Testicular Trauma and Injury Management in Singapore

• Severe testicular pain following trauma
• Visible swelling or bruising of the scrotum
• Difficulty walking due to testicular discomfort
• Nausea or vomiting accompanying testicular pain
• Any penetrating injury to the scrotal area
• Testicular pain persisting more than one hour after injury
• Blood in urine following genital trauma

• Testicular rupture confirmed by ultrasound
• Large haematocele (blood collection around testis)
• Testicular dislocation from normal position
• Penetrating injuries to the scrotum
• Suspected testicular torsion following trauma
• Avulsion injuries with tissue loss
• Bilateral testicular trauma

• Minor contusions without rupture
• Small haematoceles without active bleeding
• Mild scrotal swelling with intact testicle
• Resolved pain with normal ultrasound findings

Professional evaluation by a urologist is essential for all testicular injuries, as clinical examination alone may miss significant pathology. Even seemingly minor trauma can cause substantial damage requiring intervention.

Conservative treatment suits minor testicular trauma without evidence of rupture or significant haematocele. This approach includes scrotal support, ice application, anti-inflammatory medications, and activity restriction. Serial examinations and ultrasound monitoring ensure no delayed complications develop. Most minor injuries resolve within 1-2 weeks with conservative care.

Surgical exploration remains the definitive treatment for testicular rupture, large haematoceles, or unclear ultrasound findings. Through a scrotal incision, the surgeon evacuates blood clots, assesses testicular viability, and repairs the tunica albuginea (testicular covering). Devitalised tissue is debrided while preserving maximum viable testicular tissue. The procedure typically takes 30-60 minutes under general or spinal anaesthesia.

In cases of extensive testicular destruction or devascularisation, orchiectomy (testicle removal) may be necessary. This decision involves careful intraoperative assessment of tissue viability. Partial orchiectomy preserves hormone function when possible. For complete removal, prosthetic implant placement can address cosmetic concerns.

High-resolution ultrasound with Doppler flow assessment provides crucial diagnostic information. Surgical loupes enhance visualisation during repair. Absorbable sutures minimise foreign body reactions. Modern haemostatic agents control bleeding while preserving tissue.

Initial evaluation includes detailed history of the injury mechanism and timing. Physical examination assesses scrotal swelling, tenderness, and testicular position. Ultrasound imaging with Doppler flow studies evaluates testicular integrity and blood flow. Blood tests may check for infection markers and baseline hormone levels.

Patients receive pain medication and antibiotics if infection risk exists. For surgical cases, fasting requirements are explained. Consent discussions cover potential outcomes including fertility implications. Ice packs reduce swelling while awaiting definitive treatment.

For surgical exploration, anaesthesia is administered based on patient preference and medical status. The surgical site is prepared with antiseptic solution. A midline scrotal incision provides access to both testicles if needed. The surgeon inspects the injured testicle, evacuates haematomas, and irrigates the surgical field.

Testicular repair involves suturing tears in the tunica albuginea with absorbable sutures. Non-viable tissue is debrided. The testicle is returned to proper anatomical position. A drain may be placed for large haematoceles. The procedure takes 30-90 minutes depending on injury extent.

Recovery room monitoring ensures stable vital signs and adequate pain control. Scrotal support and ice packs minimise swelling. Patients receive instructions on wound care and activity restrictions. Most patients return home the same day for minor repairs. Complex injuries may require overnight observation.

Initial pain management includes oral analgesics and anti-inflammatories. Antibiotics continue for 5-7 days. Follow-up appointments are scheduled for wound checks. Warning signs requiring immediate medical attention are reviewed with patients and caregivers.

Scrotal elevation and ice application (20 minutes on/off) reduce swelling and discomfort. Pain typically peaks within the first day then gradually improves. Light activities are permitted, but lifting and straining should be avoided. Shower permission depends on wound closure method.

Bruising and swelling are expected and may worsen initially. Oral pain medications manage discomfort effectively for most patients. Scrotal support garments provide comfort during ambulation. Patients monitor for signs of infection or excessive bleeding.

Gradual activity increase as tolerated, avoiding strenuous exercise or heavy lifting. Wound inspection ensures proper healing without infection. Swelling progressively decreases though some firmness may persist. Most patients return to desk work within 3-5 days.

Follow-up appointments assess healing progress and address concerns. Sutures, if non-absorbable, are removed at 7-10 days. Ultrasound may evaluate post-operative changes. Sexual activity restrictions continue during initial healing.

Complete healing occurs within 4-6 weeks. Return to sports and heavy physical activity requires clearance, usually after 4-6 weeks. Testicular atrophy monitoring continues for several months as delayed changes can occur. Fertility testing may be recommended 3-6 months post-injury if conception is planned.

Regular self-examination helps detect any abnormal changes. Annual urological follow-up monitors for long-term complications. Hormone levels may be checked if bilateral injury or orchiectomy was performed.

Scrotal swelling and bruising are universal following testicular trauma and its treatment. These resolve within 2-3 weeks with supportive care. Temporary decreased fertility may occur but usually recovers within 3-6 months. Mild chronic discomfort affects some patients but improves with time.

Post-operative wound discomfort is expected and managed with analgesics. Scrotal haematoma formation occurs in 5-10% of surgical cases. These small blood collections usually reabsorb without intervention. Temporary testicular hypersensitivity during healing is common.

Infection occurs in less than 2% of cases with appropriate antibiotic prophylaxis. Signs include fever, increasing pain, and wound drainage. Testicular atrophy may develop weeks to months post-injury despite successful initial treatment. This results from vascular compromise during the initial trauma.

Chronic pain syndromes affect a small percentage of patients. Management may require pain specialist involvement. Infertility risk increases with bilateral injuries or significant unilateral damage. Anti-sperm antibody formation can occur following blood-testis barrier disruption.

Our experienced urologists employ meticulous surgical technique and comprehensive post-operative care protocols to minimise complication risks. Regular follow-up ensures early detection and management of any developing issues.