What Is Ruptured Testicle

  • Poojasree Ramesh Masters of Pharmacy (Pharmacy practice) - SRM Institute of Science and Technology
  • Saira Loane Master's of Toxicology, Institute of Biomedical Research, University of Birmingham

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Introduction

A testicular rupture is characterized by the extrusion of the contents of the scrotum along with the rupture of the tunica albuginea. Testicular rupture is a urological emergency that primarily affects young people. Early diagnosis and appropriate medical interventions would increase the possibility of testis salvage and protect testicular functions. Studies showed that about 50 kg of direct force would cause testicular rupture. Some reports also noted that the right testis is more likely than the left to be trapped against the inner thigh or pubis, likely due to its bigger volume and cranial position.1

When conservative management is used for testicular contusions or ruptures, the failure rate is 45%, and the orchiectomy rate is 45% when delayed exploration is necessary. The incidence of rupture in cases of blunt testicular trauma is 48%. When patients with testicular trauma are examined early on, the rate of orchiectomy drops to 9%, hospital stays are shorter, the duration of disability is significantly shorter, and patients can resume normal activities more quickly.2

Anatomy and physiology of testicles 

 the following five anatomical features enable the thermistor to remain cool: 1) the dartos muscle, 2) the cremaster muscle, 3) the countercurrent heat exchange system, 4) an absent fatty skin layer, and 5) an abundance of sweat glands. When the surrounding temperature rises, the dertosmuscles contract and relax. By causing them to move farther away from the body, the local heat source, cools the testicles. In the spermatic cord, the muscle fibres act similarly, but they are more directly positioned away from the body. Some of the warm blood in the prostate artery is transferred to the cooler as it flows peripherally to the prostate, returning blood to the surrounding veins of the parietal plexus. As blood flows toward the teeth, this circulating heat exchange system causes the blood in that particular artery to gradually cool.3

Diagnostic criteria 

The primary imaging technique used in cases of blunt scrotal trauma is scrotal ultrasonography (US). With acute scrotal lesions, US is a straightforward, quick-acting, and noninvasive technique that has been extensively utilized. In the US, testicular rupture is commonly characterized by heterogeneous parenchymal echotexture and irregular margins. Sonographic imaging may also reveal other abnormalities in this instance, such as hematocele formation, thickening of the scrotal wall, and decreased or absent blood flow on colour or power Doppler sonography.1

When the results of the US are unclear, MRI is considered a crucial second-line examination strategy for differentiating scrotal disease. MRI is an auxiliary examination method in soft tissue disease [29, 30]. MRI shows its benefits in identifying the testis and surrounding tissues to aid in the diagnosis of blunt scrotal diseases because of its high soft tissue contrast and multiplanar capability 1

Acute scrotal infections are commonly diagnosed noninvasively using magnetic resonance imaging (MRI) and ultrasound (US). An approach used to diagnose and treat scrotal diseases with minimal invasiveness is the scrotoscope. Using a scrotoscope can help manage lesions in the scrotum and provide direct observation of intra-scrotal lesions, which can improve the accuracy of diagnosing and treating intra-scrotal lesions simultaneously.1

Treatment 

Testicular injuries is an uncommon emergency. While blunt injuries can be treated conservatively, penetrating injuries require surgical revision. Nonetheless, the likelihood of testicular preservation increases with prompt surgical intervention in cases of testicular rupture. Therefore, in order to prevent complications and lower the incidence of secondary orchiectomy, a thorough urological diagnosis is essential.4

The most common management approach for testicular ruptures now involves surgical exploration and repair within the first 72 hours. The appropriate incision should be planned based on the hemiscrotal anatomy. To fully expose the involved scrotal contents, a transverse or vertical incision is typically made. After opening the tunica vaginalis, draining the hematocele, and pulling out the testis, the ruptured tunica albuginea will be examined. Surgeons will use a scrotoscope to view the rupture of the tunica albuginea directly through a mini-invasive incision after removing any blood clots with regular saline. An absorbable suture is used to close the tunica albuginea after the necrotic, non-viable tissue and any remaining healthy bleeding edges have been removed. 

After the involved hemiscrotal is closed using an absorbable suture technique in two layers, the testis is returned to its natural position, and a drainage may be inserted. Should repair be unattainable, an orchiectomy may be carried out.  Following the rule out of massive hematomas or hematocele, a conservative regimen may be chosen for delayed surgical reconstruction of a ruptured testis.1

An innovative method for fixing testicular rupture following blunt trauma

A testicular exploration was conducted, and the hematoma was removed. Testicular tissue that was extruded yet still viable was located and saved. A "neo capsule" was formed around the testis and extruded tissue using the free edges of the parietal tunica vaginalis. This method preserves the 

objectives of scrotal exploration without sacrificing extruded but viable testicular tissue and may lower the chance of decreased hormone and fertility function.5

Summary

In conclusion, a ruptured testis is a serious medical condition that requires immediate medical attention and surgical intervention. Early diagnosis and treatment can significantly impact the outcome and the preservation of testicular function. It is important to seek medical care without delay and follow up with appropriate medical professionals to address any potential long-term concerns.

References

  1. Wang, Z., Yang, Jr., Huang, Ym. et al. Diagnosis and management of testicular rupture after blunt scrotal trauma: a literature review. Int Urol Nephrol 48, 1967–1976 (2016). https://doi.org/10.1007/s11255-016-1402-0
  2. Cass AS. Testicular trauma. J Urol. 1983 Feb;129(2):299-300. doi: 10.1016/s0022-5347(17)52062-5. PMID: 6834494.
  3. Morgentaler A, Stahl BC, Yin Y. Testis and temperature: a historical, clinical, and research perspective. J Androl. 1999 Mar-Apr;20(2):189-95. PMID: 10232653.
  4. Lyttwin B, Moltzahn F, Thalmann GN. Therapiemanagement des stumpfen Hodentraumas [Therapeutic management of blunt testicular trauma]. Urologe A. 2017 Jul;56(7):864-867. German. doi: 10.1007/s00120-017-0383-7. PMID: 28405707.
  5. Molokwu CN, Doull RI, Townell NH. A novel technique for repair of testicular rupture after blunt trauma. Urology. 2010 Oct;76(4):1002-3. doi: 10.1016/j.urology.2010.06.011. PMID: 20932424.

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Poojasree Ramesh

Masters of Pharmacy (Pharmacy practice) - SRM Institute of Science and Technology

I’m working as Associate safety data management specialist. I have experience in Hospital as an Intern. I got exposure in ward round participation, ADR detection, Patient counselling and so on during my intern.

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