If any imaging study suggests testicular injury, the usual course of action is surgery. Under anesthesia, a cut is made in the scrotum and the contents are checked. If the testicle has torn, it can be repaired if it has good blood supply and the other testicle has enough of its cover. Your urologist will most often fix the tear with stitches and close the scrotum skin. In some cases, he/she will leave a plastic tube in the scrotum for a short time to drain blood and other fluids.
Sometimes an injury is so bad the testicle can't be fixed. In this case, your urologist will remove the testicle. This doesn't mean you can't father a child, though. Only 1 working testicle is needed for normal fertility. A single testicle will most often make normal amounts of sperm and testosterone. If your other testicle is normal, you should be able to get your partner pregnant.
If your physical exam and ultrasound suggest the injury has caused epididymitis, you'll likely be treated without surgery. You may be given anti-inflammatory meds (such as ibuprofen) and again be told to wear a jock strap. If needed, your urologist may also give you an antibiotic. It takes about 6 to 8 weeks for the swelling to go away. You may have to have many follow-up visits with your urologist to chart your progress. If conservative measures (meds and jock strap) don't work, surgery may be needed and the testicle may have to be removed.