Role of Ultrasonography for Testicular Injuries in Penetrating Scrotal Trauma

OBJECTIVE To review our 12-year experience with penetrating scrotal trauma in civilians and to evaluate the diagnostic utility of scrotal ultrasound prior to operative intervention. MATERIALS AND METHODS We retrospectively studied all patients who had sustained penetrating scrotal trauma between 2002 and 2014. Charts were reviewed for demographic data, mechanism of injury, scrotal ultrasound findings, patient treatment, and outcomes. The sensitivity, specificity, negative predictive value, and positive predictive value of scrotal ultrasound in relation to scrotal exploration findings were calculated. RESULTS We reviewed the charts of 91 patients who had sustained penetrating scrotal injuries between 2002 and 2012. A total of 28 charts were excluded due to death from other injuries or incomplete information. Of the remaining 63 patients, 25 (40%) underwent immediate surgical intervention whereas 38 (60%) underwent scrotal ultrasound. Sixteen patients had a positive ultrasound, of which 12 (80%) were found to have testicular injuries upon scrotal exploration. Of the 22 patients with a negative ultrasound, 14 were managed expectantly and 8 underwent exploration, all of which (100%) were negative for testicular injury. Of the 14 patients who were managed with observation, none had developed complications of an inaccurate or delayed diagnosis. Scrotal ultrasound sensitivity and specificity in this series were 100% and 84.6%, respectively. CONCLUSION In the setting of penetrating trauma. a well-performed scrotal ultrasound is highly sensitive and specific for scrotal content injuries, making nonoperative management an appropriate treatment option in otherwise stable patients. (C) 2016 Elsevier Inc.