For blunt trauma, and in the hands of an experienced physician, bedside ultrasonography can be considered; vascular flow settings can be used to identify testicular rupture and compromised vascular flow (Figure 9).24 Clinicians should not rely on ultrasound for penetrating trauma; most penetrating scrotal injuries should be explored due to the limited sensitivity and variable levels of skill with ultrasound.15

Initial operative management involves thoroughly assessing the injury sites, removing wound contaminants, and debriding non-viable tissue. This is done in conjunction with copious, low-pressure irrigation of the wound.7 (See External Genitalia Injuries in Appendix A: Urological Diagnosis and Treatments.)