Value of diagnostic ultrasound in patients with chronic scrotal pain and normal findings on clinical examination.

OBJECTIVES

Chronic scrotal pain is a frequent complaint. In many patients with scrotal pain, scrotal ultrasound is performed when the physical examination reveals no abnormalities. We evaluated the yield of scrotal ultrasound in patients with chronic scrotal pain and a normal physical examination.

METHODS

The study involved the findings in 111 patients with scrotal pain lasting longer than 2 weeks, in whom physical examinations and urinalyses were normal and who underwent ultrasound evaluation. Follow-up data were available.

RESULTS

The median age at first presentation was 37 years. The median duration of pain at presentation was 5 months. The pain in the scrotum was localized to the right side in 37% of patients, to the left in 41 %, and bilaterally in 22%. Eighty-three percent had intermittent complaints, and 17% experienced continuous pain. In searching for a cause of the scrotal pain, 65% of patients were found to have a relevant medical history, such as regional surgery, infection, trauma, and low back pain, and 57% described provocative factors. Scrotal ultrasound revealed 12 epididymal cysts less than 0.5 cm and three subclinical varicoceles, but no clinically significant abnormalities. After a median follow-up of 12 months, the pain continued in 70%, although without the development of serious scrotal pathologic features.

CONCLUSIONS

Scrotal ultrasound has no diagnostic value in patients with chronic scrotal pain in whom the physical examinations and urinalyses are normal. A patient's history may suggest an extrascrotal cause of his pain.