Is a testicular rupture an emergency case?

Testicular Rupture is a Surgical Emergency

Yes, testicular rupture is absolutely a surgical emergency requiring immediate evaluation and surgical exploration to prevent testicular loss and preserve fertility. Prompt surgical intervention within hours of injury is critical for testicular salvage, with delayed treatment significantly increasing the risk of orchidectomy and long-term complications including hypogonadism and infertility 1, 2, 3, 4.

Why This is an Emergency

Testicular rupture represents disruption of the tunica albuginea with exposure of seminiferous tubules, requiring urgent surgical repair to prevent irreversible testicular damage. 5, 2, 3

• Time-sensitive tissue viability: Delayed surgical intervention beyond several hours dramatically reduces testicular salvage rates and increases the need for orchidectomy 1, 3
• Risk of permanent complications: Without prompt repair, patients face hypogonadism, infertility, chronic pain, and complete testicular loss 2, 4
• High salvage rates with early surgery: Immediate surgical exploration and repair results in significantly higher preservation rates compared to delayed or conservative management 1, 3

Clinical Presentation Requiring Emergency Action

Look for acute scrotal pain with rapid onset following blunt trauma (sports injury, motor vehicle accident, assault), accompanied by scrotal swelling, ecchymosis, and a firm, tender testicle. 6, 1, 2

Key clinical features demanding immediate action:

• Sudden severe testicular pain following direct trauma to the scrotum 6, 2
• Gross scrotal swelling and ecchymosis of the affected hemiscrotum 1, 2
• Firm, enlarged testicle on examination, often with inability to palpate normal testicular contour 6, 1
• Scrotal hematoma with progressive swelling 1, 4

Immediate Diagnostic Approach

Obtain urgent scrotal ultrasound with Doppler as the first-line imaging to confirm testicular rupture, showing disruption of the tunica albuginea, heterogeneous testicular parenchyma, and hematocele. 6, 7, 4

Diagnostic pathway:

• Ultrasound findings diagnostic of rupture: Discontinuity of tunica albuginea, heterogeneous testicular echotexture, hematocele, and possible decreased blood flow 7, 5, 4
• CT may identify injury first: In polytrauma patients undergoing trauma protocol CT, scrotal hematoma/fluid should raise immediate suspicion for testicular injury requiring follow-up ultrasound 4
• Do not delay surgery for imaging if clinical suspicion is high: When examination strongly suggests rupture, proceed directly to surgical exploration rather than waiting for confirmatory imaging 6, 3

Emergency Management Algorithm

Proceed immediately to surgical exploration for suspected or confirmed testicular rupture—this is the definitive management and should not be delayed. 1, 5, 3

Surgical approach:

1. Emergency scrotal exploration through hemiscrotum incision 1, 2
2. Evacuate hematoma and debride necrotic tissue to assess extent of injury 1, 5
3. Primary repair of tunica albuginea when viable testicular tissue remains 1, 5, 3
4. Orchidectomy only if testis is completely destroyed or non-viable 1, 3

Critical Pitfalls to Avoid

Never adopt a "wait and see" approach or attempt conservative management for suspected testicular rupture—this invariably leads to testicular loss. 1, 3

Common errors:

• Delaying surgical consultation for imaging: When clinical examination strongly suggests rupture, imaging should not delay surgical exploration 6, 3
• Misdiagnosing as simple contusion: Progressive pain with firm, swollen testicle indicates rupture, not simple trauma 6, 1
• Attempting conservative management: Unlike testicular fracture without tunica albuginea rupture, complete rupture requires surgical repair 5, 3
• Waiting for "improvement": Each hour of delay decreases salvage rates and increases complications 1, 2, 3

Special Considerations

Testicular rupture most commonly affects males aged 15-40 years following sports injuries, motor vehicle accidents (especially motorcyclists), or interpersonal violence. 1, 2

• Unilateral injury predominates: Approximately 98.5% of blunt testicular trauma results in unilateral injury 1
• Mechanism matters: Rupture typically occurs when the testicle is compressed against the pubic bone 2, 3
• Rare association with malignancy: In rare cases, underlying testicular tumors may lower the threshold for rupture with trivial trauma 1