Management of Scrotal Injury with Severe Swelling

Initial Evaluation

Patients with suspected testicular rupture after scrotal injury with severe swelling should undergo prompt surgical exploration, debridement, and tunical closure when possible, or orchiectomy when non-salvageable, to prevent complications such as ischemic atrophy and infection, as recommended by the American Urological Association 1, 2
Ultrasound with Doppler is the first-line imaging modality for evaluating scrotal trauma with severe swelling, with high sensitivity for distinguishing between various etiologies, according to the European Association of Urology 3
The most specific findings on ultrasound suggesting testicular rupture include loss of testicular contour and heterogeneous echotexture of testicular parenchyma, as reported by the American Institute of Ultrasound in Medicine 4, 5
Clinical signs of testicular rupture include scrotal ecchymosis, swelling, and difficulty identifying testicular contours on physical examination, as described by the American Urological Association 4, 5, 6

If clinical examination or ultrasound suggests testicular rupture, immediate surgical exploration is indicated, with debridement of non-viable tissue and closure of the tunica albuginea when possible, as recommended by the American College of Surgeons 4, 5, 6
Tunica vaginalis flap or graft may be used when primary closure of tunica albuginea is not possible, as described by the Society of Academic Urologists 1, 2
Orchiectomy should be performed only when the testis is non-salvageable, as recommended by the American Urological Association 4, 5, 6

Early exploration and repair prevent complications including ischemic atrophy of the testis and infection, as reported by the European Association of Urology 4, 5, 6

Evaluate for concomitant urethral injury if there is blood at the urethral meatus, gross hematuria, or inability to void, as recommended by the American Urological Association 4, 5, 6
For extensive genital skin loss or injury, perform exploration and limited debridement of clearly non-viable tissue, as described by the American College of Surgeons 4, 6
Wound management options include gauze dressings with frequent changes, silver sulfadiazine or topical antibiotic with occlusive dressing, and negative pressure dressings, as reported by the Wound Healing Society 4, 6