Scrotal injuries – damage to the testicles, appendages of the testicles, spermatic cords caused by the impact of various traumatic factors. Injuries to the organs of the scrotum are accompanied by sharp pain, painful shock, the formation of hematoma and swelling of the scrotum, sometimes open wounds, testicular prolapse, rupture and separation of the scrotum. Diagnosis of injuries of the scrotum and its organs is carried out using ultrasound, diaphanoscopy, MRI, revision of the scrotum organs. Depending on the type of injury, the treatment of damage to the organs of the scrotum may include removal of a hematoma, stopping bleeding, antishock therapy, testicular resection, orchiectomy or epididymectomy, suturing of the vas deferens, etc.
Scrotal injuries are anatomical or functional injuries of the male genitals located in the scrotum that occur when exposed to external mechanical, chemical, temperature, electrical and other factors. In the structure of damage to the genitourinary system, injuries to the organs of the scrotum occupy about 25%. Among the victims, 80% are young and middle-aged patients. In urology and andrology, scrotal injuries are often combined with penile injuries. Given the high prevalence of scrotal injuries among men of reproductive age, the issues of providing quality medical care are of great medical and social importance.
According to the nature of the damage (the presence of a violation of the integrity of the skin), there are closed (blunt, subcutaneous) and open injuries. Both groups of injuries can occur without damage to the organs of the scrotum or with their interest (damage to the testicle, appendage, spermatic cord). Closed injuries include bruising and pinching of the scrotum. In peacetime, closed scrotum injuries are 6-8 times more common than open ones.
According to the etiology, open injuries of the scrotum organs can be stabbed, cut, bitten, gunshot (blind or through, bullet or fragmentation, with or without a foreign body in the scrotum), etc. Traumatic amputation of the scrotum is a particularly severe type of open injury. By the presence or absence of a combination with injuries of other organs, scrotal injuries can be isolated or combined. Most often, injuries of the scrotum organs are combined with wounds of the urethra, bladder, rectum, pelvic bones, soft tissues of the thighs, which requires the involvement of not only urologists, but also proctologists and traumatologists in their treatment.
Blunt trauma of the scrotal organs accounts for almost 80% of all cases of damage to this anatomical area. The direct causes of closed injuries to the scrotum and its organs are beating, road accidents, injuries at home or at work, during sports (martial arts, cycling, equestrian sports, etc.). Most often, closed injuries are the result of a direct blow to the scrotum. Compression of the scrotum during sexual contacts, blockages in mines, accidents, earthquakes and other disasters can be a damaging factor. Chronic injuries of the scrotal organs associated with vibration, shaking, overheating can lead to a violation of spermatogenesis (oligospermia, asthenozoospermia, azoospermia).
Thermal injuries to the organs of the scrotum can include burns with boiling water, steam, hot objects, chemicals, frostbite. Knife and gunshot wounds leading to open injury of the scrotum organs occur in 5% of cases. A bitten injury can be inflicted by both an animal and a sexual partner.
Closed Scrotal injuries
With closed injuries, the organs of the scrotum may remain intact or be damaged to one degree or another. Among the injuries there are bruises, dislocation and rupture of the testicle and appendage, injuries of the spermatic cord.
The looseness of connective tissue and abundant vascularization of the scrotum contribute to the fact that closed injuries in almost all cases occur with the formation of hematomas. Hemorrhages in the scrotum may be superficial or accompanied by massive hemorrhagic infiltration, spreading to the tissues of the penis, perineum, anterior abdominal wall, inner thighs. Due to bruising, the scrotum acquires a purplish-blue, sometimes blue-black color, significantly increases in size on the side of the injury.
Closed injuries of the scrotal organs (especially testicles and appendages) are characterized by acute intense pain, often by pain shock phenomena. When the membranes of the testicle rupture, an intravaginal hemorrhage occurs – a hematocele; the scrotum is tense, the testicle is not palpable. With dislocation (dislocation of the testicle), its torsion in the area of the spermatic cord or displacement (false cryptorchidism) may occur. Dislocation of the testicle can be inguinal, pubic, perineal, abdominal. Closed injuries of the spermatic cord are rare, since this anatomical formation is well protected. Usually, with injuries, there is a bruise of the spermatic cord, compression by a large hematoma.
Due to damage to the organs of the scrotum, post-traumatic orchitis and epididymitis, phlegmon and gangrene of the scrotum, atrophy of the testicular parenchyma and infertility can develop. Injuries to the organs of the scrotum significantly increase the risk of testicular cancer.
Open scrotum injuries
Open scrotal injuries are accompanied by traumatic shock in almost all cases. There is a pronounced pain syndrome, bleeding (both external and internal). With wounds of the spermatic cord, bleeding from the wound can be very dangerous. The victim may be in a state of collapse or fainting. Adynamia, pallor and moisture of the skin, weak rapid pulse, arterial hypotension are objectively determined. Due to edema and imbibition of loose tissue by blood, the scrotum increases in size.
With gaping wounds of the scrotum, testicular prolapse may occur. Open damage to the scrotum can lead to wounds of the protein membrane of the testicle, detachment of a part of the testicle, its fragmentation, complete detachment, damage to the appendage. Traumatic amputation of the scrotum occurs with the phenomena of traumatic shock, severe blood loss. In the perineum area there is a wound with the remains of the scrotum skin, bleeding vessels of the spermatic cord.
Traumatic damage to the organs of the scrotum should not be ignored by a urologist, andrologist, surgeon, traumatologist, since the reproductive and general health of a man depends on the completeness of diagnosis and medical care. The preliminary type of injury and the degree of damage is determined on the basis of complaints, anamnesis, examination and palpation of the scrotum.
The method of primary instrumental examination is ultrasound of the scrotum organs, which allows to diagnose hematocele, testicular concussion or rupture, the presence of a foreign body in the tissues of the scrotum. Ultrasound of the scrotal vessels allows you to assess testicular perfusion and detect vascular damage. Informative MRI is used to recognize the nature of closed injuries. Intravaginal hematoma must be distinguished from dropsy of the testicular membranes (hydrocele). Since puncture of the testicular membranes in case of injuries is extremely undesirable, it is advisable to use scrotal diaphanoscopy for differential purposes.
Treatment of scrotal injuries can be conservative or operative. With uncomplicated scrotal injuries, symptomatic therapy is performed (anti-inflammatory, antibacterial, painkillers, hemostatic agents). In the first hours after injury, local cooling of the scrotum, immobilization by applying a pressure bandage or suspension is indicated. After 3-4 days, thermal physiotherapy is prescribed for the speedy resorption of subcutaneous hemorrhages: sollux, UHF, paraffin therapy.
In case of dislocation, a closed manual or surgical reposition of the testicle is performed, which, if necessary, is supplemented with subcutaneous orchipexia. In the presence of extensive and deep post-traumatic hematomas, their drainage is carried out. An open revision of the scrotum organs allows you to remove non–viable tissues, suture ruptures, resect the testicle, perform orchiectomy or epididymectomy according to indications, and lower the testicle into the scrotum.
Open injuries require performing the PHO of scrotal wounds, opening the testicular membranes, removing the hematoma, stopping bleeding; conducting an audit of the testicle, appendage and spermatic cord. Depending on the detected damage, restoration of the integrity or ligation of the vas deferens, removal of the testicle or appendage can be carried out. When the scrotum is detached with the testicles hanging on the spermatic cords, they are immersed in specially formed “pockets” under the skin of the thigh, and after a few weeks they are transferred to the scrotum formed from the skin flap. Patients with traumatic testicular amputation are indicated for testicular transplantation or implantation of an artificial testicle. In case of bitten wounds, rabies vaccine is administered to patients; in case of other open injuries, tetanus and anti–gangrenous serum is administered.
Prognosis and prevention
The main danger of injuries to the organs of the scrotum is a complete violation of sexual and reproductive function, leading to a difficult experience of a man’s condition. The unfavorable prognosis is promoted by massive damage to the organs of the scrotum, late medical treatment that does not allow performing organ-preserving operations, post-traumatic complications. Prevention of scrotal injuries requires caution in everyday life and at work, protection of the perineum during sports, etc. Patients who have suffered a scrotal injury should be under the dynamic supervision of a urologist-andrologist for timely detection of abnormalities in the functioning of the genitourinary system.