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Evaluation of nonacute scrotal conditions in adults

Robert C Eyre, MD
Section Editor
Michael P O'Leary, MD, MPH
Deputy Editor
Howard Libman, MD, FACP


The spectrum of conditions that affect the scrotum and its contents ranges from incidental findings that require patient reassurance to acute pathologic events that necessitate expeditious diagnosis and treatment. This topic reviews the conditions that a clinician is likely to encounter on routine physical examination. The most common nonacute scrotal conditions include varicocele, hydrocele, epididymal cyst and spermatocele, testicular cancer, chronic epididymitis, and cryptorchidism.

Acute scrotal pain in adults and scrotal disorders in children are discussed separately. (See "Evaluation of acute scrotal pain in adults" and "Evaluation of scrotal pain or swelling in children and adolescents".)


The testis, tunica vaginalis, epididymis, spermatic cord, appendix testis, and appendix epididymis are anatomic structures that may be involved in nonacute scrotal conditions (figure 1):

The testis (testicle) is the male gonad responsible for production of sperm and androgens (primarily testosterone). The normal testis is ovoid, about 3 to 5 cm in length, and firm with smooth surfaces. One testis may be slightly larger than the other, and one testis (usually the left) may hang slightly lower.

The tunica vaginalis is a fascial layer which encapsulates a potential space that encompasses the anterior two-thirds of the testis. Different types of fluid may accumulate within the tunica vaginalis (eg, water with a hydrocele, blood with a hematocele, pus with a pyocele).

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Literature review current through: Dec 2017. | This topic last updated: Dec 11, 2017.
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  1. Rifkin MD, Kurtz AB, Pasto ME, Goldberg BB. Diagnostic capabilities of high-resolution scrotal ultrasonography: prospective evaluation. J Ultrasound Med 1985; 4:13.
  2. Crawford P, Crop JA. Evaluation of scrotal masses. Am Fam Physician 2014; 89:723.
  3. The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics. World Health Organization. Fertil Steril 1992; 57:1289.
  4. Practice Committee of the American Society for Reproductive Medicine, Society for Male Reproduction and Urology. Report on varicocele and infertility: a committee opinion. Fertil Steril 2014; 102:1556.
  5. Madgar I, Weissenberg R, Lunenfeld B, et al. Controlled trial of high spermatic vein ligation for varicocele in infertile men. Fertil Steril 1995; 63:120.
  6. Nieschlag E, Hertle L, Fischedick A, et al. Update on treatment of varicocele: counselling as effective as occlusion of the vena spermatica. Hum Reprod 1998; 13:2147.
  7. Abdel-Meguid TA, Al-Sayyad A, Tayib A, Farsi HM. Does varicocele repair improve male infertility? An evidence-based perspective from a randomized, controlled trial. Eur Urol 2011; 59:455.
  8. Evers JL, Collins JA, Vandekerckhove P. Surgery or embolisation for varicocele in subfertile men. Cochrane Database Syst Rev 2001; :CD000479.
  9. Hadziselimovic F, Herzog B, Jenny P. The chance for fertility in adolescent boys after corrective surgery for varicocele. J Urol 1995; 154:731.
  10. Yamamoto M, Hibi H, Hirata Y, et al. Effect of varicocelectomy on sperm parameters and pregnancy rate in patients with subclinical varicocele: a randomized prospective controlled study. J Urol 1996; 155:1636.
  11. Chomyn JJ, Craven WM, Groves BM, Durham JD. Percutaneous removal of a Gianturco coil from the pulmonary artery with use of flexible intravascular forceps. J Vasc Interv Radiol 1991; 2:105.
  12. Halpern J, Mittal S, Pereira K, et al. Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications. Asian J Androl 2016; 18:234.
  13. Choyke PL, Glenn GM, Wagner JP, et al. Epididymal cystadenomas in von Hippel-Lindau disease. Urology 1997; 49:926.
  14. Muglia V, Tucci S Jr, Elias J Jr, et al. Magnetic resonance imaging of scrotal diseases: when it makes the difference. Urology 2002; 59:419.
  15. Lewis AG, Bukowski TP, Jarvis PD, et al. Evaluation of acute scrotum in the emergency department. J Pediatr Surg 1995; 30:277.
  16. Siegel A, Snyder H, Duckett JW. Epididymitis in infants and boys: underlying urogenital anomalies and efficacy of imaging modalities. J Urol 1987; 138:1100.
  17. Ferguson L, Agoulnik AI. Testicular cancer and cryptorchidism. Front Endocrinol (Lausanne) 2013; 4:32.
  18. Oh J, Landman J, Evers A, et al. Management of the postpubertal patient with cryptorchidism: an updated analysis. J Urol 2002; 167:1329.