Case Reports
© 1990 S. Karger AG. Basel
Urol Int 1990;45:310-312
Traumatic Dislocation of the Testes
Shigehiko Koga, Yoshitaka Arakaki, Masanori Matsuoka
Department of Urology, Okinawa Chubu Hospital, Gushikawa City, Okinawa, Japan
Key Words. Testis dislocation • Trauma • Ultrasonography
Abstract. Traumatic dislocation of the testis is an unusual disorder. A case of bilateral traumatic dislocation of the
testes is presented. Ultrasound examination is very useful for determination of the preoperative diagnosis and
management of the dislocated testis.
Introduction
Dislocation of the testis is a rare trauma. Alyea [1]
classified dislocation of the testis into 3 types: (1) inter­
nal dislocation, the testis is forced through the external
inguinal ring, with the resultant inguinal canal, abdomi­
nal or femoral testis; (2) superficial dislocation, the testis
is forced subcutaneously on the circumference of a circle
with the external inguinal ring as the center, and (3) com­
pound dislocation, true herniation of the testis through
the scrotal wall. However, traumatic compound disloca­
tion is not accepted as dislocation of the testis in this
article. We report an additional case of bilateral trau­
matic dislocation of the testes and present the preopera­
tive sonographic findings.
Case Report
A 17-year-old boy was admitted to our hospital on July 7, 1985,
after the motorcycle he was riding at a high speed collided with a
car. On admission, work up revealed a bilateral empty scrotum and
a fracture on the right femur. Both testes were present in the scro­
tum before the accident. The patient did not present with lacera­
tions, abrasions and pain on the slightly reddish scrotum. Abdomi­
nal palpation revealed two masses, one near McBurney’s point and
one in the left inguinal region (fig. 1). After his general condition
improved, a urological examination was obtained on July 9, 1985.
Real-time sonography was performed. The frequency of the trans­
ducer was 5 MHz. The sonographic findings showed that both
0042-1138/90/0455-0310$2.75/0
masses were present in the subcutaneous tissue and anterior to the
external oblique fascia. Echo patterns of both masses were homoge­
neous medium level echoes similar to the testis (fig. 2). Both abdom­
inal masses were considered to be bilaterally dislocated testes. Man­
ual reduction of the dislocated testes failed, so wc performed imme­
diate surgical intervention. Both masses were the dislocated testes
covered with tunica vaginalis. The tunica albuginea was intact.
Their blood supply was good. Each testis was located between the
external oblique fascia and Scarpa’s fascia. Operative findings were
identical to those found on sonography. Both testes were returned to
the scrotum and fixed. Histologic examination of the testes revealed
normal findings. The postoperative course was good.
Discussion
Traumatic dislocation of the testis is rare and only 50
cases have been reported, 13 being bilateral in English
literature [2, 3], This trauma is often caused when a vehi­
cle rolled over the scrotum and perineum, or when the
patient had straddled the gasoline tank in a motorcycle
accident. A force may squeeze the testis up out of the
scrotum. Our case was a superficial dislocation which is
the most common form.
Herbst and Polkey [4] reported torsion of a dislocated
testis, while Edson and Meek [5] reported a case of dis­
location of the testis with rupture. A dislocated testis
associated with rupture or torsion needs immediate sur­
gical intervention. We performed a sonographic exami­
128.111.121.42 - 3/5/2018 11:35:40 AM
nation for an accurate preoperative diagnosis. Albert [6]
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Traumatic Dislocation of the Testes 311

Fig. 2. A Longitudinal section of a right mass. Sonography showed that the right mass (b) was located anterior to the external oblique
fascia, a = External oblique muscle; c = rectus muscle. B Longitudinal section of a left mass. Sonography showed that the left mass (d) was
located in the subcutaneous tissue, e = Left femoral vein; f = left femoral artery.

and Friedman et al. [7] have described that sonography
reveals abnormal findings, such as sonolucent areas or
dense echoes, within tunica albuginea of a ruptured testis
in the scrotum. If a dislocated testis is ruptured, a preop­
erative sonographic examination would reveal abnormal
findings such as those above. The sonographic findings
of the masses in our case were homogeneous echoes sim­
ilar to the testis and there were no findings of testicular
rupture. The operative findings confirmed the sonogra­
phy. Sonographic examination is very useful for diagno­
Morgan [8] and Goulding [9] recommend initial man­
ual reduction. If manual reduction fails at the time of
presentation, they recommend manual reduction again
on the 3rd or 4th day after injury when edema has sub­
sided but before fibrous adhesions have developed.
However, it is dangerous to wait for a few days in a case
with torsion. We should evaluate torsion and rupture of
the testis with sonography, radionuclide imaging or
Doppler ultrasound before waiting or after manual re­
duction. If torsion and rupture of a dislocated testis can­
128.111.121.42 - 3/5/2018 11:35:40 AM

sis and management. not be ruled out, immediate surgical intervention should
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312 Koga/Arakaki/Matsuoka

be performed. Biopsy of both testes showed normal find­
ings in our case. Some reports stated atrophy of seminif­
erous tubules and absent sperm formation [9, 10]. These
cases were treated more than 1 month after dislocation
of the testis. Injury of the scrotal skin is not so severe in
many reported cases, so traumatic dislocation of the tes­
tis is often overlooked for a long time. It is important to
palpate the scrotum in traumatic patients.
6 Albert NE: Testicular ultrasound for trauma. J Urol 1980; 124:
558-559.
7 Friedman SG, Rose JG, Winston MA: Ultrasound and nuclear
medicine evaluation in acute testicular trauma. J Urol 1981; 125:
748-749.
8 Morgan A: Traumatic luxation of the testis. Br J Surg 1965:52:
669-672.
9 Goulding FJ: Traumatic dislocation of the testis: addition of two
cases with changing etiology. J Trauma 1976;16:1000-1002.
10 Pollen JJ, Funckes D: Traumatic dislocation of the testes. J
Trauma 1982;22:247-249.

References
1 Alyea EP: Dislocation of the testis. Surg Gynecol Obstet 1929;
49:600-616.
2 Nagarajan VP, PranikofT K, Imahori SC, Rabinowitz R: Trau­
matic dislocation of testis. Urology 1983;22:521-524. Received: July 24, 1989
3 O’Connell R, Hargan B, Murphy DM, Ward F: Traumatic dislo­ Accepted: August 23, 1989
cation of the testis, lr Med J 1984;77:107-108.
4 Herbst RH, Polkey HJ: Luxatio testis traumatica and experi­ Shigehiko Koga, MD
mental study of the mechanism. Am J Surg 1936;34:18-33. Department of Urology
5 Esdon M, Meek JM: Bilateral testicular dislocation with unilat­ Nagasaki University School of Medicine
eral rupture. J Urol 1974;122:419-420. Nagasaki City, Nagasaki 852 (Japan)

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