Usefulness of Preoperative Ultrasound for the Evaluation of Testicular Rupture in the Setting of Scrotal Gunshot Wounds.

PURPOSE: A scrotal gunshot wound may result in testicular injury, necessitating urgent scrotal exploration and attempted testicular salvage. Scrotal ultrasound is highly sensitive and specific for testicular rupture in the setting of blunt scrotal trauma but it has been poorly studied in the setting of scrotal gunshot wounds. Our objective was to determine the accuracy of scrotal ultrasound to identify testicular rupture following a scrotal gunshot wound. MATERIALS AND METHODS: We retrospectively reviewed the records of patients with a scrotal gunshot wound from 2003 to 2014 in whom preoperative ultrasound was done prior to scrotal exploration. A heterogeneous echo pattern of testicular parenchyma with contour loss was considered a positive examination for testicular rupture. Patients underwent scrotal exploration within 24 hours of presentation. The sensitivity and specificity of ultrasound were estimated and compared to operative findings. ROC curve analysis was done. RESULTS: Of 75 patients who sustained a scrotal gunshot wound ultrasound was positive in 30 and negative in 45. No ultrasound revealed bilateral injuries. Scrotal exploration demonstrated a total of 40 testicular ruptures in 35 patients, of which 30 testicles were salvaged. Ten orchiectomies were performed. The sensitivity and specificity of ultrasound were 60% and 95%, respectively, with 16 missed injuries and 6 false-positive findings. Positive predictive value was 80% and negative predictive value was 87%. The ROC AUC was 0.79. In 6 of the 16 missed injuries there was an ipsilateral hematocele or hematoma. CONCLUSIONS: The sensitivity of scrotal ultrasound is limited for evaluating testicular rupture after a scrotal gunshot wound. Large coincident hematoceles or hematomas may obscure the diagnosis of testicular rupture. Negative ultrasound should not preclude scrotal exploration after a scrotal gunshot wound is sustained.

[Therapeutic management of blunt testicular trauma]. / Therapiemanagement des stumpfen Hodentraumas.

Testicular trauma is a rare emergency. While penetrating injuries need surgical revision, blunt injuries may be treated conservatively. However, in case of testicular rupture early surgical intervention increases the chance of testicular preservation. Therefore, a meticulous urological diagnosis is important to avoid complications and to reduce rates of secondary orchiectomy.

[Seminal vesiculoscopy: Past, status quo, and prospects].

Seminal vesiculoscopy is a new technology in uro-andrology developed in recent 10 years, which is a set of clinical operational techniques for observing the ejaculatory duct, seminal vesicle, ampullar region of the vas deferens and their surrounding structure, determining the cause, location and degree of the disease, and accomplishing such treatment procedures as irrigation, resection, incision, fulguration, hemostasis, expansion, drainage, and removal of hematocele, stones or obstruction in the distal seminal duct region. Therefore, it is not only an etiologically diagnostic technique, but also a minimally invasive surgical approach to the management of common diseases of the distal seminal duct region. Seminal vesiculoscopy has irreplaceable advantages of safety, effectiveness, minimal invasiveness, rapid recovery, and few complications.

Perforated Meckel's diverticulum presenting as a hematocele on scrotal sonography.

Hemorrhage from ectopic gastric mucosa is the most common presenting symptom of Meckel's diverticulum. Diverticular perforation, although rare, is a potentially life-threatening complication. Various imaging modalities can aid in the preoperative detection of Meckel's diverticulum. We report the sonographic findings of a hematocele as the heralding sequela of a perforated Meckel's diverticulum in an 11-month-old boy.

Scrotal migration of a ventriculoperitoneal shunt: a case report and review of literature.

Ventriculoperitoneal (VP) shunt insertion may be associated with migration into the abdominal wall, gastrointestinal tract, bladder, vagina, scrotum, and mediastinum. Migration of the VP shunt into the scrotum has been rarely reported. We present a 1 year old boy with cerebrospinal fluid hydrocele due to the migration of a VP shunt catheter into the right side scrotum.

A novel technique for repair of testicular rupture after blunt trauma.

OBJECTIVE: To present a simple technique for the repair of a ruptured testis after blunt trauma when extruded but viable testicular tissue prevents closure of the testicular capsule during surgical exploration. Preservation of viable testicular tissue is important because the risk of impaired fertility and hormone function is minimized. METHODS: A 25-year-old male sustained a ruptured right testis confirmed by ultrasound. Testicular exploration was performed and hematoma evacuated. Extruded but viable testicular tissue was identified and preserved. The free edges of parietal tunica vaginalis was used to create a "neocapsule" around the testis and extruded tissue. RESULTS: There were no postoperative complications. Follow-up Doppler ultrasound scan at 3 months showed a viable testis with no atrophic changes. CONCLUSIONS: This technique avoids the loss of extruded but viable testicular tissue and may reduce the risk of impaired fertility and hormone function, without compromising the goals of scrotal exploration.

Report of 4 cases of testicular rupture in adolescent boys secondary to sports-related trauma.

Testicular rupture is a rare entity in children and adolescents. This is due to the smaller size of the testicles in these patients, the well-protected location of the testicles, and the high degree of mobility of these organs. We present 4 cases of testicular rupture occurring in preadolescent and adolescent boys over an 11-month period in a tertiary care pediatric emergency department.

Accuracy of ultrasonography in diagnosis of testicular rupture after blunt scrotal trauma.

OBJECTIVES: The aim of this study is to determine the accuracy of ultrasonography for the diagnosis of testis rupture after scrotal trauma and its sensitivity and specificity for testis rupture, tunica albuginea breach, testicular hematoma, testis avulsion, epididymis injuries, and hematocele. METHODS: Between 1996 and 2006, 33 patients underwent surgical exploration for blunt scrotal trauma. All these patients had an emergency scrotal ultrasonography with the use of a 7.5 or 10 MHz linear transducer. Ultrasonographic findings were compared with surgical findings to calculate sensitivity and specificity of ultrasonography for each type of lesion. RESULTS: Of 33 patients, 16 presented a testis rupture. Testis rupture was in all cases suspected ultrasonographically by the loss of contour of the testis and heterogeneous parenchyma. Tunica albuginea breach was visualized in only 8 patients. Sensitivity and specificity of ultrasound for testis rupture were 100% and 65%, respectively. Moreover, ultrasonography allowed diagnosis of hematocele (sensitivity: 87% and specificity: 89%), testicular hematoma (sensitivity: 71%, specificity: 77%), and testis avulsion (sensitivity: 100%, specificity: 97%). Ultrasonography results for epididymis injuries were poor. On 7 patients, 3 epididymis lesions were misdiagnosed by ultrasound examination. CONCLUSIONS: Ultrasonography can distinguish various scrotal injuries. Testicular rupture is probably the most severe injury that needs early surgical treatment to improve testis salvage rate. In our work, ultrasonography is highly sensitive in the diagnosis of testis rupture and can provide information on the scrotal contents integrity that can help the physician to determine the optimal treatment.

[Chronic calcified hematocele. Case report]. / Hematocele crónico calcificado. A proposito de un caso.

OBJECTIVE: Chronic hematoceles are rare scrotal masses. Most of them include trauma, torsion, tumor, and surgery as possible causes. We describe the case of an old diabetic patient, who is attended for presenting a marked increase in size of the right hemiescrotum and pain. METHODS: We described computed tomography and sonographic findings. RESULTS/CONCLUSIONS: Frequently, a varicocele is an associated finding. Presumibly, minor trauma results in rupture of dilated vessels. In sonographic exploration, they have a more complex heterogeneous appearance with echogenic debris and septations. Most hematoceles spontaneously resolve with conservative therapy.

[Scrotal ultrasonography. Part I: common non-cancerous pathologies]. / Echographie scrotale. Partie I: Pathologies non tumorales courantes.

Pathological processes of the scrotum are very numerous. They are composed by few common well known diseases and a large spectrum of rare lesions. The testis may be involved by some systemic diseases. Ultrasound is the main modality for scrotal imaging and complementary to clinical evaluation. When a tumoral process is suspected, surgery is required to confirm the diagnosis and provide histology. The role of MR remains under evaluation.

Scrotal hematocele as an unusual presentation of blunt abdominal trauma in three male infants.

Three infants presented with bluish discoloration and swelling of the scrotum with no history of scrotal trauma. Sonography revealed unilateral hematoceles in 2 cases and bilateral hematoceles in the third. All 3 infants had intact testes. The communicating hematoceles were the result of hemoperitoneum due to splanchnic hematoma.

[Vaginal ultrasound in ovarian pregnancy]. / Vaginosonographie bei ovarieller Gravidität.

A 34-year-old woman had a serum hCG level of 4596 mIU/mL on cycle day 48 and an empty uterus with an IUD in situ. Transvaginal sonography showed a 20 mm ring-like thick-walled hyperechogenic structure within the right ovary. The echogenic ring was surrounded by irregular, hypoechogenic structures suggestive of an ovarian pregnancy with periluteal haemorrhage and blood clots. The ruptured cystic ovarian pregnancy and the corpus luteum were removed by laparoscopy. Histopathology showed isolated chorionic villi within haemorrhagic areas in the vicinity of the corpus luteum. Transvaginal sonography is of diagnostic value in differentiating an ovarian pregnancy from a tubal ectopic pregnancy.

Late complications after systemic methotrexate treatment of unruptured ectopic pregnancies: a report of three cases.

BACKGROUND: The use of methotrexate (MTX) by systemic administration in the treatment of unruptured ectopic pregnancy has been reported as a safe and effective method. CASES: We report three cases (one hematosalpinx and two pelvic hematocoeles) of complications after the use of MTX in the treatment of unruptured ectopic pregnancies. All three cases came to our observation for pelvic pain, abnormal bleeding and a pelvic mass after an interval of 3-5 months, subsequent to the disappearance of symptoms and normalization of serum human chorionic gonadotropin beta-subunit (beta-hCG) levels. CONCLUSIONS: These findings suggest that: (a) such complications should be considered before selecting the mode of treatment for ectopic pregnancy; and (b) that an early ultrasonographic control should be performed after MTX treatment even when the decline in beta-hCG levels suggests a successful resolution. This would permit an early diagnosis of these late complications.

[Our experience concerning scrotal traumatology]. / La nostra esperienza sulla traumatologia scrotale.

The Authors present their experience on 24 blunt scrotal traumas observed since January 1991. They underline the importance of an ecographic scanning that enables a precise evaluation of the traumatic event. Patients that present positive ultrasonic findings are promptly operated thus permitting bleeding and infection control. In this way gonadic function is restored and hospital care reduced. The diagnostic approach is presented, cases reported and results discussed. After a review of the literature on the topic they stress the role of Eco-Color-Doppler examination in scrotal blunt trauma for the intrinsic characteristics of precision, rapidity and non invasivity. This permits a nosologic evaluation of all types of blunt trauma and selects, for surgery, only those patients with a well definied diagnosis.

Fibrous pseudotumor of the tunica vaginalis testis: imaging appearance.

Fibrous pseudotumor is a benign paratesticular tumor that typically presents as a painless mass of the hemiscrotum. Because this tumor can mimic a malignant process, it is usually not diagnosed preoperatively. We describe a case of fibrous pseudotumor of the tunica vaginalis, demonstrating the ultrasound and magnetic resonance image (MRI) appearance with pathologic correlation.