Radiological diagnosis: scrotal ultrasound and Doppler ultrasound in the diagnosis of male infertility

Objective: To review the ultrasound technique, normal anatomy, bibliography, as well as the most frequent scrotal ultrasound findings in infertile patients studied in our center over the last five years, with special emphasis in the diagnosis of varicocele and its follow-up after surgical treatment or embolization.

Methods: We reviewed a total of 439 male patients with the diagnosis of infertility referred to our vascular ultrasound section between 1998 and 2004, and 101 patients referred for ultrasound control after treatment of varicocele (endovascular or surgical).

Results: The most frequent diagnosis associated with infertility were left varicocele (146 patients, 33.3%), right varicocele (39 patients, 8.9%) and intratesticular varicocele (1 patient, 0.2%). Only one patient had a right-side-only varicocele (0.2%), the rest of the cases of right varicocele having bilateral affectation (38 patients, 8.7%). Other relevant diagnoses found were testicular atrophy, epididymal lesions, microlithiasis, inguinal scrotal hernias, testicular tumors, and dilation of the rete testis.

Conclusions: Testicular ultrasound should be performed in every patient with unexplained infertility and abnormal sperm analysis. It allows diagnosis of more pathologic conditions than physical examination. Besides a rapid varicocele screening, colour Doppler ultrasound allows us to evaluate its hemodynamic repercussion, by studying the spectral display, colour and response to Valsalva's. It also provides an exact measure of testicular volume, allows to detect the presence of dystrophic changes in the testicle, as well as anomalies of the epididymis and vas deferens, such as cystic dilations. It is also the test of choice to detect non descended testicles. Ultrasound may also detect non palpable testicular tumors which are more prevalent in this group of patients.