Editing Lower Urinary Tract Trauma (section)

==== <span style="color:#ff0000">Diagnosis and Evaluation</span> ====

===== <span style="color:#ff0000">History and Physical Exam</span> =====
* '''History'''
** Most patients complain of exquisite scrotal pain and nausea.
*** '''≈5% of spermatic cord torsions are believed to be precipitated by trauma'''; torsion should be considered in all cases of significant scrotal pain without signs or symptoms of major scrotal trauma
* Physical exam
** Clinical examination of the scrotum following trauma can be limited due to significant scrotal swelling and patient discomfort
** Swelling and ecchymosis are variable, and the degree of hematoma may not correlate with the severity of testicular injury; absence does not entirely rule out testicular rupture, and contusion without fracture can manifest as significant bleeding.
** Scrotal hemorrhage and hematocele along with tenderness to palpation often limit a complete physical examination.
** '''A nonpalpable testis in a trauma patient should raise the possibility of dislocation outside the scrotum'''. Manual or surgical reduction of the displaced testis is indicated.

===== <span style="color:#ff0000">Imaging</span> =====
* '''<span style="color:#ff0000">Modality: ultrasound</span>'''
** Can reliably diagnose testicular rupture with a high level of accuracy in the setting of blunt scrotal trauma.
*** The utility of scrotal ultrasound for the evaluation of testicular rupture in the setting of penetrating scrotal trauma is limited.
** '''<span style="color:#ff0000">Ultrasound findings suggestive of testicular fracture include (2):</span>'''
**# '''<span style="color:#ff0000">Heterogeneous pattern of the testicular parenchyma</span>'''
**# '''<span style="color:#ff0000">Disruption of the testicular contour/tunica albuginea</span>'''
** '''<span style="color:#ff0000">A normal or equivocal ultrasound study should not delay surgical exploration when physical examination findings suggest testicular damage; definitive diagnosis is often made in the operating room.</span>'''