Buckley Jill C, McAninch Jack W
Department of Urology, University of California School of Medicine and Urology Service, San Francisco General Hospital, San Francisco, California, USA.
J Urol. 2006 Jan;175(1):175-8. doi: 10.1016/S0022-5347(05)00048-0.
We determined the use of scrotal ultrasonography in the initial diagnosis and management of testicular injuries due to blunt scrotal trauma.
We performed a retrospective review of 65 patients presenting to our Emergency Department with blunt scrotal trauma in the last 25 years. In 47 patients an inconclusive clinical examination prompted scrotal ultrasonography. A heterogeneous echo pattern of the testicular parenchyma with loss of contour definition was the basis for diagnosis of testicular rupture. The sensitivity and specificity of scrotal ultrasonography were determined by comparing this radiographic criterion with definitive intraoperative findings and the need for delayed orchiectomy due to undiagnosed testicular rupture.
Of the 65 patients sustaining blunt scrotal trauma 44 (68%) underwent scrotal exploration, and 30 (46%) of these injuries involved rupture of the tunica albuginea. Among the 47 scrotal ultrasounds performed to supplement a nondiagnostic clinic examination, there were 32 suspected testicular ruptures. Thus, the 2 false-positives resulted in a specificity of 93.5% in those patients explored. No delayed orchiectomies were performed for missed testicular ruptures, resulting in 100% sensitivity. The majority of testicular ruptures were salvaged (83%), with only 5 of the 30 (17%) requiring orchiectomy (4 of these patients had delayed presentation greater than 48 hours).
Scrotal ultrasonography, with the single radiographic finding of a heterogeneous echo pattern of the testicular parenchyma with loss of contour definition, is highly sensitive and specific in the diagnosis of testicular rupture in an otherwise equivocal scrotal examination. Accurate diagnosis and prompt repair led to a salvage rate for testicular rupture specifically of 83% and overall of 92%, with preservation of the testicular parenchyma and hormonal function, and avoidance of the delayed complications of chronic pain, atrophy and orchiectomy associated with missed testicular rupture.
我们确定了阴囊超声在钝性阴囊外伤所致睾丸损伤的初始诊断及处理中的应用价值。
我们对过去25年中因钝性阴囊外伤就诊于我院急诊科的65例患者进行了回顾性研究。47例患者因临床检查结果不明确而行阴囊超声检查。睾丸实质回声不均匀且轮廓不清是诊断睾丸破裂的依据。通过将该影像学标准与术中确诊结果以及因未诊断出的睾丸破裂而需延迟行睾丸切除术的情况进行比较，来确定阴囊超声的敏感性和特异性。
在65例钝性阴囊外伤患者中，44例（68%）接受了阴囊探查，其中30例（46%）损伤累及白膜破裂。在为补充非诊断性临床检查而进行的47例阴囊超声检查中，有32例怀疑睾丸破裂。因此，2例假阳性结果导致在接受探查的患者中特异性为93.5%。没有因漏诊睾丸破裂而进行延迟睾丸切除术，敏感性为100%。大多数睾丸破裂得到了挽救（83%），30例中只有5例（17%）需要行睾丸切除术（其中4例患者就诊延迟超过48小时）。
阴囊超声检查，仅凭睾丸实质回声不均匀且轮廓不清这一影像学表现，在阴囊检查结果不明确的情况下，对睾丸破裂的诊断具有高度敏感性和特异性。准确的诊断和及时的修复使睾丸破裂的挽救率达到83%，总体挽救率为92%，保留了睾丸实质和激素功能，避免了与漏诊睾丸破裂相关的慢性疼痛、萎缩及睾丸切除术等延迟并发症。
