What Are Scrotal Calculi and Scrotal Pearls?
Scrotal calculi and scrotal pearls are terms used to describe small calcified bodies found within the scrotum. These entities are typically incidental findings during scrotal ultrasound examinations, where they are easily recognised due to their hyper-echoic nature, meaning they reflect ultrasound waves well, creating a distinct acoustic shadow. They can also be detected during surgery or by patients during self-examination of the testes.
How Common Are Scrotal Calculi and Scrotal Pearls?
The detection rate of scrotal calculi and pearls is increasing with the use of high-frequency ultrasound, which provides clearer images. A retrospective study reported an incidence of 2.65% in 868 patients referred from urologic and surgical clinics. This suggests that these calcifications are not uncommon and are frequently observed during routine scrotal examinations.
Characteristics and Ultrasound Appearance
Scrotal pearls appear as mobile, round echogenic (bright on ultrasound) foci lying between the layers of the tunica vaginalis (the membrane surrounding the testes), with larger calculi demonstrating discrete acoustic shadowing. They can be solitary or multiple and are often associated with a hydrocele (a fluid-filled sac around a testicle), which may render them impalpable during a physical exam. Typically, these pearls range in size from several millimeters up to just over 1 cm. However, there are rare instances of significantly larger pearls, such as a documented case of a giant scrotal pearl measuring 8.7 x 7.2 x 6.5 cm and weighing 420 g.
What Causes Scrotal Calculi and Scrotal Pearls?
The exact cause of scrotal calculi and pearls is unclear. However, several potential factors have been identified:
- Trauma or Inflammatory Diseases: They may develop following trauma or inflammation of the scrotum.
- Detached Appendices: They can arise from detached portions of the appendices testis or epididymis, often after events like torsion or infarction (tissue death due to lack of blood supply).
- Hydrocele Association: There is a significant association between hydrocele and scrotal calculi. Hydrocele may contribute to the formation of these calcifications by promoting crystallisation of substances within the scrotal fluid. In Aslan et al.'s study, hydrocele was the most common additional scrotal abnormality, present in 29.8% of cases. Similarly, Tan et al. found that more than 50% of patients with scrotal calculi also had a hydrocele.
- Microtrauma: Repetitive microtrauma, similar to that experienced by mountain bikers, may also result in the formation of these calcifications.
Do Scrotal Calculi and Scrotal Pearls Cause Symptoms?
The clinical significance of scrotal calculi and pearls is uncertain. Some researchers suggest that they can cause scrotal pain. This pain may result from the movement of the calculi within the fluid between the layers of the tunica vaginalis, irritating the surrounding soft tissue. However, no substantial evidence exists regarding the long-term effects of chronic irritation caused by these calcifications. To date, no information is available in the literature about the results of chronic irritation due to scrotal calculi.
Words of Wisdom from a Consultant Urologist
Scrotal calculi and pearls, while often incidental findings, should not be ignored if they are associated with pain or other symptoms. High-frequency ultrasound has significantly improved our ability to detect these calcifications early. While the exact cause remains unclear, understanding the potential link with hydrocele can guide better management and patient education. If you experience scrotal pain or notice any abnormalities, it is essential to seek medical advice for appropriate diagnosis and management.
