Accuracy of ultrasound diagnosis after blunt scrotal trauma (10 years experience)

Abstract

Objectives:To evaluate the role of ultrasonography (US) and its accuracy, sensitivity and specificity for the diagnosis of testicular rupture after blunt scrotal trauma. Moreover, tunica albuginea breach, testicular hematoma, testis avulsion, epididymal injuries and hematocele are particularly examined. Patients and Methods: Between 1998 and 2008, 24 patients presented to Suez Canal University Hospital after blunt scrotal trauma and underwent surgical exploration. All patients had an emergency scrotal US examination with the use of a 7.5-10 MHz linear transducer. US findings were compared with the surgical findings to calculate the sensitivity and specificity of US for each type of lesion. Results: Out of 24 patients, 12 were diagnosed as having testicular rupture and tunica albuginea breach was visualized on US in 6 patients. Sensitivity and specificity of US were 92% and 50% for testicular rupture, 85% and 75% for hematocele, 80% and 79% for testicular hematoma, and 100% and 96% for testicular avulsion, respectively. US diagnosis of epididymal injuries was poor as it failed to detect 3 out of 5 epididymal lesions. Conclusion: US was highly sensitive in the diagnosis of testis rupture. This can provide information on the integrity of the scrotal contents that can help the physician to determine the optimal treatment.

Testicular Rupture: A Tough Nut to Crack

“…Higher rates of adverse outcomes (impaired fertility, hypogonadism, testicular loss) were associated with this delay in care. 8 In the case of testicular rupture, salvage rates are as high as 90% when surgery is performed within 72 hours. When surgical intervention is delayed beyond 72 hours, salvage rates decline to approximately 45%.…”

“…The accuracy of US for the evaluation of these pathologies has been established through retrospective studies that have compared sonographic findings against those found on subsequent scrotal exploration, the traditional gold standard for diagnostic and therapeutic evaluation. 6 , 8 The post-traumatic ultrasonic evaluation for hematocele has been shown to be 85–87% sensitive and 75–89% specific according to two studies of 24 and 33 patients, respectively. 6 , 8 Three studies, consisting of 33, 65, and 24 patients, have reported the sonographic findings for testicular rupture to be 92–100% sensitive while being 50–93.5% specific.…”

“… 6 , 8 The post-traumatic ultrasonic evaluation for hematocele has been shown to be 85–87% sensitive and 75–89% specific according to two studies of 24 and 33 patients, respectively. 6 , 8 Three studies, consisting of 33, 65, and 24 patients, have reported the sonographic findings for testicular rupture to be 92–100% sensitive while being 50–93.5% specific. 6 – 8 The accuracy of US in the diagnosis of testicular fracture is less well established since the diagnosis is uncommon and most of these patients are managed non-operatively.…”

“… 6 , 8 Three studies, consisting of 33, 65, and 24 patients, have reported the sonographic findings for testicular rupture to be 92–100% sensitive while being 50–93.5% specific. 6 – 8 The accuracy of US in the diagnosis of testicular fracture is less well established since the diagnosis is uncommon and most of these patients are managed non-operatively.…”