Endorectal MR imaging seems to be indicated in carefully selected patients-specifically, those with three or more positive biopsy specimens, a palpable tumor, and/or a PSA level greater than 10 ng/mL.

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Imaging in male hypofertilityHypofertile men are being increasingly investigated in an effort to ®nd a curable cause for their infertility. This mainly involves azoospermic patients with a normal FSH level and a normal testicular volume, in whom an obstructive cause is routinely sought. It also involves those not azoospermic, in whom a cause is more routinely sought in an attempt to improve the quality of the semen. Scrotal ultrasonography (US), and TRUS with highfrequency transducers and colour Doppler imaging have proved to be very reliable adjuncts to clinical examination in assessing the presence of total or partial obstruction of the seminal tract, detecting in¯ammatory changes of the deep genital tract, and detecting and quantifying venous re¯ux in the spermatic veins. Azoospermic patientsOver the last decade, and especially since the beginning of the 1990s, endorectal US with high-frequency probes [1], which clearly show the caudal junction of the vas deferens and seminal vesicles, has been used to determine the cause of distal obstruction. In selected cases, endorectal MRI can show abnormalities of the caudal junction of the vas deferens and seminal vesicles more accurately than US [2].

IntroductionUltrasonography of the male genital tract is routinely performed to assess several diseases in man. A major field is prostate transrectal sonography combined with US-guided biopsies used to improve, in combination with PSA assay, early detection and staging of prostate cancer. Two other fields have gained clinical importance. The first is male hypofertility. Improvement of in vitro fertilization techniques has led to a huge increase in pretreatment investigation by imaging of hypofertile men, with emphasis on azoospermic patients, to try to find the cause of infertility, before contemplating invasive techniques for only diagnostic purposes, such as testicular biopsy or surgical deferentography. It also concerns non-azoospermic patients in whom the search for a deleterious factor is more and more routinely conducted to improve the quality of the semen. Scrotal and transrectal ultrasonography with high-frequency probes and use of color Doppler imaging have proved to be very reliable adjuncts to clinical examination to assess the presence of an obstruction (total or partial) of the seminal tract, to detect inflammatory changes in the deep genital tract and to detect and quantify a venous reflux in the spermatic veins. The second field is male sexual impotence. Initial enthusiasm concerning noninvasive investigation of impotent men by color Doppler sonography to detect a vascular abnormality (arterial or venous) of the penile vasculature has been tempered by the fact that surgical or interventional treatments used to treat penile artery stenoses or incompetence of the veno-occlusive system were found to give poor results, and now these treatments have been superseded by the advent of medical treatments based on intracavernosal injection of vasoactive drugs and more recently by the possibility of circumventing vasculogenic impotence by a peroral treatment, namely Viagra. US has thus become useful in only highly selected patients presenting with sexual impotence.

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