Ectopic Scrotum: A Rare Clinical Entity

ABSTRACT

Congenital scrotal disorders, including penoscrotal transposition, bifid scrotum, ectopic scrotum, and accessory scrotum are unusual anomalies. We present a case of ectopic scrotum with renal agenesis.


Atul Khandelwal, Mahendra Singh, Rajesh Tiwari, Vijoy Kumar, Sanjay Kumar Gupta, Rohit Upadhyay

Submitted October 11, 2012 - Accepted for Publication November 8, 2012


KEYWORDS: Ectopic, scrotum, suprainguinal

CORRESPONDENCE: Atul Khandelwal, MBBS, MS, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India ()

CITATION: UroToday Int J. 2012 December;5(6):art 68. http://dx.doi.org/10.3834/uij.1944-5784.2012.12.13

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INTRODUCTION

Congenital scrotal disorders, including penoscrotal transposition, bifid scrotum, ectopic scrotum, and accessory scrotum are unusual anomalies [1,2]. We present a case of ectopic scrotum with renal agenesis.

CASE REPORT

A 35-year-old male presented with swelling of the right side of the abdomen. There was no family history of any congenital anomalies. His physical examination showed an ectopic scrotum in the right inguinal area. The left hemiscrotum was in a normal location, and the left testis was contained in the left hemiscrotum. Scrotal raphe did not develop. The right hemiscrotum was located in the right inguinal area, and the right testis was contained in the hemiscrotum. The phallus was normal. His hematological and biochemical tests were normal. His abdominal sonography and renal isotope scan showed agenesis of the right kidney. The patient underwent right scrotoplasty and orchidopexy. The right testis showed normal characteristics. The patient proved asymptomatic during six weeks of follow-up.

DISCUSSION

Congenital scrotal disorders include four groups of anomalies: penoscrotal transposition, bifid scrotum, ectopic scrotum, and accessory scrotum [1,2]. Ectopic scrotum occurs in a variety of locations ranging from perineum and inguinal canal to the medial thigh, but it is mainly found in inguinal, suprainguinal, infrainguinal, or perineal areas [3,12]. Scrotal development starts with the appearance of paired labioscrotal swellings lateral to the cloacal membrane at the 4-week gestation period [3,17]. The genital tubercle elongates to form the penis and is flanked by these labioscrotal swellings. After 12 weeks, these swelling migrate inferomedially, or, by a different assumption, they grow toward each other to form the scrotum. The median scrotal raphe is the result of this fusion [17].

On the other hand, a condensation mesenchymatous tissue appears during the fifth week, and then it extends from the mesonephros to the abdominal wall. These tissues develop into the gubernaculum, and the inferior gubernaculum inserts into the labioscrotal swellings to descend into the testis [17].

Because gubernaculum and scrotal embryogenesis are related both anatomically and chronologically, it is advocated that a defect in distal gubernacular formation could prevent the migration of labioscrotal swelling and would result in a unilateral ectopic scrotum [3,14].

Lockwood described 4 different locations of the distal gubernacular attachment: the pubic area, saphenous area, superficial inguinal area, and perineal area. Therefore, the testis with the predominant portion of gubernaculums is misdirected to one of these other sides [4].

In most cases of unilateral scrotum, the testis is in the abnormally positioned scrotum. This also supports the statement that gubernaculum, which is present before the labioscrotal swellings, have begun their migration, and it directs testicular descent to the scrotum in this case of superficial inguinal locus [12].

A case with suprapubic inguinal scrotum was reported to be associated with ipsilateral upper tract anomalies, where there is not any renal anomaly with infrainguinal ectopic scrotum [14,15]. Unilateral penoscrotal transposition has been reported previously, 23 times only, in worldwide literature. All of these cases, including our own, have had associations with genitourinary anomalies.

FIGURES AND TABLES

Figure 1

Table 1

REFERENCES

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