Urological trauma

　　Male external genitalia are exposed to the outside world and may suffer trauma from violent blows. For example, football players may be struck by a powerful football or injured in the scrotum; improper use of force during physical labor may result in injury to the scrotum by sticks, stones, instruments, and other objects. At the same time, due to the function of sexual behavior, male genital trauma may also be related to trauma associated with sexual behavior.

　　The main complications are infections and sexual dysfunction. Sexual dysfunction refers to abnormality in one or more stages of the five stages of sexual activity, such as sexual desire, penile erection, sexual intercourse, climax, and ejaculation, affecting the normal progression of sexual activity. The most common male sexual dysfunction is erectile dysfunction and abnormal ejaculation. Male sexual function is a complex physiological process involving various aspects, such as nervous, mental factors, endocrine function, and sexual organs, among which the sexual conditioned reflex of the cerebral cortex plays a particularly important leading role. Therefore, the causes of male sexual dysfunction are also multifaceted, and can be generally divided into functional sexual dysfunction and organic sexual dysfunction. The former accounts for the majority of sexual dysfunction, while the latter is quite rare.

　　The severity of penile trauma varies with the direction and magnitude of the external force, with common symptoms including pain, swelling, hematuria, and urinary obstruction.

　　After scrotal trauma, the scrotum may swell and bleed, the skin in the scrotal area may become blue or black, and severe pain may occur.

　　After testicular trauma, severe pain may occur, radiating to the lower abdomen, lumbar region, even the upper abdomen, and shock may occur in severe cases. There may be a large hematoma in the scrotum, and the scrotal wall may become瘀血青紫.

　　How to prevent male reproductive organ trauma?

　　Pay attention to personal safety and prevent injuries from sports, accidents, traffic, falls, knife cuts, and so on. Regularly go to the hospital for check-ups in this regard, seek medical attention in a timely manner if there are any abnormalities, and prevent infection.

　　Male external genitalia are exposed to the outside world and may suffer trauma from violent blows. For example, football players may be struck by a powerful football or injured in the scrotum; improper use of force during physical labor may result in injury to the scrotum by sticks, stones, instruments, and other objects. At the same time, due to the function of sexual behavior, male genital trauma may also be related to trauma associated with sexual behavior.

　　9. Penile injury can often be diagnosed correctly based on the history of injury and local manifestations, and usually does not require special examination. cavernosography can reflect the location and extent of cavernosal injury. The characteristics of ultrasound imaging include abnormal thickness and continuity of the various layers of tissue in the penis, and local hyperechoic hematoma can be found. CDI observation shows abnormal blood flow signal distribution.

　　8. The scrotum is located on the surface of the body, and the location and extent of injury can be easily diagnosed. Ultrasound examination helps to correctly judge scrotal hematoma and determine whether the testicle is injured; it also helps determine the indications for surgical exploration, such as testicular rupture and foreign body retention.

　　7. The diagnosis of simple testicular injury is not difficult through medical history and physical examination, but testicular injury often complicates with scrotal hematoma and scrotal injury, which must be confirmed by auxiliary examinations such as ultrasound or even CT. However, the latter is a radiographic examination that can cause damage to spermatogenic function, and it should be avoided as much as possible. Sometimes, it is difficult to distinguish between late-stage (after 3 months) testicular hematoma and testicular tumor, and CT thin-section scanning can be used for diagnosis.

　　1. Local hematoma in testicular injury should be immediately treated with cold compress to reduce bleeding. Support and stabilize the testicle to alleviate pain. If the hematoma does not absorb, incision and drainage should be performed. Severe cases require hospital examination and treatment.

　　2. During the treatment of testicular injury, it is best to preserve the testicle. In cases with severe injury and shock, anti-shock treatment should be provided. The above-mentioned is collision injury, clean the wound surface, remove necrotic tissue, repair and suture, try to preserve the testicular tissue to maintain male function. In cases with hematoma, it should be completely removed to avoid infection caused by hematoma. In cases where both testicles are injured and the testicular artery is not injured, the testicle should not be removed. If the testicle has been amputated, consider performing testicular autotransplantation or heterotransplantation. In cases of severe scrotal injury, scrotaloplasty can be performed to enclose the testicle.

　　3. In cases of testicular injury complicated with shock, active anti-shock treatment should be given, and analgesia, hemostasis, and anti-infection treatment should be provided simultaneously. Patients with stable conditions should rest in bed, elevate the scrotum, and apply local cold compresses to alleviate pain and promote healing. Early testicular dislocation can be tried by manipulation, but if there is significant edema, manipulation may not be successful, and open surgery should be performed as soon as possible to reposition and fix the testicle. For testicular torsion, surgical repositioning should be performed within a few hours, and the testicle should be fixed at the bottom of the scrotum to prevent atrophy or necrosis and prevent recurrence of torsion.

　　4. For open testicular injuries, thorough debridement should be performed, foreign bodies should be removed, necrotic testicular tissue should be excised, and the tunica albuginea of the testicle should be sutured after hemostasis. In cases with combined injury of the spermatic artery, if the testicular injury is not severe, it can be preserved and repaired using microsurgical techniques. For severe testicular swelling, the tunica albuginea should be incised to reduce tension and then sutured to prevent excessive pressure from compressing the testicular tissue and causing atrophy. A rubber drain should also be placed in the scrotum to prevent the occurrence of scrotal hematoma and infection.

　　5. The only indication for orchidectomy is the complete cessation of blood supply to the testicle. For cases with severe testicular injury and complete damage to the testicular tissue, it is necessary to perform orchidectomy, and efforts should be made to preserve part of the testicular white membrane because there are many cells that secrete androgens on the inside of the white membrane. For testicular torsion, if the testicle has necrotized, orchidectomy should be performed.

　　1. Penile Trauma

　　1. Penile Contusion: Generally, it can heal spontaneously. If there is a marked hematoma, aspiration or incision and drainage can be performed.

　　2. Penile Fracture: Early surgery, remove hematoma, and suture the white membrane.

　　3. Penile Strangulation: Remove (excise) the foreign ring and avoid additional injury.

　　4. Penile Dislocation: Surgical Reduction.

　　5. Penile Amputation: Replantation or Reconstruction.

      6. If there is urethral injury, urethral repair and suprapubic cystostomy should be performed.

　　2. Scrotal Trauma

　　After scrotal injury, the patient should rest quietly, elevate the scrotum with a bandage, and apply local cold compress. After 2-3 days, switch to hot compress to promote the absorption of the hematoma. For larger hematomas, use rhubarb powder or Daqili powder, mixed with vinegar for external application. Take the bruise tablet and Yunnan Baiyao internally. When there is a large hematoma and a large amount of effusion, the doctor should perform puncture and aspiration of the effusion, and inject hyaluronidase 1500u to accelerate the absorption of the hematoma. When the hematoma becomes solid, use traditional Chinese medicine: 15g of Chenglingxian, 1g of Honghua, 10g of Chishao, 10g of Luoshiteng, 10g of Gancao, 10g of Congxu, decocted with wine for external washing. Take Dahuoluo Dan, 654-2 tablets, or consult a traditional Chinese medicine doctor for medication. If there are symptoms of infection and fever, antibiotics should be used. During the treatment period, sexual activity should be prohibited, and massage, hot compress, and arbitrary medication should be avoided. If there are any problems, medical treatment should be sought promptly.

　　3. Testicular Trauma

　　The key to treating testicular trauma is early surgery exploration, which can significantly reduce the rate of orchidectomy. During the operation, the degree of injury is identified, and efforts are made to preserve the testicle. For those with orchidectomy or postoperative testicular atrophy due to insufficient male hormone secretion, male hormone treatment or testicular transplantation should be supplemented. Thorough hemostasis should be performed during the operation, strict aseptic technique should be followed, and appropriate antibiotics should be used postoperatively to avoid hematoma and infection, which can further damage the testicle.