Symptoms of Testicular Rupture
Testicular rupture presents with scrotal ecchymosis, swelling, and difficulty identifying testicular contours on physical examination, requiring prompt surgical exploration to prevent complications such as ischemic atrophy and infection. 1
Primary Clinical Manifestations
- Acute onset of scrotal pain following blunt trauma to the scrotum 2, 1
- Scrotal ecchymosis (bruising) and marked swelling of the affected hemiscrotum 1, 3
- Difficulty palpating and identifying normal testicular contours due to severe swelling 1
- Perineal bruising may be present in cases of significant trauma 3
Associated Symptoms
- Pain may not be relieved when the testicle is elevated (negative Prehn sign), which helps differentiate from inflammatory conditions 2
- Nausea and vomiting may occur due to severe pain 2, 1
- Difficulty walking or moving due to pain 2
- In cases involving motorcycle or vehicle accidents, patients may present with additional traumatic injuries 3, 4
Diagnostic Indicators
- Loss of normal testicular contour on examination suggests rupture of the tunica albuginea 1
- Ultrasound findings indicating testicular rupture include:
Clinical Course
- Symptoms typically worsen rapidly after injury 2
- Without prompt intervention, increasing pain and swelling occur as hematoma expands 1, 6
- Risk of testicular ischemia increases with delayed treatment beyond 72 hours 6
- Potential for testicular atrophy if not properly managed 1, 6
Red Flags Requiring Immediate Attention
- Rapid onset of severe scrotal pain and swelling following trauma 2, 1
- Visible scrotal hematoma or ecchymosis 1, 3
- Inability to clearly palpate testicular borders due to swelling 1
- Blood at the urethral meatus, gross hematuria, or inability to void (suggesting concomitant urethral injury) 1
Diagnostic Approach
- Ultrasound with Doppler is the first-line imaging modality for evaluating suspected testicular rupture 1, 5
- CT findings of scrotal hematoma/fluid may raise initial suspicion in trauma patients undergoing trauma protocol imaging 4
- MRI can provide additional evaluation when ultrasound results are equivocal 5
While some studies suggest conservative management may be appropriate in select cases 7, the American Urological Association guidelines recommend prompt surgical exploration for suspected testicular rupture to prevent complications and preserve testicular function 2, 1.