Bilateral Testicular Injury from External Trauma

Abstract

Among 79 patients with testicular injury as a result of external trauma 5 had bilateral injury. Such injury occurred in only 1 of 66 patients (1.5 per cent) with blunt trauma versus 4 of 13 (31 per cent) with penetrating trauma. Bilateral ruptures were managed by bilateral partial orchiectomy in 2 cases, and orchiectomy with contralateral débridement and suturing in 1. Of 2 patients with unilateral rupture and contralateral contusion the contusions were treated by evacuation of the hematoma and the ruptures were managed by orchiectomy in 1 and partial orchiectomy in the other. Four patients were available for followup. One patient was hormonally anorchid but he obtained normal erections with testosterone cypionate, 1 had normal serum testosterone concentrations but borderline normal semen analysis, and 1 had reduced erections and borderline normal semen. The remaining patient had normal erections and no semen analysis was performed. The nature of the injury rather than the type of treatment appears to be the primary determinant of the outcome in these cases.

Management of 53 Cases of Testicular Trauma

“…Defense mechanisms of the testicle itself in clude: the mobility within the scrotum, the tough and resilient tunica albuginea, and the withdrawal from dan ger by cremaster contraction [15,18].…”

Preventable causes of male infertility

“…Two single-institution series reported between 31 and 67 cases of testicular trauma requiring surgery in a 10-year period [16,85]. Quesada et al [85] showed that men with unilateral testicular trauma requiring orchiectomy or open repair failed to show a significant decrease in the follow-up sperm density.…”

“…Quesada et al [85] showed that men with unilateral testicular trauma requiring orchiectomy or open repair failed to show a significant decrease in the follow-up sperm density. Cass et al [16] reviewed the literature on bilateral testicular trauma and revealed that only four patients have had followup semen analysis, and these showed an average sperm density of 37x106)'cc, with none having fewer than 20x 106 sperm/cc. Spermatogenic dysfunction in testicular trauma patients appears to be secondary to direct cell injury and, perhaps due, to the formation of antisperm antibodies from disruption of the blood-testes barrier.…”

Sonographic Findings of Typical and Atypical Scrotal Trauma

“…Bilateral injuries occur more commonly in the setting of penetrating trauma than in the other forms of trauma. 44 Penetrating injuries can disrupt the tunica albuginea, as well as penetrate the testicular parenchyma itself, causing a fracturelike injury. Ultrasound is capable of assessing the degree of injury to direct appropriate management.…”