Treatment of Scrotolith
Scrotoliths are benign calcified loose bodies within the tunica vaginalis that require no treatment unless symptomatic, in which case surgical excision during hydrocelectomy is curative. 1, 2
Clinical Significance and Natural History
- Scrotoliths (also called "scrotal pearls") are benign calcified fibrous bodies found within the tunica vaginalis that form from chronic inflammation, trauma, or torsion and detachment of testicular or epididymal appendages 1
- These lesions are clinically benign and do not require intervention unless causing symptoms 1, 2
- They can mimic tumors on physical examination, making imaging essential for accurate diagnosis 1
Diagnostic Approach
- High-resolution scrotal ultrasound with Doppler is the diagnostic modality of choice to identify scrotoliths and differentiate them from testicular masses 3, 4, 1
- On ultrasound, scrotoliths appear as free-floating, echogenic lesions within the hydrocele sac, typically isoechoic to surrounding tissue 2
- The American College of Radiology recommends scrotal ultrasound as the definitive imaging modality when clinical findings are equivocal or when underlying pathology needs to be excluded 4
Treatment Algorithm
Asymptomatic Scrotoliths
- No treatment is required for incidentally discovered scrotoliths in asymptomatic patients 1, 2
- Reassurance that the finding is benign is appropriate 1
Symptomatic Scrotoliths
- Surgical excision is the treatment of choice when patients are symptomatic (pain, discomfort, or concern about the mass) 2
- Surgery typically involves removal of the scrotolith combined with hydrocelectomy, including excision, eversion, and plication of the tunica vaginalis to prevent recurrence 2
- Prognosis after surgical removal is favorable with low recurrence rates 2
Important Clinical Considerations
- Scrotoliths are frequently associated with chronic hydroceles, so addressing both pathologies during a single surgical procedure is appropriate 2
- Histologically, scrotoliths show concentric collagen lamellae enclosing calcified tissue debris without vascular structures 1
- The condition should be distinguished from testicular microlithiasis, which is an intratesticular finding that does not require treatment in the absence of solid masses or risk factors for germ cell tumors 3