Evaluation of nonacute scrotal pathology in adult men
- Robert C Eyre, MD
Robert C Eyre, MD
- Associate Professor of Surgery
- Harvard Medical School
The spectrum of conditions that affect the scrotum and its contents ranges from incidental findings that merely require explanation and patient reassurance to acute pathologic events that require expeditious diagnosis and treatment. This topic reviews the conditions that a physician is likely to encounter on routine physical examination. Acute scrotal pain in adults and testicular and scrotal disorders in children are discussed separately. (See "Evaluation of the acute scrotum in adults" and "Evaluation of scrotal pain or swelling in children and adolescents".)
The tunica vaginalis and the epididymis are two important landmarks for the scrotal examination (figure 1). The tunica vaginalis is a potential space that encompasses the anterior two-thirds of the testicle and is where fluid from a variety of sources may accumulate. The epididymis usually is positioned posterolaterally to the testicle and must be differentiated from an abnormal mass. The spermatic cord, which consists of the testicular vessels and the vas deferens, is connected to the base of the epididymis.
Cryptorchidism is failure of descent of the testes into the scrotum during fetal development. The defect may result in the testes being located within the abdomen, inguinal canal, or some other ectopic location. Both unilateral and bilateral cryptorchidism are associated with impaired spermatogenesis and an increased risk of testicular tumors. (See "Undescended testes (cryptorchidism) in children: Management", section on 'Testicular cancer'.)
Approximately 30 percent of premature and 5 percent of full-term males will have an undescended testicle (UDT) noted during the first year of life. Most of these subsequently descend into the scrotum so that cryptorchidism is present in approximately 1 percent of boys at age one year.
Cryptorchidism in children and adolescents is discussed in detail separately. (See "Undescended testes (cryptorchidism) in children: Clinical features and evaluation" and "Undescended testes (cryptorchidism) in children: Management", section on 'Complications and sequelae'.)
- Crawford P, Crop JA. Evaluation of scrotal masses. Am Fam Physician 2014; 89:723.
- 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.
- Hadziselimovic F, Herzog B, Jenny P. The chance for fertility in adolescent boys after corrective surgery for varicocele. J Urol 1995; 154:731.
- Sandlow J. Pathogenesis and treatment of varicoceles. BMJ 2004; 328:967.
- Evers JL, Collins JA, Vandekerckhove P. Surgery or embolisation for varicocele in subfertile men. Cochrane Database Syst Rev 2001; :CD000479.
- Choyke PL, Glenn GM, Wagner JP, et al. Epididymal cystadenomas in von Hippel-Lindau disease. Urology 1997; 49:926.
- 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.