Testicular dislocation is a rare condition in which a testis is dislocated from its normal position within the scrotum to another location, most commonly the superficial inguinal pouch.

Epidemiology

The condition mainly occurs in younger men with a mean age of 25 years ².

Clinical presentation

Pain is usually present ¹. On examination, an empty hemiscrotum can be palpated ¹. 

Pathology

Motorcycle accidents are the most common cause (80%) ². Blunt force to the testis can rupture the fascia of the spermatic cord and force the testis out of the scrotum. Unilateral or bilateral dislocation are equally common ².

The sites of dislocation in descending prevalence include ²:

• superficial inguinal pouch (50%)

• pubic

• penile

• inguinal canal

• intra-abdominal

• perineal

Radiographic features

Ultrasound

Findings include ¹:

• an absence of one or both testis in the scrotum

• an extra-scrotal testis (most commonly in the superficial inguinal pouch)

Doppler ultrasound can also be used to define blood flow in the testis.

CT

The role of CT in testicular dislocation can be confirmation of an abdominally dislocated testis and to also delineate the extent of the causative traumatic injury ².

Treatment and prognosis

Manual reduction can be attempted but is only successful in 15% of cases ³.  Surgical treatment in addition to being more successful also allows torsion to be corrected if present ³. Fertility may be affected and a heightened risk of testicular malignancy can occur if the testis is not reduced for a prolonged period ².

DIfferential diagnosis

• ectopic testes

• undescended testes