Testicular damage
Introduction
Introduction to testicular injury The soft tissue of the scrotum is relaxed, and the testicular activity is large, but the contents of the scrotum are crisp and the damage resistance is poor. Therefore, the damage of the scrotum and its contents is not uncommon in clinical practice. It usually occurs in young adults, often with testicular, sphincter, spermatic cord and scrotal wall damage. The common cause of injury is direct violence. basic knowledge The proportion of illness: 0.02--0.03% Susceptible people: more than men Mode of infection: non-infectious Complications: orchitis infertility
Cause
Causes of testicular injury
Causes
The testicular position is in the superficial exposed part. Because the scrotum has a good protective structure and is free to move, the injury is not easy. The type of injury is open, closed, and the cause of the injury is direct violence or indirect damage.
Trauma (20%):
In the damage caused by bullets, there are often multiple combined injuries. In the case of shrapnel, the testicles will have some, most or all of the defects, direct puncture injury, because the testicular activity is large, the possibility of injury to the testicle is small.
Contusion (40%):
Caused by kicking, falling or riding across. In the testicular leucorrhea, the testicular tissue bulges into sputum. If the main artery of the testis is injured, the testicles are atrophied. In severe cases, the testicles are necrotic. When the testicles are twisted, the testicles begin to be hemorrhagic infarction, and gradually there is oozing fluid in the capsular sac. It becomes bloody after serousness, and when the torsion is still unable to be relieved, the arteries are atresia, blood supply is stopped, testicular necrosis, and atrophy.
Prevention
Testicular injury prevention
1. Prevention is mainly to avoid trauma.
2, early detection, early diagnosis, early treatment is also important to prevent this disease.
Complication
Testicular injury complications Complications orchitis infertility
1. Orchitis: This disease can usually cause bacterial infection due to open testicular damage, which can be directly spread to the testis or by blood. The pathogens are mainly Escherichia coli, Staphylococcus and Streptococcus.
2. spermatic rupture: usually caused by sharp injury, spermatic cord accompanied by spermatic vein, so after the fracture can cause a lot of bleeding, even hemorrhagic shock, once the reflex should be actively treated.
3. Infertility: Testicular tissue is destroyed due to severe damage to the testes or spermatic cord. Causes spermatogenesis disorders, which can lead to infertility.
Symptom
Symptoms of testicular injury Common symptoms Acute pain, scrotal swelling, nausea, testicular atrophy, hematoma, ecchymosis, cyst, testicular varicose veins
1. There is a history of trauma to the scrotum.
2. Local severe pain: pain can be radiated to the lower abdomen, waist or upper abdomen, and even painful shock can occur, accompanied by nausea and vomiting.
3. Check the scrotal swelling, skin bruising, the testicular swelling of the affected side is hard, there is obvious tenderness, often accompanied by scrotal hematoma, hydrocele or hydrocele, etc., when the testicular ischemic atrophy, testis is small And soft.
4. When the testicle ruptures: The testicular boundary is unclear; when the testicular dislocation, the scrotum is empty, often in the lower abdomen, the perineal sputum and the testicular mass; when the testicle is twisted, the testicle is elevated in the transverse position or the epididymis is in front of the testicle, spermatic cord Thickening, when lifting the scrotum and testicles, the pain is not alleviated or worsened.
After the scrotum injury, due to the clinical manifestations of scrotal swelling, pain and ecchymosis, the diagnosis is not difficult. It is important to determine whether the testicle is damaged or not. If it is delayed, it often causes hematoma formation, and then infection or compression of the testicle, ischemia, The testicular atrophy eventually affects the patient's sexual function and fertility. For this reason, many scholars believe that the B-ultrasound test is helpful for judging the testis, and the damage range is very beneficial. Gao Yong used B ultrasound to examine 28 patients with scrotal closure injury, 12 There were abnormal changes in the testicles: 4 cases of testicular swelling with single or multiple hypoechoic areas (hematoma) with unclear borders; 5 cases of testicular contours with echo interruption (white membrane rupture); 3 cases of normal testicular loss, broken The ends are separated from each other, and the section is irregular (testicular rupture), 10 of which are confirmed by surgery. In addition, in the absence of hematoma testicular injury, the choice of treatment method is quite troublesome. Martinez-Pineiro et al. propose testicular contusion or hematoma <1/ 3, can be monitored dynamically, such as lesions > 2 / 3, or rupture of the white membrane is treated with surgery.
Examine
Test for testicular damage
B-ultrasound and Doppler examination have certain value in judging testicular rupture and testicular blood supply reduction. When testicular rupture, testicular hypoechoic area may occur; when testicular torsion, there may be a decrease in testicular blood perfusion. If the diagnosis cannot be confirmed, Surgical exploration is available.
Diagnosis
Diagnosis and identification of testicular injury
diagnosis
Diagnosis can be made according to symptoms and laboratory tests.
Differential diagnosis
1. Acute epididymis, orchitis: There are also symptoms such as testicular pain and scrotal swelling. The testicles and epididymis are swollen, hard and tender, but the disease is more common in adulthood. The disease is slower, although the scrotum is swollen, but no Skin cyanosis and other changes, often have a history of the use of instruments in the urethra and indwelling catheterization, accompanied by systemic symptoms such as chills, fever, blood routine examination showed a significant increase in neutrophils.
2. Incarcerated oblique sputum: When the inguinal hernia is incarcerated, there may be severe pain in the scrotum, and the tenderness is obvious, but the disease generally has a history of reversible scrotum or inguinal mass, and abdominal pain. Nausea, vomiting, no anal exhaust defecation and other symptoms, check the abdominal bowel sounds hyperthyroidism, there is a sound of gas over the water; can be sputum and scrotum oval mass, normal testicles, no tenderness, no pain changes when moving.
3. Testicular tumor: The testicle is progressively enlarged, hard, but no history of trauma, the mass is heavy and inelastic, no obvious tenderness, AFP alpha-fetoprotein, HCG human chorionic gonadotropin and other tumor markers are sometimes examined. It can be positive, and the retroperitoneal lymph node CT or lymphography can sometimes find enlarged lymph nodes invaded by cancer. If necessary, surgical exploration and biopsy can be used to find tumor cells.
