Orchiectomy after testicular trauma in a 45-year-old man: A case report

Abstract

Testicular trauma is a rare but significant condition that can result in severe damage to the testicles. In some cases, when the trauma is extensive and irreparable, orchiectomy, which refers to the surgical removal of one or both testicles, may be necessary. A 45-year-old man experienced testicular trauma as a result of a sporting event. Upon examination, it was determined that the trauma had caused severe damage to the affected testicle, leading to compromised blood supply and persistent pain. The presence of compromised blood supply was assessed through a combination of clinical evaluation and diagnostic imaging (scrotal ultrasound). The imaging findings indicate reduced blood flow to the testicle. Considering alternative treatment options and potential complications, the medical team decided to proceed with orchiectomy. Orchiectomy is a significant surgical procedure performed as a last resort when other treatments are not viable or when complications such as infection or severe pain are present. The decision to perform orchiectomy depends on the extent of the testicular trauma and the patient's overall health. It has implications for fertility and hormone production, with the remaining testicle typically compensating for the functions of the removed testicle. Prompt medical intervention is crucial in evaluating the severity of the injury and determining the appropriate course of treatment. Orchiectomy should be considered when the testicle is extensively damaged and irreparable, making testicular trauma resulting in the need for orchiectomy a complex and challenging situation.

Introduction

Testicular trauma is a relatively uncommon urological emergency that can lead to significant morbidity if not managed promptly and effectively [1]. Testicular trauma, although relatively rare, can occur due to various causes such as sports injuries, accidents, or direct blows to the groin region [2]. In severe cases, where the testicles are extensively damaged and cannot be salvaged, the surgical removal of one or both testicles, known as orchiectomy, may be considered [3]. This article presents a case report of a 45-year-old man who underwent an orchiectomy following testicular trauma, highlighting the importance of prompt medical intervention and discussing the implications of the procedure. The work has been reported in line with the SCARE 2020 Criteria. The SCARE 2020 Criteria is a standardized framework for reporting surgical case reports. It provides a checklist that ensures comprehensive and transparent reporting. The criteria cover essential elements such as title, abstract, introduction, presentation of the case, surgical procedure, postoperative management, discussion, and conclusion. By following the criteria, authors can improve the quality and consistency of their case reports, making them more informative and valuable for readers. The guidelines aim to enhance transparency, completeness, and standardization in case report publications, promoting knowledge dissemination and evidence-based practice in surgery [4].

Presentation of case

A 45-year-old previously healthy man presented to the emergency department with severe scrotal pain and swelling following a blunt injury during a sporting event (Fig. 1). The patient reported immediate pain and swelling in the scrotum after being struck by a hockey stick. On physical examination, the scrotum was grossly swollen, erythematous, and tender. The left testicle was significantly enlarged and indurated compared to the contralateral side. There were no evident signs of external injury or skin lacerations.

Fig. 1.

Testicular trauma.

In the emergency department, the patient underwent a scrotal ultrasound, which revealed a heterogeneous echotexture with areas of disrupted parenchyma in the left testicle, suggestive of testicular rupture. No evidence of associated intratesticular hematoma or hydrocele was noted. Based on the clinical presentation and imaging findings, a diagnosis of testicular trauma was made.

During surgical exploration, the scrotum was opened through a midline scrotal incision. Upon exposure, the left testicle was found to be significantly enlarged, indurated, and grossly abnormal compared to the contralateral side. There were no apparent signs of external injury or skin lacerations.

Upon closer examination, multiple bleeding points were observed on the surface of the left testicle, particularly in the lower pole region. These bleeding points appeared to originate from disrupted blood vessels within the testicular parenchyma. The bleeding was actively oozing, indicating compromised vascular integrity.

Further exploration revealed extensive disruption of the testicular tissue with loss of normal architecture. The affected testicle appeared hemorrhagic and edematous, with areas of parenchymal rupture and focal areas of avascular necrosis. The disrupted testicular tissue had a friable consistency, and no identifiable viable testicular tissue was observed.

In contrast, the right testicle appeared grossly normal with intact tissue architecture, no signs of bleeding, and preserved vascular supply.

In consideration of the severity of the testicular injury, the compromised blood supply, and the absence of salvageable testicular tissue, a decision was made to proceed with complete excision (orchiectomy) of the left testicle. This was done to prevent the potential complications associated with the extensive tissue damage, such as infection or necrosis.

In the initial evaluation, the patient's hormonal status was assessed through blood tests, including measurements of testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) levels (Fig. 2).

Fig. 2.

Orchiectomy.

The initial hormone panel revealed a significant decrease in testosterone levels compared to the reference range for his age. Testosterone, a key hormone responsible for various physiological functions, including libido, bone health, and muscle mass, was found to be below the normal range. The patient's LH and FSH levels were also evaluated to assess the functioning of the hypothalamic-pituitary-gonadal axis.

Due to the loss of one testicle, which serves as a primary source of testosterone production, the patient's hormone levels were indicative of primary hypogonadism. Primary hypogonadism occurs when the testes are unable to produce sufficient testosterone due to damage or removal.

Considering the implications of low testosterone levels, including decreased libido, fatigue, and potential impact on bone density, the patient was started on testosterone replacement therapy (TRT). The goal of TRT was to restore testosterone levels to within the normal range, thus alleviating symptoms and maintaining overall hormonal balance.

Regular monitoring of hormone levels was initiated to ensure appropriate dosing and response to therapy. Follow-up assessments included periodic measurements of testosterone, LH, and FSH levels to guide treatment adjustments and ensure optimal hormone replacement.

Additionally, it is important to note that psychological and emotional support were provided to the patient throughout the process. Adjusting to the physical and hormonal changes after orchiectomy can have significant psychological and emotional impact. Counseling and support services were offered to address any concerns, provide education about the effects of hormonal changes, and help the patient cope with the emotional aspects of the procedure.

The patient's postoperative course was uneventful, with appropriate wound healing and resolution of scrotal swelling. He was discharged on the second postoperative day with instructions for scrotal support and close follow-up. Postoperative counseling regarding potential fertility concerns and the possibility of testosterone replacement therapy was provided. Long-term surveillance for testicular malignancy was also emphasized.

Discussion

Testicular trauma resulting in the need for orchiectomy is a complex and challenging situation for both patients and healthcare professionals. This discussion aims to explore various aspects related to orchiectomy after testicular trauma in a 45-year-old man.

• 1.Severity of Testicular Trauma: The decision to perform an orchiectomy depends on the severity of the testicular trauma. In cases where the testicle is extensively damaged and cannot be salvaged, or if there is a risk of infection or other serious complications, orchiectomy may be necessary. It is crucial for healthcare professionals to carefully assess the extent of the injury and consider alternative treatment options before opting for surgical intervention [5].
• 2.Importance of Prompt Medical Intervention: Testicular trauma requires immediate medical attention. Delayed diagnosis and treatment can lead to long-term complications and negatively impact the patient's overall well-being. Timely intervention not only helps in managing acute pain and minimizing potential complications but also aids in preserving fertility and hormonal balance [6].
• 3.Implications for Fertility and Hormone Production: Orchiectomy has significant implications for fertility and hormone production. In cases where only one testicle is removed, the remaining testicle generally compensates for hormone production and sperm production. However, if both testicles are removed, the patient becomes infertile and requires hormone replacement therapy to maintain appropriate levels of testosterone. Healthcare professionals should provide comprehensive counseling and support to patients to help them understand these implications and address any concerns or emotional distress [7].
• 4.Psychological and Emotional Impact: The psychological and emotional impact of undergoing an orchiectomy should not be overlooked. Losing a testicle can affect body image, self-esteem, and sexual well-being. It is essential for healthcare professionals to provide empathetic care, offer psychological support, and consider appropriate referral to mental health professionals when needed. Open communication and counseling can help patients cope with the emotional aspects of the procedure and adapt to the changes in their body [8].
• 5.Follow-up Care and Rehabilitation: After an orchiectomy, regular follow-up appointments are necessary to monitor the patient's recovery, assess hormone levels, and provide necessary hormone replacement therapy if required. Rehabilitation programs, including physical therapy and support groups, can aid in the patient's physical and emotional recovery. Close collaboration between healthcare professionals and patients is crucial to ensure optimal post-operative care and address any concerns or complications that may arise [9].
• 6.Individualized Approach: Each case of testicular trauma and subsequent orchiectomy is unique, requiring an individualized approach. Factors such as the patient's age, overall health, desire for future fertility, and personal preferences should be carefully considered when making treatment decisions. A multidisciplinary approach involving urologists, endocrinologists, psychologists, and other healthcare professionals can provide comprehensive care and address the diverse needs of the patient [10].

Conclusion

The case report of orchiectomy after testicular trauma in a 45-year-old man highlights the importance of prompt medical intervention, comprehensive patient evaluation, and individualized treatment decisions. Orchiectomy, although a significant procedure with implications for fertility and hormone production, may be necessary in cases of severe testicular trauma where preservation of the testicle is not possible or poses risks for complications. Providing holistic care, including emotional support and counseling, is essential to help patients navigate the physical and psychological challenges associated with the procedure. Continued research, advancements in surgical techniques, and improved rehabilitation programs can contribute to better outcomes and enhanced quality of life for individuals undergoing orchiectomy after testicular trauma.

Sources of funding

None.

Consent

Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.

CRediT authorship contribution statement

Naser Parizad, Rasoul Goli, and Navid Faraji: Study concept, data collection, writing the paper and making the revision of the manuscript following the reviewer's instructions.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.