Testicular trauma, though relatively uncommon, constitutes a critical urological emergency that demands prompt recognition and appropriate management. The potential consequences extend beyond acute pain and physical injury, often impacting long-term testicular viability, hormonal function, and fertility potential. Injuries may result from blunt or penetrating mechanisms and can range from minor contusions to complete testicular rupture. Early and accurate diagnosis—typically via scrotal ultrasonography with Doppler—is essential for optimal decision-making. However, the choice between surgical and conservative treatment remains a subject of ongoing debate. This is particularly evident in borderline cases where imaging findings are inconclusive, and clinical presentation is ambiguous. The lack of standardized treatment protocols adds further complexity, with variations in practice influenced by institutional resources, surgeon experience, and patient-specific factors. As such, there is a growing need for evidence-based guidelines to support individualized yet consistent care strategies that prioritize testicular preservation, minimize complications, and optimize long-term reproductive and endocrine outcomes. To systematically evaluate and compare clinical outcomes of surgical and conservative treatment approaches in patients with testicular trauma, with a focus on testicular salvage, endocrine function, fertility, and complication rates. To systematically evaluate and compare clinical outcomes of surgical and conservative treatment approaches in patients with testicular trauma, with a focus on testicular salvage, endocrine function, fertility, and complication rates.

A systematic review was conducted using PubMed, Scopus, and Cochrane Library to identify studies published up to 2015 that directly compared surgical and conservative management of testicular trauma. Inclusion criteria focused on clinical outcomes such as salvage rates, long-term hormonal profiles, fertility data, and complication incidence. Study quality was assessed using the AMSTAR tool for systematic reviews.

Ten studies involving 280 patients were included. Surgical intervention—typically performed in cases involving tunica albuginea rupture or large hematomas—resulted in higher testicular salvage rates compared to conservative approaches. Conservative treatment was successful in minor injuries, such as contusions or small hematomas, and was associated with fewer immediate complications. Long-term follow-up revealed comparable outcomes in serum testosterone levels and fertility indices across both groups. However, testicular atrophy was reported more frequently in conservatively managed patients.

Surgical management offers superior testicular salvage in cases of severe trauma and remains the recommended approach, particularly in patients presenting with clear ultrasound or intraoperative evidence of tunica albuginea rupture, large intratesticular hematomas, or compromised blood flow. Prompt surgical exploration and repair not only reduce the risk of orchiectomy but also allow for direct evaluation and debridement of devitalized tissue, promoting better preservation of testicular function. In contrast, conservative treatment may be appropriate for less severe injuries such as minor contusions or small hematomas without signs of rupture; however, this approach is not without risks. Delayed complications, most notably testicular atrophy due to unresolved hematoma, ischemia, or undetected rupture, have been reported more frequently in non-operative cases. Despite the differences in initial management strategies, long-term outcomes with regard to endocrine function—measured by serum testosterone levels—and fertility potential, including spermatogenesis and semen parameters, appear to be comparable between the two groups in most published studies. Nonetheless, the risk-benefit balance must be carefully assessed in each individual case, and shared decision-making with the patient is essential, especially when testicular preservation and future fertility are of concern.

Tailored management based on injury severity is essential in testicular trauma. While surgical treatment ensures better salvage in severe cases, conservative management remains a viable option for minor injuries. Further prospective, randomized trials are needed to optimize treatment algorithms and improve patient outcomes.

Mora R, Nabhani J, Bakare T, Khouri R, Samplaski M. The effect of testicular trauma on male infertility. Hum Fertil (Camb). 2023 Dec;26(5):1093-1098. doi:10.1080/14647273.2022.2135464.
Parizad N, Faraji N, Goli R. Orchiectomy after testicular trauma in a 45-year-old man: a case report. Trauma Case Rep. 2023 Nov 22;48:100971. doi:10.1016/j.tcr.2023.100971.
Shams M, Tanveer Y, Iqbal M. Complete rupture of testis after blunt trauma. Cureus. 2023 Oct 30;15(10):e47968. doi:10.7759/cureus.47968.