Testicular injury

　　One, Etiology

　　The testis is located in a superficial and exposed area. Since the scrotum has a good protective structure and is freely movable, it is not easy to be injured. The types of injury are open and closed, and the causes of injury include direct violence or indirect injury.

　　1. Trauma caused by gunshots often has multiple combined injuries, and in cases of shrapnel injury, the testis may have partial, most, or complete defects. Direct piercing injury, because the testis has a large degree of mobility, the possibility of injury to the testis is small.

　　2. Contusion caused by kicking, falling, or riding over.

　　Two, Pathogenesis

　　The testis protrudes into a hernia due to injury of the tunica albuginea of the testis, if the main artery of the testis is injured, the testis will atrophy, and in severe cases, the testis will necrose. When the testis twists, it starts with hemorrhagic infarction, and gradually there is effusion of fluid in the tunica vaginalis sac, initially serous and later becoming hemorrhagic. If the twist cannot be relieved, the artery will become occluded, blood supply will stop, and the testis will necrose and atrophy.

　　1. Orchitis:This disease can usually be caused by bacterial infection due to open testicular injury, which can directly spread to the testicle or cause blood-borne infection. The main pathogens are Escherichia coli, Staphylococcus, and Streptococcus.

　　2. Spermatic cord rupture:It is usually caused by sharp object injury, and the spermatic cord is accompanied by the spermatic vein, so it can cause a large amount of bleeding, even hemorrhagic shock, once the reflex response should be actively treated.

　　3. Contraception and infertility:Due to severe injury to the testicle or spermatic cord, the testicular tissue is destroyed, causing spermatogenic disorders, which can lead to infertility.

　　1. There is a history of scrotal trauma.

　　2. Local severe pain: the pain can radiate to the lower abdomen, waist, or upper abdomen, and even cause painful shock. During the pain, symptoms such as nausea and vomiting may also occur.

　　3. Examination shows scrotal swelling, skin cyanosis and ecchymosis, the testicle on the affected side is enlarged and hard, with obvious tenderness, often accompanied by scrotal hematoma, hydrocele, or hematocele, and in the later stage, when the testicle is ischemic and atrophic, the testicle becomes small and soft.

　　4. When the testicle ruptures: the boundary of the testicle is unclear; when the testicle is dislocated, the scrotum is empty, often in the lower abdomen, and the testicular mass can be palpated in the perineum; when the testicle twists, the testicle is elevated in a transverse position or the epididymis is located in front of the testicle, the spermatic cord becomes thick, and when the scrotum and testicle are lifted, the pain does not subside or even worsens.

　　After scrotal injury, due to scrotal swelling, pain, ecchymosis, and other clinical manifestations, diagnosis is not difficult. It is important to determine whether the testicle is injured. If it is neglected, it often leads to hematoma formation, followed by infection or compression of the testicle, ischemia, and eventually testicular atrophy, affecting the patient's sexual function and fertility. Therefore, many scholars believe that ultrasound examination is very helpful in determining whether the testicle is injured and the extent of the injury. Gao Yong conducted B-ultrasound examination on 28 patients with closed scrotal injury, and 12 cases showed abnormal changes in the testicle: 4 cases showed enlargement of the testicle with a single or multiple unclearly defined hypoechoic areas (hematoma); 5 cases showed echo interruption in the contour of the testicle (white membrane rupture); 3 cases lost the normal shape of the testicle, the ends were separated, and the cross-section was irregular (testicular rupture), among which 10 cases were confirmed by surgery. In addition, in cases of testicular injury without hematoma, the choice of treatment method is quite difficult. Martinez-Pineiro et al. proposed that if the testicular contusion or hematoma is 2/3, or the white membrane is ruptured, surgical treatment should be adopted.

　　This disease is caused by direct trauma to the testicle, such as kicking, falling, or being stepped on. Therefore, attention should be paid to living habits, high-risk workers such as construction workers and miners are prone to injury, and protection should be paid attention to during the work process. Stay calm when facing things, avoid emotional excitement and conflict, which can lead to this disease. In addition, early detection, early diagnosis, and early treatment are also of great significance for the prevention of this disease.

　　Ultrasound and Doppler examination are valuable for judging testicular rupture and decreased blood supply to the testicle. When the testicle ruptures, a hypoechoic area of the testicle may appear; when the testicle twists, there may be a decrease in blood perfusion to the injured side of the testicle. If the diagnosis cannot be made clear, surgical exploration can be performed.

　　1. Foods beneficial for testicular injury:

　　Eat more fresh vegetables and fruits.

　　2. Foods to avoid for testicular injury:

　　Avoid greasy and heavy foods, strong spirits, and spicy fried foods.

　　First, Treatment

　　During the treatment of testicular injury, try to retain the testicle, and antishock treatment should be given to those with severe injury and shock.

　　1. Clean the wound, remove necrotic tissue, repair and suture, try to retain testicular tissue to maintain male function. For those with hematoma, thoroughly remove the hematoma to avoid infection caused by the hematoma. When both testicles are injured, do not remove the testicle if there is no injury to the testicular artery. If the testicle is already amputated, consider performing testicular in situ transplantation or heterotopic transplantation. If the scrotum is severely injured, perform scrotal plastic surgery to wrap the testicle.

　　2. Local hematoma should be treated with cold compress immediately after contusion to reduce bleeding. Elevate and fix the testicle to relieve pain. If the hematoma does not absorb, incision and drainage should be performed, and a small incision of the white membrane can be made to reduce the intratesticular pressure if the testicle is swollen and painful, but attention should be paid to the occurrence of spermatocoele.

　　3. The testicle should be复位fixed as soon as possible for dislocation and torsion, in addition to testicular fixation, the spermatic cord should also be appropriately fixed to avoid recurrence of dislocation or torsion. If the treatment time is delayed and the testicle has necrotized, the testicle should be removed to avoid infection in the scrotum.

　　Second, Prognosis

　　Many observations have confirmed that early surgery and exploration not only can clear the hematoma and prevent infection, but also can greatly reduce the rate of orchiectomy through testicular repair, thereby alleviating the psychological burden of patients and infertility caused by autoimmune reactions. For example, among the 65 patients treated by Cass, 23 cases were treated without surgery, and 5 cases underwent orchiectomy due to delayed surgery, accounting for 22%. The rate of orchiectomy for those with early surgery and exploration was only 7%. Villar also pointed out that 45% of patients treated without surgery were unsuccessful, often resulting in delayed exploration due to complications such as persistent pain and infection, and 45% underwent orchiectomy, forming a sharp contrast with the 5% rate of orchiectomy among those who underwent surgery within 72 hours.