RSS Feeds

Joshua Kuroda-Grauer, a Major League Baseball player for the Athletics team currently based in West Sacramento, had already hit the first home run of his professional career Monday night against the Arizona Diamondbacks when his night took a painful turn. In the fifth inning, the 23-year-old rookie infielder hit a foul ball that ricocheted directly into his groin, dropped to his knees in the batter's box, then got back up and reached first base with a hit on the very next pitch. He kept playing for another half-inning before leaving the game. Hours later, he underwent emergency surgery for a ruptured testicle. 

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.

What do urologists think? "I can't believe he continued to play after that," says Dr. Ashley Winter, a urologist in Los Angeles who has performed emergency surgery for testicular rupture (but did not treat Kuroda-Grauer). 

Here's what actually happens when a testicle ruptures, why doctors treat it as a surgical emergency, and what recovery typically looks like.

What is a ruptured testicle?

When a testicle ruptures, the tough outer covering, called the tunica albuginea, actually tears open after an extremely forceful blow.

"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.

"Think of it as if you had a balloon—but imagine the balloon was a very thick lining," she says. A powerful impact can cause that lining to tear, allowing the soft tissue inside to bulge outward. "It's pretty gnarly."

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?

Doctors don't wait to operate because every hour can increase the risk of permanent damage.

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 injury is also excruciating. "It's so painful," Winter says. Beyond the torn tissue itself, internal bleeding and swelling can intensify the agony. Prompt surgery gives doctors the best chance of stopping the bleeding, relieving pressure, and saving the injured testicle before the damage becomes irreversible.

What happens during surgery?

The surgery itself is relatively straightforward. "It should be a pretty quick surgery," Winter says.

Surgeons open the scrotum and lift out what Winter calls "the exploded testicle." Any tissue that has died is carefully removed, and healthy tissue is preserved and tucked back in. Bleeding is stopped, and the torn outer covering is stitched back together. Before finishing, surgeons also check that blood is still flowing normally through the organ, typically with an ultrasound. 

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?

Pain usually improves once the damaged tissue has been repaired, though recovery doesn't happen overnight.

"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."

Returning too soon could cause fresh bleeding or disrupt the repair. Because isolated ruptured testicles are so uncommon—most occur alongside other serious injuries, since they usually happen after serious accidents—there's limited research on recovery timelines. That's part of why a case like this one is so unusual, Winter says: "Most testicular trauma is not an isolated thing, like a baseball hitting your scrotum." 

Can a ruptured testicle cause long-term problems?

It can—but not always.

Even when surgeons successfully save the testicle, the injury itself may leave lasting effects. Over time, the injured testicle may become smaller or produce less testosterone or sperm than it did before. "He might have a smaller testicle," she says of a hypothetical patient. "That testicle might produce less testosterone. That testicle might produce less sperm."

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?

If you've taken a hard hit to the groin, don't try to tough it out if the pain is severe or the swelling is dramatic, Winter says. "If you have that severe of an injury that you're worried about testicular rupture, you should probably just go to the emergency room." 

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."

The bottom line: This isn't the kind of injury to monitor at home. “It's not like a minor thing," she says.

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."

She wonders whether the high-profile nature of this injury could change players' minds. "I'd be really interested to know what the actual rate of cup usage is—and after this, if it doesn't go up a lot," she says. 

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."

The House passed a more than $1 trillion annual defense bill on Wednesday, moving the unusually contentious measure forward after it earlier stalled in both chambers.

The bill, known as the National Defense Authorization Act (NDAA), passed by a 216-212 vote. The House mostly voted along party lines, with Democrats overwhelmingly voting against the measure, citing their objections to President Donald Trump’s war in Iran. 

“As we support anything in the defense area, we are de facto supporting this war with no end in sight,” Rep. Adam Smith of Washington, the ranking Democrat on the House Armed Services Committee, said on Wednesday.

The legislation will now need to win approval in the Senate, where it could face a difficult path. Last week, Democrats in the upper chamber blocked the Senate version of the measure for the same reason the majority of their colleagues in the House voted against the bill on Wednesday.. 

And the House rule that advanced the bill to consideration on the floor of the lower chamber also included language to attach it to a contentious piece of voting legislation before it is sent to the Senate. That measure, the SAVE America Act, would impose stricter ID requirements for voters nationwide, among other provisions. Trump has aggressively pushed for the passage of the SAVE America Act ahead of the pivotal fall midterms, stating that he will not sign any other legislation until it is sent to his desk. House Republicans passed the measure in February, but it has stalled in the Senate, where Republican leaders have said they do not have the votes to pass it.

The NDAA itself would allocate more than $1 trillion to the Department of Defense (DoD), as well as roughly $40 billion to the Department of Energy to oversee the U.S.’s nuclear arsenal and more than $10 billion for other matters related to the military. The package also contains a provision that stipulates that service members will receive a pay raise. 

Earlier this year, the President proposed increasing DoD spending to $1.5 trillion—an increase of about $600 billion from last year.

In previous years, Congress has generally approved the annual defense bill with widespread support across the political aisle. But this year, the measure has become snarled in tensions over defense spending levels and the SAVE America Act.

On the House floor on Wednesday, Smith said that many lawmakers are “trying to work in a bipartisan way.” 

“But,” Smith continued, “we have to do that against the backdrop of an unbelievably partisan and in many ways out of control Administration and Department of Defense.”

“This year, we have issues that have risen above the normal flow of partisan divide,” he continued, citing the significant proposed increase in the defense budget, as well as the war in Iran.

On June 30, several House Republicans stalled progress on the NDAA and other legislative priorities in an effort to push for stronger action on the SAVE America Act. The standstill stemmed, in part, from the House rule that would have attached the restrictive voter ID legislation with the NDAA after it passed the lower chamber; one GOP lawmaker called the rule a "procedural head fake,” arguing that the Senate could detach the SAVE America Act from the defense bill. The bloc of House Republicans who rebelled against the move called on the party to take more radical steps to pass Trump’s restrictive voter ID law.

Senate Democrats, meanwhile, expressed their frustrations with the ongoing war in the Middle East by preventing the NDAA from moving forward.

On July 14, the measure failed to advance in the upper chamber in a vote of 50-46—a result that fell short of the 60-vote threshold required for it to proceed to the Senate floor. Lawmakers voted largely along party lines.

“The NDAA cannot become a permission slip for that recklessness that we see occurring in Iran,” Senate Minority Leader Chuck Schumer said before casting his vote. “Donald Trump does not get to drag the American people deeper into a war he cannot explain and does not know how to end—and then demand that Congress look the other way.”

Democrats have repeatedly pushed for greater congressional oversight over the war, which started when the U.S. and Israel launched military strikes on Iran on Feb. 28, is now in its fifth month and has led to the deaths of 17 American service members. The U.S. and Iran agreed to a memorandum of understanding in June that provided the framework for negotiating a final peace deal. But amid conflict over the key Strait of Hormuz, the U.S. resumed strikes against Iran earlier this month, with Trump declaring the tenuous cease-fire under the memorandum “over.”

Several Democrats on the House floor on Wednesday also criticized the increase in defense spending at a time when the Trump Administration has made significant cuts to many health care and social programs. But Republicans argued that the increase is necessary.

“For the first time in 40 years, we’ve been presented a budget that accounts for the true cost of American deterrence,” Rep. Mike Rogers, the Republican chairman of the House Armed Services Committee, said on the House floor. “This top line begins to reverse the damage caused by decades of underinvestment in the U.S. military.”

Also on Wednesday, the House adopted a $95 billion budget proposal focused on a number of Trump’s policy priorities, including the war in Iran—a measure that was supported only by Republicans, while Democrats, and two GOP members breaking from the rest of their party, objected to it.