A testicular rupture is a severe injury characterized by a tear in the tunica albuginea, the tough, protective fibrous layer that encases the testicle. This condition occurs most often as a result of blunt force trauma to the scrotum, such as a direct impact from a sports injury or an accident. The rupture is a serious medical emergency that requires immediate attention due to the risk of permanent damage to the organ.
Why Immediate Medical Attention Is Required
A ruptured testicle does not possess the capacity to heal on its own. The tear in the tunica albuginea allows the internal testicular contents to extrude and blood to leak, forming a hematocele, which places pressure on the organ’s blood supply. The resulting lack of blood flow, known as testicular ischemia, can rapidly lead to tissue death in the affected area.
A delay in seeking treatment dramatically decreases the likelihood of successfully saving the testicle. Studies indicate that if surgical repair is performed within 72 hours of the injury, the testicular salvage rate is approximately 90%. This high success rate drops significantly to around 45% if the surgical intervention is delayed beyond the 72-hour mark. Prolonged ischemia caused by the injury or subsequent internal pressure promotes infection and irreversible damage, which necessitates the removal of the testicle, an operation called an orchiectomy.
Confirming the Diagnosis
Once a patient arrives at the emergency room following blunt scrotal trauma, the physician begins with a physical examination, which may be challenging due to the severe pain and swelling. Findings such as significant pain, discoloration, and an inability to clearly feel the contours of the testicle suggest a serious underlying injury. The primary method for confirming a rupture is a scrotal ultrasound with Doppler studies.
This imaging technique is non-invasive and provides a detailed view of the internal structures and blood flow within the scrotum. The most specific finding indicating a rupture is a clear disruption, or discontinuity, in the otherwise smooth, echogenic line of the tunica albuginea. Doppler imaging is concurrently used to evaluate the vascular status, showing whether blood flow to the testicle is compromised, which helps determine the extent of the damage and the need for immediate surgery. The ultrasound also identifies the presence of a hematocele, the collection of blood surrounding the testicle.
Surgical Repair and Intervention
The goal of this procedure is to preserve as much viable testicular tissue as possible and restore the integrity of the organ. Under general anesthesia, the surgeon makes an incision in the scrotum to gain access to the injured testicle.
The surgery involves several steps, beginning with the drainage and evacuation of the hematocele. The surgeon then carefully assesses the exposed testicular tissue, debriding any non-viable or necrotic tissue that has been damaged beyond repair. Finally, the tear in the tunica albuginea is closed using fine, absorbable sutures. If the damage is too extensive, such as when the internal contents are severely compromised or the blood supply cannot be salvaged, the surgeon may be forced to perform an orchiectomy to prevent complications like infection and long-term pain.
Recovery and Long-Term Function
Following successful surgical repair, the patient’s recovery typically involves several weeks to months, depending on the severity of the initial injury. Patients are usually advised to wear an athletic supporter for scrotal support and to avoid strenuous activities and heavy lifting for a period of weeks. Pain management and monitoring for signs of infection or complications are the immediate post-operative concerns.
A successfully repaired testicle should generally regain its ability to produce sperm and testosterone. Even in cases where an orchiectomy is necessary and one testicle is removed, the remaining healthy testicle is typically able to compensate fully, maintaining normal testosterone levels and sufficient sperm production for fertility. Patients with bilateral damage or those who experience testicular atrophy may require hormonal evaluation and potentially testosterone replacement therapy.