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Genitourinary tract injuries account for 3 to 10% of trauma patients, and scrotal trauma is particularly prevalent in males 10 to 30 years of age. Prompt diagnosis and timely surgical intervention are essential to prevent future complications of infertility, delayed orchiectomy, infection, and testicular atrophy. While clinical examination provides valuable information, it may be inconclusive due to soft tissue swelling and difficult to perform due to testicular pain with palpation. Conversely, testicular rupture does not always present with pain or tenderness. Imaging can contribute additional support for surgical evaluation in scrotal trauma. Current AUA guidelines support ultrasound in blunt scrotal trauma to confirm testicular rupture while recommending early exploration in penetrating injuries due to the high incidence of testicular rupture. This review discusses the existing literature on the use of various imaging modalities in assessment of blunt and penetrating scrotal trauma and common imaging findings.

This research was supported in part by the Proposed Research Initiated by Students and Mentors (PRISM) Program, University of Maryland School of Medicine Office of Student Research.

INTRODUCTION AND OBJECTIVES: Clinical trials have suggested that pelvic floor rehab (PFR) can improve early urinary control following radical prostatectomy. However, the details surrounding its use in clinical practice and its contribution to cost and value are not well understood. In this context, we examined the use of PFR in a diverse statewide quality improvement collaborative, including patient characteristics, implementation patterns, and costs.METHODS: Using registry data from the Michigan Urological Surgery Improvement Collaborative and claims data from Michigan Value Collaborative, we identified all men who underwent a laparoscopic radical prostatectomy from 04/2014 through 11/2015 with insurance from Medicare or a large commercial payer. All men reported pre-operative urinary function using the STAR questionnaire with scores ranging from 0 (worst) to 21 (best). We compared patient demographics, cancer characteristics, pre-operative urinary function, and 90-day total episode costs of patients who did and did not receive PFR.RESULTS: 142 men met our inclusion criteria, of whom 53 (37%) received pelvic floor rehab. There were no differences in patient or cancer characteristics among patients who did and did not receive PFR. Patients initiated PFR an average of 34 days after discharge (range 15-83 days). Mean baseline urinary function scores were worse for PFR patients (17.8 vs 19.3, p¼0.01). Ninety-day episode costs were similar in the two cohorts, with PFR contributing an average of $422, or 3% of total episode costs.CONCLUSIONS: In a statewide collaborative, PFR is used in the minority of cases, but its use appears to be concentrated among patients with worse baseline urinary function. Incremental costs from PFR are modest, accounting for 3% of 90-day episode costs. In the era of value-based care, decisions about further expanding this therapy will depend on studying its comparative impact on post-operative patient reported outcomes in large groups of non-clinical trial patients.

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