The Empty Scrotum

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Introduction

Empty scrotum is a clinical situation in which the testis is absent from the scrotum.

This may be bilateral or unilateral.

Causes of empty scrotum

These include:

  1. Undescended testis
  2. Ectopic testis
  3. Retractile testis
  4. Absent (vanishing) testis
  5. Atrophic testis
  6. Surgical removal (for treatment of other conditions)

1. Undescended testis

  • Here, the testis is arrested in its normal path of descent.
  • Unilateral arrest is more common than bilateral arrest
  • Incidence at birth is about 3% in full term infants, 30% in preterm infants and 1% in adulthood

Symptoms and clinical features of empty scrotum

  1. Absence of one or both testes from the scrotum
  2. Pain from trauma to the testis
  3. Infertility (in adulthood)
  4. Atrophic testis
    • The testis, if palpable cannot be manipulated into the scrotum
  5. Inguinal hernia may be present on the affected side

Complications of empty scrotum

  1. Torsion of the spermatic cord
  2. Trauma to the testis
  3. Malignancy
  4. Infertility

Investigations

  • Urinary 17-ketosteroids, gonadotropins
  • Serum testosterone
  • Ultrasonography
  • Computed tomography
  • Laparoscopy
  • Magnetic Resonance Imaging

Management

1. Hormone therapy:

  • Human chorionic gonadotropin, 1,500 units/week intramuscularly, for a total of 9 injections
  • Applicable only to special cases

2. Surgical treatment:

  • In those with undescended testes
  • Bring testis down and fix it in the scrotum

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