Clinical relevance of scrotal and transrectal ultrasonography in andrological patients.

Sonography of the scrotal contents, the prostate and the seminal vesicles has become an important diagnostic tool in andrology. In a prospective study of 1048 consecutive patients attending the Institute of Reproductive Medicine only 520 patients (49.6%) did not show sonographic abnormalities of the scrotal contents. The leading abnormality in the other 528 patients (50.4%) was a varicocele (194 patients, 18.5%), increased size of the epididymis (147 patients, 14.0%), epididymal cyst or spermatocele (55 patients, 5.2%), hydrocele (104 patients, 9.9%), testicular non-homogeneity (92 patients, 8.8%), testicular hypoechogenicity (132 patients, 12.6%), testicular cyst (12 patients, 1.1%) and testicular tumour (5 patients, 0.5%) (sum of percentages exceeds 50.4% because of multiple abnormalities in individual patients). In addition to the high incidence of pathological findings, the significantly higher incidence of testicular tumours compared to the general population and the early detection by ultrasonography render scrotal sonography a diagnostic procedure with high clinical relevance. Transrectal sonography of the prostate and seminal vesicles is valuable for detection of chronic urogenital infections or functional abnormalities of the seminal vesicles in infertile patients. In hypogonadal patients, transrectal examination of the prostate should be performed longitudinally to monitor the biological efficacy of testosterone treatment by measuring prostate growth and, in combination with palpation and PSA measurements, to screen for prostate cancer.