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Objectives To describe our experience of all patients presenting to a tertiary referral centre over a 3 year time period with blunt scrotal trauma and to describe a methodical approach for managing this group of patients. Methods A retrospective analysis was performed on all patients presenting to the Emergency Department (ED) of a level 1 trauma centre with blunt scrotal trauma from 2010 to 2013 inclusive. Inclusion criteria included a recent history of blunt scrotal trauma with associated pain and/or swelling of the affected testis on clinical examination. Results Twenty-seven male patients with a median age of 19 (range 8–65) years were included and all but 1 patient underwent scrotal ultrasonography upon presentation. Sixteen patients (59%) presented with scrotal trauma secondary to a sports related injury. Fifteen patients were managed conservatively and of the 12 who underwent urgent exploration 9 had a testicular rupture, including 1 who had an emergency orchidectomy due to a completely shattered testis. Four patients had >30% of the testis replaced by necrotic tissue/haematoma; of which 2 ultimately underwent orchidectomy and insertion of testicular prosthesis. Conclusion Our findings demonstrate that the necessity for scrotal protection in sports that predispose to scrotal trauma should be reviewed. We also demonstrate the importance of scrotal ultrasonography for determining an appropriate management strategy (i.e. conservative versus surgical treatment) in this young patient cohort.

Objective To determine the yield of follow-up imaging in patients sustaining renal trauma at our level-1 trauma center and hence, whether the 2013 European Association of Urology guidelines are clinically applicable. Methods All patients who attended Cork University Hospital with a diagnosis of renal injury from 2000-2012 were identified. Review of all medical records and radiologic imaging was undertaken. Injuries were graded using the American Association for the Surgery of Trauma Organ Injury Scale and were grouped as low-grade injuries (I, II, and III) or high-grade injuries (IV and V). Results One hundred and two patients (105 renal units) were identified with a median age of 23 years (interquartile range, 18-39 years). The mechanism of injury was blunt force in 98 of 102 cases (96%). Injuries were diagnosed at the time of admission using contrast-enhanced computed tomography (CT) imaging. Low-grade injuries accounted for 78 of 102 cases (77%); all were managed conservatively with a complication rate of 2 of 78 (3%). Twenty-four patients (23%) had high-grade injuries; 2 cases required nephrectomy, 22 of 24 (92%) were managed conservatively with a complication rate of 5 of 24 (21%). All patients with complications were symptomatic, prompting repeat imaging. Overall, 38 of 102 patients (37%) underwent at least 1 follow-up CT: 20 of 78 (25%) of low-grade injuries and 18 of 24 (75%) of high-grade injuries. Concurrent thoracoabdominal injuries mandated the need for repeat CT evaluation in 21 of 38 patients (55%). Thirty-one (30%) patients were reimaged by renal ultrasonography. Conclusion Selective reimaging of renal injuries based on clinical and laboratory criteria would have detected all complications. The 2013 European Association of Urology guidelines on urologic trauma are clinically appropriate in a major tertiary-trauma unit.

Objective: To analyse the long-term efficacy of combined interferon-α (IFN-α) and interleukin-2 (IL-2) subcutaneously, with 5-fluorouracil (5-FU) intravenously in a general multicentre setting, as treatment for metastatic renal cell carcinoma (RCC). Methods: Fifty-nine patients with metastatic RCC were scheduled to receive an 8-week cycle of immunotherapy. Karnofsky score ranged from 70 to 100 (median 90). Thirty-one patients at presentation had metastases of which 14 underwent nephrectomy. Metastases occurred in multiple organs (lung 74%, mediastinal lymphadenopathy 22%, bone 21%). Therapeutic response and survival were analysed. Results: Nine patients died from disease progression prior to completion of one full cycle. Six cases (10%) have stable disease at a follow-up of 51 months (range 20–88 months). Currently 11 patients (19%) are alive at a mean follow-up of 45 months (range 18–88 months). Forty-eight patients (81%) died of their disease at a mean follow-up of 10 months (range 0.5–46 months). Survival rate at 1 year was 53%, at 2 years 21%, at 3 years 16% and at 5 years 5%. Overall median survival is 10 months. Conclusion: IL-2 and IFN-α with 5-FU based immunotherapy achieve durable survival rates at 3 years in a minority of patients. Addition of 5-FU does not increase survival in our group. This study population is very different to other reported series. However it reflects better the entire population with metastatic RCC though results are subsequently poorer. Identifying patients that will respond is paramount.

Bilateral traumatic dislocation of the testis is rare. We report a case of testicular rupture and bilateral dislocation with associated pelvic fracture caused by a motorcycle accident. Serious testicular trauma resulting in testicular rupture is not uncommon. However, testicular dislocation is rare and occurs along the inguinal canal. Pelvic fractures from motorcycle accidents predispose ectopic dislocation. We report a case of retrovesical testicular dislocation in the presence of pelvic fracture. CASE REPORT A 37-year-old male presented after a head-on high velocity motorcycle accident. Injuries included a comminuted pelvic fracture (see figure). There was marked scrotal and perineal ecchymosis and hematoma. Both testes were impalpable. Ultrasound confirmed an empty scrotum and demonstrated the left testis in the groin. Scrotal exploration revealed a partially ruptured left testis in the left superficial inguinal pouch. The perineal floor was disrupted because of the pelvic fracture and the intact right testis was located retrovesically. Repair of the left testis and bilateral orchiopexy were performed. DISCUSSION