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Tunica Vaginalis Flap for Repair of Ruptured Testis: A single-center experience with 4 patients
Pamela Ellsworth, MD1, Ashley Matthew, Medical student2.
1University of Massachusetts Memorial Medical Center, Worcester, MA, USA, 2University of Massachusetts Medical School, Worcester, MA, USA.

BACKGROUND: The standard management of testicular rupture is debridement of devitalized tissue and re-approximation of the tunica albuginea. In the setting of a large defect, primary closure may not be feasible without excision of viable testicular tissue. We describe our experience with a tunica vaginalis vascularized graft for coverage in the setting of a large defect in four patients.
METHODS: In 4 patients , the defect in the tunica albuginea was too large for primary closure without debridement of viable testicular tissue. A vascularized tunica vaginalis graft was used to cover the defect, without debriding viable tissue. We review these 4 cases, 3 traumatic and 1 iatrogenic, of testicular rupture in adolescent males, all of whom had postoperative follow-up with scrotal ultrasound and/or physical examination.
RESULTS: We present a series of four patients with testicular rupture with a large defect. In 3 patients, the cause of rupture was traumatic, in the 4th, it was iatrogenic. Intraoperative assessment in all 4 cases revealed a defect too large for primary closure without debridement of viable testicular tissue. In order to cover the defect, a vascularized tunica vaginalis graft was used in all patients. A viable testis with good flow and volume of 80% or greater than that of the contralateral testis on ultrasound was noted on follow up in 2 cases (Table 1). Two of the four patients did not follow-up for post-operative ultrasound evaluation, one of which did not have contralateral testis. Post-operative physical exam revealed normal appearance in 75% of patients, but one had a previously small, undescended testis, therefore was noted to have a small testis in good position on the affected side
CONCLUSIONS: In the case of testicular rupture associated with large defects, the use of vascularized tunica vaginalis graft helps preserve testicular volume and normal physical appearance. This approach should be considered in cases of a large defect, especially with any compromise or absence of contralateral testis.
Table 1. Post-operative physical exam and ultrasound characteristics
PatientPhysical examRight testisLeft testisUS - Flow/scar
1Normal appearance4.5x1.9x3.0 (13.4 ml)4.4x2.1x2.9 (14.0ml)Good flow/scar in fracture site 13 months postop
2Normal appearance4.5x2.5x2.6 (13.6 ml)3.8x2.8x2.1 (11.7 ml)*Normal flow - 2.5 months postop
3Same size on physical examination and orchidometer assessment - 8 mos postopNo postop US performedNo postop US performedN/A
4Small testis in good position. Prior history of small undescended testis - 7 mos postopNot presentNo postop US performedN/A


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