Two Words to Make You Wince: Ruptured Testicle

Growing up, every boy heard a story about some kid, usually from a couple of towns away, who suffered a severe groin injury due to some shudder-inducing event: a horrific bike accident, an errant baseball, a chain-link fence that was very nearly cleared.

In my case, I heard the story at a teenage summer job at a horse ranch. The first thing we were told was the harrowing tale of a boy who lost a testicle because he carelessly walked behind a horse and received a kick below the belt. Regardless of whether the kid actually existed, we all groaned, crossed our legs and took the lesson to heart when approaching the animals.

Whether we can verify these specific stories or not, a ruptured testicle is very real—and potentially dangerous. Here's what you need to know.

What exactly is a ruptured testicle?

Most testicular or scrotal injuries are caused by blunt trauma (44.6 percent) or a penetrating mechanism (50.5 percent), in the delicate words of a 2018 U.S. analysis. Of those penetrating injuries, 75.8 percent were due to firearms, so maybe don't keep your pistol in your waistband like a movie character.

Of these types of injuries, a testicular rupture or fracture is one of the worst results. That's what happens when the tough outer material protecting the testicle rips or tears, resulting in the extrusion of the contents of the testicle.

"Luckily, this is very uncommon and will typically happen only with a major injury to the testicle where it is crushed against something, like the pubic bone," said William Brant, M.D., the chief of urology at the Salt Lake City Veterans Affairs Medical Center. "The testicle has a thick lining called the tunica albuginea, and when this tears, the contents of the testicle can start coming out."

Yes, you can think of it as "popping" a testicle. But if you dare to look at photos—don't!—you'll see it's a meatier, messier situation than, say, popping a water balloon.

However, take heart: the dense tunica albuginea membrane that protects the testicle is a lot more difficult to break than a balloon. In fact, it's very strong, according to Amy Pearlman, M.D., the director of men's health at the Carver College of Medicine at University of Iowa Health Care.

"It's going to require a good amount of force in order to break it open," she said. "Just because someone has testicular pain doesn't mean they have a rupture."

Symptoms of a rupture

Testicular pain can happen for a variety of reasons. But a ruptured testicle is likely to be accompanied by a traumatic event that results in significant bruising and swelling.

"Sometimes, you can see the testicle coming out of the skin," Pearlman said. "It's usually someone coming in from the trauma bay, the ER. It can be from a car accident; it could be a sports injury—that's why it's important to protect the testicles during sporting events."

While a bruised testicle is painful, it will likely heal on its own. But if you have intense pain, swelling or discoloration of the scrotum, you should get checked out.

How to diagnose the condition

When your healthcare professional suspects a ruptured testicle, they use an ultrasound to see if there is damage. The device is noninvasive and uses sound waves to create an image of what's going on inside, just like when a pregnant woman gets scanned to see the condition of her fetus.

However, the bruising and swelling of the testicle is sometimes so pronounced that it's difficult to tell exactly what's happening by using an ultrasound. At this point, your doctor may recommend exploratory surgery, which sounds a lot worse than it is. Despite the thin skin of the scrotum, opening it up and getting a firsthand look at the testes is a simple, safe procedure.

Treatment of a ruptured testicle

If the ultrasound or exploratory surgery determines there is a rupture, the next step is to repair it.

First, any blood that has accumulated in the area is evacuated. Then the doctor assesses the damage and sets about repairing it.

"We make sure we cauterize any bleeding and then we just sew it back together," Pearlman said. "Now, sometimes if there's a rupture, there could be a big defect in there. Sometimes, if we try to close that tunica albuginea, we might be causing too much compression on that testicular tissue. So if that's the case and we can't close it, we can use nearby tissue and close that defect."

If the damage is extensive and a great deal of the contents of the testicle are extruded and damaged, some of them might have to be removed. Even so, the testicle can often still be saved.

"You have these seminiferous tubules [in the testicle], these little squiggly things, and that's where the sperm are made," Pearlman said. "So we'll remove anything that doesn't look healthy. And then if there's some testicular tissue remaining that looks like it's still getting good blood supply, we'll keep it."

The aftermath

Sometimes, however, there's just too much damage, and the testicle has to be removed. Fortunately, normal sexual function and fertility are usually still possible even with just one testicle.

But it's not a bad idea to get a fertility workup if you've experienced severe testicular trauma and you're having trouble conceiving, Pearlman said. Even if you just want to know what your sperm parameters are following a testicular rupture or other trauma, it's never a bad time to get checked.

Finally...

Doctors can save a ruptured testicle 80 percent to 90 percent of the time if the patient gets surgery within 72 hours. However, that percentage is halved if you wait too long, so don't hesitate.

"If there's bruising, swelling and some kind of trauma, I'd say it's a good idea to go to the ER to at least get an ultrasound for either reassurance or to say 'I'm not sure what's going on, but we need to explore,'" Pearlman said.