Scrotal abnormalities

Last updated: August 29, 2023

Summarytoggle arrow icon

Scrotal abnormalities include various conditions such as varicoceles, hydroceles, and malpositioning of the testicles (e.g., cryptorchidism, retractile testes). The most common congenital anomaly is cryptorchidism, which involves the incomplete descent of the testicle into the scrotum. The testicle may be located within the abdominal cavity, inguinal canal, or at the external inguinal ring. Cryptorchidism is associated with an increased risk of infertility and/or testicular cancer; therefore, early diagnosis and initiation of medical or surgical treatment are essential. Retractile testes usually do not require surgical intervention. A varicocele is the abnormal dilation of the pampiniform vessels within the scrotum. Patients may complain of a dull, aching, and swollen scrotum (typically on the left). A “bag of worms” sensation may be palpable at the apex of the scrotum. Surgery is required in complicated cases (i.e. concurrent testicular atrophy or infertility), while conservative treatment may be considered in older patients. A hydrocele is a fluid-filled sac derived from the tunica vaginalis or remnant of the processus vaginalis (infantile hydrocele) which results in a painless swelling of the scrotum that occurs at birth or later in life. Typical clinical findings and transillumination confirm the diagnosis. Hydroceles usually resolve spontaneously, but surgery may be indicated in prolonged congenital forms to prevent inguinal hernia.

Cryptorchidismtoggle arrow icon

Ectopic testistoggle arrow icon

Close urological monitoring is necessary, as the risk of testicular cancer and infertility is increased.

Retractile testistoggle arrow icon

Varicoceletoggle arrow icon

Grading of varicocele (Sarteschi classification) [6]
Grade Characteristics
Grade I
  • No visible varicosity
  • Reflux in vessels of the inguinal channel only when provoked by Valsalva maneuver
Grade II
Grade III
Grade IV
Grade V

Always perform an ultrasound of both testicles when varicocele is suspected, as the condition may occur bilaterally.

A unilateral right-sided varicocele is uncommon and should raise suspicion of a mass in the retroperitoneal space (Ormond disease, lymphoma, renal cell carcinoma) blocking the spermatic vein.

Hydroceletoggle arrow icon

A hydrocele must be differentiated from an inguinal hernia.

Referencestoggle arrow icon

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  2. Pauroso S, Di Leo N, Fulle I, Di Segni M, Alessi S, Maggini E. Varicocele: Ultrasonographic assessment in daily clinical practice. Journal of Ultrasound. 2011; 14 (4): p.199-204.doi: 10.1016/j.jus.2011.08.001 . | Open in Read by QxMD
  3. $Report on varicocele and infertility.
  4. Siegel MJ, Coley BD. Pediatric Imaging. Lippincott Williams & Wilkins ; 2006
  5. IPEG Guidelines for Inguinal Hernia and Hydrocele. Updated: November 4, 2009. Accessed: February 15, 2017.
  6. Politoff L, Hadziselimovic F, Herzog B, Jenni P. Does hydrocele affect later fertility?. Fertil Steril. 1990; 53 (4): p.700-703.
  7. Cryptorchidism (Undescended Testes). Updated: November 1, 2016. Accessed: February 15, 2017.
  8. Al-Salem AH. Undescended Testes (Cryptorchidism). Springer International Publishing ; 2020: p. 137-145
  9. $AUA releases new clinical Guideline on the evaluation and treatment of cryptorchidism.
  10. WENZLER DL, BLOOM DA, PARK JM. What is the Rate of Spontaneous Testicular Descent in Infants With Cryptorchidism?. J Urol. 2004; 171 (2): p.849-851.doi: 10.1097/01.ju.0000106100.21225.d7 . | Open in Read by QxMD

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