Uncommon Scrotal Trauma: Insights from Four Distinct Cases and Review of the Literature

<i>Background: </i>Scrotal trauma represents a rare but serious urological emergency with potential consequences on fertility, endocrine function, and overall quality of life. Atypical cases such as self-mutilation, human bites, animal horn injuries, or war-related wounds pose significant diagnostic and therapeutic challenges. <i>Methods: </i>We report four unusual cases of scrotal trauma managed in a university teaching hospital. Clinical, surgical, therapeutic, and follow-up data were retrospectively analyzed. A targeted literature review was conducted to support the discussion on multidisciplinary management strategies. <i>Results: </i>The first case involved bilateral testicular self-amputation in a patient with paranoid schizophrenia, treated with surgical debridement, hemostatic ligation, testosterone replacement therapy, and psychiatric follow-up. The second case described a bull horn injury in a teenage cattle breeder, presenting with grade III left scrotal trauma (AAST), managed surgically. The third case involved bilateral scrotal human bite injuries sustained during a school altercation, treated with wound closure, antibiotic prophylaxis, serological monitoring, and medico-legal documentation. The fourth case concerned a soldier injured by an improvised explosive device (IED), presenting with extensive penoscrotal tissue loss and left testicular destruction, managed by damage control surgery and followed by andrological, orthopedic, and psychological care. <i>Conclusion: </i>Atypical scrotal trauma requires prompt, individualized, and multidisciplinary diagnostic and therapeutic approaches. Early surgical exploration, tailored psychological support, and specific risk prevention measures are essential to optimize both functional and psychosexual outcomes in these patients.