What are the main components of the scrotum. How do glands in the scrotum function. What conditions can affect scrotal health. How can you maintain optimal scrotal health.

The Scrotum: Structure and Purpose

The scrotum is a remarkable anatomical structure that plays a crucial role in male reproductive health. This sac of skin, located at the front of the pelvis between the legs, serves as a protective housing for the testicles. Its primary function is to maintain an optimal temperature for sperm production, which is slightly lower than the core body temperature.

The scrotum’s ability to regulate temperature is facilitated by its unique anatomy:

• The dartos fascia, a layer of smooth muscle that allows the scrotum to contract and relax
• The cremaster muscle, which can raise or lower the testicles in response to temperature changes
• A network of blood vessels that help dissipate heat

This temperature regulation is critical for maintaining healthy sperm production and storage. The scrotum’s external position allows it to keep the testicles about 2-4°C (3.6-7.2°F) cooler than the core body temperature, which is ideal for sperm development.

Glandular Components of the Scrotum

While the scrotum itself is not a gland, it contains and protects several important glandular structures. The primary glandular components within the scrotum are:

Testicles (Testes)

The testicles are the most prominent glandular structures within the scrotum. These oval-shaped organs serve two critical functions:

1. Sperm production: The testicles contain seminiferous tubules where sperm cells are produced through a process called spermatogenesis.
2. Hormone production: Specialized cells within the testicles, known as Leydig cells, produce testosterone and other androgens.

How do the testicles manage these dual roles? The answer lies in their complex internal structure, which includes:

• Seminiferous tubules: These coiled tubes make up most of the testicular volume and are the site of sperm production.
• Interstitial tissue: This tissue between the tubules contains the Leydig cells responsible for testosterone production.
• Rete testis: A network of channels that collect and transport sperm from the seminiferous tubules.

Epididymis

The epididymis is a highly coiled tubular structure located on the posterior surface of each testicle. Its functions include:

• Sperm maturation: As sperm cells travel through the epididymis, they undergo final maturation and acquire motility.
• Sperm storage: The epididymis serves as a temporary storage site for mature sperm before ejaculation.
• Fluid absorption and secretion: It helps concentrate sperm and provides a supportive environment for their survival.

The epididymis is divided into three main regions: the head (caput), body (corpus), and tail (cauda). Each section plays a specific role in sperm development and storage.

The Spermatic Cord: A Lifeline for Testicular Function

The spermatic cord is a vital structure that connects each testicle to the abdominal cavity. While not a gland itself, it contains several crucial components that support the function of the scrotal glands:

• Vas deferens: This muscular tube transports mature sperm from the epididymis to the ejaculatory ducts.
• Blood vessels: The testicular artery supplies oxygenated blood to the testicle, while veins drain deoxygenated blood.
• Lymphatic vessels: These help maintain fluid balance and play a role in immune function.
• Nerves: Sensory and autonomic nerves regulate testicular function and sensation.

The spermatic cord’s intricate arrangement of structures ensures that the testicles receive adequate blood supply, innervation, and a pathway for sperm transport.

Common Conditions Affecting Scrotal Health

Several conditions can impact the health and function of the scrotum and its contents. Understanding these issues is crucial for maintaining reproductive health:

Varicocele

A varicocele is an enlargement of the veins within the scrotum, similar to varicose veins in the legs. This condition affects about 15% of adult males and can lead to:

• Reduced sperm production and quality
• Testicular atrophy (shrinkage)
• Fertility issues
• Discomfort or a feeling of heaviness in the scrotum

Treatment options for varicoceles include surgical repair or minimally invasive procedures to block the affected veins.

Hydrocele

A hydrocele is an accumulation of fluid around the testicle, causing swelling of the scrotum. While often painless, large hydroceles can cause discomfort and may require treatment. Hydroceles can be:

• Congenital: Present at birth due to incomplete closure of the processus vaginalis
• Acquired: Developing later in life due to inflammation, injury, or blocked fluid drainage

Many hydroceles resolve on their own, especially in infants. However, persistent or symptomatic hydroceles may require surgical drainage or repair.

Epididymitis

Epididymitis is inflammation of the epididymis, often caused by bacterial infections. Symptoms can include:

• Pain and swelling in the scrotum
• Fever and chills
• Urinary symptoms such as frequency or burning
• Discharge from the penis

Treatment typically involves antibiotics and supportive measures such as rest and pain relief. Chronic epididymitis can lead to fertility issues if left untreated.

Testicular Torsion: A Medical Emergency

Testicular torsion occurs when a testicle rotates, twisting the spermatic cord and cutting off blood supply. This condition requires immediate medical attention to prevent permanent damage or loss of the affected testicle.

Key points about testicular torsion include:

• It most commonly affects adolescents and young adults
• Symptoms include sudden, severe scrotal pain, swelling, and nausea
• Emergency surgery is necessary to untwist the cord and restore blood flow
• Delay in treatment can lead to testicular necrosis within hours

Awareness of the symptoms and the need for urgent care is crucial in cases of suspected testicular torsion.

Maintaining Scrotal Health: Prevention and Care

Proper care and attention to scrotal health can help prevent many common issues and promote overall reproductive well-being. Here are some essential tips:

1. Perform regular self-examinations: Monthly testicular self-exams can help detect lumps, swelling, or other abnormalities early.
2. Practice good hygiene: Keep the scrotal area clean and dry to prevent skin irritation and fungal infections.
3. Wear appropriate clothing: Choose breathable, supportive underwear to maintain optimal temperature and reduce the risk of trauma.
4. Protect against injury: Use athletic cups or supporters during sports or high-impact activities.
5. Maintain a healthy lifestyle: A balanced diet, regular exercise, and avoiding tobacco can support overall reproductive health.
6. Seek prompt medical attention: Don’t ignore persistent pain, swelling, or other unusual symptoms in the scrotal area.

By following these guidelines, men can take proactive steps to protect their scrotal health and address potential issues before they become serious.

Advanced Diagnostic Techniques for Scrotal Health

When scrotal health concerns arise, healthcare providers have several advanced diagnostic tools at their disposal:

Ultrasound Imaging

Scrotal ultrasound is a non-invasive, radiation-free imaging technique that provides detailed views of the scrotum’s internal structures. It can help diagnose:

• Testicular tumors
• Varicoceles
• Hydroceles
• Epididymal cysts
• Testicular torsion

The real-time nature of ultrasound also allows for assessment of blood flow, which is crucial in cases of suspected torsion.

Magnetic Resonance Imaging (MRI)

While less commonly used than ultrasound, MRI can provide highly detailed images of scrotal structures. It may be employed when:

• Ultrasound results are inconclusive
• There’s a need to differentiate between benign and malignant lesions
• Evaluating the extent of testicular cancer

MRI’s superior soft tissue contrast can offer valuable insights in complex cases.

Semen Analysis

When fertility is a concern, a semen analysis can provide crucial information about:

• Sperm count
• Sperm motility
• Sperm morphology
• Semen volume and composition

This test can help identify issues related to sperm production or transport that may not be apparent through physical examination alone.

The Impact of Environmental Factors on Scrotal Health

Environmental factors can significantly influence scrotal health and function. Understanding these impacts is crucial for maintaining optimal reproductive health:

Temperature Exposure

The scrotum’s temperature-regulating mechanism can be compromised by prolonged exposure to heat sources such as:

• Hot tubs and saunas
• Tight-fitting clothing
• Laptop computers placed directly on the lap
• Occupational heat exposure (e.g., welders, bakers)

Chronic heat exposure can negatively impact sperm production and quality. Minimizing these exposures and allowing for proper cooling can help maintain optimal testicular function.

Environmental Toxins

Certain environmental toxins and chemicals can adversely affect scrotal health and fertility. These include:

• Heavy metals (e.g., lead, mercury)
• Pesticides and herbicides
• Endocrine-disrupting chemicals (e.g., bisphenol A, phthalates)
• Radiation exposure

Minimizing exposure to these substances through proper workplace safety measures and consumer choices can help protect scrotal health.

Lifestyle Factors

Various lifestyle choices can impact scrotal health and function:

• Smoking: Can reduce sperm quality and increase the risk of testicular cancer
• Alcohol consumption: Excessive drinking may lower testosterone levels and impair sperm production
• Diet: A balanced diet rich in antioxidants supports overall reproductive health
• Exercise: Regular physical activity promotes hormonal balance and circulation

Making informed lifestyle choices can contribute significantly to maintaining optimal scrotal health.

Emerging Therapies and Research in Scrotal Health

The field of reproductive medicine is continually evolving, with new therapies and research offering hope for improved scrotal health and function:

Microsurgical Techniques

Advancements in microsurgery have revolutionized the treatment of various scrotal conditions:

• Varicocelectomy: Minimally invasive procedures using microscopic visualization can improve outcomes and reduce complications
• Vasectomy reversal: Microsurgical techniques have increased success rates for men seeking to restore fertility after vasectomy
• Testicular sperm extraction (TESE): Microsurgical approaches allow for more precise and effective sperm retrieval in cases of non-obstructive azoospermia

Regenerative Medicine

Emerging research in regenerative medicine shows promise for addressing various scrotal health issues:

• Stem cell therapy: Potential applications in treating testicular failure and improving spermatogenesis
• Tissue engineering: Development of bioengineered testicular tissue for transplantation or in vitro sperm production
• Growth factor therapies: Investigating the use of specific growth factors to enhance testicular function and repair

Genetic and Molecular Approaches

Advances in genetic and molecular biology are opening new avenues for understanding and treating scrotal health conditions:

• Genetic screening: Identifying genetic factors contributing to male infertility and testicular cancer risk
• Targeted therapies: Developing treatments that address specific molecular pathways involved in testicular disorders
• Epigenetic interventions: Exploring ways to modify gene expression to improve testicular function and fertility

These emerging fields of research hold great promise for the future of scrotal health and male reproductive medicine.

As our understanding of scrotal anatomy, function, and health continues to grow, so too do the opportunities for improved diagnosis, treatment, and prevention of scrotal disorders. By staying informed about these advancements and maintaining good scrotal health practices, men can take proactive steps to protect their reproductive well-being and overall quality of life.

Anatomy and Function, Diagram, Conditions, and Health Tips

What is the scrotum?

The scrotum is a sac of skin that hangs from the body at the front of the pelvis, between the legs. It sits next to the upper thighs, just below the penis. The scrotum contains the testicles. These are two oval-shaped glands responsible for producing and storing sperm. They also produce several hormones, the main one being testosterone.

The scrotum hangs outside the body because it needs to maintain a slightly lower temperature than the rest of the body. This lower temperature helps to maintain sperm production. Scrotal tissues help protect the structures inside the testicles, where sperm and important hormones are produced.

In addition, the scrotum protects the testicles and major blood vessels, as well as tubes that release sperm from the testicles into the penis for ejaculation.

Anatomy and function of the scrotum

The scrotum is a sack of skin divided in two parts by the perineal raphe, which looks like a line down the middle of the scrotum.

The raphe joins the internal septum with the scrotum. The septum splits the scrotal sac into two parts with similar anatomy.

Each side of the scrotum usually consists of a:

• Testicle. Each testicle produces hormones, the main one being testosterone, with the help of parts of the brain like the hypothalamus and pituitary gland. They also contain tubules and cells that produce sperm, or spermatozoa. Sperm are transferred from the testicle to the epididymis.
• Epididymis. An epididymis is located on the top of each testicle. Each epididymis is a tightly coiled tube. They store sperm created in each testicle until they’re mature, usually for about 60 to 80 days. The epididymis also absorbs extra fluid secreted by the testicle to help move sperm through the reproductive tract.
• Spermatic cord. Each spermatic cord contains blood vessels, nerves, lymph vessels, and a tube called the vas deferens. This tube moves sperm out of the epididymis into ejaculatory ducts. The blood vessels maintain the blood supply for the testicle, vas deferens, and cremaster muscle. The nerves transport information from the spinal cord to and from the scrotum, testicles, and cremaster muscle.
• Cremaster muscle. Each cremaster muscle surrounds one of the testicles and its spermatic cord. The muscle helps to move the testicle toward and away from the body to maintain the ideal temperature for sperm production. This is why the scrotum hangs lower in warm conditions and closer to the body in cold weather.

All of these structures are surrounded by the scrotal wall. This wall is lined with smooth muscle called the dartos fascia muscle. This muscle, along with the cremaster muscles, help to expand or tighten the skin of the scrotum as it moves up and down.

Scrotum diagram

Explore the interactive 3-D diagram below to learn more about the scrotum.

What conditions affect the scrotum?

Many conditions can affect your scrotum and its contents. Here’s a list of some of the most common ones.

Inguinal hernia

An inguinal hernia happens when part of your small intestine pokes through an opening in your abdominal wall into your scrotum. Some inguinal hernias follow the path of the spermatic cord into the scrotum, while others stay outside it.

Symptoms of an inguinal hernia can include:

• bulging or swelling around your pubic area that feels like it’s aching or burning
• uncomfortable groin sensation or pain when you cough, laugh, or bend over
• heaviness around your groin area
• an enlarged scrotum

Some inguinal hernias can be dangerous if left untreated. You may need surgery to repair an inguinal hernia and prevent tissue death due to lack of blood flow.

Hydrocele

A hydrocele happens when excess fluid builds up in the cavities around one of your testicles. This is sometimes present at birth, but it can also result from an injury or inflammation.

Hydrocele symptoms include:

• scrotal swelling that gets more noticeable as the day goes on
• dull ache in your scrotum
• feeling of heaviness in your scrotum

Hydroceles usually don’t require treatment unless they’re very large or painful. Most go away on their own, but more severe cases might require surgical repair.

Varicocele

A varicocele is a swollen collection of veins in your scrotum. It doesn’t always cause symptoms. When it does, symptoms include:

• a dull, aching pain in your scrotum
• pain that gets worse throughout the day
• pain that starts to go away when you lie down
• a scrotum that may feel like a “bag of worms”

You can have a varicocele your entire life and never need treatment. However, they can sometimes cause infertility or testicular shrinkage, so it’s best to have it checked out by your doctor.

Spermatocele

A spermatocele, or spermatic cyst, happens when a fluid-filled sac forms in the epididymis. These cysts aren’t cancerous or life-threatening, but they can cause pain and discomfort if they’re large.

Larger, more painful spermatoceles may need to be removed with surgery.

Testicular torsion

Testicular torsion means that your testicle has rotated in the scrotum. This twisting of the spermatic cord cuts off blood supply, nerve function, and sperm transport to your testicle. This condition is considered a medical emergency.

Symptoms of testicular torsion include:

• severe scrotum pain and swelling
• testicle swelling
• lower abdomen pain
• nausea and vomiting
• testicle feeling higher or out of place
• urinating more than usual

Seek emergency medical care for any of these symptoms.

Several things may increase the risk of testicular torsion, including:

• injury to the scrotum
• exercising too long or hard
• free movement of the testicle in the scrotum caused by a genetic condition

Testicular torsion occurs more frequently in young children, teens, and young adults. Your doctor can temporarily treat testicular torsion by repositioning the testicle by hand. However, it frequently reoccurs. Experts recommend surgery to permanently fix the problem, ideally within 12 hours from the start of symptoms.

Epididymitis

Epididymitis happens when the epididymis becomes infected or inflamed. It’s often the result of a sexually transmitted infection (STI), such as chlamydia or gonorrhea.

Symptoms of epididymitis can include:

• scrotum or testicle pain or tenderness
• warmness or redness in your scrotum
• unusual fluid coming from your penis
• frequent or painful urination
• bloody semen
• fever

Depending on the type of infection, you may need to take antibiotics or antiviral medication.

Orchitis

Orchitis refers to an infected or inflamed testicle. Like epididymitis, orchitis often results from an infection caused by an STI. Other causes can include tuberculosis, viruses like mumps, fungi, and parasites, along with other diseases that lead to inflammation.

Orchitis symptoms include:

• testicular pain and tenderness
• swollen testicle
• fever
• nausea
• vomiting
• feeling significantly ill

Treatment depends on the cause. Ultrasound of the scrotum and testicles can help determine the diagnosis and severity of the condition. Serious infections may require hospitalization or surgery.

Testicular cancer

Testicular cancer happens when cells abnormally multiply within the tissue of your testicles. It commonly starts in the cells that make sperm.

The cause of testicular cancer isn’t always clear. According to the American Cancer Society, testicular cancer is the most commonly diagnosed cancer in males between the ages of 15 and 44.

Symptoms of testicular cancer can include:

• lump in your testicle
• feeling of scrotum heaviness
• fluid buildup in your scrotum
• testicular pain
• abdomen or back pain
• swollen or tender breast tissue

Treatment depends on your stage of cancer. Sometimes, your doctor will surgically remove the testicle. Radiation therapy or chemotherapy may also be part of the treatment plan. Stem cell transplant may also be used.

What are common symptoms of a scrotum condition?

See your doctor if you notice any of the following common symptoms in your scrotum, testicles, or genital area:

• mild or severe pain that lasts a long time
• groin pain with activity
• swollen areas
• redness, rashes, or sores
• feeling of heaviness
• tender areas
• severe pain in your scrotum that happens without warning
• urinating more than usual
• blood in your urine or semen
• discharge or drainage from the penis

Also see your doctor if you notice pain in your lower abdomen or back, or extra breast tissue growth.

Tips for a healthy scrotum

Here are some lifestyle tips for keeping your scrotum in good health:

• Do a monthly testicular self-exam. Roll each testicle around in your scrotum using your fingers. Check for lumps and swollen or tender areas.
• Bathe regularly. Take a shower or bath regularly to keep your entire genital area clean. This reduces your risk of skin infections that can cause other complications. Keep your penis and scrotal area dry after bathing. Moisture trapped in the area can quickly become a breeding ground for fungus.
• Wear loose, comfortable clothing. Try to avoid wearing tight underwear and pants. Allow your scrotum to hang naturally from your body to help keep the scrotal temperature low and prevent injury.
• Wear protection when you have sex. Wear a condom when doing any kind of sexual activity involving your penis. This helps to prevent sexually transmitted infections that affect your scrotum and testicles, as well as your partner.
• Trim instead of shaving. If hair management is important to you, trimming rather than shaving or other complete hair removal systems is least likely to cause skin irritation, allergic reactions, trauma, or infections.

Anatomy, Abdomen and Pelvis, Scrotum – StatPearls

Rosa A. Garcia; Hussain Sajjad.

Author Information and Affiliations

Last Update: July 25, 2022.

Introduction

The scrotum is a male reproductive structure located under the penis. It has the shape of a sac and divides into two compartments. The structures contained in this sac include external spermatic fascia, testes, epididymis, and spermatic cord. The scrotum derives from the labioscrotal swelling, which is an embryonic structure that appears in the fourth week of embryonic development. Congenital malformations may occur during the development of the scrotum. These malformations can present in conjunction with other defects due to a common embryologic origin.

Structure and Function

Structure: 

The scrotum is a thin external sac that is located under the penis and is composed of skin and smooth muscle. This sac is divided into two compartments by the scrotal septum. The average wall thickness of the scrotum is about 8 mm. It has a parietal and a visceral layer. The parietal layer has the function of covering the inner aspect of the scrotal wall and the visceral layer coats the testis and epididymis. The structures contained in the scrotal sac are the external spermatic fascia, testes, epididymis, and spermatic cord.

Function:

The scrotum is responsible for protecting the testes. It helps with the thermoregulation of the testicles. It keeps the temperature of the testis several degrees below the average body temperature, which is an essential factor for sperm production.

Embryology

The labioscrotal swellings are the structures that appear during the fourth week of gestations and give origin to the scrotal tissue. These two structures are present lateral to the genital tubercle. The migration of the labioscrotal swellings takes place in the 9th to 11th weeks of gestation and follows in a caudal and medial direction until they fuse at the 12th-week of gestation and form the scrotum.[1][2]

Blood Supply and Lymphatics

Blood  Supply:

Arteriovenous anastomoses and subcutaneous plexuses are responsible for providing blood supply to the scrotum. The external pudendal branches arising from the femoral arteries and the scrotal branches of the in the internal pudendal arteries play a significant role in supplying blood to the scrotum. The nomenclature of the venous drainage of the scrotum mirrors the previously mentioned corresponding arteries.

 Lymphatic drainage:

The arrangement of the lymphatic drainage of the scrotum is related to the development of this sac. The wall of the scrotum drains into the superficial inguinal lymph nodes. On the other hand, the contents of the scrotum drain to the lumbar lymph nodes. It is important to recall that the testes migrate from the abdominal wall through the inguinal canal and into the scrotum. During this path, the testis will drag its blood supply and lymph vessels into the scrotal sac.[3]

Nerves

The innervation of the scrotum derives from the branches of the following four nerves: genitofemoral, pudendal, posterior femoral cutaneous, and ilioinguinal nerves.

Anterior Innervation:

The cremaster muscle and anterior scrotum receive their innervation by the genital branch of the genitofemoral nerve. This nerve arises from the L1-L2 segments of the lumbosacral plexus and then travels through the inguinal canal to supply the anterior skin of the scrotum.

Posterior Innervation:

The posterior scrotum is innervated by branches of the pudendal nerve and by the posterior femoral cutaneous nerve.

The ilioinguinal nerve also aids the genitofemoral nerve in the innervation of the cremasteric muscle.

Cremasteric Reflex:

Both the ilioinguinal and the genitofemoral nerves provide a sensory synapse that activates the motor neurons responsible for the cremasteric reflex.[4] This physiologic reflex has both protective and thermoregulatory testicular functions.[5]

Muscles

The scrotum is a fibromuscular structure. The muscle fibers contained in the scrotum are the dartos muscle and the cremasteric muscle. The dartos muscle is a smooth muscle sheet located underneath the skin of the scrotum. The cremasteric muscle is a paired muscle that has many protective functions. This paired muscle is composed of two parts, a medial cremaster portion originating from the pubic tubercle and the lateral cremaster portion originating from the internal oblique muscle.

Physiologic Variants

The scrotum may present with congenital malformations that are due to abnormal development of the labioscrotal swellings, which occur during intrauterine development. These malformations may include accessory scrotum, bifid scrotum, ectopic scrotum, and penoscrotal transposition.

Accessory Scrotum:

It is the rarest of congenital abnormalities of the scrotum. Although exact etiology is not clear, it is thought to occur due to the abnormal migration of labioscrotal swellings during the 4th to 12th weeks of development. The most common location of an accessory scrotum is mid perineum. The accessory scrotum does not contain testes. This additional tissue will have the same histologic features present in a typically developed scrotum and does not interfere with the development of the customarily positioned scrotum.[1][6]

Bifid Scrotum:

A bifid scrotum is an abnormal cleft that presents in the midline of the scrotum. This cleft is caused by an incomplete fusion of the labioscrotal folds. The incomplete fusion can be attributed to an under-secretion of androgens during the first trimester. This androgenic under-secretion can also cause hypospadias and maybe the reason why most patients that are born with a bifid scrotum also present with hypospadias.[7]

Ectopic Scrotum:

An ectopic scrotum occurs when the normal scrotum that is usually located under the penis is found in a different location. The main factor of this abnormality is a defect in the formation of the gubernaculum. The most common sites in which you can find an ectopic scrotum include a suprainguinal, inguinal, infra-inguinal, or perineal region.

Penoscrotal Transposition: 

This condition is a genital malpositioning in which the penis is lying in an abnormal location in relation to the scrotum. This rare malformation is due to a defect of the scrotum during its caudal migration in the 9th to 11th week of gestation. This inversion can be classified as either partial or complete. A partial transposition occurs when the penis lies in the middle of the scrotum. A complete penoscrotal transposition, on the other hand, is seen when the penis emerges beneath the scrotum.  The literature has shown that this anomaly can present in conjunction with central nervous system, cardiovascular and gastrointestinal tract congenital malformations[2]

Surgical Considerations

Cryptorchidism:

One of the most common neonatal malformations is an undescended testicle. It occurs in about 2-4% of male neonates. Given the numerous associated complications of cryptorchidism, those patients with failure of the testes to spontaneously descend require a surgical repair called orchiopexy. The traditional approach of the orchiopexy is by making an inguinal incision. Given the numerous structures that can suffer injury through this incision, a trans scrotal approach was introduced. The advantages of this effective technique include uncomplicated dissection, better wound healing, and shorter operation time. The disadvantages of this approach include wound infections, testicular hypotrophy, hydrocele, and hernias.[8]

Testicular Torsion:

Testicular torsion is a vascular emergency defined as a rotation of the spermatic cord that causes strangulation of the testicular artery, which leads to loss of blood supply to the testicle. This pathology requires a prompt surgical approach. A defect in embryologic development of the tunica vaginalis is mainly responsible for testicular torsion. Patients with testicular torsion may present with acute pain, nausea, and vomiting. Testicular torsion should be approached urgently, given that after the first 24 hours of the loss of blood supply, the tissue can suffer necrosis. Once the tissue is necrotic, there is very little likelihood of saving the testis.[3]

Hematocele:

Hematocele is a blood collection in the scrotum that can be associated with a traumatic injury or a surgical procedure. It can be diagnosed using a scrotal ultrasound. This blood collection usually self resolves, but in rare cases, it may develop calcifications, which are extra-testicular lesions palpated on physical exams.[9][10]

Clinical Significance

The genitourinary male physical examination has great significance in diagnosing many pathologies. Some of the clinical diseases that may show local signs detected on a physical exam are noninflammatory edema, cellulitis, and Fournier gangrene.

Noninflammatory Edema:

Noninflammatory edema may be visible on a scrotal ultrasound as a fluid collection that is not associated with scrotal wall hyperemia. The pathophysiology attributed to this edema could be heart failure, liver failure, lymphatic obstruction, or a fluid imbalance.

Cellulitis:

Cellulitis should be included in the differential diagnoses in any patient presenting with scrotal pain and a thickened erythematous scrotum on a physical exam. This diagnosis should be considered in any patient with a past medical history of immunosuppression, diabetes, or obesity, presenting with local signs of inflammation in the scrotum.

Infectious Diseases: 

Many microorganisms can colonize in the scrotum and cause an infection. From the components of the scrotum, the tail of the epididymis is one of the first sites of infections, given that it is the most vascularized portion of the scrotum. Any infection originating from a surrounding anatomical structure can migrate and eventually infect the scrotum. The most common microorganisms infecting the scrotum are bacterial pathogens, among which Escherichia coli, Proteus, Neisseria gonorrhea, and Chlamydia trachomatis predominate.

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Figure

Median sagittal section of pelvis, Sacrum, Peritoneum, Vesical Layer, Fascia of urogenital diaphragm; Superior and Inferior Layer, Bladder, Prostate, Symphysis pubis, Rectum, Anal Canal, corpus cavernosum penis and Urethra, Bulb, Scrotum, Urogenital diaphragm, (more…)

Figure

The Male Genital Organs, The scrotum. On the left side the cavity of the tunica vaginalis has been opened; on the right side only the layers superficial to the Cremaster have been removed. Contributed by Gray’s Anatomy Plates

Figure

Scrotum anatomy. Image courtesy S Bhimji MD

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Disclosure: Rosa Garcia declares no relevant financial relationships with ineligible companies.

Disclosure: Hussain Sajjad declares no relevant financial relationships with ineligible companies.

Atteroma of the scrotum – diagnosis and treatment at affordable prices in Chelyabinsk

Atheroma of the scrotum is a benign formation in the genital area, which appears as a result of blockage of the ducts of the sebaceous glands. Atheroma of the scrotum almost never becomes malignant, but there are many complications that not only reduce the quality of life, but also cause the development of serious diseases. Therefore, timely treatment is a necessary preventive measure. The sooner the patient seeks help, the sooner the problem is resolved.

What does atheroma of the scrotum look like

This is a small seal, round or oval in shape, rising above the skin. Upon closer examination, one can see a hole in the growth capsule through which a viscous content with an unpleasant odor comes out. This is the secret of the sebaceous gland, which does not come out due to blockage of the duct.

Causes of atheroma or cyst of the scrotum

The scrotum contains a large number of sebaceous and sweat glands. Glands are necessary for thermoregulation, tk. when the temperature changes, the production of spermatozoa is disrupted. And if the rules of intimate hygiene are not observed, hormonal changes, obesity, or if the genital organs are injured, blockage of the sebaceous gland may develop. A cyst is formed, the cycle of sebaceous secretion is disrupted and a tumor develops.

Clinically atheroma of the scrotum does not manifest itself in any way. On palpation, the formation is densely elastic, clearly defined, mobile, the size, as a rule, does not exceed 1.5 cm. The skin over the formation is not changed. But this is only before the appearance of complications, and complications occur in 75% of cases.

First of all, it is an inflammation of atheroma. With this pathology, there is pain in the genitals, extending to the anterior-lateral surface of the thighs and anus. The sexual organs increase in size. The skin of the testicles and perineum turns red, becomes painful and hot to the touch. The body temperature rises. If the cyst is not opened, suppuration will begin.

Even if it did not come to inflammation of atheroma, the question of the normal functioning of the reproductive sphere is acute. Due to the increase in internal pressure, there are problems with the production of sperm, which can lead to erectile dysfunction.

Treatment of atheroma of the scrotum consists in its removal. This could be:

• Surgical excision
• Radio wave removal
• Laser Removal

The surgical method of treatment is used for large sizes or multiple atheromas. Such treatment involves general anesthesia, therefore it has a number of contraindications.

The use of a radio wave method or a laser allows the procedure to be performed under local anesthesia and with a minimal risk of bleeding. The duration of the procedure is 15-20 minutes. The rehabilitation period is up to 14 days, depending on the location and size of atheroma. Physiotherapy can speed up healing.

Doctors

Ziganshin Oleg Raisovich

Andrologist-urologist, dermatovenereologist, D.M.N., Professor, Honored Doctor of the Russian Federation

Cost of admission – 2000/1800

Kukarkin Nikolay Yurievich

Urologist, KMN, ultrasound diagnostics doctor | Admission fee: 1500/1200

Admission fee — 1500

Treatment of atheroma of the scrotum in the URO-PRO clinic in Krasnodar

Price list Atheroma of the scrotum

Procedure name							Price
Consultation of the doctor of the head of the urological department for primary patients							RUB 2,500. 00
Consultation of a urologist – oncologist							3 000.00 rub.
Urologist consultation for primary patients (C.M.N.)							2 000.00 rub.
Consultation of a urologist for primary patients (men)							RUB 1,500.00
Urologist consultation for primary patients (women)							3 000.00 rub.
Consultation of the doctor of the head of the urological department for repeat patients							RUB 2,200.00
Urologist consultation for repeat patients (C.M.N.)							RUB 1,700.00
Urologist consultation for repeat patients (men)							RUB 1,300.00
Urologist consultation for repeat patients (women)							2 000. 00 rub.
Therapeutic maintenance and prophylactic treatment of erectile dysfunction using intracavernous injections No. 1 (including dosage selection)							RUB 1,800.00
Therapeutic supportive and prophylactic course of treatment of erectile dysfunction using intracavernous injections No. 1 (including dosage selection using an auto-injector)							RUB 6,800.00
Therapeutic maintenance and prophylactic course of treatment of erectile dysfunction with drugs for oral administration (selection of dosage, correction during treatment)**							from 300.00 rub.
Therapeutic maintenance and prophylactic course of treatment of pelvic inflammatory diseases (dose selection, correction during treatment)							3 000.00 rub.
Therapeutic maintenance and prophylactic course of treatment of adenoma (including dosage selection, correction during treatment)							3 000. 00 rub.
Removal of formations on the genitals and perineum by the apparatus “SURGITRON”
up to 2.0 cm²							5 000.00 rub.
affected area from 2.0 to 5.0 cm²							RUB 10,000.00
affected area from 5.0 cm²							RUB 15,000.00
The course of treatment of balanoposthitis *							from 4 000.00 rub.
The course of treatment of non-gonococcal urethritis (with or without instillation according to indications) *							from 5,000.00 rubles
The course of treatment of inflammatory diseases of the pelvic organs*							from 10 000.00 rub.
The course of treatment of non-inflammatory diseases of the pelvic organs*							from 10 000. 00 rub.
Course of treatment for erectile dysfunction*							from 10 000.00 rub.
The course of treatment of prostate adenoma*							from 8 000.00 rub.
The course of treatment of chronic bacterial cystitis *							from 10 000.00 rub.
The course of treatment of chronic recurrent cystitis*							from 20 000.00 rub.
Uroflowmetry study for urological patients							500.00 rub.
Uroflowmetry study with decoding							1 000.00 rub
Prostate Massage No. 1							RUB 900.00
Operation Circumcisio (circumcision of the foreskin) by category:
1 category of complexity /standard technique/							RUB 30,000. 00
2nd category of complexity /with foreskin and frenulum plate/							RUB 36,000.00
3 category of complexity / technique from two cuts with preservation of f. Baka/							RUB 42,000.00
Ligation and transection of the testicular vein (Marmar operation (varicocele))							RUB 36,000.00
Revision of the scrotum (Bergman operation (hydrocele))							RUB 35,000.00
Microsurgical varicocelectomy according to Marmar (infertility treatment)							RUB 70,000.00
Microsurgical varicocelectomy according to Goldstein (infertility treatment)							RUB 80,000.00
Bergman operation (hydrocele)							RUB 20,000.00
Operation Lord (hydrocele)							RUB 30,000. 00
Wilkenmann operation (hydrocele)							RUB 35,000.00
Surgical treatment of premature ejaculation by selective denervation of the glans penis							RUB 50,000.00
Pulsed radiofrequency pudendal nerve denervation							RUB 45,000.00
Total neurolysis (treatment of premature ejaculation)							RUB 60,000.00
Treatment of erectile dysfunction by excision of the deep dorsal vein							RUB 90,000.00
Testicular prosthesis (without prosthesis cost)							RUB 30,000.00
Phalloplasty (ligamentotomy)							RUB 60,000.00
Ligation of the superficial dorsal vein							RUB 25,000.00
Orchiectomy (removal of the testicle) unilateral							RUB 25,000. 00
Orchiectomy (removal of the testicle) bilateral							RUB 40,000.00
Micro-TESE (microsurgical testicular biopsy)							RUB 85,000.00
Biopsy of the testicle, epididymis and spermatic cord (TESE (open testicular biopsy))							RUB 35,000.00
Frenuloplasty (plasty of the frenulum of the penis)							RUB 10,000.00
Surgical treatment of urinary incontinence with TVT (without TVT cost)							RUB 32,500.00
Surgical treatment of cystocele with TVT method (excluding TVT cost)							RUB 38,000.00
Micropercutaneous laser nephrolithotripsy							RUB 132,000.00
Phalloprosthetics with a 1-component implant (without the cost of the implant)							RUB 120,000. 00
Phalloprosthesis with 1-component implant							RUB 210,000.00
Phalloprosthetics with a 3-component implant (without the cost of the implant)							RUB 190,000.00
Phalloprosthetics with a 3-component implant							RUB 540,000.00
Phalloprosthetics with a 3-component implant with a lengthening effect							RUB 670,000.00
Phalloprosthetics with a 3-component implant with a lengthening effect in case of sclerosis of the cavernous bodies							RUB 860,000.00
Removal of neoplasms on the genitals and perineum using the “SURGITRON” apparatus, the area of ​​the neoplasm is up to 2.0 cm2							5 000.00 rub.
Removal of neoplasms on the genitals and perineum using the “SURGITRON” apparatus, the area of ​​the neoplasm is from 2. 0 to 5.0 cm2							RUB 10,000.00
Removal of neoplasms on the genitals and perineum using the “SURGITRON” apparatus, the area of ​​the neoplasm is from 5.0 cm3							RUB 15,000.00
Ultrasound-guided prostate biopsy (transrectal polyfocal prostate biopsy)							RUB 15,000.00
Endoscopic injection of Botox into the bladder (without the cost of the drug)							RUB 15,200.00
Removal and processing of seams							1 200.00 rub
Day hospital stay							RUB 1,700.00
Foley catheter insertion							RUB 1,200.00
Nesbit operation (surgical treatment of curvature of the penis)							RUB 65,000.00
Vasoresection bilateral							RUB 20,000. 00
Removal of atheroma of the scrotum							5 000.00 rub.
Cystoscopy (for women)							RUB 7,000.00
Cystoscopy (for men)							RUB 9,000.00
Pieloscopy							RUB 20,000.00
Diagnostic biopsy (examination cost not included)							7 000.00 rub
Endoscopic injection of botulinum toxin into the bladder (without the cost of the drug)							RUB 15,200.00
Laser vaporization of leukoplasia of the bladder							RUB 30,000.00
Botulinum therapy of the pelvic floor muscles for 1 trigger (without the cost of the drug)							RUB 6,000.00
Puncture and sclerosis of the kidney cyst							RUB 25,000. 00
Meatotomy (dissection of the external opening of the urethra)							RUB 12,000.00
Ascending urethrography							RUB 10,000.00
Prosthetics with segmental prostheses in a circle without lipofilling of the penis							RUB 40,000.00
One-stage transvesical adenomectomy							RUB 60,000.00
TUR-prostatic hyperplasia (without the cost of anesthesia, hospital, and ICU)							RUB 70,000.00
TUR – bladder biopsy (excluding histology)							RUB 35,000.00
Radical TUR of the bladder with intravesical chemoprophylaxis							RUB 75,000.00
TUR-bladder neck							RUB 40,000.00
Cystolithotripsy (crushing of a stone in the bladder)							RUB 35,000. 00
Remote shock wave lithotripsy (initial session)							RUB 30,000.00
Remote shock wave lithotripsy (repeated session)							RUB 25,000.00
Cystolithotomy							RUB 30,000.00
Spermatocelectomy (excision of an epididymal cyst)							RUB 35,000.00
Rigid ureteroscopy							RUB 15,000.00
Rigid ureteroscopy + contact lithotripsy:
1- category of complexity-lower 1/3 of the ureter							RUB 30,000.00
2- category of complexity – medium 1/3 of the ureter							RUB 40,000.00
3- category of complexity – upper 1/3 of the ureter							RUB 50,000. 00
Ureteral catheterization							5 000.00 rub.
Insertion of an internal drainage stent							RUB 12,000.00
Removal of the stent internal drainage							RUB 8,000.00
Radical prostatectomy, open							RUB 150,000.00
Radical prostatectomy, laparoscopic							RUB 200,000.00
Radical nephroureterectomy, open							RUB 100,000.00
Radical nephroureterectomy, laparoscopic							RUB 150,000.00
Kidney resection open							RUB 120,000.00
Kidney resection laparoscopic							RUB 180,000.00
Percutaneous nephrolitholapaxy (PNL):
1- category of complexity – stone up to 20 mm							RUB 80,000. 00
2- category of complexity – stone over 20 mm							RUB 90,000.00
3- category of difficulty – coral stone, multiple stones							RUB 100,000.00
Laparoscopic nephropexy							RUB 90,000.00
Removal of a urethral polyp							RUB 25,000.00
Excision of the paraurethral cyst							RUB 30,000.00
Laparoscopic excision of a kidney cyst:
1st category of complexity – single cysts up to 50 mm							RUB 80,000.00
2-category of complexity – single cysts over 50 mm							RUB 95,000.00
3-category of complexity – multiple cysts or complex localization of the cyst							RUB 115,000. 00
Flexible ureteropyelolithotripsy (R.I.R.S):
1- category of complexity-stone up to 10 mm							RUB 80,000.00
2- category of complexity – stone over 10 mm							RUB 100,000.00
3- category of difficulty – multiple stones							RUB 120,000.00
Repair (plasty) of the urethra using a skin flap							RUB 100,000.00
Restoration (plasty) of the urethra using the oral mucosa							RUB 120,000.00
Urethral bougienage							RUB 1,500.00
Penis enlargement by lipofilling							RUB 50,000.00
Installation of an artificial sphincter Coloplast							RUB 200,000. 00
Excision of the diverticulum of the bladder 1st grade of complexity (excluding the cost of anesthesia, hospital stay, PGI)							RUB 45,000.00
Testicular descent, orchiopexy (without the cost of anesthesia, hospital stay)							RUB 25,000.00
Plastic surgery of the ureteropelvic segment in case of hydronephrosis (endovideosurgical access) (excluding the cost of anesthesia, hospital stay, PGI) with stenting:
1- category of complexity (anastomic)							RUB 100,000.00
2- category of complexity (augmentation)							RUB 130,000.00
Urethral plastic surgery (excluding the cost of anesthesia, hospital stay, PGI) according to Holtsov							RUB 80,000.00
Plastic surgery of the urogenital fistula							RUB 80,000. 00
Surgical treatment of Peyronie’s disease (plaque excision)							RUB 100,000.00
Surgical treatment of Peyronie’s disease – plasty of the membranes with a free flap							RUB 130,000.00
Removal of oleogranuloma of the penis							RUB 45,000.00
Removal of oleogranuloma of the penis with plastic surgery of the skin of the scrotum (one-stage)							RUB 70,000.00
Ureterolithotomy in the upper third of the ureter (open)							RUB 50,000.00
Ureterolithotomy in the upper third of the ureter (endovideosurgical)							RUB 90,000.00
Dynamic monitoring of patients using the penile tumescence recorder Adroscan with a stay in the hospital							RUB 4,500. 00
Cystolithotomy							RUB 30,000.00
Percutaneous puncture nephrostomy (without drainage cost)							RUB 17,000.00
Intraoptic urethrotomy							RUB 25,000.00
Hypospodia surgery by category:
1 category of difficulty							RUB 50,000.00
2nd category of difficulty							RUB 75,000.00
3 category of difficulty							RUB 90,000.00
Trocar epicystostomy							RUB 15,000.00
Treatment of myofascial syndrome:
Botulinum toxin injection up to 100 IU (without cost of the drug)							250. 00 rub.
Botulinum toxin injection over 100 IU up to 200 IU (without the cost of the drug)							200.00 rub.
Injection of botulinum toxin over 200 units (without the cost of the drug)							180.00 rub.
Blockade of the spermatic cord							RUB 6,000.00
Bladder hydrofusage							9 000.00 rub
Individual maintenance course of myostimulation of the pelvic floor muscles							4 000.00 rub.
Individual maintenance course of tibial neuromodulation							4 000.00 rub.
Botulinum therapy of pelvic floor muscles for 1 trigger (without drug cost)							RUB 6,000.00
PRP therapy (1 vial)							RUB 12,500. 00
Injection of anti-inflammatory and antibacterial drugs into the prostate gland							3 000.00 rub.
Bladder instillation (without the cost of the drug)							RUB 1,600.00
Instillation of the urethra (without the cost of the drug)							RUB 1,600.00
Thermotherapy procedure on THERMEX TURAPY device							RUB 40,000.00
Puncture and sclerosis of a kidney cyst							RUB 25,000.00
Laparoscopic adenomectomy:
1 category of complexity / removal of adenoma up to 100 cm3							RUB 100,000.00
2 category of complexity / removal of adenoma from 100 cm3 up to 150 cm cube.							RUB 130,000.00
3 category of complexity / removal of adenoma over 150 cm3							RUB 150,000.00
Thickening of the penis with the Powerfill implant (including the cost of the implant):
1 difficulty							RUB 75,000.00
2 difficulty							RUB 150,000.00
Scrotum plastic surgery							RUB 25,000.00
Laser enucleation of prostate adenoma							RUB 110,000.00
Plasmolifting (1 tube)							4 000.00 rub.
Plasmolifting (2 tubes)							RUB 7,000.00
Plasmolifting (3 tubes)							RUB 10,000.00
Vaso-vasoanastomosis							RUB 110,000. Leave a Reply Cancel reply Your email address will not be published. Required fields are marked * Comment * Name * Email * Website