Prevalence of scrotal calculi and its relationship to pain

Abstract

303T he presence of scrotal calculi is a relatively rare condition that is characterized by the presence of freely mobile calcified bodies between the layers of the tunica vaginalis of the testes, which are often found in patients who have been referred for scrotal ultrasound (1). The etiology of the scrotal calculi is uncertain. However, inflammatory changes within the remnants of the appendix, testis or epididymis may play a role in the development of these types of calculi (1, 2). There are a limited number of studies on scrotal calculi in the literature, and most of these are case reports. Furthermore, to our knowledge, no clinical trial has focused on whether there is a relationship between scrotal calculi and pain.The purpose of this large series study was to determine the frequency of scrotal calculi in men who were referred for scrotal ultrasound, and to identify any associated pathologic conditions in order to investigate whether any relationship exists between the presence of scrotal calculi and pain. Materials and methodsThis research was approved by the institutional human ethics committee at our hospital. A retrospective review of the radiology data processing system database revealed the existence of 4084 ultrasonography (US) scrotal reports from 3435 men between January 2008 and February 2011.US examinations were performed using US equipment with a 9-14 MHz linear probe (Logic9, GE Healthcare, Milwaukee, Wisconsin, USA) and with an 8-14 MHz linear probe (Technos MPX, Esaote, Genoa, Italy). US examinations were performed by two radiologists who were experienced in ultrasound techniques. The examinations were performed while the patient was lying in the supine position. The scrotum was immobilized prior to the application of a small amount of gel, and the US scans were performed in the transverse, longitudinal and multiple oblique planes. In this study, the patient information and the US findings were obtained from the US reports. These reports had been recorded in the radiology information system and we evaluated each of the scrotal US reports.Scrotal calculi were defined as typical round or oval echogenic foci with or without acoustic shadowing that were located between the layers of the tunica vaginalis of the testes (Fig. 1). Additionally, scrotal abnormalities, such as the presence of hydrocele or varicocele, or any other testicular or epididymal abnormalities that were reported during the scrotal US examination, were noted.Following the identification of scrotal calculi from the US reports, a total of 67 patients were contacted by phone, and 40 patients were interviewed. Subsequently, patients were asked whether they had any scrotal PURPOSEThe purpose of this study was to determine the frequency of scrotal calculi in men referred for scrotal ultrasonography (US), to identify any associated pathologies, and to investigate if any relationship exists between scrotal lithiasis and pain. MATERIALS AND METHODSThis was a retrospective study in which 4084 scrotal US examinations in 3435 men were eval...

Scrotal calculi in clinical practice and their role in scrotal pain: A prospective study

“…The prevalence of scrotal calculi is thought to be very low in the general asymptomatic population. In a recent study by Tan et al, a scrotal calculus was found in 1.95% of a total of 3,435 patients who were evaluated retrospectively with radiology records. Also, Artaş and Orhan evaluated 868 patients prospectively and found the incidence to be 2.65%.…”

“…On US examination, scrotal calculi are oval or round concretions that can float freely in a hydrocele or appear as a fixed hyperechoic focus with or without acoustic shadowing between the layers of the TVT . Movement of these stones, especially in a hydrocele, helps to differentiate them from other scrotal‐content calcifications, such as in cystoceles and urethroscrotal fistulas .…”

“…CDUS was used to document blood flow and measure Doppler indices in the spermatic cord to diagnose a varicocele and to evaluate the vascularization of the testis and epididymis for the diagnosis of torsion or inflammation. Round or oval echogenic foci floating or located between the layers of the TVT were assessed as scrotal calculi, whether they cast acoustic shadowing or not (Figure ) …”

“…They are most commonly described as freely floating or fixed calcifications between the layers of the tunica vaginalis testis (TVT). They have been said to have no clinical significance in several studies …”

Sonography of the Scrotum

“…The term intrascrotal calculi refers to rarely found round or oval loose bodies situated between parietal and visceral lamina of the tunica vaginalis, which are considered benign and without clinical importance 11 , 12 . The reported frequency of these calculi on sonography is approximately 2% 12 , 13 . The frequency is much higher (41%) in patients with coexisting hydrocele 11 .…”