Delayed Diagnosis and Treatment of Traumatic Testicular Dislocation: A Case Report and Literature Review

Traumatic testicular dislocation is a rare complication secondary to different kinds of accidents. A 61-year-old man, who was injured by wall collapse and was diagnosed as pelvic fracture and posterior urethral rupture 5 months ago, came to the urologic department to seek urethral reconstruction. However, thorough physical examination and imaging examination confirmed a round mass in the right inguinal region and an empty right scrotum, which support diagnosis of testicular dislocation. The patient did not take the initiative to complain about that because he thought the right testis had been destroyed by the accident already. So the patient underwent fiber cystourethroscopy, urethral reconstruction, and orchiopexy. No testicular atrophy was confirmed at follow-up. We reviewed previous reports about traumatic testicular dislocation and analyzed the cause of delayed diagnosis.

Staged laparoscopic traction orchiopexy by Shehata: first experience, technical features, results

Purpose – to evaluate the results of proposed method of staged laparoscopic traction orchiopexy by Shehata on the basis of our own experience in the treatment of children with abdominal cryptorchidism. Materials and methods. During the period 2019–2021, 18 boys aged 9 months – 4 years were operated with staged laparoscopic traction orchiopexy procedure. Right unilateral abdominal cryptorchidism observed in 10 children, left – in 6, bilateral – in 2. Indications for the procedure were cases of intra-abdominal testicular retention with short vessels. Results. Pelvic and iliac retentions observed in 44% of cases. In 22% testicles were located close to the inner inguinal ring, in 33% the distance between testicle and inguinal canal opening reached 3–4 cm. The 2nd stage was carried out in 3 months. Successful orchiopexy was conducted then in 94% cases without any vascular tension. No cases of testicular dislocation or atrophy have been reported. The volume of operated testicles was smaller than the healthy ones in 78% cases objectively. Conclusions. The experience of Shehata operation showed good effect of the method for correction of abdominal cryptorchidism. Indications for staged laparoscopic traction orchiopexy are abdominal undescended testicles with insufficient length of vessels. The technique allows to achieve effective elongation of spermatic vessels in a short period of time and to minimize the risks of atrophy, compared with the 2-stage Fowler–Stephens operation. This study was conducted in accordance with the principles of the Helsinki Declaration. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed parental agreement was obtained for the research. No conflict of interests was declared by the authors. Key words: abdominal cryptorchidism, orchiopexy, staged treatment, Shehata procedure.

Rare case of traumatic bilateral testicular dislocation

Bilateral traumatic testicular dislocation is an uncommon condition and usually occurs after a direct impact on the scrotum. Herein, we report this as a rare case of a 21-year-old man presenting with bilateral traumatic dislocation of testes into the inguinal canal following a motorcycle accident. Imaging studies ruled out any other associated injuries. The patient underwent bilateral orchidopexy without any further complications.

Relato de caso: Luxação testicular por trauma

Resumo: Introdução: A luxação testicular após trauma perineal contuso é um evento raro, que ocorre principalmente em acidentes de motocicleta e traumas por montaria em cavalos. Devido à sua raridade e por estar geralmente associada com outras lesões graves, pode haver demora em seu diagnóstico e tratamento. O diagnóstico pode ser estabelecido no exame físico com a ausência de testículo no saco escrotal. Tomografia computadorizada (TC) e ultrassom com doppler também são ferramentas úteis no diagnóstico dessa condição. O tratamento pode ser realizado com redução manual ou cirurgia. Desenvolvimento: MJFS, masculino, vítima de acidente motociclístico com trauma contuso de pelve e membros inferiores. Durante a avaliação inicial foi constatada fratura de membro inferior esquerdo e disjunção da sínfise púbica. O paciente foi submetido a alinhamento do membro inferior e optou-se pelo tratamento conservador da disjunção púbica. Após um mês do acidente o paciente relata dor pélvica à esquerda. Ao exame físico foi constatada a ausência do testículo na bolsa escrotal esquerda com massa palpável dolorosa na região pélvica esquerda. Foi realizada então uma TC de pelve que mostrou o testículo esquerdo ectópico em tecido subcutâneo externo ao canal inguinal esquerdo. MJFS foi submetido à cirurgia para liberação e inserção do testículo na bolsa escrotal. O procedimento se deu sem intercorrências e o paciente recebeu alta em bom estado geral. Considerações finais: A luxação testicular é um evento facilmente detectado em exame físico. Pode provocar complicações como ruptura testicular, atrofia testicular, malignidade futura, infertilidade e disfunção endócrina, além de poder se associar com outras lesões como as de trato urinário. Dessa forma, é importante estar atento para sua ocorrência diante de um trauma pélvico. Abstract: Introduction: Testicular dislocation after blunt perineal trauma is a rare event, which occurs mainly in motorcycle accidents and horse riding trauma. Due to its rarity and because it is usually associated with other serious injuries, there may be a delay in its diagnosis and treatment. The diagnosis can be established on physical examination with the absence of a testicle in the scrotum. Computed tomography and doppler ultrasound are also useful tools in the diagnosis of this condition. Treatment can be performed with manual reduction or surgery. Development: MJFS, male, victim of a motorcycle crash suffered a hip and lower limb contusion. During the initial evaluation, fracture of the left lower limb and a pubic disjunction were observed. The patient underwent lower limb alignment and conservative treatment of the public disjunction. After one month of the accident, the patient referred left pelvic pain. The physical examination revealed absence of the testicle in the left scrotum and a bulge in the left pelvic area, with tenderness. Then, a computed tomography (CT) scan was performed, which showed a left ectopic testicle in the subcutaneous tissue external to the left inguinal canal. MJFS underwent surgery to release and insert the testis into the scrotum. The procedure was uneventful and the patient was discharged without major complaints. Final considerations: Testicular dislocation is an easily detected event on physical examination. It can cause complications such as testicular rupture, testicular atrophy, future malignancy, infertility and endocrine dysfunction, in addition to being associated with other injuries such as urinary tract injuries. Thus, it is important to be aware of its occurrence in the face of a pelvic trauma.

Pelvic Fracture Associated with Intrapelvic Dislocation of Testis

Introduction: Intrapelvic testicular dislocation is rare injury with the possibility of missed or delayed diagnosis. Timely diagnosis of intrapelvic testicular dislocation can prevent iatrogenic testicular injury during surgery and its long-term sequel. Case Report: A 30-year-old male after motorbike accident presented with a pelvic injury with intrapelvic dislocation of testis. Timely and appropriate diagnosis of injuries, specially intrapelvic dislocation of testis, required early orchidopexy and open reduction and internal fixation of the anterior column, leading to excellent outcome. Conclusion: In cases of polytrauma and pelvic injuries specially motorbike accidents, testicular dislocation should be ruled out before definitive surgery. Adequate communication and co-ordination between orthopedic surgeon, radiologist, and urologist can lead to excellent outcomes. Keywords: Testicular dislocation, ectopic testicular dislocation, intrapelvic dislocation of testis.

Managing traumatic testicular dislocations: what we know after two centuries

Traumatic testicular dislocation (TTD) is a rare consequence of blunt scrotal trauma. A 21-year old gentleman presented with inguinal pain following a motorcycle accident and physical examination revealed absence of both testes within a well-formed scrotal sac with bilateral inguinal swellings. Ultrasonography confirmed viability and location of the testes at the superficial inguinal pouch. He underwent emergent surgical reduction with orchidopexy and was discharged the next day. No evidence of testicular dysfunction or atrophy was noted at follow-up. We reviewed reports of TTDs reported in English over the last two centuries and discuss its occurrence, evolution and management.

A rare case of testicular dislocation with inguinal hernia as a delayed presentation after scrotal trauma

Testis can be damaged either by blunt or penetrating trauma. Traumatic dislocation of testis is rare sequelae of scrotal trauma. Patients usually present at the time of injury and diagnosis is usually made on emergent basis. However, delayed or missed diagnosis may occur as scrotal injury may be overlooked in the presence of other associated injuries or due to lack of awareness of its possible occurrence. In this article, we report a case of 60 years old gentleman who presented with inguinal hernia with empty left hemiscrotum with history of blunt injury to scrotum 15 years back. The peculiarity of case lies in the fact that the dislocation of testis was diagnosed 15 years after trauma and the displaced testis was found to be atrophic.