Editing Lower Urinary Tract Trauma (section)

==== <span style="color:#ff0000">Management</span> ====
* Minor scrotal injuries without testicular damage may be managed with ice, elevation, analgesics, and irrigation and closure.
* '''<span style="color:#ff0000">Indications for scrotal exploration (6):</span>'''
*# '''<span style="color:#ff0000">Imaging findings of testicular rupture</span>'''
*# '''<span style="color:#ff0000">Equivocal imaging but suspected testicular rupture</span>'''
*# '''<span style="color:#ff0000">Large hematoma</span>'''
*#* '''Should be explored and drained even in the absence of testicular rupture''' to prevent progressive pressure necrosis and atrophy, delayed exploration, and orchiectomy.
*# '''<span style="color:#ff0000">Clear physical findings of testicular rupture</span>'''
*# '''<span style="color:#ff0000">Penetrating scrotal injuries</span>'''
*#* Inspect for testicular, vascular and vasal injury; >50% will have testicular rupture
*#** The injured vas should be ligated with nonabsorbable suture, and delayed reconstruction should be performed if necessary
*#* '''<span style="color:#ff0000">≈30% of gunshot wounds injure both testes, and exploration of the contralateral testis should be considered, depending on the findings of physical examination and the path of the projectile</span>'''
*# '''<span style="color:#ff0000">Significant hematoceles</span>''' (not in 2020 AUA guidelines)
*#* Up to 80% are caused by testicular rupture
* '''<span style="color:#ff0000">Early exploration and repair of testicular injury is associated with (6):</span>'''
*# '''<span style="color:#ff0000">Increased testicular salvage rates</span>'''
*#* '''<span style="color:#ff0000">Salvage rates with exploration and repair within 72 hours of injury: >90%</span>'''
*#** '''Orchiectomy rates 3-8x higher with conservative management and delayed surgery'''
*#** '''Recall'''
*#*** '''Penile fracture: repair within 7 days does not adversely affect outcomes'''
*#*** '''Ischemic priapism: shunting procedure is considered within 72 hours of onset'''
*# '''<span style="color:#ff0000">Reduced ischemic atrophy</span>'''
*# '''<span style="color:#ff0000">Reduced risk of infection</span>'''
*# '''<span style="color:#ff0000">Preservation of fertility and hormonal function</span>'''
*# '''<span style="color:#ff0000">Reduced convalescence and disability</span>'''
*# '''<span style="color:#ff0000">Faster return to normal activities</span>'''
* '''Technique'''
** '''Incision:''' transverse scrotal incision is preferable in most cases.
** The tunica albuginea should be closed with small absorbable sutures after removal of necrotic and extruded seminiferous tubules.
** '''Every attempt to salvage the testis should be performed;''' loss of capsule tissue may require removal of additional parenchyma to allow closure of the remaining tunica albuginea.
*** '''A flap or graft of tunica vaginalis may be used to cover a large defect in the tunica albuginea in an otherwise salvageable testis'''
*** '''<span style="color:#ff0000">Orchiectomy is performed when the testicle non-salvagable</span>'''
* Males with a solitary testis
** Testicular injuries are exceedingly rare in boys involved in individual or team contact sports and recreational activities.
** Parents of boys with a solitary testis should be appropriately counseled, and a protective cup device should be recommended.