What are the symptoms of testicular damage?

For most men, testicular damage is a very painful thing, because testicular damage will cause very severe pain, and this pain will radiate to many parts of the body. Generally speaking, this pain is extremely uncomfortable, and severe cases can even cause shock, so it is very harmful. In addition, testicular damage is also accompanied by the following symptoms.

Symptoms of testicular injury:

1. History of scrotal trauma.

2. Local severe pain: The pain can radiate to the lower abdomen, waist or upper abdomen, and may even cause painful shock. The pain may also be accompanied by nausea and vomiting.

3. Examination may reveal scrotal swelling, bruising and congestion of the skin, enlarged and hard testicle on the affected side, with obvious tenderness, often accompanied by scrotal hematoma, hydrocele or hemocele, etc. In the later stage of testicular ischemia and atrophy, the testicle becomes small and soft.

4. When the testicle ruptures: the testicular boundary is unclear; when the testicle is dislocated, the scrotum is empty, and a testicular-like swelling is often felt in the lower abdomen and perineum; when the testicle is torsioned, the testicle rises and becomes horizontal or the epididymis is located in front of the testicle, the spermatic cord becomes thicker, and the pain does not decrease or even worsens when the scrotum and testicle are lifted.

After scrotal injury, due to clinical manifestations such as scrotal swelling, pain and ecchymosis, diagnosis is not difficult. The important thing is to determine whether the testicles are injured. If they are misdiagnosed, it often leads to hematoma, followed by infection or testicular compression, ischemia, and ultimately testicular atrophy, affecting the patient's sexual function and fertility. For this reason, many scholars believe that B-ultrasound examination is very helpful in judging whether the testicles are injured and the extent of the injury. Gao Yong examined 28 patients with scrotal closure injury with B-ultrasound, and 12 of them had abnormal testicular changes: 4 had enlarged testicles with a single cyst inside. 1 or more hypoechoic areas with unclear boundaries (hematoma); 5 cases of testicular contour discontinuity (rupture of the tunica albuginea); 3 cases of loss of normal testicular shape, separation of the ends, and irregular cross-section (testicular rupture), 10 of which were confirmed by surgery. In addition, the choice of treatment method for testicular injury without hematoma is quite tricky. Martinez-Pineiro et al. suggested that if the testicular contusion or hematoma is <1/3, dynamic monitoring can be performed, and if the lesion is >2/3 or the tunica albuginea is ruptured, surgical treatment should be adopted.

Differential diagnosis:

1. Acute epididymitis and orchitis

There are also symptoms such as testicular pain and scrotal swelling. Examination of the testicles and epididymis shows enlargement, hardness, and obvious tenderness. However, this disease is more common in adults, with a slow onset. Although the scrotum is swollen, there are no changes such as cyanosis and congestion of the skin. There is often a history of using instruments in the urethra and indwelling catheterization, accompanied by systemic symptoms such as chills and fever. Routine blood tests show a significant increase in the number of neutrophils.

2. Incarcerated indirect hernia

In case of incarcerated inguinal oblique hernia, there may be severe pain in the scrotum, and the pain is obvious. However, this disease generally has a history of reducible scrotal or groin swelling, and has symptoms such as abdominal distension, nausea, vomiting, and no anal gas and defecation. Examination of the abdomen shows hyperactive bowel sounds, with a sound of gas passing through water, and an oval swelling in the scrotum can be palpated. The testicles are normal and tender, and the pain symptoms do not change when moving.

3. Testicular tumor

The testicles are progressively enlarged and hard, but there is no history of trauma. The mass feels heavy and inelastic, and there is no obvious tenderness. Tests for tumor markers such as AFP alpha-fetoprotein and HCG human chorionic gonadotropin can sometimes be positive. Retroperitoneal lymph node CT or lymphangiography can sometimes reveal enlarged lymph nodes infiltrated by cancer. If necessary, surgical exploration and biopsy can be performed to detect tumor cells.