Diagnostic value of scrotal sonography in infertile men

Abstract

Summary Scrotal sonography with a 7.5 MHz sector scanner was performed on 658 consecutive patients of our infertility clinic. The incidence of pathological findings was unexpectedly high. Forty per cent of the patients revealed pathological structures such as varicoceles (21%), hydroceles (7%), epididymal abnormalities (6%), spermatoceles (6%), intratesticular hyper‐ and hypoechoic changes (4.5%), intratesticular cysts (1%) and tumours or carcinoma in situ (CIS) (0.6%). Sonographic evaluation and measurement of the caput epididymidis was compared with palpation. Sonography distinguished size ranges of “normal” and “thickened” epididymides as diagnosed by palpation. Cystic structures were proven in 56% of cases with “thickened” epididymides. The sonographically determined diameters of doppler‐negative blood vessels were significantly smaller than those of doppler‐positive vessels. Sonography revealed a higher occurrence of varicoceles than diagnosed by palpation (76% by palpation). Only 58% of sonographically identified hydroceles and only 67% of sonographically detected spermatoceles were detected by palpation. One testicular tumour and one case with CIS were only seen by sonography and not suspected on palpation. The results demonstrate that sonography represents a valuable tool in the routine diagnosis of andrological patients. Zusammenfassung Bei 658 konsekutiven Patienten unserer Fertilitätssprechstunde wurde routinemäßig eine sonographische Untersuchung der Skrotalorgane mit einem 7, 5 MHz Sektor‐Schallkopf durchgeführt. Die Inzidenz pathologischer Befunde war überraschend hoch. Bei 40% der Patienten fanden sich pathologische Strukturen, wie Varikozelen (21%), Hydrozelen (7%), Anomalien des Nebenhodens (6%), Spermatozelen (6%), intratestikuläre hyper‐ und hypoechogene Veränderungen (4,5%), intratestikuläre Zysten (1%) und Tumoren oder Carcinoma‐in situ [CIS] (0,6%). Die sonographische Untersuchung und Vermessung des Nebenhodenkopfes wurde mit dem Palpationsbefund verglichen. Bei der Palpation wurde zwischen “normal großem” und “verdicktem” Nebenhoden unterschieden. Zystische Strukturen wurden in 56% der “verdickt” palpierten Nebenhoden nachgewiesen. Der sonographisch ermittelte Durchmesser von Doppler‐negativen Gefáßen war signifikant kleiner als der von Dopplerpositiven Gefäßen. Im Vergleich zur klinischen Untersuchung fand sich sonographisch eine höhere Inzidenz von Varikozelen (76% palpiert), von Hydrozelen (58% palpiert) und von Spermatozelen (67% palpiert). Ebenso wurden ein Tumor und das CIS nur auf Grund des sonographischen Bildes entdeckt und einer operativen Diagnose zugeführt. Diese Ergebnisse zeigen, daß die Sonographie eine wertvolle Bereicherung der andrologischen Routinediagnostik darstellt.

Ultrasonographic determination of caput epididymis diameter is strongly predictive of obstruction in the genital tract in azoospermic men with normal serum FSH

“…The area under the ROC curve (AUC), an indicator of the overall correct classification rate, was higher than 0.5 for the three different parameters. 136 Andrology, 2013, 1, 133-138 classified as "normal" based on palpation of left and right epididymis (Nashan et al, 1990). Epididymis abnormalities consisting in subjective evidence of duct ectasia, partial absence or inflammatory mass like were significantly more frequent in obstructive compared with non-obstructive azoospermia (Moon et al, 2006;Du et al, 2010).…”

Current management of the adolescent varicocele

“…Measurement of testis volume can be accomplished with the use of comparative ovoids, orchidometers (Prader, Rochester, or Takahara) [15], or ultrasonography. Some have found the use of orchidometers to be equally as effective in estimating testicular volumes, at a lower expense [16], than testicular ultrasound [17]. It is our experience, however, that the orchidometer is too insensitive to volume differentials relative to ultrasound to be used routinely in determining growth impairment.…”

Genitourinary Problems in Bicyclists

“…Frauscher et al [26] recently studied scrotal ultrasound findings of mountain bikers and found a significantly high incidence of pathology such as epididymal cysts or scrotal calculi [26]. Nashan et al [27] performed ultrasounds on 658 patients in a fertility clinic and identified similar scrotal pathology in 40% of the patients. While no causal relationship may be derived from these two studies, it is curious that cyclists develop similar scrotal pathology as that found in a significant proportion of patients seeking evaluation for infertility.…”