A ruptured testicle is a urological emergency that does not heal on its own and requires immediate medical intervention. This injury involves a tear in the testicle’s tough, protective outer layer, the tunica albuginea. Without prompt surgical repair, the damage can lead to severe consequences, including the loss of the testicle or a significant reduction in its function. Recognizing the severity and acting quickly are paramount to preserving the organ’s viability.
Understanding Testicular Rupture
The testicle is an oval-shaped gland encased by a dense, fibrous capsule known as the tunica albuginea. This layer provides structural integrity and protection for the softer, internal tissue where sperm production occurs. A testicular rupture occurs when a force causes a tear in this robust outer membrane.
The injury is typically caused by blunt force trauma, such as a direct blow to the groin, which compresses the testicle against the pubic bone. When the tunica albuginea tears, the internal contents, including the sperm-producing seminiferous tubules, can extrude. This disruption also causes internal bleeding within the scrotum, which is known as a hematocele.
Recognizing Symptoms and Immediate Action
The symptoms following a traumatic injury to the scrotum are severe and should prompt immediate medical evaluation. The most recognizable sign of a potential rupture is sudden, intense, and unrelenting pain in the affected testicle. This acute pain often radiates upward toward the groin or lower abdomen and does not subside with rest or over-the-counter pain relievers.
The injury rapidly causes pronounced swelling and bruising of the scrotum due to the internal bleeding. Patients may also experience systemic symptoms, such as nausea and vomiting, which are common reactions to severe testicular pain. The testicle itself may feel abnormally hard, lumpy, or have an irregular contour upon gentle examination.
It is necessary to seek emergency care immediately if a testicular rupture is suspected. Time is a determining factor for testicular salvage, with the best outcomes occurring when surgical repair is performed quickly. Delaying treatment significantly increases the risk of complications, including infection, tissue death, and the need for testicle removal.
Medical Intervention and Surgical Repair
The standard treatment for a confirmed testicular rupture is an urgent surgical procedure called scrotal exploration. The surgery is performed under general anesthesia and typically begins with an incision made in the scrotum to access the injured testicle. The primary goal is to assess the extent of the damage and preserve as much viable testicular tissue as possible.
The surgeon first drains any accumulated blood (hematocele) that has formed within the scrotal sac, as this pooling blood can place damaging pressure on the testicle. Next, any non-viable or severely damaged tissue is carefully removed, a process called debridement. The procedure involves closing the tear in the tunica albuginea using fine, absorbable sutures.
Primary closure of the tunica albuginea restores the testicle’s protective barrier and helps maintain its shape. If the tear is too extensive for a simple closure, the surgeon may use surrounding tissue, such as a flap of the tunica vaginalis, to patch the defect. If the damage is too severe, if blood flow is compromised, or if the testicle is unsalvageable, the surgeon must perform an orchiectomy, which is the removal of the testicle.
Long-Term Prognosis and Functional Outcomes
The long-term prognosis following a testicular rupture is strongly linked to how quickly the patient received surgical repair. Studies indicate that the success rate for saving the testicle is significantly higher (80% to 90%) if surgical exploration and repair occur within 72 hours of the injury. A delay beyond this window can drastically reduce the salvage rate (45% to 55%).
Even after a successful repair, the testicle may face two main functional concerns: the production of testosterone and the production of sperm. Hormonal function is often preserved, as one healthy testicle can typically maintain normal testosterone levels. However, the injured testicle may experience atrophy, or shrinkage, over time.
This atrophy can lead to a reduction in its contribution to overall sperm count and quality, potentially resulting in subfertility. Early surgical intervention helps to minimize the risk of developing antisperm antibodies, which occur when the immune system is exposed to the testicle’s contents following the rupture.
Although subfertility is a risk, having one healthy testicle is generally sufficient for maintaining normal sexual function and the ability to father children. Patients are advised to follow up with a urologist to monitor for long-term complications, such as atrophy, and to assess fertility health.