Povrede skrotuma i testisa

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Povrede skrotuma i testisa
Klasifikacija i spoljašnji resursi

Povreda skrotuma i testisa naneta oštrim mehaničkim oruđem u seksualnoj torturi
eMedicine med/2859 radio/682

Povrede skrotuma i testisa su mehaničkom silom izazvana oštećenja tkiva skrotoma i testisa. Tupa trauma skrotuma, u zavisnosti od mehanizma povrede, obično ima za posledicu pojavu hematoma u području genitalne i perinealne regije. Takođe trauma može uzrokovati i torziju testisa.[1]

Etiopatogeneza[uredi - уреди | uredi izvor]

Najčešće izolovane povrede skrotuma su,[2]

Laceracije

Laceracije skrotuma su manje povrede, povrđinske prirode, sa dobrom prognozom, koje može da budu uivena primarno, a ako su sasvim male, mogu da zarastu spontano, bez šava

Avulzije.

Avulzije skrotuma su povrede ozbiljnije prirode. Primarni cilj kod zbrinjavanja ovih povreda je da testisi budu pokriveni kožom. Dakle, ukoliko postoji defekt kože skrotuma, testisi moraju da se pokriju režnjevima kože iz okoline.

Rupture

Najčešća povreda testisa je ruptura. Može biti inkompletna, odnosno, samo ruptura tunike albuginea. Veoma teška (kompletna) ruptura testisa uz destrukciju organa zove se konkvasacija.

Kontuzje

Kontuzije, koje nastaju tupom mehaničkom silom obično ne zahtevaju operativni tretman izuzev kod „luksacije testisa“ - kada se pod dejstvom traume testis izbaci iz uobičajenog ležišta uz kidanje tunika.[3]

Klinička slika[uredi - уреди | uredi izvor]

Klinička slika traume u području skrotuma može varirati od veoma blage, u obliku edema ili manje ekstravazacije krvi, do vrlo teške u smislu povreda većih krvnih sudova, koje dovode do infarkta i atrofije testisa.[4]

Dijagnoza[uredi - уреди | uredi izvor]

Dijagnoza se postavlja na osnovu anameneze (u kojoj bolesdnik navodi povredu), fizičkog pregleda i ultrasonografije.[5]

Ultrasonografskim pregledom važno je ustanoviti da li postoje ruptura tunike albugineje testisa i nedostatak cirkulacije testisa.[6]

Terapija[uredi - уреди | uredi izvor]

Ako je tunika albugineja testisa intaktna, a cirkulacija testisa uredna, lečenje je konzervativno; uključuje mirovanje i analgeziju, hladne obloge i lokalnu aplikaciju heparin kreme. Skrotum se podupire zavojem u obliku „praćke“ čime se uspostavlja adekvatna drenaža.[7]

Ultrazvučnim pregledom treba redovno pratiti stanje cirkulatornog statusa i resorpciju hematoma. Antibiotska profilaksa se preporučuje u slučaju da postoji sumnja na popratni epididimitis ili rizik za razvoj infekcije.[8]

Hirurško lečenje se može primeniti ako skrotalni hematom (hematokela) prelazi veličinu od 5 sm radi bržeg oporavka i povratka svakodnevnim aktivnostima.

Penetrantneo traume skrotuma potrebno je uvek uhirurški eksplorirati.[9][10] Ako se konstatuje povreda testisa ona se zbrinjava konzervativnim debridmanom testikularnog tkiva, a u težim slučajevima amputacijom testisa, dok se koža skrotuma rekonstruiše, kožnim šavom.[11][12]

Zbog dobre vaskularizacije i elastičnosti, skrotum je zahvalan za hirurško zbrinjavanje.

Izvori[uredi - уреди | uredi izvor]

  1. Lrhorfi H, Manunta A, Rodriguez A, Lobel B. Trauma-induced testicular torsion. J Urol 2002; 168: 2548.
  2. Karmazyn B, Steinberg R, Kornreich L. Clinical and sonographic criteria of acute scrotum in children: a retrospective study of 172 boys. Pediatr Radiol. Mar 2005; 35 (3): 302-10
  3. Jecmenica DS, Alempijevic DM, Pavlekic S, Aleksandric BV. Traumatic testicular displacement in motorcycle drivers. J Forensic Sci. 2011 Mar. 56(2):541-3.
  4. Bjurlin MA, Kim DY, Zhao LC, Palmer CJ, Cohn MR, Vidal PP, et al. Clinical characteristics and surgical outcomes of penetrating external genital injuries. J Trauma Acute Care Surg. 2013 Mar. 74 (3):839-44.
  5. Chandra RV, Dowling RJ, Ulubasoglu M, Haxhimolla H, Costello AJ. Rational approach to diagnosis and management of blunt scrotal trauma. Urology. 2007 Aug. 70(2):230-4.
  6. Buckley JC, McAninch JW. Use of ultrasonography for the diagnosis of testicular injuries in blunt scrotal trauma. J Urol. 2006 Jan. 175(1):175-8.
  7. Ramdas S, Thomas A, Arun Kumar S. Temporary ectopic testicular replantation, refabrication and orthotopic transfer. J Plast Reconstr Aesthet Surg. 2007. 60(7):700-3.
  8. Bromberg W, Wong C, Kurek S, Salim A. Traumatic bilateral testicular dislocation. J Trauma. 2003 May. 54(5):1009-11.
  9. O'Brien MF, Collins DA, McElwain JP, Akhtar M, Thornhill JA. Traumatic retrovesical testicular dislocation. J Urol. 2004 Feb. 171(2 Pt 1):798.
  10. van der Horst C, Martinez Portillo FJ, Seif C, Groth W, Jünemann KP. Male genital injury: diagnostics and treatment. BJU Int. 2004 May. 93(7):927-30.
  11. Yap SA, DeLair SM, Ellison LM. Novel technique for testicular salvage after combat-related genitourinary injury. Urology. 2006 Oct. 68(4):890.e11-2.
  12. Baskin LS, McAninch JW. Reconstruction of testicular rupture. McAninch JW, ed. Traumatic and Reconstructive Urology. Philadelphia: WB Saunders; 1996. 733-6.

Literatura[uredi - уреди | uredi izvor]

  • Cubillos J, Reda EF, Gitlin J, Zelkovic P, Palmer LS. A conservative approach to testicular rupture in adolescent boys. J Urol. 2010 Oct. 184(4 Suppl):1733-8.
  • Freehill MT, Gorbachinsky I, Lavender JD, Davis RL 3rd, Mannava S. Presumed testicular rupture during a college baseball game: a case report and review of the literature for on-field recognition and management. Sports Health. 2015 Mar. 7 (2):177-80.
  • Joudi FN, Lux MM, Sandlow JI. Testicular rupture secondary to paint ball injury. J Urol. 2004 Feb. 171(2 Pt 1):797.
  • Frauscher F, Klauser A, Stenzl A, Helweg G, Amort B, zur Nedden D. US findings in the scrotum of extreme mountain bikers. Radiology. 2001 May. 219(2):427-31.
  • Bieniek JM, Sumfest JM. Sports-related testicular injuries and the use of protective equipment among young male athletes. Urology. 2014 Dec. 84 (6):1485-9.
  • Ko SF, Ng SH, Wan YL, et al. Testicular dislocation: an uncommon and easily overlooked complication of blunt abdominal trauma. Ann Emerg Med. 2004 Mar. 43(3):371-5.
  • Wan J, Corvino TF, Greenfield SP, DiScala C. Kidney and testicle injuries in team and individual sports: data from the national pediatric trauma registry. J Urol. 2003 Oct. 170(4 Pt 2):1528-3; discussion 1531-2.
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  • Valentino M, Bertolotto M, Derchi L, Bertaccini A, Pavlica P, Martorana G, et al. Role of contrast enhanced ultrasound in acute scrotal diseases. Eur Radiol. 2011 Jun 2.
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  • Phonsombat S, Master VA, McAninch JW. Penetrating external genital trauma: a 30-year single institution experience. J Urol. 2008 Jul. 180(1):192-5; discussion 195-6.
  • A Ward M, L Burgess P, H Williams D, E Herrforth C, L Bentz M, D Faucher L. Threatened fertility and gonadal function after a polytraumatic, life-threatening injury. J Emerg Trauma Shock. 2010 Apr. 3(2):199-203.
  • Molokwu CN, Doull RI, Townell NH. A novel technique for repair of testicular rupture after blunt trauma. Urology. 2010 Oct. 76(4):1002-3.
  • Yoshimura K, Okubo K, Ichioka K, Terada N, Matsuta Y, Arai Y. Restoration of spermatogenesis by orchiopexy 13 years after bilateral traumatic testicular dislocation. J Urol. 2002 Feb. 167(2 Pt 1):649-50.
  • Lysiak JJ, Nguyen QA, Kirby JL, Turner TT. Ischemia-reperfusion of the murine testis stimulates the expression of proinflammatory cytokines and activation of c-jun N-terminal kinase in a pathway to E-selectin expression. Biol Reprod. 2003 Jul. 69(1):202-10.
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  • Bedir S, Yildirim I, Sümer F, Tahmaz L, Dayanç M, Peker AF. Testicular dislocation as a delayed presentation of scrotal trauma. J Trauma. 2005 Feb. 58(2):404-5.
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  • Hendry WF. Testicular, epididymal and vasal injuries. BJU Int. 2000 Aug. 86(3):344-8.
  • Lrhorfi H, Manunta A, Rodriguez A, Lobel B. Trauma induced testicular torsion. J Urol. 2002 Dec. 168(6):2548.
  • Mohr AM, Pham AM, Lavery RF, Sifri Z, Bargman V, Livingston DH. Management of trauma to the male external genitalia: the usefulness of American Association for the Surgery of Trauma organ injury scales. J Urol. 2003 Dec. 170 (6 Pt 1):2311-5.

Spoljašnje veze[uredi - уреди | uredi izvor]


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