Organ-preserving operation in case of massive testicular rupture

The objective is to present a clinical case of blunt trauma of the scrotum with a massive testicular crush. The presented nosology, methods of diagnosis and surgical treatment is highlighted.Clinical case. Patient, 18 years old, was admitted to the clinic with acute symptoms and complaints of pain and increased size of the right part of the scrotum. Questioning revealed that 48 hours prior the patient received a blunt injury of the scrotum. Ultrasound of the scrotal organs showed that in the right part of the scrotum testicle is not clearly differentiated, in the lower pole hypoechogenic signal is observed, no blood flow was evident using the color Doppler mode, but examination of the upper pole showed weak blood flow, the epididymis was partially differentiated. Hematocele was observed. The diagnosis of injury of the scrotal organs was confirmed, traumatic injury of the right testicle. Emergency surgery was performed: necrotized areas of the lower pole of the testicle were resected, plastic sealing of the upper pole of the right testicle to the epididymis was performed. Postoperative period was free of complications. The patient was discharged on day 6 after the surgery. Control ultrasound after 3 months showed that the right testicle was smaller, its echostructure was homogenous, blood flow in the testicular parenchyma was observed. Hormonal status, blood testosterone levels, ejaculate parameters were normal.Conclusion. The presented clinical observation confirms that organ-sparing interventions for massive crush injury of the testicle with minimal volume of viable tissue are possible but patient’s age and time after injury should be taken into account.