The ultrasonographic features in 26 cases of blunt testicular trauma were reviewed. Ultrasonography diagnosed correctly in 11 surgically proven cases of testicular rupture. There were three false-positive cases, two with a large scrotal hematocele and one with epididymis rupture. there were no false-negative cases. The sensitivity and specificity of ultrasonographic diagnosis were 100% and 80% respectively. The positive and negative predictive values were 78. 6% and 100% respectively. Therefore, the negative diagnosis by ultrasonography can warrant conservative therapy.
Diagnosis ; Epididymis ; Hematocele ; Male ; Rupture ; Sensitivity and Specificity ; Ultrasonography*

BACKGROUND: Testicular rupture is a surgical emergency which command immediate repair. If surgery is delayed, a hematoma causes severe pain and loss of spermatogenesis as well as hormonal functions. Scrotal ultrasonography has been helpful in early diagnosis of testicular rupture. But disadvantage of ultrasonography include a relatively low signal-to-noise level, tissue nonspecificity, lack of contrast media, a small field of view, and dependence on the operators skill and the patients physique. Also the diagnostic accuracy, sensitivity or specificity of scrotal ultrasonography was variable in regard to authors. And so, a diagnostic accuracy of scrotal ultrasonography was evaluated in scrotal trauma. METHODS: We reviewed 38 patients of scrotal trauma from May, 1994 to March, 1998. 6 patients were treated conservatively following scrotal sonography and 10 patients treated only surgical exploration without ultrasonography. Surgical exploration was performed in 22 case, which were evaluated by ultrasound before surgical treatment. In a such 22 cases, diagnostic accuracy of scrotal ultrasonography was evaluated. RESULTS: We compared ultrasound before treatment with surgical exploration finding in a such 22 cases. The ultrasonographic features in 7(31.8%) out of 22 cases, which showed testicular ruptured, but surgical exploration revealed testicular rupture in 5 and epididymal rupture in 1, simple hematocele in 1. In 15(68.2%) out of 22 cases the simple hematocele was diagnosed by ultrasonography, but surgical finding feature in of the 7 cases revealed testicular rupture, epididymal rupture in 1, simple hematocele in 7. The sensitivity and specificity for the ultrasonography are 42.9% and 87.5%, and the positive and negative predictive values are 86.5% and 46.7%, respectively. Ultrasonography is low sensitive in identifying testicular rupture. CONCLUSION: Ultrasonography include a relatively low signal-to-noise level, tissue nonspecificity, lack of contrast media, a small field of view, and dependence on the operators skill and the patients physique. Therefore, early surgical exploration for saving the testis should be performed that sonographically by seeing hypoehoic peripheral lesions and disappearance of normal ovoid form of testis, hematocele in scrotal sac.
Contrast Media ; Early Diagnosis ; Emergencies ; Hematocele ; Hematoma ; Humans ; Male ; Rupture ; Sensitivity and Specificity ; Spermatogenesis ; Testis ; Ultrasonography*

A clinical observation was made on 27 cases of injuries of external genitalia of the in-patient in the department of uro1ogy, Capital Armed Forces General Hospital during the period from January. 1977 to December, 1978. The results were as follows: 1) The rate of genitourinary injuries accounted for 19.5 per cent to the total admission patients during Z years. Twenty-nine per cent of all injuries were in patients with injuries of externa1 genitalia and they accounted for 5. 7 per cent to the total admission. 2) Most favorable age was in from 20 to 30 years for 96 per cent. 3) Kick or blow was the most frequent cause of the injuries (66.7%) and the next iatrogenic. Straddle fa11, automobile accident. gun shot and suicidal attempt were listed not less frequently. 4) Majority of injuries of external genitalia involved scrotum and testes. 5) 5cases (18.5%) of injuries of external genitalia were associated with injuries of other organs, especially with urethral injuries in 3 cases. 6) Surgical treatment was done on 20 of 27 cases of injuries of external genitalia and conservative treatment was done on others. In all scrotal explorations, drainage and compression dressing were utilized. These were resulted in a decrease of edema and hematoma formation. 7) Complications, such as chronic nonspecific epididymitis, hydrocele or hematocele etc., resulted from conservative treatment that had been done in 5 (75%) of 7 cases.
Arm ; Automobiles ; Bandages ; Drainage ; Edema ; Epididymitis ; Genitalia* ; Hematocele ; Hematoma ; Hospitals, General ; Humans ; Male ; Scrotum ; Testis

Closed chest trauma occasionally results in the development of traumatic lung cyst or pulmonary hematocele.Radiologically, this latter rarely mimicks posterior mediastinal mass, which can cause unnecessary surgicalresection, We encountered two cases of pulmonary hematocele simulating posterior mediastinal mass. Multiplicity ofthe lesion, fracture of surrounding bony structure, decrease of mass size at follow-up examination, an acute anglebetween the mass and chest wall, peripheral rim enhancement of the mass, as seen on CT scans, or characteristicsignal intensity suggesting hematoma, as seen on MR images, helped differentiate pulmonary hematocele fromposterior mediastinal mass.
Follow-Up Studies ; Hematocele* ; Hematoma ; Lung ; Male ; Thoracic Wall ; Thorax ; Tomography, X-Ray Computed

To determine the value of ultrasonography for the diagnosis of testicular rapture due to blunt trauma, we reviewed 69 patients of blunt scrotal trauma, which were evaluated by ultrasound before treatment. Thirty patients were managed conservatively, of which 3 cases were explored lately due to persistent pain or mass, and 39 explored immediately. Of the 30 patients treated conservatively the injury was resolved in 27. Surgical exploration of the 42 cases revealed testicular rupture in 29 and simple hematocele in 13. Analysis of the 29 cases with testicular rupture demonstrated that orchiectomy rates were 20% in early exploration and 53% in delayed exploration. in the 27 cases the testicular rupture was correctly diagnosed by ultrasonography, and there were 4 false-positive and 2 false-negative diagnoses of rupture. The specificity and sensitivity for the diagnosis of testicular rupture are 70% and 93%, and the positive and negative predictive values are 87% and 82%, respectively. Ultrasonography used in conjunction with a thorough physical examination is highly sensitive in identifying testicular rupture, and can provide objective information supporting the need for early surgical exploration in patients with blunt scrotal trauma.
Diagnosis ; Hematocele ; Humans ; Male ; Orchiectomy ; Physical Examination ; Rupture* ; Sensitivity and Specificity ; Ultrasonography*

This article presents changes in the testis and epididymis after a vasectomy as well as illustrate the various vasectomy-related abnormalities on sonographic examination. In patients with scrotal pain after a recent vasectomy, the sonographic findings include enlargement of the epididymis with an ill-defined border and hematoma, or a hematocele surrounding the testis and epididymis. Vasectomy-related changes are likely attributable to post-vasectomy obstructive changes and increased intraluminal pressure in the efferent ducts, epididymides, and vas deferens. The typical sonographic changes after a vasectomy primarily include epididymal thickening and epididymal tubular ectasia with diminished blood flow in the epididymis. Spermatoceles display various sonographic findings, from multilocular cysts, to cystic lesions with low-echo levels, to a solid mass. Sperm granulomas appear as well-circumscribed heterogeneous masses on sonography and are commonly found at the epididymis or the ends of the severed vas deferens. The hydrocele, varicocele, epididymal cysts, and testicular cysts can also be associated; however, these findings are nonspecific. When radiologists encounter abnormalities of the scrotum, it would be useful to obtain a history of vasectomy to enable a correct diagnosis. Understanding of sonographic features of vasectomy-related changes and abnormalities is essential for correct diagnosis and proper management.
Dilatation, Pathologic ; Epididymis ; Granuloma ; Hematocele ; Hematoma ; Humans ; Male ; Scrotum ; Spermatocele ; Spermatozoa ; Testis ; Varicocele ; Vas Deferens ; Vasectomy

Ultrasound has been shown to be effective in the diagnosis of a variety of scrotal abnormalities. We performed ultrasound of the scrotum in 22 patients with conventional 3.75 MHz real time scanner. There were 6 intratesticular lesions-3 spermatic cord torsion, 1 malignant lymphoma,1 leukemic infiltration and l yolk sac tumor. Extratesticular abnormalities included acute epididymitis, chronic epididymitis, Tb epididymitis, epididymal cyst peritesticular abscess, spermatocele, hematocele and infected hydrocele. Sonography accurately distinguished between testicular and extratesticular masses in all cases and pathologic correlation were obtained for operated scrotal lesions. The results were as follows. l. Out of 22 patients, chief complaints of 9 were acute sctotum and 13 were scrotal mass. 2. Of 9 cases with acute scrotum, ultrasonography detected 5 cases with acute epididymitis, 3 cases with spermatic cord torsion and l case with hematocele. 3. Of 13 cases with scrotal mass, surgical exploration was done in 1O cases. 9 cases were confirmed same as post-operative finding (90% accuracy). One case with hematoma was confirmed to infected hydrocele after operation. 4. Ultrasound characteristics of 22 patients were classified as follows. 13 were hypoechoic, 4 were anechoic, 3 were mixed and 2 were hyperechoic.
Abscess ; Diagnosis ; Endodermal Sinus Tumor ; Epididymitis ; Hematocele ; Hematoma ; Humans ; Leukemic Infiltration ; Male ; Scrotum ; Spermatic Cord Torsion ; Spermatocele ; Ultrasonography

Early diagnosis and prompt surgical exploration in blunt scrotal trauma is mandatory to save the affected testis and decrease the morbidity. We reviewed 25 cases of blunt scrotal trauma evaluated with ultrasonography as a result of violence, sports, traffic accident from March, 1989 to February, 1997. The right side was affected slightly more often than the left side. Sonography identified scrotal hematocele in 21 out of 25 cases and 4 cases had no evidence of scrotal hematocele. In 7 out of 21 cases with scrotal hematocele, ultrasonography showed rupture sites of the tunica albuginea (5) and intratesticular radiolucency displacing the normal echogenicity of the testicular parenchyina (2). In the other 14 cases ultrasonography showed no evidence of rupture. In 4 cases without scrotal hematocele, one was diagnosed as traumatic orchitis due to testicular enlargement and two had focal intratesticular hematoma so that these cases didn't undergo explorations. And 1 case had rupture of the tonics albuginea combined with testicular torsion at the time of exploration. Surgical explorations were performed in 19 (76.0%) out of 25 cases, who showed definitive rupture sites of the tunica albiginea (8), large hematoma and/or persistent severe pain without being seen rupture sites of the tunica albuginea (11) on ultrasonography and their operative methods were orchiectomy in 9 (36.0%), evacuation of the hematocele in 6 (24%), partial orchiectomy in 2 (8.0%) and simple closure of the tunica in 2 cases (8.0%). There was a direct relationship between salvageability and early surgery. In 13 out of 19 cases who underwent explorations within 3 days after trauma, the surgical managements comprised evacuation of the hematocele in 5 (38.5%), orchiectomy in 4 (30.8%), partial orchiectomy in 2 (15.4%), and simple closure of the tunica in 2 cases (IS.4%). However, in 6 cases who underwent explorations 4 days later after trauma, the surgical managements comprised orchiectomy in 5 (83.3%) and evacuation of the hematoma in 1 case (16.7%). In comparison with operative findings, 5 of the 14 cases, in which ultrasonography showed large hematocele without rupture of the tunica, had rupture of the tunica. Also, 7 cases, in which ultrasonography showed rupture of the tunica, all had rupture of the tonics. All patients with a history of blunt scrotal trauma, followed by a large hematocele without lure of the tunica or severely distorted testis on ultrasonography should have early surgical exploration to exclude injury to the testicle. A delayed treatment decreases the salvage rate due complications, such as ischemic necrosis and severe inflammatory reaction.
Accidents, Traffic ; Early Diagnosis ; Hematocele ; Hematoma ; Humans ; Male ; Necrosis ; Orchiectomy ; Orchitis ; Rupture ; Spermatic Cord Torsion ; Sports ; Testis ; Ultrasonography ; Violence

OBJECTIVETo evaluate the effect of laparoscopic spleen-preserving operation for traumatic spleen rupture.

METHODSFrom 1997 to 2003, 15 cases of traumatic spleen rupture were treated with laparoscopic spleen-preserving operation in our hospital. Nine cases had operation history in the middle and lower abdomen. ZT binding, electrocoagulation, fibrin and gelfoam tamping and suture repairing were used in patients with spleen rupture of grade I and grade II. Combined hemostasis was used for spleen rupture of grade III.

RESULTSAll patients did not need laparotomy during operation and no postoperative bleeding occurred. They were all cured and followed up for 3-12 months. Determination of immunoglobulins after operation showed normal, and spleen ultrasonic examination, CT and body state evaluations were all satisfactory.

CONCLUSIONSLaparoscopy in the management of spleen trauma can be used in confirmed diagnosis and in determining the degree of spleen injury. For patients with stable vital signs laparoscopic spleen-preserving operation can be used. The laparoscopic spleen-preserving operation is safe in the treatment of traumatic spleen rupture.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Hematocele ; etiology ; Humans ; Laparoscopy ; adverse effects ; methods ; Length of Stay ; Male ; Middle Aged ; Splenic Rupture ; surgery ; Treatment Outcome

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.
Calculi ; diagnostic imaging ; surgery ; Drainage ; Ejaculatory Ducts ; diagnostic imaging ; Endoscopy ; methods ; Genital Diseases, Male ; diagnostic imaging ; surgery ; Hematocele ; diagnostic imaging ; surgery ; Humans ; Male ; Minimally Invasive Surgical Procedures ; Seminal Vesicles ; diagnostic imaging ; Vas Deferens ; diagnostic imaging