71(1):52-6
  17. Kim SH, Park S, Choi SH, Jeong WK, Choi JH. Significant predictors for determination of testicular rupture on sonography: a prospective study. J Ultrasound Med. 2007 Dec;26(12):1649-55
  18. Muglia V, Tucci S Jr, Elias J Jr, Trad CS, Bilbey J, Cooperberg PL. Magnetic resonance imaging of scrotal diseases: when it makes the difference. Urology. 2002 Mar;59(3):419-23
  19. Hedayati V, Sellars ME, Sharma DM, Sidhu PS. Contrast-enhanced ultrasound in testicular trauma: role in directing exploration, debridement and organ salvage. Br J Radiol. 2012 Mar;85(1011):e65-8full-text
  20. Kim SH, Park S, Choi SH, Jeong WK, Choi JH. The efficacy of magnetic resonance imaging for the diagnosis of testicular rupture: a prospective preliminary study. J Trauma. 2009 Jan;66(1):239-42
  21. Cubillos J, Reda EF, Gitlin J, Zelkovic P, Palmer LS. A conservative approach to testicular rupture in adolescent boys. J Urol. 2010 Oct;184(4 Suppl):1733-8
  22. Chang AJ, Brandes SB. Advances in diagnosis and management of genital injuries. Urol Clin North Am. 2013 Aug;40(3):427-38
  23. Morey AF, Metro MJ, Carney KJ, Miller KS, McAninch JW. Consensus on genitourinary trauma: external genitalia. BJU Int. 2004 Sep;94(4):507-15PDF
  24. McAninch JW. Management of genital skin loss. Urol Clin North Am. 1989 May;16(2):387-97
  25. Hobbs CJ, Osman J. Genital injuries in boys and abuse. Arch Dis Child. 2007 Apr;92(4):328-31full-text
  26. Kadish HA, Schunk JE, Britton H. Pediatric male rectal and genital trauma: accidental and nonaccidental injuries. Pediatr Emerg Care. 1998 Apr;14(2):95-8
  27. Cass AS. Testicular trauma. J Urol. 1983 Feb;129(2):299-300
  28. Phonsombat S, Master VA, McAninch JW. Penetrating external genital trauma: a 30-year single institution experience. J Urol. 2008 Jul;180(1):192-5

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National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T908627, Scrotal Trauma - Emergency Management; [updated 2018 Nov 30, cited place cited date here]. Available from Registration and login required.

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