Testicular Injury in Children: When To See A Doctor

Testicles aren’t protected by muscles and bones since they are outside the body, which makes it easier for testicles to be struck, hit, kicked, or crushed. Loosely attached to the body and made of a spongy material, testicles can usually absorb collisions without permanent injury. However, when the tough covering is torn or shattered, blood can leak, stretching the scrotum until tense, which can lead to infection.

Testicular injuries are relatively uncommon, but you should be aware that they can happen. They most commonly occur in boys who play sports or are more active. If your son’s testicles are struck or impacted some way, he will feel pain or might feel nauseated for a short time. With a minor injury, the pain and any other symptoms should gradually cease in less than an hour. If swelling does not go away or if extreme pain lasts longer than an hour, the injury needs to be checked.

Though most testicular injuries are minor and will go away within one hour, more serious cases of testicular injury can include:

  • Testicular Torsion – The testicle twists around, cutting off blood supply, which can occur from serious trauma to the testicles, strenuous activity, or for no apparent reason.
    • Testicular torsion isn’t common, but when it does occur, it’s typically in individuals between the ages of 12 to 18 years old.
    • If it happens, see a doctor as soon as possible, ideally within six hours. After six hours, there is a much greater possibility that complications could result. We may fix the problem by manually untwisting the testicles. If that treatment fails, surgery may be necessary.
  • Testicular rupture — A rare type of testicular trauma that can happen when the testicles receives a forceful direct blow or when the testicles are crushed against the pubic bone (the bone forming the front of the pelvis), causing blood to leak into the scrotum. Testicular rupture causes extreme pain, swelling in the scrotum, nausea, and vomiting. Surgery is necessary to repair the ruptured testicle.

If your son’s testicular injury pain doesn’t subside in less than an hour, we suggest seeing a professional. Schedule a visit if your son is experiencing the following:

  • Pain that doesn’t subside or your son experiences extreme pain lasting longer than an hour
  • Swelling or bruising of the scrotum or a puncture of the scrotum or testicles
  • Nausea and vomiting that doesn’t go away
  • Fever

There are various options for treating minor testicular injury at home, including:

  • Pain relievers
  • Rest
  • Gently supporting the testicles with supportive underwear
  • Applying ice packs to the area
  • Avoiding strenuous activity for a few days

If your son plays sports, exercises frequently or lives an all-around active life, he should take precautions to avoid testicular injuries. Prevention options include:

  • Wearing an athletic cup or athletic supporter.
  • Cups are best used when participating in sports where testicles might get hit or kicked such as football, hockey, soccer, or karate.
  • An athletic supporter, or jock strap, is a cloth pouch to keep testicles close to your body. Athletic supporters are best for strenuous exercise — cycling, or doing any heavy lifting.

Testicular Masses in Children

Testicular masses (or tumors) are growths found on the testicle. The cause is unknown, although researchers know that most masses start in the germ cells – the cells in the embryo that become the cells that make up the male reproductive system. The masses can be either benign or malignant. Certain inherited defects have been associated with an increased risk for germ cell tumors. Boys with undescended testicles have an increased risk of developing testicular germ cell tumors.

Growths on testicles are rare, however when they do occur, they are most often found in boys under age five or those who experience puberty early. Although most masses are benign and do not spread, they still require surgery. Any abnormalities to a boy’s testicles need to be checked right away.

Though symptoms may appear differently per case, common symptoms include:

  • Swollen testicles
  • Hard testicles
  • Abnormal shape, or irregularity in testicular size
  • Testicular pain (although some tumors are painless)

A parent or health-care provider identifies most testicular tumors as non-tender swellings in a boy’s scrotum. Most scrotal masses are due to far more common problems, such as:

  • Hernina
  • Hydrocele
  • Infection of the epididymis
  • Testicular torsion

We will determine a mass from these more common conditions by how it feels and if light shines through it. In addition to a complete medical history and physical examination, we may also perform:

  • Ultrasound – To identify what the mass is and whether more tests or surgery is needed. We use ultrasounds to view internal organs as they function and to evaluate blood flow.
  • Computerized Tomography Scan (CT or CAT scan) – Shows detailed images bones, muscles, fat, and organs.
  • Biopsy – A sample of tissue is removed from the mass and examined under a microscope.
  • Magnetic Resonance Imaging (MRI) – A diagnostic procedure using a magnet, radiofrequencies, and a computer to generate detailed images of organs and structures within the body.
  • Complete Blood Count (CBC) – A measurement of the size, number, and maturity of different blood cells in a specific amount of blood.

Treatment for testicular masses depends on a variety of factors identified through your child’s diagnosis. However, here is a look at potential treatment options that may be utilized:

  • Surgical or medical correction of benign masses.
  • Orchiectomy – Testicular masses, if malignant, are usually removed along with the entire affected testicle. If the tumor is malignant, your son may also need to receive one or more of the following treatments:
  • Chemotherapy – A drug treatment that interferes with the cancer cell’s ability to grow or reproduce. Chemotherapy may be used alone or with other therapy.
  • Radiation therapy – A treatment using high-energy rays (radiation) from a specialized machine to damage or kill cancer cells and shrink tumors.

Understanding Undescended Testes

Undescended testicles refers to when the testicles do not come all the way down into the scrotal sac, and this condition occurs in about 3 percent of newborns and up to 21 percent of premature newborns. In about half of these cases, the testicles will descend on their own during the first 6 to 12 months of life, however testicles will not descend spontaneously after 12 months of age. As a result, about 1 to 2 percent of boys require treatment. Most boys with undescended testes also have a hernia on the affected side that needs to be repaired.

Testicles (testes) typically descend or drop into the scrotal area during the latter part of pregnancy, in response to the baby’s hormones. The testicles are responsible for making sperm and the male sex hormone testosterone. The scrotum allows the testicles to be in a cooler environment than the body because sperm cannot develop at body temperature. If the testicles do not descend into the scrotum, sperm do not mature and the longer this lasts, the lower the chances sperm will mature normally.

There are several types based on the symptoms your son may be experiencing, these include:

  • Ascending Testicle:
    • Increasingly, many boys are being diagnosed with an undescended testicle later in childhood, often between 6 and 10 years of age. These boys had normally descended testicles as infants. Many professionals in the medical community think that the spermatic cord does not grow normally as the child grows, and the testicles gradually become undescended. These testicles need surgical treatment to move the testicle into the scrotum.
  • Retractile Testes:
    • Be sure not to confuse undescended testicles with ‘retractile’ testes. After about age six months, normal babies and male children have a reflex that pulls the testicles up to protect them when he is cold or frightened. These testicles are in the scrotum at other times and do not require any treatment.

In most children, it is not known why the testicles do not descend. However some common causes may include:

  • Abnormalities to testicles
  • A mechanical problem that leads the testicles to descend or drop but miss the scrotum, and end up adjacent to the scrotum, called “ectopic testicles”.
  • Insufficient hormones to stimulate the testicles normally

There is only one available treatment, which is recommended after six months of age, though the time between six and 18 months of age is generally considered the best. This treatment option is a surgery known as Orchiopexy.

  • Requires general anesthesia
  • Baby can almost always go home the same day and usually acts normal within one to two days.
  • An incision about one inch long is made in the groin area.
  • The testicle is separated from surrounding tissues so it drops easily into the scrotum where it is stitched into place. In some cases, the testicle is too high for this simple operation and more complex procedures (and sometimes even two operations) are needed.
  • Overall, the success rate with surgery is 98%.
  • If there is a hernia, it will be fixed during surgery.

Our experts are here to help diagnose testicular conditions and create the best custom care plan for your situation. It is important that your doctor works with you to accurately diagnose your child’s symptoms and tailor a unique treatment plan to fit your specific needs. We at Western Michigan Urological Associates want to work with you to find the best option for you and your family. Ask Your Primary Care Provider for a Referral.