In addition to arterial bleeding, vascular structures of the penis and scrotum should be addressed during the initial surgery, specifically, the corpora cavernosa, corpus spongiosum, and bilateral testes (Figure 10). Lacerations to the corpora cavernosa can be closed with absorbable sutures. Attempts should be made to avoid the dorsal neurovascular structures. If the injury is dorsal, the neurovascular structures can be elevated off the corpora cavernosum to preserve the vascular supply to the glans and sensation to the penis. Avoid aggressive over-sewing of the corpus spongiosum in favor of closure to its tunical covering reducing the risk of ischemic changes distal to the injury site in these complex wounds.24,25 Patients with penetrating scrotal wounds or evidence of testicular rupture on exam should undergo scrotal exploration. Ruptured testes are managed with irrigation and debridement of non-viable seminiferous tubules. The tunica albuginea is then closed with fine (4-0 or 5-0) absorbable suture (PDS or Vicryl), returned to the scrotum, and an orchiopexy with three-point fixation is performed.15 A tunica vaginalis flap can be used to close the defect when there is insufficient tunica to obtain a tension-free closure over the exposed tubules. A drain (e.g., Penrose) should typically be left following scrotal exploration for trauma.26 A delay in managing a testicular injury is acceptable when the patient is too unstable or there is insufficient expertise to manage it at initial exploration. Every attempt should be made to salvage viable testicular tissue, especially when both testicles are involved or a unilateral orchiectomy is required. The injured testis should be wrapped in saline-soaked gauze and protected with multiple layers of additional dressing. All findings should be documented and communicated to the next echelon of care.