Testicular Trauma

The first sign of trauma to the testicle or scrotum is most often severe pain. Pain around the testicle may also be due to infection or swelling of the epididymis ("epididymitis"). Because the epididymis has a very thin wall, it easily becomes red and swollen by infection or injury. If not treated, in rare cases the blood supply to the testicle can get blocked. This can lead to loss of the testicle.

Men who suffer more than a minor injury to the scrotum should seek care by a urologist. Reasons to seek medical care are:

• any penetrating injury to the scrotum
• bruising and/or swelling of the scrotum
• trouble peeing or blood in the urine
• fevers after testicular injury

Though not linked to the injury, a large number of testicular tumors are found after minor injuries when men are more likely to carefully check their testicles. Many men don't notice the painless, solid lump bulging from the smooth testicular cover until they have a reason to look. Even if you think this is a simple bruise, it's a medical emergency. Testicular cancer caught early can often be cured. But tumors found late often need drawn-out treatment with surgery, radiation, and chemotherapy.

Testicular injuries can be caused by penetrating forces (such as stab wounds or gunshot wounds) or blunt forces (such as a kick or baseball to the scrotum). These can cause all or part of the testicle to rip, as well as loss of the whole testicle. An injury from a penetrating object, such as a knife or bullet that punctures the scrotum, may cause a minor scrape to the skin or major damage to the blood vessels to the testicle. An injury caused by a direct blow can tear the cover of the testicle or harm its blood vessels.

Your urologist can often figure out how bad the injury to the testicle is with a physical exam. After asking questions about how the injury occurred, as well as other questions about your health, he/she will look at your scrotum. It's often easy for your urologist to feel the tough testicle cover, as well as the thin, soft epididymis. He/she will also feel the structures that run into the testicle--the artery, vein and vas deferens--to make sure they're normal.

If all seem normal with no injury, your urologist will likely give you pain meds, such as acetaminophen or ibuprofen. You'll also be told to wear a jock strap to support the scrotum.

If it's not clear if injury has occurred, your urologist may ask for a scrotal ultrasound scan. Ultrasound uses sound waves bouncing off organs to make a picture of what's inside your body. Based on the same sonar sound waves that guide submarines, this device can safely image parts of the sac, including the testicle, epididymis and spermatic cord, to check the blood flow.

Though no imaging test is 100% perfect, ultrasound is easy to do, uses no X-rays, and clearly shows the structure of the scrotum. In rare cases, the ultrasound leaves more questions than answers. Your urologists may ask for magnetic resonance imaging (MRI), a more sophisticated imaging technique.

If any imaging study suggests testicular injury, the usual course of action is surgery. Under anesthesia, a cut is made in the scrotum and the contents are checked. If the testicle has torn, it can be repaired if it has good blood supply and the other testicle has enough of its cover. Your urologist will most often fix the tear with stitches and close the scrotum skin. In some cases, he/she will leave a plastic tube in the scrotum for a short time to drain blood and other fluids.

Sometimes an injury is so bad the testicle can't be fixed. In this case, your urologist will remove the testicle. This doesn't mean you can't father a child, though. Only 1 working testicle is needed for normal fertility. A single testicle will most often make normal amounts of sperm and testosterone. If your other testicle is normal, you should be able to get your partner pregnant.

If your physical exam and ultrasound suggest the injury has caused epididymitis, you'll likely be treated without surgery. You may be given anti-inflammatory meds (such as ibuprofen) and again be told to wear a jock strap. If needed, your urologist may also give you an antibiotic. It takes about 6 to 8 weeks for the swelling to go away. You may have to have many follow-up visits with your urologist to chart your progress. If conservative measures (meds and jock strap) don't work, surgery may be needed and the testicle may have to be removed.

I've noticed pain in my scrotum and testicle but I don't remember any injury. What should I do?

There are many possible causes of scrotal or testicle pain, such as epididymitis, swelling of the testicle, and problems with other parts of the scrotum. You should be checked by a urologist to find the source.

I was hit by a knee during a basketball game and have since noticed a new lump in my scrotum. It doesn't hurt, but should I do anything about it?

Like many young men, you're likely checking yourself for the first time now that you've had a sporting injury. There's a good chance that the lump or "new" mass you've just felt is a normal part of the anatomy (your epididymis). But it could be an injury or even testicular cancer. Any new lump should be checked at once by a trained urologist. With his/her skill, a urologist will ease your mind and point you to swift and proper treatment.

I'm 55 years old and noticed a lump in my scrotum after being hit in the groin during a pick-up game of baseball. Could this be testicular cancer, or am I too old for that?

Testicular cancer can show up at any age, though most cases are seen between 15 and 35 years of age. Any man with a new lump in his scrotum should see a urologist right away. Often, you won't need any further tests because your urologist can make a diagnosis with a physical exam. He/she may also ask for an ultrasound, though. While some masses are safe (benign), many can be cancer (malignant). The good news is that testicular cancer caught early can be treated with good results. Don't be afraid to call a urologist.

I noticed blood in my urine after being hit with a baseball. I don't feel any lumps. Should I still report this to my urologist?

Absolutely. Blood in the urine that's visible to the naked eye is almost always due to a urological problem. You need to see a urologist right away to find the reason.

What can I do to prevent injury to my testicles?

There are many common-sense steps you can take to lower your risk of testicular trauma. Wear a seat belt when driving a car. If you work around machinery that has exposed chains or belts, make sure your clothes are tucked in and loose belts or other items that can catch aren't exposed. Wear a jock strap when playing sports. If the activity has a chance of rough contact (as in baseball, football, or hockey), use a hard cup.