Injuries to the organs of the scrotum are injuries to the genitals of a man located in the scrotum of the testicles and appendages of the testicles, as well as the spermatic cords caused by traumatic effects. Injuries to organs located in the scrotum are often combined with injuries to the penis. Taking into account the fact that men of reproductive age are most often exposed to such injuries, it can be concluded that timely and proper first aid plays a very important role.
The content of the article:
Causes of scrotal injuries
Symptoms of scrotal injuries
Diagnosis of scrotal injuries
Treatment of scrotal injuries
Injuries of the scrotum organs
Causes of scrotal injuries
The direct causes of damage to the scrotum and the organs in it are beatings, various types of accidents, injuries in everyday situations and at production facilities, as well as when practicing certain sports, such as martial arts, cycling and equestrian sports. In addition to the above, compression of the scrotum during sexual contacts can be a damaging factor. Chronic injuries of the scrotal organs caused by constant vibration, frequent shaking, overheating can lead to a noticeable violation of spermatogenesis. In addition to mechanical factors, thermal effects can have a negative impact on the normal state of the scrotum organs. Such factors include burns with boiling water or steam, burns with hot objects, as well as chemical burns and frostbite. Knife wounds and gunshot wounds occur only in 5% of cases. Separately, wounds from animal bites or sexual partner are isolated.
Injuries to the organs of the scrotum are of a closed and open type. Injuries of the scrotum of the closed type are injuries without a noticeable violation of the integrity of the skin, and open forms are injuries with a violation of the integrity of the skin of the scrotum. Most often there are closed forms of injuries, but open ones are also not uncommon. When the scrotum is damaged, the organs are rarely injured, since at the moment of injury, a reflex contraction of the muscles occurs, lifting the testicles and thereby avoiding the zone of action of the traumatic force. Testicles are a very vulnerable organ, but on the other hand, they recover quickly after minor injuries, because they consist of spongy tissue, have a relatively free location in relation to the body, which allows them to absorb direct mechanical impact. Such injuries rarely have lingering consequences, sexual desire is not disturbed and spermatogenesis does not suffer.
A closed injury to the organs of the scrotum can lead to rupture of the testicle only in cases when the blow falls directly on the testicle itself. In some cases, a traumatic impact can push the testicle up to the inguinal canal or through it into the abdominal cavity. Such damage occurs in road accidents among motorcyclists due to a sharp impact on the gas tank. According to statistical data of urological centers, open injuries of the scrotum organs are much less common than closed ones — only in 20% of cases.
Closed injuries are conditionally divided into:
injuries with hemorrhages in the skin or scrotum cavity, with the formation of massive bruises. Most bruises in this case resolve on their own, without requiring special medical intervention.;
hematomas with bruises of the testicle and its appendage. With hematomas, the scrotum of the patient increases significantly in size. In some cases, a hematoma may require surgical intervention, namely the opening of the hematoma itself and drainage, carried out in order to get rid of stagnant blood;
crushing, tearing, crushing of the testicles and appendages are considered quite severe injuries and it is impossible to cure this type of damage without surgery.
In turn , open injuries of the scrotum organs are divided into:
significant wounds — tears, incisions, massive burns that do not penetrate directly into the cavity of the scrotum itself;
penetrating wounds of the scrotum without injury to the testicles;
penetrating wounds to the scrotum with varying degrees of damage to the testicles and appendages, up to their separation.
All of the above open injuries of the scrotum require immediate surgical treatment.
There are also bitten wounds of the scrotum and the organs located in it. For example, in the case of a dog bite, the patient must be vaccinated against rabies.
There are also chronic scrotal injuries. These include frequent bruises that occur due to constant shaking, vibration or squeezing, as well as frequent overheating. Such injuries can lead to violations of the hormonal function of the testicles and the process of sperm production.
Symptoms of scrotal injuries
With closed injuries and injuries, patients often observe the formation of hemorrhages. Such hemorrhages can manifest themselves in the form of bruises, as well as in the form of a powerful hemorrhagic infiltration, which extends both to the penis and to the entire perineum. Often, hemorrhage can spread to the inner part of the thigh, and to the anterior abdominal area.
As many patients note, the pain with closed scrotum injuries is not strong and is quickly replaced by a feeling of heaviness or overstrain. Due to the formation of hemorrhages, the skin on the scrotum becomes purple-blue, and sometimes black. Such injuries of the scrotum organs are accompanied by deep hemorrhages, which are conditionally divided into extravaginal and intravaginal.
With extravaginal hemorrhages, the blood that has poured inside does not penetrate deeper than the vaginal membrane of the testicle. In the case of extravaginal hemorrhage, the size of the hematoma may be different. In some cases, hemorrhage of small size, in others, the blood spreads from the testicle up to the external opening of the inguinal canal. This type of hemorrhage occurs when the spermatic cord and testicular membrane are injured. In such cases, it is possible to palpate the patient’s testicle.
Intravaginal hemorrhages are also called hematocele. This type of hemorrhage occurs due to damage to the testicle or vaginal membrane. Upon examination and palpation, such a hemorrhage can be mistaken for dropsy of the testicular membranes.
Despite the typical symptoms, it is often very difficult to determine the type of hemorrhage. Most severe injuries lead to the accumulation of various hemorrhages.
So, let’s list the first important symptoms of rupture of the membranes of the testicle: hemorrhage, the scrotum is in a tense state, the testicle is not palpable. If the testicle is dislocated, its twisting may occur. Dislocation of the testicle can be inguinal, perineal, pubic and abdominal.
Due to damage to the organs located in the scrotum, diseases such as: post—traumatic orchitis and epididymitis, scrotal gangrene, scrotal phlegmon, testicular parenchyma atrophy, and eventually infertility develop. A patient who has experienced injuries to the scrotum organs is more likely to develop testicular cancer.
Diagnosis of scrotal injuries
Injuries and injuries to organs located in the scrotum should by no means be ignored by a urologist, andrologist, surgeon and traumatologist, since the reproductive health of a man directly depends on timely treatment, completeness of diagnosis and proper medical care. The initial type of scrotal injury and the degree of its damage is determined by doctors based on complaints, examination, anamnesis and palpation of the scrotum.
For a full-fledged diagnosis of scrotal injuries, diaphanoscopy is most often used, as well as ultrasound examinations.
The information obtained during ultrasound diagnostics is fully complemented by Doppler tomography and duplex tomography – they are also able to provide the necessary information about the state of testicular perfusion.
To determine subcutaneous testicular ruptures, MRI and CT techniques are used.
There is no special technique for the prevention of scrotum injury today, but all men need to remember to be careful while participating in sporting events and other active actions.
Treatment of scrotal injuries
Treatment of scrotal injuries primarily depends on the nature of the injury, the duration of exposure to the traumatic factor and the severity of the injury itself.
The treatment of simple injuries is most often not medicamental, but of the expectant type. For example, bruises with small superficial hemorrhages are usually treated conservatively.
In the first hours after the patient receives a scrotum injury, it is necessary to immobilize the scrotum, give it an elevated position with a suspension or a tight bandage. It is advisable to cool the damaged scrotum, for which you can use an ordinary ice bubble, pre-wrapped with a towel. On the second day after injury, thermal procedures are used, increasing in intensity, namely: warming compresses and hot water bottles, sedentary baths, sollux, paraffin applications. Due to the abundant blood supply to the scrotum, the resorption of hemorrhages will occur much faster.
Open-type injuries are subjected to immediate surgical intervention. These include testicular ruptures, extensive superficial and deep hemorrhages, which are accompanied by severe pain, nausea, copious vomiting and shock.
Also, indications for mandatory surgery at a later date after injury may be long-term non-disappearing scrotal hematomas.
Depending on the nature of the damage, during the operation can be carried out:
removal of superficial as well as deep hematomas and stopping bleeding;
removal of non-viable testicular tissues, its membranes and appendage;
suturing of the testicular albumen, where testicular resection and ependymectomy should be performed;
the reduction of the testicle to its usual location — the scrotum and its further fixation, and, if there is a dislocation, unwinding of the spermatic cord;
stitching of the vas deferens or its ligation.
In case of damage of such a nature as testicular detachment, in most cases it makes no sense to perform reconstructive operations, since this will not bring the desired result. The separation of the entire scrotum and the organs in it occurs when careless work with rotating machines and mechanisms in production. Damage to the scrotum and testicles with such injuries is of a total nature, it is not possible to perform reconstructive surgery.
With injuries of a less complex type (for example, dislocation of the testicle), if no other damage is observed and the testicle is not changed, the patient is given intravenous anesthesia, then with careful massaging movements they try to push the testicle into the scrotum.
In the case of a gunshot wound, doctors resort to anti-shock therapy and wound treatment. In case of an open injury, surgical excision of the wound is performed, after which the wound is sewn up. If the scrotum is to be amputated with intact and preserved testicles, the surgeon places the testicles under the skin of the thigh. After a certain period of time has passed, a “new” scrotum will be surgically formed from this skin flap.
In cases of refusal by the patient from hospitalization and surgical intervention, suppuration of hematomas often occurs. Prevention of such complications consists in careful performance of surgery and a course of antibacterial therapy.
The main danger with injuries to the scrotum organs is a violation of the sexual and reproductive function of the patient. An unfavorable prognosis is promoted by damage to the organs of the scrotum, as well as later seeking help from medical professionals. Prevention of injuries to the scrotum organs does not exist today, but every man himself should remember the consequences of such injuries. It is extremely important to be careful at home and at work, to protect the perineum when doing sports, which will allow you to keep vital organs intact and safe.
