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Review
. 2025 Sep 26.
doi: 10.1002/pd.6898. Online ahead of print.

Prenatal Evaluation of Scrotal Masses: A Systematic Literature Review

Federica Romanzi  1 , Chiara Di Ilio  1 , Chiara Airoldi  2 , Gloria Anderson  1 , Eleonora Torcia  1 , Francesca Felici  1 , Maria Vittoria Alesi  1   3 , Rossana Cottone  1   3 , Giulia Di Marco  1 , Elvira Passananti  1 , Alessandra Familiari  1   3 , Tullio Ghi  1   3 , Elisa Bevilacqua  1   3
Affiliations
Review

Prenatal Evaluation of Scrotal Masses: A Systematic Literature Review

Federica Romanzi et al. Prenat Diagn. .

Abstract

Evaluation of fetal genitalia is often neglected after determining fetal sex, yet the identification of a scrotal mass may suggest significant underlying conditions requiring specific management. We conducted a systematic literature review, following PRISMA guidelines and registered with PROSPERO (CRD42024559035), on the five most common causes of prenatal scrotal masses: inguinoscrotal hernia (IH), meconium periorchitis (MPO), testicular solid tumors (TST), hydrocele (H), and testicular torsion (TT). A total of 83 cases were included (IH = 31; MPO = 23; TST = 6; H = 10; TT = 13), all diagnosed in the third trimester. IH typically presented as unilateral right-sided masses (63%), while MPO and H were predominantly bilateral (72% and 100%). TST and TT were mainly unilateral with no side preference. IH and MPO showed larger average diameters (> 35 mm). Additional findings were often associated with IH and MPO. MPO had the highest rates of preterm delivery (48%), neonatal medical support (40%), and urgent surgery (60.86%). IH and TST were usually associated with term deliveries and scheduled surgery (92.31% and 100%). TT showed a high incidence of urgent surgery (61.54%). This review outlines key sonographic features of prenatal scrotal masses to guide differential diagnosis and optimize perinatal care strategies.

Keywords: differential diagnosis; inguinoscrotal hernia; meconium periorchitis; prenatal diagnosis; scrotal masses; testicular torsion; testicular tumor; ultrasound.

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