Scrotal Trauma: An Underestimated Urological Emergency, Clinical, Ultrasonographic, and Surgical Analysis
Bjane O, Tmiri A, Mehdi I, Deghdagh Y, Kbirou A, Moataz A, Dakir M, Debbagh A and Aboutaieb R
Abstract
Introduction: Blunt scrotal trauma is a urological emergency that is increasingly encountered, particularly in adolescents and young adults. Diagnosis may be challenging due to difficulties in obtaining an accurate and complete assessment of the lesions, and management often requires choosing between conservative medical treatment and surgery, which may sometimes be radical. This study aimed to identify the main etiological factors, describe clinical and paraclinical features, evaluate therapeutic strategies, and determine prognostic elements to optimize testicular preservation.
Materials And Methods: We conducted a retrospective study including 34 male patients presenting with trauma to the external genital organs, managed in the urology department of CHU Ibn Rochd, Casablanca, from March 2021 to March 2025. Collected data included injury mechanisms, clinical presentation, results of complementary examinations (particularly scrotal ultrasound), therapeutic approaches (medical and surgical), and patient outcomes.
Results: The mean patient age was 27 years (range 15–45). Blunt trauma accounted for the majority of cases, most frequently resulting from physical assaults (75%), followed by road traffic accidents. The most common symptoms were scrotal pain and swelling. Scrotal ultrasonography, performed in 75% of cases, revealed scrotal hematoma in 17 patients and tunica albuginea rupture in 6 patients. All patients underwent surgical exploration. Procedures included testicular salvage with resection of extruded testicular pulp and tunica albuginea repair (4 cases), evacuation of testicular hematoma (2 cases), management of hematocele with drainage, and orchiectomy in one case of complete testicular necrosis. Early postoperative outcomes were favorable, and overall evolution was positive in 82% of patients. Two late complications were noted: testicular atrophy and persistent testicular pain.
Discussion: Our findings confirm the rarity but potential severity of scrotal trauma, with young adults being the most frequently affected population. Because physical examination is often limited by pain and edema, scrotal ultrasonography remains the key diagnostic tool. Early surgical exploration significantly improves testicular preservation and reduces the need for orchiectomy, consistent with existing literature. Long-term complications such as atrophy or chronic pain may occur, highlighting the need for adequate follow-up.
Conclusion: Scrotal trauma requires prompt and appropriate management to improve functional outcomes and reduce long-term sequelae. Scrotal ultrasound and early surgical exploration play essential roles in optimizing testicular preservation. Larger multicenter studies are warranted to refine diagnostic and therapeutic strategies.
