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Injury Repair
What is
Injury Repair?
Testicular injuries (testicular fractures) are
often suspected following a traumatic blow to
the groin or scrotum. When there is a history of
a traumatic blow to the scrotum, a testicular
ultrasound is usually obtained to evaluate
possible damage to the testicle. Unfortunately
this radiographic evaluation is not 100 percent
accurate in making the diagnosis of a fractured
testicle.
Surgical exploration of the scrotum and possible
repair of a fractured testicle is therefore
recommended whenever a testicular fracture is
documented by the ultrasound or if, in the
surgeon's opinion, a testicular fracture could
be present and was not diagnosed via the
ultrasound.
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Effects
of Injury Repair
Injury
repair procedures will correct the injury or
trauma to the scrotal area.
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Candidates for Injury Repair
However, get to a doctor
immediately
if:
-
the
pain doesn't subside or you experience extreme
pain that lasts longer than an hour
-
you
have swelling or bruising of the scrotum or a
puncture of the scrotum or testicle
-
you
continue to have nausea and vomiting
-
you
develop a fever
-
These
are symptoms of a much more serious injury that
needs to be addressed as soon as possible.
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Your Consultation
If you need to see a doctor,
he or she will first ask how long you have been
experiencing pain and how severe your discomfort
is. To rule out a hernia or other problem as the
cause of the pain, the doctor will examine your
abdomen and groin; check your scrotum for
swelling, color, and damage to the skin; and
examine the testicle itself. Because infections
of the reproductive system or urinary tract can
sometimes cause similar pain, your doctor may do
a urine test to rule out a urinary tract
infection or infection of the reproductive
organs.
Because blunt injuries to the testicle are
difficult to recognize, high-resolution
ultrasonography has become a key element in the
evaluation of scrotal trauma.
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The
Injury Repair Procedure
Exploration of the scrotum through a vertical
incision allows inspection of the scrotal
contents; when spermatic cord injury is
discovered, the incision can be extended
cephalad to the groin. The goal is preservation
of testicular parenchyma for endocrine and
cosmetic purposes; normal sperm production and
transport are not expected after repair of
rupture. Clots and extruded seminiferous tubules
are debrided with scissors to allow closure of
the tunica albuginea over the edematous
parenchyma. A continuous 3-0 slowly absorbable
suture is sufficient.
When spermatic cord injury is detected, the
first priority is determination of the viability
of the testis. A small incision into the tunica
albuginea should cause some bleeding; if the
testis is cyanotic and does not bleed when cut,
orchiectomy should be performed. If only the vas
deferens or spermatic vessels are injured, the
testis will remain viable. Ligation of the
spermatic vessels is performed in the standard
fashion; if vasal ligation is necessary, use of
nonabsorbable suture with long tails enables
later identification for reconstruction if
infertility ensues.
Scrotal skin lacerations can be closed primarily
in most instances. Exceptions arise if there is
a prolonged delay between injury and definitive
care or if grossly contaminated wounds are
associated with rectal injuries. Hemostasis
should be meticulous. Interrupted suture closure
of the tunica dartos and skin in separate
layers, with a Penrose drain brought out through
a separate dependent stab wound, limits
postoperative hematoma formation. Fluffed gauze
should be used for dressing, and a scrotal
supporter should be used to keep the scrotum
elevated. The Penrose drain is removed on
postoperative day 1. There are no major
restrictions to activity after scrotal surgery,
and patients can be discharged once they have
recovered from associated injuries.
Scrotal avulsion can be devastating and must be
differentiated from complex lacerations. Skin
avulsed by shear forces in MVCs may be suitable
for cleansing and preparation for full- or
split-thickness grafts; however, when high-speed
rotating machinery is the mechanism, as when
clothing and skin are caught in a power takeoff,
this approach is not recommended. The intrinsic
microvasculature of the skin is probably
damaged. Scrotal skin loss caused by burns or
electrical or mechanical injury usually spares
the testis, which has a separate blood supply.
Conservative debridement is possible if there is
no infection, but the demarcation between viable
and nonviable tissue should be identified before
extensive debridement.84 Management depends on
the amount of skin remaining. Options include
primary closure, immediate coverage with meshed
split-thickness skin grafts, and placement of
the testes in subcutaneous pouches in the thigh.
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Recovery
Following a testicular injury, a testicular
ultrasound is done three months after surgery to
check for testicular atrophy (a small testicle)
that may develop despite repair of the fractured
testicle.
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Frequently Asked Questions
Q:
How do testicular injuries happen?
A:
If you're a guy who plays sports, likes to lift
weights and exercise a lot, or leads an
all-around active life, you've probably come to
find out that the testicles are kind of
vulnerable and can be injured in a variety of
ways. Because they hang in a sac outside the
body (the
scrotum),
the testicles are not protected by bones and
muscles like other parts of your reproductive
system and most of your other organs. Also, the
location of the testicles makes them prime
targets to be accidentally struck on the playing
field or injured during strenuous exercise and
activity.
The
good news is that because the testicles are
loosely attached to the body and are made of a
spongy material, they're able to absorb most
collisions without permanent damage. Testicles,
although sensitive, can bounce back pretty
quickly and minor injuries rarely have long-term
effects. Also, sexual function or sperm
production will most likely not be affected if
you have a testicular injury.
You'll
definitely feel pain if your testicles are
struck or kicked, and you might also feel
nauseous for a short time. If it's a minor
testicular injury, the pain should gradually
subside in less than an hour and any other
symptoms should go away. In the meantime, you
can do a few things to help yourself feel better
such as take pain relievers, lie down, gently
support the testicles with supportive underwear,
and apply ice packs to the area. At any rate,
it's a good idea to avoid strenuous activity for
a while and take it easy for a few days.
Q:
What are some examples of testicular injuries?
A:
Examples of serious testicular injury are
testicular torsion
and
testicular rupture. In the case
of
testicular torsion, the testicle
twists around, cutting off its blood supply.
This can happen due to a serious trauma to the
testicles, strenuous activity, or even for no
apparent reason.
Testicular torsion isn't common, but when it
does happen, it most often occurs in guys ages
12 to 18. If it occurs, it is
crucial
to see a doctor as soon as possible - within 6
hours of the time the pain starts.
Unfortunately, after 6 hours, there is a much
greater possibility that complications could
result, including reduced sperm production or
the loss of the testicle. The problem may be
fixed by a doctor manually untwisting the
testicle. If that doesn't work, surgery will be
necessary.
Testicular rupture
can also happen, but it is a rare type of
testicular trauma. This can happen when the
testicle receives a forceful direct blow or when
the testicle is crushed against the
pubic bone
(the bone that forms the front of the pelvis),
causing blood to leak into the scrotum.
Testicular rupture, like testicular torsion and
other serious injuries to the testicles, causes
extreme pain, swelling in the scrotum, nausea,
and vomiting. To fix the problem, surgery is
necessary to repair the ruptured testicle.
Q:
How can I prevent testicular injuries?
A:
Take precautions to avoid testicular injuries,
especially if you play sports, exercise a lot,
or just live an all-around active life. Here are
some tips to keep your testicles safe and sound:
-
Protect your testicles.
Always wear an athletic cup, athletic
supporter (jockstrap), or compression shorts
when playing sports or participating in
strenuous activity. Athletic cups are usually
made of hard plastic, are worn over the groin
area, and provide a good degree of shielding
and safety for the testicles. Cups are best
used when participating in sports where your
testicles might get hit or kicked, like
football, hockey, soccer, rugby, or karate. A
jockstrap is basically a cloth pouch that you
wear to keep your testicles close to your
body. They're best used when participating in
strenuous exercise, cycling, or doing any
heavy lifting.
-
Check your fit.
Make sure the athletic cup and/or jockstrap is
the right size. Safety equipment that's too
small or too big won't protect you as
effectively.
-
Keep
your doctor informed.
If you experience testicular pain even
occasionally, talk to your doctor about it.
-
Be
aware of the risks of your sport or activity.
If you play a sport or participate in an
activity with a high risk of injury, talk to
your coach or doctor about any additional
protective gear you should use.
The following list of Urology procedures are
performed at Beverly Hills Medical Group -
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