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Testicular Trauma

Read the "Ask a Urologist: Athletic Cups and Supporters" article from the Spring 2014 edition of UrologyHealth extra.

Because the testicles are located within the scrotum, which hangs outside of the body, they do not have the protection of muscles and bones that most organs have. This makes it easier for the testicles to be struck, hit, kicked or crushed. The following information should help explain why timely evaluation and proper management are critical for the best outcomes.

What happens under normal conditions?

As the producers of sperm and testosterone, the testicles essential for reproduction and normal male hormones. But they are also prone to injuries that can leave damage to either the entire gland or essential parts of it.

Suspended in the scrotum, the skin pouch below the penis, each testicle is surrounded by the tunica albuginea, a tough, fibrous covering that encases and protects the delicate gland tissue within it. Although tough, it can be torn or "fractured" by a blunt or violent force.

Sperm cells are produced in the testicle and travel to the epididymis, a rubbery gland along the backside of the testicle contains a single coiled tube formed by the merger of thousands of sperm-producing ducts originating inside the testicle. Sperm stop briefly in the epididymis to mature before exiting in semen through the vas deferens, a tube that connects with the urethra. Unlike the vas deferens, which is covered by a thick muscle wall, the epididymis has a coating that is both thin and fragile. As such, it is at higher risk for inflammation or injury.

What are the causes of testicular injury?

While testicular injuries can be from penetrating forces (e.g., stab wounds, gunshot wounds) or blunt forces (e.g., kick to the scrotum, baseball to the scrotum), they all have the potential of inflicting similar injuries: partial or complete ripping of the testicle as well as loss of the entire testicle. An injury sustained from a penetrating object such as a knife or bullet that punctures the scrotum, may cause a minor scrape to the skin or major injury to the blood vessels to the testicle itself. An injury can also be caused by a direct blow— such as a kick or baseball to the groin — causing a tear in the covering of the testicle or injury to its blood vessels.

What are the symptoms of testicular injury?

While trauma to the testicle or scrotum usually produces severe pain as a first symptom, it can also result in actual physical injury to any of its contents. When the testicle's tough covering is torn or shattered , the blood leaks from the injury, stretching the normally elastic scrotum until it is tense. While this collection of blood can lead to infection, there also may be additional fertility problems due to the ultimate loss of a testicle or immune system problems that affect the remaining testicle. In severe cases of testicular injury, part or all of the injured testicle may need to be removed.

Considerable pain around the testicle may also be due to epididymitis, infection or inflammation of the epididymis. Because the epididymis, the lengthy coil alongside the testicle, is a very thin-walled gland it easily becomes red and swollen either by infection or injury. If left untreated, the condition rarely can lead to a loss of the testicle due to blockage of the blood supply to the testicle.

The symptoms mentioned above may indicate a very treatable, benign problem. But surprisingly, a substantial number of testicular tumors are discovered after minor injuries when men are more likely to carefully examine the testicles. Many men are not aware of the painless, solid lump, bulging from the smooth testicular covering until they have a reason to examine themselves. Do not make the mistake of many men who postpone medical care, thinking they are dealing with a simple bruise. This is a medical emergency! While testicular cancer caught early is generally curable, malignancies discovered late often require prolonged treatment involving surgery, radiation and chemotherapy.

Men who suffer more than a minor injury to the scrotum should seek an evaluation by a urologist. Reasons to seek medical care include:

  • Any penetrating injury to the scrotum
  • Bruising and/or swelling of the scrotum
  • Difficulty urinating or blood in the urine
  • Fevers after testicular injury

How are testicular injuries treated?

A urologist can often determine the extent of injury to the testicle with a simple physical examination. After the urologist asks questions about how the injury occurred as well as other medical history questions, he or she will examine the contents of the scrotum. In doing so, the tough covering overlying the testicle can generally be easily felt as well as the narrow, soft epididymis. The structures that run into the testicle including the artery, vein and vas would then be felt to ensure that they are normal.

If everything appears normal, with no injury present, the urologist will probably prescribe pain medication such as acetaminophen or ibuprofen. A patient will also be advised to wear a jock strap, which provides good support for the scrotum.

If it unclear if an injury has occurred, the urologist may request a scrotal ultrasound scan. Based on the same sonar sound waves that guide submarines, this device can safely and effectively image parts of the sac, including the testicle, epididymis and spermatic cord to examine the blood flow.

Although no imaging test is 100 percent perfect, ultrasound is an attractive alternative because it is easy to perform, uses no X-rays and clearly shows the physical structure of the scrotum. On rare occasions, the urologists may request an MRI, a more sophisticated imaging technique, if the ultrasound leaves more questions than answers.

If any imaging study suggests testicular injury, the usual course of action is an operation where, under anesthesia, an incision is made in the scrotum and the entire contents are examined. If a tear of the testicle has occurred and the testicle can be repaired (if it has good blood supply and the remaining testicle has sufficient covering available), the urologist will usually repair the defect with stitches and then close the scrotum skin. In some cases, the urologist will leave a temporary plastic drain in the scrotum to drain blood and other fluids.

On occasion, an injury can be so severe that the testicle cannot be repaired. If this occurs, the urologist will remove the testicle. That does not mean the patient cannot father a child, however. If the patient's other testicle is normal, he should be able to impregnate his partner. Also, the patient's hormone levels should remain steady since only one testicle is required for either function

If the patient's physical examination and ultrasound suggest that the injury has caused epididymitis, he will probably be treated without surgery, given an anti-inflammatory medication (such as ibuprofen) and encouraged again to wear a jock strap. If necessary, the urologist may also prescribe an antibiotic. It generally takes six to eight weeks for the swelling to subside. The patient may have to have several follow-up visits with the urologist to chart his progress. Further, if conservative measures (medications and jock strap) do not work, surgery may be required and the testicle may have to be removed.

Frequently asked questions:

I have noticed pain in my scrotum and testicle but I do not remember any injury. What should I do?

There are many possible causes of scrotal or testicle pain including epididymitis, inflammation of the testicle and problems with other parts of the scrotum. Whatever the source, you should be examined by a urologist, a specialist trained in such problems.

I was hit by a knee during a basketball game and have since noticed a new lump in my scrotum. It does not hurt but should I do anything about it?

Like many young men, you are probably examining yourself for the first time now that you have had a sporting injury. There is a good chance that the lump or "new" mass you have just felt is a normal part of the anatomy (your epididymis). But it could be an injury or even testicular cancer. Any new lump should be checked immediately by a trained urologist. With his/her expertise, a urologist will ease your mind and point you to swift and accurate treatment.

I'm 55 years old and noticed a lump in my scrotum after being hit in the groin during pick-up game of baseball? Could this be testicular cancer or am I too old for that?

Testicular cancer can occur at any age, even though the most cases are between 15 and 35. Anyone with a new lump in the scrotum should see a urologist immediately. Often you will not need any further tests because the urologist can make a diagnosis with a physical examination. However, the urologist may also request an ultrasound. While some masses are not cancer (benign), many can be malignant. The good news, however, is that testicular cancer can be treated effectively (if caught early. So do not be afraid to contact a urologist!

I noticed blood in my urine after being hit with a baseball. I do not feel any lumps. Should I still report this to my doctor?

Absolutely. Blood in the urine that is visible to the naked eye is almost always due to a urologic problem. You need to see a urologist immediately for evaluation to sort out the possibilities.

What can I do to prevent injury to my testicles?

There are many common-sense steps you can take to reduce your risk of testicular trauma. Wear a seat belt when driving a car. Make sure your clothes are tucked in and you are not exposing loose belts or other items to machinery that has exposed chains or belts. Wear a jock strap when playing sports. If the activity could produce severe contact (as in baseball, football or hockey) use a hard cup to reduce the risk.

Reviewed January 2011

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Testicular Trauma Glossary
  • anatomy: The physical structure of an internal structure of an organism or any of its parts.

  • anesthesia: Loss of sensation in any part of the body induced by a numbing or paralyzing agent. Often used during surgery to put a person to sleep.

  • antibiotic: Drug that kills bacteria or prevents them from multiplying.

  • artery: Blood vessel that carries blood from the heart to various parts of the body.

  • benign: Not malignant; not cancerous.

  • cancer: An abnormal growth that can invade nearby structures and spread to other parts of the body and may be a threat to life.

  • chemotherapy: Treatment with medications that kill cancer cells or stop them from spreading.

  • diagnosis: The process by which a doctor determines what disease or condition a patient has by studying the patient's symptoms and medical history, and analyzing any tests performed (e.g., blood tets, urine tests, brain scans, etc.).

  • epididymis: A coiled tube attached to the back and upper side of the testicle that stores sperm and is connected to the vas deferens

  • epididymitis: An inflammation of the epididymis.

  • epididymitis: An inflammation of the epididymitis which is an elongated structure connected to the posterior surface of the testis.

  • fertility: The ability to conceive and have children.

  • fibrous: Consisting of or resembling fibers.

  • gene: The basic unit capable of transmitting characteristics from one generation to the next.

  • gland: A mass of cells or an organ that removes substances from the bloodstream and excretes them or secretes them back into the blood with a specific physiological purpose.

  • groin: The area where the upper thigh meets the lower abdomen.

  • hormone: A natural chemical produced in one part of the body and released into the blood to trigger or regulate particular functions of the body. Antidiuretic hormone tells the kidneys to slow down urine production.

  • immune system: The body's system for protecting itself from viruses and bacteria or any "foreign" substances.

  • incision: Surgical cut for entering the body to perform an operation.

  • infection: A condition resulting from the presence of bacteria or other microorganisms.

  • inflammation: Swelling, redness, heat and/or pain produced in the area of the body as a result of irritation, injury or infection.

  • inflammatory: Characterized or caused by swelling, redness, heat and/or pain produced in an area of the body as a result of irritation, injury or infection.

  • ions: Electrically charged atoms.

  • malignancies: Cancerous growths.

  • malignant: A cancerous growth that is likely to grow and spread which can cause serious disablement or death.

  • MRI: Also referred to a magnetic resonance imaging. A diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.

  • penis: The male organ used for urination and sex.

  • radiation: Also referred to as radiotherapy. X-rays or radioactive substances used in treatment of cancer.

  • scrotal: Relating to the scrotum, the sac of tissue that hangs below the penis and contains the testicles.

  • scrotal: Relating to the scrotum, the sac of tissue that hangs below the penis and contains the testicles.

  • scrotum: Also referred to as the scrotal sac. The sac of tissue that hangs below the penis and contains the testicles.

  • semen: Also known as seminal fluid or ejaculate fluid. Thick, whitish fluid produced by glands of the male reproductive system, that carries the sperm (reproductive cells) through the penis during ejaculation.

  • semen: The thick whitish fluid, produced by glands of the male reproductive system, that carries the sperm (reproductive cells) through the penis during ejaculation.

  • sperm: Also referred to as spermatozoa. Male germ cells (gametes or reproductive cells) that are produced by the testicles and that are capable of fertilizing the female partner's eggs. Cells resemble tadpoles if seen by the naked eye.

  • spermatic cord: A cord by which a testis is suspended in the scrotum.

  • testicle: Also known as testis. Either of the paired, egg-shaped glands contained in a pouch (scrotum) below the penis. They produce sperm and the male hormone testosterone.

  • testicular: Relating to the testicle (testis).

  • testicular cancer: Cancer of the testis.

  • testosterone: Male hormone responsible for sexual desire and for regulating a number of body functions.

  • tissue: Group of cells in an organism that are similar in form and function.

  • tumor: An abnormal mass of tissue or growth of cells.

  • tunica: Thin membranous or fibrous outer layer.

  • tunica albuginea: The hard covering that covers the testicle.

  • ultrasound: Also referred to as a sonogram. A technique that bounces painless sound waves off organs to create an image of their structure to detect abnormalities.

  • urate: A salt of uric acid.

  • urethra: A tube that carries urine from the bladder to the outside of the body. In males, the urethra serves as the channel through which semen is ejaculated and it extends from the bladder to the tip of the penis. In females, the urethra is much shorter than in males.

  • urge: Strong desire to urinate.

  • urine: Liquid waste product filtered from the blood by the kidneys, stored in the bladder and expelled from the body through the urethra by the act of urinating (voiding). About 96 percent of which is water and the rest waste products.

  • urologist: A doctor who specializes in diseases of the male and female urinary systems and the male reproductive system. Click here to learn more about urologists. (Download the free Acrobat reader.)

  • urology: Branch of medicine concerned with the urinary tract in males and females and with the genital tract and reproductive system of males.

  • vas: Also referred to as vas deferens. The cordlike structure that carries sperm from the testicle to the urethra.

  • vas deferens: Also referred to as vas. The cordlike structure that carries sperm from the testicle to the ejaculatory duct, whicn in turn carries it to the urethra.

  • vein: Blood vessel that drains blood away from an organ or tissue.

Testicular Trauma Anatomical Drawings

click images for a larger view





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