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Abstract
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Purpose
According to the AAST (American Association for the Surgery of Trauma) injuries to the testes are rare, but there are many reports in the literature on other organs using the AAST Organ Injury Scale (OIS). In the present study, the authors evaluated the usefulness of the AAST OIS when applied to the testis.
Materials and Methods
A retrospective review was performed on 65 patients (mean age 30.0 years) with a testis injury treated between March 1986 and July 2006. Of the 65 patients, preoperative ultrasonography was performed on 51. Injuries were classified according to the OIS of the AAST, based on history taking, a physical examination and scrotal ultrasonography.
Results
Of the 51 patients, 46 and 5 underwent surgical intervention and conservative management, respectively. Of the included patients, 38 were found to have abnormal testis contours on ultrasonography, 29 had a rupture of the tunica albuginea, with a sensitivity of 76.3%. Of the 13 patients with normal contours, the tunica albuginea was normal in 7, and 8 underwent operation, with a specificity of 87.5%. Of the 12 Grade I patients, 7 underwent an operation, but the testes contours were normal. Of the 8 Grade II patients, only 1 underwent a primary repair with partial orchiectomy, but of the 45 Grades III, IV or V patients, 35 underwent a primary repair with a partial orchiectomy or orchiectomy with a hematoma evacuation performed in 10.
Conclusions
Ultrasonography was found to be the most effective modality for detecting a rupture of the tunica albuginea, and the authors conclude that the AAST OIS can be used to determine the treatment modality. Our recommended treatment policy is as follows; conservative for Grade I, exploration and repair for Grade II, and exploration, and a partial orchiectomy or orchiectomy for Grades III, IV or V. In particular, an orchiectomy is the most commonly used modality for Grade V. |