Normal and Abnormal Scrotum

This book is an academic and practical guide to the diagnostic methods and management strategies for both common and rare scrotal diseases. Chapters focus on the normal anthropometric measures of the scrotum as a unique organ and the latest relevant advancements in the field. Techniques including scrotal reconstruction for congenital abnormalities, trauma, and cancer-related extirpation are all covered. Critical tools and methods related to aesthetics are also detailed. Emphasis is also placed on identifying common pitfalls and how to avoid them, ensuring that the reader is fully equipped to deal with a range of scenarios. Normal and Abnormal Scrotum describes how to approach diagnosing and managing the entire range of scrotal diseases, making it essential for all general practitioners, pediatricians, urologists, and pediatric and aesthetic surgeons who encounter these patients in their day-to-day practice. Foreword 6 Contents 7 Contributors 9 1 Introduction 10 References 12 2 Nomenclature and Terminology 13 Further Readings 18 3 Scrotum in Human Conscience 19 3.1 Scrotum in History 19 3.2 Scrotum and Masculine Self-Image 24 3.3 Scrotum and Various Neurotic Symptom 25 3.4 Scrotum and Castration Psychological Impact 26 3.5 Scrotum at Early Toilet Training 27 3.6 Scrotum and Cryptorchidism 27 3.7 Role of Scrotum in Masturbation and Sexual Activity 29 References 32 4 Scrotum Evolution 34 References 41 5 Animals Scrota 42 5.1 Testicular Position of Animals 42 5.2 Animal Scrotal Pigmentation 43 5.3 Variations in Testicular Sizes of Different Animals 43 5.4 Scrotal Swelling in Female Animals (Scrotolisation) 44 5.5 Scrotal Anomalies in Animals 44 5.6 Interesting Animals Scrota 52 References 54 6 Scrotal Functions and Missions 56 6.1 Physiological Function 56 6.2 Sexual Function 57 6.3 Psychological Function 58 6.4 Aesthetic Function 60 References 62 7 Embryology of Scrotum 63 References 69 8 Anatomy of the Scrotum 71 8.1 Layers of the Scrotum 71 8.2 Scrotal Rugae 73 8.3 The Septum of the Scrotum 82 8.4 Raphe of Scrotum 85 8.5 Scrotal Ligament (SL) 87 8.6 Blood Supply of Scrotum: Arterial Blood Supply: (Fig. 8.19) 90 8.7 Lymphatic Drainage of the Scrotum 93 References 94 9 Morphology and Anthropometric Measurements of Scrotum 97 9.1 Surface Anatomy 97 9.2 Scrotal Shape 98 9.3 Scrotal Rugae 106 9.4 Scrotal Colour 109 9.5 Scrotal Surface Area 110 9.6 Position of the Scrotum 113 9.7 Anoscrotal Distance (Anogenital Distance) 114 9.8 Penoscrotal Angle 116 9.9 Penoscrotal Distance 118 9.10 Normal Scrotal Asymmetry 120 References 122 10 Congenital Scrotal Anomalies 123 10.1 Introduction 123 10.2 Spectrum and Classifications of Scrotal Congenital Anomalies 124 References 125 11 Scrotal Maldevelopment Anomalies 126 11.1 Scrotal Agenesis 126 11.2 Scrotal Hypoplasia (SH) 136 References 146 12 Positional Anomalies of the Scrotum “Scrotal Transposition” 148 12.1 Introduction 148 12.2 Synonyms 149 12.3 Definition 150 12.4 Factors Determining Scrotal Position 150 12.5 Classifications of Penoscrotal Transposition 154 12.6 Associated Anomalies 163 12.7 Presentation and the Impact of PST on Health 170 12.8 Diagnosis 172 12.9 Prenatal Diagnosis 172 12.10 Treatment 173 References 174 13 Penoscrotal Fusion 177 References 189 14 Bifid Scrotum 191 14.1 Etiology 191 14.2 Manifestations and Classification of Bifid Scrotum 193 14.3 Variants of Bifid scrotum: 195 14.4 Associated Congenital Abnormalities 199 References 206 15 Ectopic Scrotum 208 References 215 16 Accessory Scrotum 217 References 225 17 Scrotal Median Raphe Anomalies 227 17.1 Normal Scrotal Raphe 227 17.2 Significance of GMR Anomalies 229 17.3 Anoscrotal Distance (Anogenital Distance) 230 17.4 Common Scrotal Raphe Anomalies 231 17.5 Median raphe cyst (MRC) 246 17.6 Rare Scrotal Raphe Anomalies 253 References 254 18 Scrotal Asymmetry 257 18.1 Physiological Scrotal Asymmetry 260 18.2 Impact of Testicular Asymmetry 260 18.3 Pathological Scrotal Asymmetry 265 References 269 19 Scrotoschisis 271 References 275 20 Scrotal Calcinosis 277 20.1 Definition 277 20.2 Historical Background 277 20.3 Clinically 278 20.4 Etiopathogenesis 278 20.5 Diagnosis 281 20.6 Differential Diagnosis 282 20.7 Treatment 282 References 283 21 Scrotal Vascular Anomalies 285 21.1 Hemangiomas 285 References 299 22 Acute Scrotum 301 References 318 23 Common Acquired Diseases of the Scrotum 321 23.1 Inguinal Hernia 321 23.2 Varicocele 324 23.3 Acute Idiopathic Scrotal Edema 326 23.4 Genital Lymphedema 328 23.5 Epididymal Cysts 329 23.6 Acquired Hydrocele 329 23.7 Hematocele 332 23.8 Pyocele 333 23.9 Scrotal Abscess 334 23.10 Fournier Gangrene 336 References 340 24 Neoplastic Lesions of Scrotum 342 24.1 Introduction to Scrotal Neoplasms 343 24.1.1 Incidence 343 24.1.2 Risk Factors 344 24.2 Diagnosis 345 24.2.1 Presentation 345 24.2.2 Differential Diagnosis 346 24.2.3 Diagnostic Workup 346 24.3 Classification and Staging 347 24.3.1 Tumor Classification 347 24.3.2 Tumor Staging 349 24.4 Treatment 349 24.4.1 Treatment Modalities 350 24.4.2 GCNIS 351 24.4.3 Stage I GCTs 351 24.4.4 Metastatic Disease: Stages IIA/B GCTs 352 24.4.5 Metastatic Disease: Stages IIC and III GCTs 352 24.4.6 Postpubertal Versus Prepubertal 353 24.4.7 COVID-19 353 24.5 Germ Cell Tumors Derived from GCNIS 354 24.5.1 Germ Cell Neoplasia in Situ 354 24.5.2 Seminoma 354 24.5.3 Embryonal Carcinoma 355 24.5.4 Yolk Sac Tumor: Postpubertal-Type 355 24.5.5 Choriocarcinoma (Trophoblastic Tumor) 356 24.5.6 Teratoma: Postpubertal-Type and with Somatic-Type Malignancy 357 24.5.7 Mixed Germ Cell Tumor 357 24.5.8 Regressed Germ Cell Tumor 358 24.6 GCTs not Derived from GCNIS 358 24.6.1 Spermatocytic Tumor 358 24.6.2 Teratoma: Prepubertal-Type 359 24.6.3 Yolk Sac Tumor: Prepubertal-Type 359 24.7 Non-Germ Cell Tumors: Sex Cord-Stromal Tumors 360 24.7.1 Leydig Cell Tumor 360 24.7.2 Sertoli Cell Tumor 362 24.7.3 Granulosa Cell Tumor 363 24.7.4 Gonadoblastoma 363 24.8 Non-Germ Cell Tumors: Miscallaneous 364 24.8.1 Hemato-Lymphoid Tumors 364 24.8.2 Tumors of Collecting Duct and Rete Testis 365 24.8.3 Metastases 365 24.8.4 Scrotal Skin Neoplasms 365 24.9 Paratesticular Neoplasms 366 24.9.1 Lipoma, Leiomyoma, and Adenomatoid Tumor 366 24.9.2 Liposarcoma, Leiomyosarcoma, and Rhabdomyosarcoma 366 24.9.3 Mesothelioma 367 24.10 Rare Scrotal Neoplasms 368 24.11 Fertility 368 24.12 Psychosexual Effects 369 24.13 Preventative Measures 370 24.13.1 Disparities 370 24.13.2 Diagnostic Delay 370 24.13.3 Prevention 371 Suggested Further Reading 375 25 Scrotal Swelling and Cysts 376 25.1 Introduction 376 25.2 Paratesticular Cysts 378 25.2.1 Epididymis 378 25.2.2 Appendiceal Cysts 379 25.2.3 Spermatic Cord 380 25.2.4 Tunica Albuginea 380 25.2.5 Extramammary Scrotal Paget’s Disease 380 25.3 Intratesticular Cysts 381 25.3.1 Simple Testicular Cysts 381 25.3.2 Complex Testicular Cysts 381 25.3.3 Dermoid and Epidermoid Testicular Cysts 382 25.3.4 Cystic Testicular Tumors 383 25.3.5 Tubular Ectasia of the Rete Testis 383 25.4 Scrotal Fluid Collections 384 25.4.1 Varicoceles 384 25.4.2 Hydroceles 384 25.4.3 Hematoceles and Hematomas 385 25.4.4 Pyoceles and Abscesses 386 25.4.5 Inguinoscrotal Hernias 386 26 Dermatological Diseases Specific to Scrotum 390 26.1 Special Characters of Scrotal Skin 390 26.2 Specific Scrotal Dermatosis 391 26.3 Scrotal Skin Involvement in Other Dermatosis 401 26.4 Scrotal Pigmentary Disorders 402 References 405 27 Scrotal Imaging 408 27.1 Introduction to Scrotal Imaging 408 27.2 Acute Scrotum 410 27.3 Scrotal Masses 418 27.3.1 Extratesticular Masses 419 27.3.2 Intratesicular Masses 421 27.4 Infertility 429 Suggested Further Reading 434 28 Scrotoplasty 435 28.1 Common Causes of Scrotal Skin Loss 435 28.2 Timing of Reconstructive Options 439 28.3 Modalities of Scrotoplasty 440 28.3.1 Skin Grafts 440 28.3.2 Local Flap 441 28.3.3 Tissue Expansion 442 28.3.4 New Modalities 443 28.4 Complications and Outcome of Scrotoplasty 443 References 445 Index 448