Subscribe for unlimited access to DynaMed content, CME/CE & MOC credit, and email alerts on content you follow.

Already subscribed? Sign in now

CME

Scrotal Trauma - Emergency Management

General Information

General InformationGeneral Information

Description

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

Anatomy

  • 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

Etiology

  • More commonly caused by blunt rather than penetrating trauma

Epidemiology

  • 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

References

References

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

DynaMed Editorial Process

  • DynaMed topics are created and maintained by the DynaMed Editorial Team and Process.
  • All editorial team members and reviewers have declared that they have no financial or other competing interests related to this topic, unless otherwise indicated.
  • DynaMed content includes Practice-Changing Updates, with support from our partners, McMaster University and F1000.

How to cite

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 https://www.dynamed.com/topics/dmp~AN~T908627. Registration and login required.

Published by EBSCO Information Services. Copyright © 2020, EBSCO Information Services. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission.

EBSCO Information Services accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional.

top

Subscribe for unlimited access to DynaMed content.
Already subscribed? Sign in