Research and reports in urology · 2026
Salvage of a Penetrating Bilateral Testicular Gunshot Injury Using an Autologous Free Tunica Albuginea Graft from the Excised Contralateral Testis: A Case Report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Saad Anas, Al-Abed Omar, Hakouk Salem, Aldakak Mohammad Alaa
Аннотация
BACKGROUND: Penetrating scrotal trauma is an uncommon but potentially devastating urogenital injury. Testicular rupture requires prompt exploration, particularly when associated with urethral or corporal trauma. When primary closure of the tunica albuginea is not feasible, reconstructive alternatives may be needed to preserve viable testicular tissue.
CASE PRESENTATION: We report an 18-year-old male who sustained a ricocheting gunshot injury to the perineum and external genitalia. After initial cystostomy and wound packing at a non-specialized hospital, he was referred to our center approximately 12 hours after injury. Exploration revealed complete destruction of the right testis, severe rupture of the left testis with extrusion of seminiferous tubules and a large tunica albuginea defect, a partial distal bulbar urethral laceration, and a 1-cm laceration of the left corpus cavernosum. The right testis was unsalvageable and excised. The urethral and corporal injuries were repaired primarily. Because the left testis could not be closed primarily and the tunica vaginalis was inadequate, an autologous free graft harvested from the tunica albuginea of the excised right testis was used to close the defect.
DISCUSSION: Previously described options for large tunica albuginea defects include tunica vaginalis-based techniques and biologic or synthetic grafts. Our approach used contralateral tunica albuginea as an immediately available autologous graft.
CONCLUSION: At 3-month follow-up, the patient had preserved testicular vascularity and volume, normal voiding and erections, and reference-range testosterone. However, persistent severe oligozoospermia and elevated gonadotropins indicated impaired spermatogenesis, prompting fertility counseling and repeat sperm cryopreservation. This technique may represent a feasible testis-sparing option in carefully selected cases.
CASE PRESENTATION: We report an 18-year-old male who sustained a ricocheting gunshot injury to the perineum and external genitalia. After initial cystostomy and wound packing at a non-specialized hospital, he was referred to our center approximately 12 hours after injury. Exploration revealed complete destruction of the right testis, severe rupture of the left testis with extrusion of seminiferous tubules and a large tunica albuginea defect, a partial distal bulbar urethral laceration, and a 1-cm laceration of the left corpus cavernosum. The right testis was unsalvageable and excised. The urethral and corporal injuries were repaired primarily. Because the left testis could not be closed primarily and the tunica vaginalis was inadequate, an autologous free graft harvested from the tunica albuginea of the excised right testis was used to close the defect.
DISCUSSION: Previously described options for large tunica albuginea defects include tunica vaginalis-based techniques and biologic or synthetic grafts. Our approach used contralateral tunica albuginea as an immediately available autologous graft.
CONCLUSION: At 3-month follow-up, the patient had preserved testicular vascularity and volume, normal voiding and erections, and reference-range testosterone. However, persistent severe oligozoospermia and elevated gonadotropins indicated impaired spermatogenesis, prompting fertility counseling and repeat sperm cryopreservation. This technique may represent a feasible testis-sparing option in carefully selected cases.