SCROTAL ULTRASOUND: PRINCIPLES AND PRACTICE
Authors:
D. L. Gilbert; B. R. Gilbert
Authors‘ workplace:
Philadelphia, PA
; Jefferson Medical College
Published in:
Urol List 2010; 8(2): 58-70
Overview
Scrotal ultrasound (US) is a routine – and often essential – component of the evaluation of the male patient presenting with scrotal symptoms. This noninvasive procedure provides the urologist with real-time information that is often invaluable in providing a rapid and accurate diagnosis. When performed in urologist’s office, it can save patients’ time and money.
Urologists are uniquely qualified by training and experience to perform, interpret, and document scrotal US studies, and should maintain a high degree of proficiency in these skills. This primary goal of this article is to provide practicing urologists with an overview of the principles and practice of office scrotal US. Initial proficiency in scrotal US requires “hands-on” training under the mentorship of an experienced sonographer, which often occurs during residency in the United States. Classes for maintaining and updating these skills are available through the American Urological Association (AUA), various academic training programs, and US equipment manufacturers. In addition, many excellent educational resources are available online.
Key words:
scrotal ultrasound, testis, diagnostics, Doppler
Sources
1. Deane C. Doppler ultrasound: Principles and practice in Doppler in obstetrics. In: Nicolaides K, Rizzo G, Hecker K et al eds. Diploma in Fetal Medicine Series. ISUOG Educational Committee; 2002.
2. Keener TS, Nghiem HV, Kreiger JN et al. Comparison of conventional color Doppler with power Doppler sonography to depict normal prostatic vasculature. JDMS 1997; 13: 63–67.
3. Rubin JM, Bude RO, Carson PL et al. Power Doppler US: a potentially useful alternative to mean frequency-based color Doppler US. Radiology 1994; 190(3): 853–856.
4. Atilla M, Sargin H, Yilmaz Y et al. Undescended testes in adults: clinical significance of resistive index values of the testicular artery measured by Doppler ultrasound as a predictor of testicular histology. J Urol 1997; 158(3 pt 1): 841–843.
5. Yee TY, Choe BY, Byun JY et al. Resistive index of the intrascrotal artery in scrotal inflammatory disease Acta Radiol 1997; 38(6): 1026–1030.
6. Mihmanli I, Kantarci F, Kulaksizoglu H et al. Testicular size and vascular resistance before and after hydrocelectomy. AJR Am J Roentgenol 2004; 183(5): 1379–1385.
7. Owen CA, Winter T. Color Doppler imaging of the scrotum. JDMS 2006; 22: 221–230.
8. Sanders LM, Haber S, Dembner A et al. Significance of reversal of diastolic flow in the acute scrotum. J Ultrasound Med 1994; 13(2): 137–139.
9. Jee WH, Choe BY, Byun JY et al. Resistive index of the intrascrotal artery in scrotal inflammatory disease. Acta Radiol 1997; 38(6): 1026–1030.
10. Baker LA, Sigman D, Mathews RI et al. An analysis of clinical outcomes using color Doppler testicular ultrasound for testicular torsion. Pediatrics 2000; 105(3 pt 1): 604–607.
11. Blaivas M, Sierzenski P, Lambert M. Emergency evaluation of patients presenting with acute scrotum using bedside ultrasonography. Acad Emerg Med 2001; 8(1): 90–93.
12. Dogra V, Bhatt S. Acute painful scrotum. Radiol Clin North Am 2004; 42(2): 349–363.
13. Weber DM, Rosslein R, Fliegel C. Color Doppler sonography in the diagnosis of acute scrotum in boys. Eur J Pediatr Surg 2000; 10(4): 235–241.
14. Dogra VS, Bhatt S, Rubens DJ. Sonographic evaluation of testicular torsion. Ultrasound Clin 2006; 1: 55–66.
15. Bartsch G, Frank S, Marberger H et al. Testicular torsion: late results with special regard to fertility and endocrine function. J Urol 1980; 124: 375–378.
16. Kravets FG, Cohen HL, Sheynkin Y et al. Intraoperative sonographically guided needle localization of nonpalpable testicular tumors. AJR Am J Roentgenol 2006; 186(1): 141–143.
17. Steinfeld AD. Testicular germ cell tumors: review of contemporary evaluation and management. Radiology 1990; 175(3): 603–606.
18. Carmignani L, Morabito A, Gadda F et al. Prognostic parameters in adult impalpable ultrasonographic lesions of the testicle. J Urol 2005; 174(3): 1035–1038.
19. Cho JH, Chang JC, Park BH et al. Sonographic and MR imaging findings of testicular epidermoid cysts. AJR Am J Roentgenol 2002; 178(3): 743–748.
20. Bhandary P, Abbitt PL, Watson L. Ultrasound diagnosis of traumatic testicular rupture. J Clin Ultrasound 1992; 20(5): 346–348.
21. Dogra VS, Gottlieb RH, Oka M. Sonography of the scrotum. Radiology 2003; 227(1): 18–36.
22. Dogra VS, Bhatt S. Categorical Course in Diagnostic Radiology: Acute Scrotal Pain: Imaging Evaluation for a More Specific Diagnosis. Ramchandani P, ed. Oak Brook, Ill; Radiological Society of North America: Genitourinary Radiology 2006: 255–270.
23. Herbener TE. Ultrasound in the assessment of the acute scrotum. J Clin Ultrasound 1996; 24(8): 405–421.
24. Haas CA, Brown SL, Spirnak JP. Penile fracture and testicular rupture. World J Urol 1999; 17(2): 101–106.
25. Grainger AJ, Hide, GH, Simon TE. The ultrasound appearances of scrotal oedema. Eur J Ultrasound 1998; 8(1): 33–37.
26. Sasso F, Nucci G, Palmiotto F et al. Acute idiopathic scrotal oedema: rare disorder or difficult diagnosis? Int J Urol Nephrol 1990; 22(5): 475–478.
27. Najmaldin A, Burge DM. Acute idiopathic scrotal oedema: incidence, manifestations and aetiology. Br J Surg 1987; 74(7): 634–635.
28. Brandes SB, Chelsky MJ, Hanno PM. Adult acute idiopathic scrotal edema. Urology 1994; 44: 602–605.
29. Gat Y, Bachar GN, Everaert K et al. Induction of spermatogenesis in azoospermic men after internal spermatic vein embolization for the treatment of varicocele. Hum Reprod 2005; 20(4): 1013–1017.
30. Cornud F, Belin X, Amar E et al. Varicocele: strategies in diagnosis and treatment. Eur Radiol 1999; 9(3): 536–545.
31. Das KM, Prasad K, Szmigielski W et al. Intratesticular varicocele: evaluation using conventional and Doppler sonography. AJR Am J Roentgenol 1999; 173(4): 1079–1083.
32. Tasci AI, Resim S, Caskurlu T et al. Color Doppler ultrasonography and spectral analysis of venous flow in diagnosis of varicocele. Eur Urol 2001; 39(3): 316–321.
33. Bach AM, Hann LE, Hadar O et al. Testicular microlithiasis: what is its association with testicular cancer? Radiology 2001; 220(1): 70–75.
34. Peterson AC, Bauman JM, Light DE et al. The prevalence of testicular microlithiasis in an asymptomatic population of men 18 to 35 years old. J Urol 2001; 166(6): 2061–2064.
35. Middleton WD, Teefey SA, Santillan CS. Testicular microlithiasis: prospective analysis of prevalence and associated tumor. Radiology 2002; 224(2): 425–428.
36. von Eckardstein S, Tsakmakidis G, Kamischke A et al. Sonographic testicular microlithiasis as an indicator of premalignant conditions in normal and infertile men. J Androl 2001; 22(5): 818–824.
37. Bennett HF, Middleton WD, Bullock AD et al. Testicular microlithiasis: US follow-up. Radiology 2001; 218(2): 359–363.
38. Whitman GJ, Hall DA, McCarthy KA et al. Testicular microlithiasis: sonographic features and significance. Radiology 1994; 193(P): 335. Abstract.
39. Furness PD III, Husmann DA, Brock JW III et al. Multi-institutional study of testicular microlithiasis in childhood: a benign or premalignant condition? J Urol 1998; 160(3 pt 2): 1151–1154.
40. Gooding GAW. Detection of testicular microlithiasis by sonography. AJR Am J Roentgenol 1997; 168(1): 281–282.
41. Winter TC 3rd, Zunkel DE, Mack LA. Testicular carcinoma in a patient with previously demonstrated testicular microlithiasis. J Urol 1996; 155(2): 648.
42. Frush DP, Kliewer MA, Madden JF. Testicular microlithiasis and subsequent development of metastatic germ cell tumor. AJR Am J Roentgenol 1996; 167(4): 889–890.
43. McEniff N, Doherty F, Katz J et al. Yolk sac tumor of the testis discovered on a routine annual sonogram in a boy with testicular microlithiasis. AJR Am J Roentgenol 1995; 164: 971–972.
44. Salisz JA, Goldman KA. Testicular calcifications and neoplasia in a patient treated for subfertility. Urology 1990; 36(6): 557–560.
45. Aizenstein RI, DiDomenico D, Wilbur AC et al. Testicular microlithiasis: association with male infertility. J Clin Ultrasound 1998; 26(4): 195–198.
46. Jarow JP. Life-threatening conditions associated with male infertility. Urol Clin North Am 1994; 21(3): 409–415.
47. Honig SC, Lipshultz LI, Jarow J. Significant medical pathology uncovered by a comprehensive male infertility evaluation. Fertil Steril 1994; 62(5): 1028–1034.
48. Clarke GN, Elliott PJ, Smaila C. Detection of sperm antibodies in semen using the immunobead test: a survey of 813 consecutive patients. Am J Reprod Immunol Microbiol 1985; 7(3): 118–123.
49. Sinisi AA, Di Finizio B, Pasquali D et al. Prevalence of antisperm antibodies by SpermMARtest in subjects undergoing a routine sperm analysis for infertility. Int J Androl 1993; 16(5): 311–314.
50. Gilbert BR, Witkin SS, Goldstein M. Correlation of sperm-bound immunoglobulins with impaired semen analysis in infertile men with varicoceles. Fertil Steril 1989; 52(3): 469–473.
51. Fuchs EF, Alexander NJ. Immunologic considerations before and after vasovasostomy. Fertil Steril 1983; 40(4): 497–499.
52. Patrizio P, Silber SJ, Ord T et al. Relationship of epididymal sperm antibodies to their in vitro fertilization capacity in men with congenital absence of the vas deferens. Fertil Steril 1992; 58(5): 1006–1010.
53. Iqbal PK, Adeghe AJ, Hughes Y et al. Clinical characteristics of subfertile men with antisperm antibodies. Br J Obstet Gynaecol 1989; 96(1): 107–110.
54. Heidenreich A, Bonfig R, Wilbert DM et al. Risk factors for antisperm antibodies in infertile men. Am J Reprod Immunol 1994; 31(203): 69–76.
55. Urry RL, Carrell DT, Starr NT et al. The incidence of antisperm antibodies in infertility patients with a history of cryptorchidism. J Urol 1994; 151(2): 381–383.
56. Harrington TG, Schauer D, Gilbert BR. Percutaneous testis biopsy: an alternative to open testicular biopsy in the evaluation of the subfertile male. J Urol 1996; 156(5): 1647–1651.
57. Schlegel PN, Su L-M. Physiological consequences of testicular sperm extraction. Hum Reprod 1997; 12(8): 1688–1692.
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Urological Journal
2010 Issue 2
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