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.