Ze względu na budowę anatomiczną męskie genitalia są narażone na różnego rodzaju urazy. Jakie wyróżnia się rodzaje urazów krocza, jakie są ich objawy i jak przebiega leczenie?
Kategorie urazów krocza
W praktyce klinicznej wyróżnia się dwa najczęściej występujące rodzaje urazów krocza: urazy tępe oraz penetrujące.
Urazy tępe
Urazy tępe występują najczęściej podczas uprawiania sportu (ponad 50 proc. przypadków) oraz w wyniku wypadków komunikacyjnych, zwłaszcza z udziałem roweru lub motocykla (ok. 20 proc. przypadków).
Wskutek bezpośredniego tępego urazu w okolicy genitalnej może dojść do pęknięcia lub uszkodzenia jądra. Uraz rzadko obejmuje oba jądra. Objawy kliniczne w takim przypadku obejmują ostry ból, obrzęk i wybroczyny w okolicach moszny, a także nudności i wymioty.
Według wytycznych Europejskiego Towarzystwa Urologicznego w przypadku stwierdzenia pęknięcia lub uszkodzenia jądra należy każdorazowo wdrożyć leczenie chirurgiczne.
Częstym następstwem tępego urazu w okolicy genitalnej jest wystąpienie krwiaka, który powinien zostać usunięty operacyjnie.
Innym rzadkim powikłaniem tępego urazu w okolicy krocza może być dyslokacja jądra (jednostronna lub obustronna). Dyslokacja może obejmować przemieszczenie w obrębie tkanki podskórnej i nadpowięziowej lub wewnętrzne przemieszczenie do kanału pachwinowego.
Leczenie polega na manualnym lub chirurgicznym sprowadzeniu jądra do moszny (orchidopeksja).
Urazy penetrujące
Do urazów penetrujących okolicy genitalnej dochodzi najczęściej na skutek postrzału, dźgnięcia ostrym przedmiotem lub pogryzienia przez zwierzę. Urazom penetrującym genitaliów często towarzyszą uszkodzenia sąsiednich struktur, takich jak pęcherz, cewka moczowa oraz naczynia udowe (ok. 70 proc. przypadków). Urazy penetrujące częściej niż urazy tępe skutkują usunięciem jądra (orchiektomia) lub ograniczeniem jego funkcjonalności.
W przypadku ran postrzałowych i kłutych w ok. 30 proc. przypadków dochodzi do uszkodzenia obu jąder. Urazy na skutek pogryzienia przez zwierzę są natomiast obarczone wysokim ryzykiem infekcji. Niezależnie od czynnika etiologicznego urazy tej kategorii powinny być leczone chirurgicznie, z zastosowaniem systemowej antybiotykoterapii.
Źródła:
H. Randhawa, U. Blankstein, T. Davies, “Scrotal trauma: A case report and review of the literature”, “Canadian Urological Association Journal” 2019, 13 (6): 67-71.
Przeczytaj także: Co to jest rana i jak powinien przebiegać proces gojenia?
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