Blunt scrotal trauma usually happens in people who are under the age of 50 years as a result of an athletic injury, an automobile injury, a straddle injury, an industrial accident, or an assault. Patients have varying amounts of bruising, pain and swelling of the scrotum following the injury.
The doctor needs to get a clear history of the mechanism of injury of the trauma and the point of maximum impact on the scrotal area. Find out if there has been bloody penile discharge or blood in the urine and find out if the person has had any previous genital pathology or masses of the testicle in the past.
The doctor should gently examine the genitalia with the knowledge that intense pain might mess up the ability to examine the area. Palpate and assess the anatomy of the structures inside the scrotum. Check a urine sample and if blood is present, do a digital rectal examination to check the prostate. If the prostate is elevated, the doctor needs to get a urologic consultation. If there is pain in what is otherwise a normal appearing scrotum, a Doppler ultrasound can be done to study the scrotum. Alternatively, a testicular scan can determine whether surgery needs to be done. If no urologist is required and no surgery is needed, provide pain relief, scrotal support, bed rest, a cold pack and follow up later with the urologist.
The doctor should not miss the possibility of a testicular torsion which can happen following a blunt trauma to the scrotum. Don’t miss the possibility of a dislocation of the testicle, in which the scrotum is empty. The testicle is found between the abdominal wall superficially in about eighty percent of cases. This requires immediate urological help.
Most blunt injuries to the testicle result in contusions to the scrotum and testicle or ruptures of the testicle. If the Doppler test or testicular scan shows that there is a serious injury, then it needs immediate urologic consultation and surgery. There may need to be an evacuation of a hematoma of the scrotum, repair of a testicular rupture and repair of testicular dislocation. If these things are done sooner rather than later, there is a greater chance of normal activity, less infection, and less atrophy of the testicle.
Testicular displacement is fortunately quite rare. It happens in traffic accidents, motor cycle accidents and sporting injuries. The force needs to be great for this to happen. One study looked at two cases of testicular torsion, one in a 21 year old and one in a 24 year old. They had all the signs of testicular displacement with an empty scrotum and obvious signs of scrotal trauma.
Both unilateral and bilateral dislocation of the testicle have been noted during autopsy specimens. For living persons, a thorough evaluation of the of the testicle, especially in motorcycle injuries. Drivers can become injured by hitting the fuel tank with the male genitalia. These injuries are important to medicolegal cases, especially if the situation resulted in a driver death.