Blunt injuries to the scrotum usually occur in patients less than 50 years of age as a result of an athletic injury, a straddle injury, an automobile or industrial accident, or an assault. Patients present with various degrees of pain, ecchymosis and swelling.
What to do:
Get a clear history of the exact mechanism of the trauma and the point of maximum impact. Determine if there was any bloody penile discharge or hematuria and whether or not the patient has any pre-existing genital pathology such as prior genitourinary surgery, infection or mass.
Gently examine the external genitalia with the understanding that intense pain may result in a suboptimal examination. If scrotal swelling is not too severe, try to palpate and assess the intrascrotal anatomy.
Obtain a urinalysis. If blood is present in the urine (or at the urethral meatus) do a digital examination of of the prostate (elevation of the prostate implies injury of the menbranous urethra) and obtain urologic consultation.
When pain or swelling prevent demonstration of normal intrascrotal anatomy, then obtain a doppler ultrasound study or testicular scan to help determine the need for operative intervention.
When urologic intervention is not required, provide analgesia, bed rest, scrotal support, a cold pack and urologic follow up.
What not to do:
Do not miss testicular torsion which can be associated with blunt trauma.
Do not miss the rare traumatic testicular dislocation which results in an "empty scrotum." The testis is found superficially beneath the abdominal wall in about 80% of such cases. Imediate urology consultation is required.
The majority of blunt testicular injuries result in either contusions or ruptures. If doppler or testicular scan studies demonstrate a serious injury, then early exploration, evacuation of hematoma, and repair of testicular rupture tend to result in an earlier return to normal activity, less infection, and less testicular atrophy.