Testicular Rupture: The Other Nutcracker Syndrome.

Scrotal trauma is a rare incident but when it occurs it is typically among 6 to 12 years old boys. It is most commonly unilateral secondary to compression of the scrotal contents against the pubic bone. The majority of trauma to the scrotal region is blunt impact but serious injuries are rare despite the vulnerable position of the testicles. The combination of the cremasteric reflex and mobility/strength of the tunica albuginea contribute to reducing occurrences. However, serious injury can occur when the testicle is trapped against the pubic bone, varying from minimal extravasation to complete parenchymal destruction. Testicular rupture is a rare injury characterized by rupture of the tunica albuginea resulting in exposure of the seminiferous tubules. Prompt evaluation of these patients is crucial as a delay in surgical care may lead to loss of the injured testicle. We present a case of acute testicular rupture in an active duty male followed by a review of the literature.

Reimbursements and frequency of tests in privately insured testicular cancer patients in the United States: Implications to national guidelines.

OBJECTIVES: The objective of this study was to assess the frequency of utilization and reimbursement of the common diagnostic tests and treatment modalities used in testicular cancer care. METHODS: LifeLink™ (IMS Health, Danbury, CT, USA) Claims Database was used. We identified 877 subjects with a primary diagnosis of testicular cancer (ICD 186.9) between 2007 and 2012. Median reimbursement and frequency of the diagnostic/treatment modalities used were recorded. RESULTS: The most common claim was a vein puncture with median reimbursement of $9.11. Tumor markers, alpha-fetoprotein and beta human chorionic gonadotropin, were ranked 6th and 7th with median reimbursement of $52.13 and $48.71, respectively. Chest X-ray and computerized tomography (CT) scan of the chest were ranked 9th and 13th with median reimbursement of $68.51 and $769, respectively. A contrast CT scan of abdomen and pelvis was the 11th most frequent claim with median reimbursement of $855.89. The three invasive treatment modalities, chemotherapy, radiation therapy, and retroperitoneal lymphadenectomy were ranked 8th, 15th, and 164th with median reimbursement of $2858.38, $3988.25, and $2009.67, respectively. CONCLUSIONS: Testicular cancer is not an inexpensive disease. Surgery is the less utilized than radiation and chemotherapy despite lower cost. This may have implications to national guidelines and training since these treatments often carry the same grade of recommendation.