The Athletics initially said Kuroda-Grauer had suffered a testicular contusion, or bruising caused by blunt trauma, but an ultrasound later revealed a rupture. Manager Mark Kotsay said after visiting Kuroda-Grauer in the hospital that the rookie was in "great spirits" and was even joking about the injury. He marveled that Kuroda-Grauer had returned to the field despite the damage. "I think he might be the only player in history to (rupture) a testicle, stay in the game, get a hit and play another half inning of defense," Kotsay said, according to MLB.com.
Here's what actually happens when a testicle ruptures, why doctors treat it as a surgical emergency, and what recovery typically looks like.
"The testicle is surrounded by this very firm lining," Winter says. Inside are microscopic tubules that produce sperm and testosterone—"almost like noodly tissue that contains all the cells that make the sperm and the testosterone.” These tubules are “very, very delicate and microscopically thin,” she says.
It's also rare. Testicular rupture generally requires "a very intense injury to that very specific area," Winter says. While she has repaired ruptured testicles in emergency surgery, she says she's more often seen them after high-speed motorcycle crashes or other crushing injuries—not sporting events.
Why is a ruptured testicle a medical emergency?
Once the outer lining tears, the testicle can bleed internally while also bleeding into the scrotum. "It's a combination of bleeding," Winter says. And there's plenty of room for that blood to accumulate. "The scrotum is very stretchable, so you can bleed and bleed and bleed," she says. "You could lose significant blood." The trapped blood creates pressure that can further injure the remaining healthy tissue, Winter says. Left untreated, she says, "you could cause permanent damage to the remainder of that testicle," potentially "requiring the testicle to be removed entirely if you wait too long."
The surgery itself is relatively straightforward. "It should be a pretty quick surgery," Winter says.
The goal is to save the testicle whenever possible—and prompt treatment can make a big difference. Studies suggest that roughly 90% of ruptured testicles can be salvaged when they're surgically repaired within about 72 hours of the injury, compared with about 45% after that window. If the blood supply has been too badly damaged, however, the surgeon may have no choice but to remove the testicle. Even when doctors are able to save it, Winter cautions that "the surgery doesn't undo the trauma." Instead, she describes it as "a cleanup job." The goal, she says, is to preserve as much healthy tissue as possible—not erase the damage that has already occurred.
What is recovery like?
"I think the pain should be significantly improved at the end of the surgery," Winter says. Still, patients need time to heal before returning to strenuous activity. While there aren't formal guidelines for elite athletes recovering from this injury, she says she would want a patient to wait "a minimum of two weeks" before doing anything "that could put him in jeopardy."
It can—but not always.
The reassuring news is that most men won't notice a major difference as long as their other testicle is healthy. "There are plenty of men with one testicle" who have normal testosterone levels and normal sperm counts, Winter says. That's because the remaining healthy testicle often compensates by producing enough testosterone and sperm on its own. The redundancy is by design, she adds: "The body wants us to survive and reproduce, so should something happen"—historically, she notes, more often from infection than from trauma—there's a backup. Even if the injured testicle has reduced function or has to be removed entirely, most patients can still expect to live healthy, normal lives.
How do you know if you've ruptured a testicle?
Doctors can often tell something is seriously wrong because the injured testicle no longer has its normal feel. "It's not that you see it—it's that you feel it," Winter says. A healthy testicle is "firm" and rounded. After a complete rupture, "it feels like mush,” she says. “It's lost its rigidity."
Does wearing a cup prevent it?
It's unclear whether Kuroda-Grauer was wearing a protective cup when he was injured. But Winter was unequivocal about what she'd advise to anyone playing contact or ball sports. "A neurosurgeon would tell people to wear helmets," she says. "As a urologist, obviously, I would tell people to wear a cup."
Whether you're stepping into a batter's box or playing pickup sports on the weekend, Winter's advice is the same: "People who are doing contact sports, remember that these are very delicate organs, at the end of the day."
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