How should a testicular laceration be treated?

For men, a torn testicle will cause severe pain, which is very uncomfortable. Usually, the cause of testicular tear is mostly trauma. For example, when engaging in some intense sports, collisions between people will inevitably hit the testicles, causing the testicles to be torn. In addition, this situation may also occur in some complex labor. How should it be treated at this time?

First, treatment

1. Open scrotal injury

Simple scrotal lacerations without infection should be cleaned and sutured as soon as possible. For severe scrotal lacerations and penetrating injuries, the wounds must be cleaned thoroughly, the inactive tissues must be cut off, and as much residual scrotal skin as possible must be retained so that it can cover the exposed testicles. For those with more scrotal skin defects and difficulty in repair, the scrotum can be reconstructed by transferring flaps or temporarily burying the testicles under the skin of the inner thigh, and then performing a second-stage scrotoplasty to return the testicles to the scrotum. Antibacterial drugs should be used more frequently after surgery to prevent infection.

2. Scrotal occlusal injury

(1) For scrotal contusion, patients should rest in bed, elevate the scrotum, apply cold compress first and then hot compress to the local area to allow the blood stasis to be absorbed as quickly as possible, and give antibiotics to prevent infection.

(2) Scrotal hematoma: Small hematoma can be treated by scrotal support, local pressure and cold compress. If the hematoma is large and gradually worsens, surgery is required to remove blood clots and stop bleeding completely. Antibiotics are used for anti-infection treatment. If infection and abscess form, incision and drainage are performed.

(3) Hemocele Hemocele is bleeding within the tunica vaginalis and should be treated as hydrocele in the early stages. If there is chronic inflammation and the tunica vaginalis is thickened and hardened, a theca resection can be performed.

(4) Hematocele with organizational hematocheilosis: After a period of time, the hematocele becomes organizational and its appearance and hardness are similar to a tumor. The organizational mass presses on the testicles, causing atrophy of the testicular tissue. Surgical removal should be adopted for treatment.

Second, differential diagnosis

1. Idiopathic scrotal gangrene

It can be caused by trauma to the scrotum, and may also cause symptoms such as scrotal swelling, purple-red skin, fever, and local pain. Scrotal gangrene is often accompanied by systemic poisoning symptoms such as chills, high fever, general weakness, and even delirium. Examination of the scrotum shows moist skin with necrotic matter, which feels like twisting hair when touched. Scrotal skin necrosis worsens within 1 to 2 days of onset. It can affect the testicular tunica vaginalis and cause the testicular spermatic cord to be exposed. Bacterial culture of the wound surface can detect more than one pathogenic bacteria, often combined with anaerobic infection.

2. Destructive orchitis

There is a history of scrotal trauma and surgery. The affected side of the scrotum is swollen and painful, the scrotal skin swelling is not obvious, and the color has not changed. Examination revealed that the affected side of the testicle is enlarged, hard, uneven, tender, and the boundary with the epididymis is sometimes unclear, and the spermatic cord is thickened.

3. Hydrocele

When scrotal trauma causes scrotal hematoma and hemocele, it is necessary to distinguish between scrotal hematoma and hydrocele. Both are cystic tumors in the scrotum, and the epididymis is not easy to touch, but hydrocele usually has no history of trauma or surgery, and the transillumination test is positive.

Third, diagnosis

The diagnosis of scrotal injury is not difficult. The diagnostic basis is: ① History of scrotal trauma; ② Scrotal swelling and pain, ecchymosis on the surface skin, hematoma in the scrotum, open injury with scrotal skin tearing and exposed testicles; ③ Negative transillumination test.

When diagnosing scrotal injury, attention should be paid to: ① Whether the scrotal injury is accompanied by other injuries, such as penile injury, testicular injury, testicular torsion, spermatic cord injury, etc.; ② The scope of scrotal hematoma; ③ Whether there is foreign matter in the scrotum.