Scrotal Ultrasound

  • Rao S. Mandalapu
  • Peter N. Tiffany
  • Bruce R. GilbertEmail author
Part of the Current Clinical Urology book series (CCU)


The scrotum is separated into right and left hemiscrotal compartments by a septum called the median raphe. The normal scrotal wall thickness varies between 2 and 8 mm. The scrotal wall contains the following structures: rugated skin, superficial fascia, dartos muscle, external spermatic fascia, cremasteric fascia, and internal spermatic fascia. These layers are indistinguishable on a normal clinical exam. The tunica vaginalis consists of parietal and visceral layers normally separated by 2–3 mL of straw-colored fluid often referred to as a physiologic hydrocele. On ultrasound this fluid is often seen as a thin anechoic rim around the head of the epididymis [1]. The parietal and visceral layers join at the posterolateral aspect of the testis where the tunica attaches to the scrotal wall [2].


Germ Cell Tumor Congenital Adrenal Hyperplasia Spermatic Cord Epidermoid Cyst Testicular Torsion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Dogra V, Bhatt S. Acute painful scrotum. Radiol Clin North Am. 2004;42(2):349–63.CrossRefPubMedGoogle Scholar
  2. 2.
    Smart JM, et al. Ultrasound findings of masses of the paratesticular space. Clin Radiol. 2008;63(8):929–38.CrossRefPubMedGoogle Scholar
  3. 3.
    Hadziselimovic F, et al. The importance of mini-puberty for fertility in cryptorchidism. J Urol. 2005;174(4 Pt 2):1536–9; discussion 1538–9.Google Scholar
  4. 4.
    Raivio T, et al. Serum androgen bioactivity in cryptorchid and noncryptorchid boys during the postnatal reproductive hormone surge. J Clin Endocrinol Metab. 2003;88(6):2597–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Kuijper EA, et al. Ultrasonographically measured testicular volumes in 0- to 6-year-old boys. Hum Reprod. 2008;23(4):792–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Aso C, et al. Gray-scale and color Doppler sonography of scrotal disorders in children: an update. Radiographics. 2005;25(5):1197–214.CrossRefPubMedGoogle Scholar
  7. 7.
    Dogra VS, et al. Sonography of the scrotum. Radiology. 2003;227(1):18–36.CrossRefPubMedGoogle Scholar
  8. 8.
    Thomas RD, Dewbury KC. Ultrasound appearances of the rete testis. Clin Radiol. 1993;47(2):121–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Bhatt S, et al. Imaging of non-neoplastic intratesticular masses. Diagn Interv Radiol. 2011;17:52–63.PubMedGoogle Scholar
  10. 10.
    Wishahi MM. Anatomy of the venous drainage of the human testis: testicular vein cast, microdissection and radiographic demonstration. A new anatomical concept. Eur Urol. 1991;20(2):154–60.PubMedGoogle Scholar
  11. 11.
    Paltiel HJ, Rupich RC, Babcock DS. Maturational changes in arterial impedance of the normal testis in boys: Doppler sonographic study. AJR Am J Roentgenol. 1994;163(5):1189–93.CrossRefPubMedGoogle Scholar
  12. 12.
    Biagiotti G, et al. Spermatogenesis and spectral echo-colour Doppler traces from the main testicular artery. BJU Int. 2002;90(9):903–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Unsal A, et al. Resistance and pulsatility index increase in capsular branches of testicular artery: indicator of impaired testicular microcirculation in varicocele? J Clin Ultrasound. 2007;35(4):191–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Pinggera GM, et al. Assessment of the intratesticular resistive index by colour Doppler ultrasonography measurements as a predictor of spermatogenesis. BJU Int. 2008;101(6):722–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Balci A, et al. Long-term effect of varicocele repair on intratesticular arterial resistance index. J Clin Ultrasound. 2008;36(3):148–52.CrossRefPubMedGoogle Scholar
  16. 16.
    Nielsen ME. Use and misuse of imaging by urologists. J Urol. 2010;184(1):12–4.CrossRefPubMedGoogle Scholar
  17. 17.
    Douglas PS. Improving imaging: our professional imperative. J Am Coll Cardiol. 2006;48(10):2152–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Hendel RC, et al. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol. 2006;48(7):1475–97.CrossRefPubMedGoogle Scholar
  19. 19.
    Lee A, et al. Acute idiopathic scrotal edema: ultrasonographic findings at an emergency unit. Eur Radiol. 2009;19(8):2075–80.CrossRefPubMedGoogle Scholar
  20. 20.
    Thomas AC, et al. Ultrasound findings of acute idiopathic scrotal edema. Scientific World Journal. 2004;4 Suppl 1:9–10.CrossRefPubMedGoogle Scholar
  21. 21.
    Grainger AJ, Hide IG, Elliott ST. The ultrasound appearances of scrotal oedema. Eur J Ultrasound. 1998;8(1):33–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Malik AM, et al. The spectrum of presentation and management of Fournier’s gangrene–an experience of 73 cases. J Pak Med Assoc. 2010;60(8):617–9.PubMedGoogle Scholar
  23. 23.
    Sorensen MD, et al. Fournier’s gangrene: management and mortality predictors in a population based study. J Urol. 2009;182(6):2742–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Levenson RB, Singh AK, Novelline RA. Fournier gangrene: role of imaging. Radiographics. 2008;28(2):519–28.CrossRefPubMedGoogle Scholar
  25. 25.
    Rajan DK, Scharer KA. Radiology of Fournier’s gangrene. AJR Am J Roentgenol. 1998;170(1):163–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Hara Y, et al. Acute scrotum caused by Henoch-Schonlein purpura. Int J Urol. 2004;11(7):578–80.CrossRefPubMedGoogle Scholar
  27. 27.
    Swygert KE, et al. Melanoma in situ involving an epidermal inclusion (infundibular) cyst. Am J Dermatopathol. 2007;29(6):564–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Germaine P, Simerman LP. Fibrous pseudotumor of the scrotum. J Ultrasound Med. 2007;26(1):133–8.PubMedGoogle Scholar
  29. 29.
    Seethala RR, et al. Diffuse fibrous pseudotumor of the testicular tunics associated with an inflamed hydrocele. Arch Pathol Lab Med. 2003;127(6):742–4.PubMedGoogle Scholar
  30. 30.
    Lowe FC. Squamous-cell carcinoma of the scrotum. Urol Clin North Am. 1992;19(2):397–405.PubMedGoogle Scholar
  31. 31.
    Jones ME, et al. Risk of congenital inguinal hernia in siblings: a record linkage study. Paediatr Perinat Epidemiol. 1998;12(3):288–96.CrossRefPubMedGoogle Scholar
  32. 32.
    Rescorla FJ, et al. The “other side” of pediatric hernias: the role of laparoscopy. Am Surg. 1997;63(8):690–3.PubMedGoogle Scholar
  33. 33.
    Erez I, et al. Preoperative ultrasound and intraoperative findings of inguinal hernias in children: a prospective study of 642 children. J Pediatr Surg. 2002;37(6):865–8.CrossRefPubMedGoogle Scholar
  34. 34.
    Osifo OD, Osaigbovo EO. Congenital hydrocele: prevalence and outcome among male children who underwent neonatal circumcision in Benin City, Nigeria. J Pediatr Urol. 2008;4(3):178–82.CrossRefPubMedGoogle Scholar
  35. 35.
    Wampler SM, Llanes M. Common scrotal and testicular problems. Prim Care. 2010;37(3):613–26, x.Google Scholar
  36. 36.
    Mihmanli I, et al. Testicular size and vascular resistance before and after hydrocelectomy. AJR Am J Roentgenol. 2004;183(5):1379–85.CrossRefPubMedGoogle Scholar
  37. 37.
    Garriga V, et al. US of the tunica vaginalis testis: anatomic relationships and pathologic conditions. Radiographics. 2009;29(7):2017–32.CrossRefPubMedGoogle Scholar
  38. 38.
    Somekh E, Gorenstein A, Serour F. Acute epididymitis in boys: evidence of a post-infectious etiology. J Urol. 2004;171(1):391–4; discussion 394.Google Scholar
  39. 39.
    Bohm MK, Gift TL, Tao G. Patterns of single and multiple claims of epididymitis among young privately-insured males in the United States, 2001 to 2004. Sex Transm Dis. 2009;36(8):490–2.CrossRefPubMedGoogle Scholar
  40. 40.
    Adams CE, Wald M. Risks and complications of vasectomy. Urol Clin North Am. 2009;36(3):331–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Greek G. Vasectomy. A safe, effective, economical means of sterilization. Postgrad Med. 2000;108(2):173–6, 179.Google Scholar
  42. 42.
    Schwingl PJ, Guess HA. Safety and effectiveness of vasectomy. Fertil Steril. 2000;73(5):923–36.CrossRefPubMedGoogle Scholar
  43. 43.
    Akbar SA, et al. Multimodality imaging of paratesticular neoplasms and their rare mimics. Radiographics. 2003;23(6):1461–76.CrossRefPubMedGoogle Scholar
  44. 44.
    Aydin H, et al. Clear cell papillary cystadenoma of the epididymis and mesosalpinx: immunohistochemical differentiation from metastatic clear cell renal cell carcinoma. Am J Surg Pathol. 2005;29(4):520–3.CrossRefPubMedGoogle Scholar
  45. 45.
    Alexander JA, Lichtman JB, Varma VA. Ultrasound demonstration of a papillary cystadenoma of the epididymis. J Clin Ultrasound. 1991;19(7):442–5.CrossRefPubMedGoogle Scholar
  46. 46.
    Salm R. Papillary sarcinoma of the epididymis. J Pathol. 1969;97(2):253–9.CrossRefPubMedGoogle Scholar
  47. 47.
    Dowling KJ, Lieb HE. Fibrosarcoma of epididymis. Urology. 1985;26(3):307–8.CrossRefPubMedGoogle Scholar
  48. 48.
    Kurihara K, et al. Papillary adenocarcinoma of the epididymis. Acta Pathol Jpn. 1993;43(7–8):440–3.PubMedGoogle Scholar
  49. 49.
    Ringdahl E, Teague L. Testicular torsion. Am Fam Physician. 2006;74(10):1739–43.PubMedGoogle Scholar
  50. 50.
    Bartsch G, et al. Testicular torsion: late results with special regard to fertility and endocrine function. J Urol. 1980;124(3):375–8.PubMedGoogle Scholar
  51. 51.
    Waldert M, et al. Color Doppler sonography reliably identifies testicular torsion in boys. Urology. 2010;75(5):1170–4.CrossRefPubMedGoogle Scholar
  52. 52.
    Jee WH, et al. Resistive index of the intrascrotal artery in scrotal inflammatory disease. Acta Radiol. 1997;38(6):1026–30.PubMedGoogle Scholar
  53. 53.
    Yagil Y, et al. Role of Doppler ultrasonography in the triage of acute scrotum in the emergency department. J Ultrasound Med. 2010;29(1):11–21.PubMedGoogle Scholar
  54. 54.
    Nakagawa A, et al. In vivo analysis of phagocytosis of apoptotic cells by testicular Sertoli cells. Mol Reprod Dev. 2005;71(2):166–77.CrossRefPubMedGoogle Scholar
  55. 55.
    Drut R, Drut RM. Testicular microlithiasis: histologic and immunohistochemical findings in 11 pediatric cases. Pediatr Dev Pathol. 2002;5(6):544–50.CrossRefPubMedGoogle Scholar
  56. 56.
    van Casteren NJ, Looijenga LH. Dohle GR Testicular microlithiasis and carcinoma in situ overview and proposed clinical guideline. Int J Androl. 2009;32(4):279–87.CrossRefPubMedGoogle Scholar
  57. 57.
    Dagash H, Mackinnon EA. Testicular microlithiasis: what does it mean clinically? BJU Int. 2007;99(1):157–60.CrossRefPubMedGoogle Scholar
  58. 58.
    Middleton WD, Teefey SA, Santillan CS. Testicular microlithiasis: prospective analysis of prevalence and associated tumor. Radiology. 2002;224(2):425–8.CrossRefPubMedGoogle Scholar
  59. 59.
    Goede J, et al. Prevalence of testicular microlithiasis in asymptomatic males 0 to 19 years old. J Urol. 2009;182(4):1516–20.CrossRefPubMedGoogle Scholar
  60. 60.
    von Eckardstein S, et al. Sonographic testicular microlithiasis as an indicator of premalignant conditions in normal and infertile men. J Androl. 2001;22(5):818–24.Google Scholar
  61. 61.
    DeCastro BJ, Peterson AC, Costabile RA. A 5-year followup study of asymptomatic men with testicular microlithiasis. J Urol. 2008;179(4):1420–3; discussion 1423.Google Scholar
  62. 62.
    Kocaoglu M, et al. Testicular microlithiasis in pediatric age group: ultrasonography findings and literature review. Diagn Interv Radiol. 2005;11(1):60–5.PubMedGoogle Scholar
  63. 63.
    Furness PD, 3rd, et al. Multi-institutional study of testicular microlithiasis in childhood: a benign or premalignant condition? J Urol. 1998;160(3 Pt 2):1151–4; discussion 1178.Google Scholar
  64. 64.
    Frush DP, Kliewer MA, Madden JF. Testicular microlithiasis and subsequent development of metastatic germ cell tumor. AJR Am J Roentgenol. 1996;167(4):889–90.CrossRefPubMedGoogle Scholar
  65. 65.
    Bennett HF, et al. Testicular microlithiasis: US follow-up. Radiology. 2001;218(2):359–63.PubMedGoogle Scholar
  66. 66.
    Dieckmann KP, Skakkebaek NE. Carcinoma in situ of the testis: review of biological and clinical features. Int J Cancer. 1999;83(6):815–22.CrossRefPubMedGoogle Scholar
  67. 67.
    Husmann DA. Cryptorchidism and its relationship to testicular neoplasia and microlithiasis. Urology. 2005;66(2):424–6.CrossRefPubMedGoogle Scholar
  68. 68.
    Comiter CV, et al. Burned-out primary testicular cancer: sonographic and pathological characteristics. J Urol. 1996;156(1):85–8.CrossRefPubMedGoogle Scholar
  69. 69.
    Angulo JC, et al. Clinicopathological study of regressed testicular tumors (apparent extragonadal germ cell neoplasms). J Urol. 2009;182(5):2303–10.CrossRefPubMedGoogle Scholar
  70. 70.
    Gooding GA, Leonhardt W, Stein R. Testicular cysts: US findings. Radiology. 1987;163(2):537–8.PubMedGoogle Scholar
  71. 71.
    Hamm B, Fobbe F, Loy V. Testicular cysts: differentiation with US and clinical findings. Radiology. 1988;168(1):19–23.PubMedGoogle Scholar
  72. 72.
    Dogra VS, et al. Benign intratesticular cystic lesions: US features. Radiographics. 2001;21 Spec No: S273–81.Google Scholar
  73. 73.
    Carver BS, Al-Ahmadie H, Sheinfeld J. Adult and pediatric testicular teratoma. Urol Clin North Am. 2007;34(2):245–51; abstract x.Google Scholar
  74. 74.
    Chou SJ, et al. Cysts of the tunica albuginea. Arch Androl. 2004;50(2):89–92.PubMedGoogle Scholar
  75. 75.
    Tammela TL, et al. Cysts of the tunica albuginea–more common testicular masses than previously thought? Br J Urol. 1991;68(3):280–4.CrossRefPubMedGoogle Scholar
  76. 76.
    Khalid M, et al. Concomitant bilateral testicular epidermoid cysts. Saudi Med J. 2008;29(6):907–9.PubMedGoogle Scholar
  77. 77.
    Dogra VS, et al. Testicular epidermoid cysts: sonographic features with histopathologic correlation. J Clin Ultrasound. 2001;29(3):192–6.CrossRefPubMedGoogle Scholar
  78. 78.
    Malvica RP. Epidermoid cyst of the testicle: an unusual sonographic finding. AJR Am J Roentgenol. 1993;160(5):1047–8.CrossRefPubMedGoogle Scholar
  79. 79.
    Loya AG, Said JW, Grant EG. Epidermoid cyst of the testis: radiologic-pathologic correlation. Radiographics. 2004;24 Suppl 1:S243–6.CrossRefPubMedGoogle Scholar
  80. 80.
    Nistal M, Mate A, Paniagua R. Cystic transformation of the rete testis. Am J Surg Pathol. 1996;20(10):1231–9.CrossRefPubMedGoogle Scholar
  81. 81.
    Nair R, et al. Tubular ectasia of the rete testis: a diagnostic dilemma. Ann R Coll Surg Engl. 2008;90(7):W1–3.CrossRefPubMedGoogle Scholar
  82. 82.
    Bree RL, Hoang DT. Scrotal ultrasound. Radiol Clin North Am. 1996;34(6):1183–205.PubMedGoogle Scholar
  83. 83.
    Atasoy C, Fitoz S. Gray-scale and color Doppler sonographic findings in intratesticular varicocele. J Clin Ultrasound. 2001;29(7):369–73.CrossRefPubMedGoogle Scholar
  84. 84.
    Bucci S, et al. Intratesticular varicocele: evaluation using gray scale and color Doppler ultrasound. World J Urol. 2008;26(1):87–9.CrossRefPubMedGoogle Scholar
  85. 85.
    Kessler A, et al. Intratesticular varicocele: gray scale and color Doppler sonographic appearance. J Ultrasound Med. 2005;24(12):1711–6.PubMedGoogle Scholar
  86. 86.
    Das KM, et al. Intratesticular varicocele: evaluation using conventional and Doppler sonography. AJR Am J Roentgenol. 1999;173(4):1079–83.CrossRefPubMedGoogle Scholar
  87. 87.
    Desai KM, Gingell JC, Haworth JM. Localised intratesticular abscess complicating epididymo-orchitis: the use of scrotal ultrasonography in diagnosis and management. Br Med J (Clin Res Ed). 1986;292(6532):1361–2.CrossRefGoogle Scholar
  88. 88.
    Mouritsen A, et al. Testicular adrenal rest tumours in boys, adolescents and adult men with congenital adrenal hyperplasia may be associated with the CYP21A2 mutation. Int J Androl. 2010;33(3):521–7.CrossRefPubMedGoogle Scholar
  89. 89.
    Claahsen-van der Grinten HL, et al. Prevalence of testicular adrenal rest tumours in male children with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Eur J Endocrinol. 2007;157(3):339–44.CrossRefPubMedGoogle Scholar
  90. 90.
    Dogra V, Nathan J, Bhatt S. Sonographic appearance of testicular adrenal rest tissue in congenital adrenal hyperplasia. J Ultrasound Med. 2004;23(7):979–81.PubMedGoogle Scholar
  91. 91.
    Proto G, et al. Bilateral testicular adrenal rest tissue in congenital adrenal hyperplasia: US and MR features. J Endocrinol Invest. 2001;24(7):529–31.PubMedGoogle Scholar
  92. 92.
    Dieckmann KP, et al. Bilateral testicular germ cell tumors. Report of nine cases and review of the literature. Cancer. 1986;57(6):1254–8.CrossRefPubMedGoogle Scholar
  93. 93.
    Datta SN, et al. A case of scrotal sarcoidosis that mimicked tuberculosis. Nat Clin Pract Urol. 2007;4(4):227–30.CrossRefPubMedGoogle Scholar
  94. 94.
    Metcalfe PD, et al. Pediatric testicular tumors: contemporary incidence and efficacy of testicular preserving surgery. J Urol. 2003;170(6 Pt 1):2412–5; discussion 2415–6.Google Scholar
  95. 95.
    Horwich A, Shipley J, Huddart R. Testicular germ-cell cancer. Lancet. 2006;367(9512):754–65.CrossRefPubMedGoogle Scholar
  96. 96.
    Schwerk WB, Schwerk WN, Rodeck G. Testicular tumors: prospective analysis of real-time US patterns and abdominal staging. Radiology. 1987;164(2):369–74.PubMedGoogle Scholar
  97. 97.
    Woodward PJ, et al. From the archives of the AFIP: tumors and tumorlike lesions of the testis: radiologic-pathologic correlation. Radiographics. 2002;22(1):189–216.PubMedGoogle Scholar
  98. 98.
    Shah A, et al. Re: new ultrasound techniques for imaging of the indeterminate testicular lesion may avoid surgery completely. Clin Radiol. 2010;65(6):496–7.CrossRefPubMedGoogle Scholar
  99. 99.
    Frush DP, Sheldon CA. Diagnostic imaging for pediatric scrotal disorders. Radiographics. 1998;18(4):969–85.PubMedGoogle Scholar
  100. 100.
    Ulbright TM, Roth LM. Recent developments in the pathology of germ cell tumors. Semin Diagn Pathol. 1987;4(4):304–19.PubMedGoogle Scholar
  101. 101.
    Thava V, Cooper N, Egginton JA. Yolk sac tumour of the testis in childhood. Br J Radiol. 1992;65(780):1142–4.CrossRefPubMedGoogle Scholar
  102. 102.
    Hasselblom S, et al. Testicular lymphoma–a retrospective, population-based, clinical and immunohistochemical study. Acta Oncol. 2004;43(8):758–65.CrossRefPubMedGoogle Scholar
  103. 103.
    Vural F, et al. Primary testicular lymphoma. J Natl Med Assoc. 2007;99(11):1277–82.PubMedGoogle Scholar
  104. 104.
    Zucca E, et al. Patterns of outcome and prognostic factors in primary large-cell lymphoma of the testis in a survey by the International Extranodal Lymphoma Study Group. J Clin Oncol. 2003;21(1):20–7.CrossRefPubMedGoogle Scholar
  105. 105.
    Carmignani L, et al. High incidence of benign testicular neoplasms diagnosed by ultrasound. J Urol. 2003;170(5):1783–6.CrossRefPubMedGoogle Scholar
  106. 106.
    Muller T, et al. Management of incidental impalpable intratesticular masses of <or = 5 mm in diameter. BJU Int. 2006;98(5):1001–4.CrossRefPubMedGoogle Scholar
  107. 107.
    Hallak J, et al. Organ-sparing microsurgical resection of incidental testicular tumors plus microdissection for sperm extraction and cryopreservation in azoospermic patients: surgical aspects and technical refinements. Urology. 2009;73(4):887–91; discussion 891–2.Google Scholar
  108. 108.
    Toren PJ, et al. Small incidentally discovered testicular masses in infertile men–is active surveillance the new standard of care? J Urol. 2010;183(4):1373–7.CrossRefPubMedGoogle Scholar
  109. 109.
    Lefort C, et al. [Ischemic orchiditis: review of 5 cases diagnosed by color Doppler ultrasonography]. J Radiol. 2001;82(7):839–42.PubMedGoogle Scholar
  110. 110.
    Tarhan S, et al. Long-term effect of microsurgical inguinal varicocelectomy on testicular blood flow. J Androl. 2011;32(1):33–9.CrossRefPubMedGoogle Scholar
  111. 111.
    Shafik A, et al. Testicular veins: anatomy and role in varicocelogenesis and other pathologic conditions. Urology. 1990;35(2):175–82.CrossRefPubMedGoogle Scholar
  112. 112.
    Gat Y, et al. Induction of spermatogenesis in azoospermic men after internal spermatic vein embolization for the treatment of varicocele. Hum Reprod. 2005;20(4):1013–7.CrossRefPubMedGoogle Scholar
  113. 113.
    Gat Y, et al. Varicocele, hypoxia and male infertility. Fluid Mechanics analysis of the impaired testicular venous drainage system. Hum Reprod. 2005;20(9):2614–9.CrossRefPubMedGoogle Scholar
  114. 114.
    Wishahi MM. Anatomy of the spermatic venous plexus (pampiniform plexus) in men with and without varicocele: intraoperative venographic study. J Urol. 1992;147(5):1285–9.PubMedGoogle Scholar
  115. 115.
    Braedel HU, et al. A possible ontogenic etiology for idiopathic left varicocele. J Urol. 1994;151(1):62–6.PubMedGoogle Scholar
  116. 116.
    Gorenstein A, Katz S, Schiller M. Varicocele in children: “to treat or not to treat”–venographic and manometric studies. J Pediatr Surg. 1986;21(12):1046–50.CrossRefPubMedGoogle Scholar
  117. 117.
    Iafrate M, et al. Varicocele is associated with an increase of connective tissue of the pampiniform plexus vein wall. World J Urol. 2009;27(3):363–9.CrossRefPubMedGoogle Scholar
  118. 118.
    The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics. World Health Organization. Fertil Steril. 1992;57(6):1289–93.Google Scholar
  119. 119.
    Benoff S, Gilbert BR. Varicocele and male infertility: part I. Preface. Hum Reprod Update. 2001;7(1):47–54.CrossRefPubMedGoogle Scholar
  120. 120.
    Robinson SP, Hampton LJ, Koo HP. Treatment strategy for the adolescent varicocele. Urol Clin North Am. 2010;37(2):269–78.CrossRefPubMedGoogle Scholar
  121. 121.
    Cornud F, et al. Varicocele: strategies in diagnosis and treatment. Eur Radiol. 1999;9(3):536–45.CrossRefPubMedGoogle Scholar
  122. 122.
    Tasci AI, et al. Color doppler ultrasonography and spectral analysis of venous flow in diagnosis of varicocele. Eur Urol. 2001;39(3):316–21.CrossRefPubMedGoogle Scholar
  123. 123.
    Kadyrov ZA, et al. [Bilateral varicocele: epidemiology, clinical presentation and diagnosis]. Urologiia. 2007;3:64–8.PubMedGoogle Scholar
  124. 124.
    Gat Y, et al. Physical examination may miss the diagnosis of bilateral varicocele: a comparative study of 4 diagnostic modalities. J Urol. 2004;172(4 Pt 1):1414–7.CrossRefPubMedGoogle Scholar
  125. 125.
    Akcar N, et al. Intratesticular arterial resistance and testicular volume in infertile men with subclinical varicocele. J Clin Ultrasound. 2004;32(8):389–93.CrossRefPubMedGoogle Scholar
  126. 126.
    Donkol RH. Imaging in male-factor obstructive infertility. World J Radiol. 2010;2(5):172–9.CrossRefPubMedGoogle Scholar
  127. 127.
    Honig SC, Lipshultz LI, Jarow J. Significant medical pathology uncovered by a comprehensive male infertility evaluation. Fertil Steril. 1994;62(5):1028–34.PubMedGoogle Scholar
  128. 128.
    McCallum T, et al. Unilateral renal agenesis associated with congenital bilateral absence of the vas deferens: phenotypic findings and genetic considerations. Hum Reprod. 2001;16(2):282–8.CrossRefPubMedGoogle Scholar
  129. 129.
    Romeo C, et al. Altered serum inhibin b levels in adolescents with varicocele. J Pediatr Surg. 2007;42(2):390–4.CrossRefPubMedGoogle Scholar
  130. 130.
    Ozden C, et al. Effect of varicocelectomy on serum inhibin B levels in infertile patients with varicocele. Scand J Urol Nephrol. 2008;42(5):441–3.CrossRefPubMedGoogle Scholar
  131. 131.
    Sakamoto H, et al. Effects of varicocele repair in adults on ultrasonographically determined testicular volume and on semen profile. Urology. 2008;71(3):485–9.CrossRefPubMedGoogle Scholar
  132. 132.
    Zucchi A, et al. Varicocele and fertility: relationship between testicular volume and seminal parameters before and after treatment. J Androl. 2006;27(4):548–51.CrossRefPubMedGoogle Scholar
  133. 133.
    Evers JH, Collins J, Clarke J. Surgery or embolisation for varicoceles in subfertile men. Cochrane Database Syst Rev. 2009(1):CD000479.Google Scholar
  134. 134.
    Schlegel PN, Su LM. Physiological consequences of testicular sperm extraction. Hum Reprod. 1997;12(8):1688–92.CrossRefPubMedGoogle Scholar
  135. 135.
    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):469–73.PubMedGoogle Scholar
  136. 136.
    Sinisi AA, et al. Prevalence of antisperm antibodies by SpermMARtest in subjects undergoing a routine sperm analysis for infertility. Int J Androl. 1993;16(5):311–4.CrossRefPubMedGoogle Scholar
  137. 137.
    Urry RL, et al. The incidence of antisperm antibodies in infertility patients with a history of cryptorchidism. J Urol. 1994;151(2):381–3.PubMedGoogle Scholar
  138. 138.
    Heidenreich A, et al. Risk factors for antisperm antibodies in infertile men. Am J Reprod Immunol. 1994;31(2–3):69–76.PubMedGoogle Scholar
  139. 139.
    Zini A, et al. Anti-sperm antibody levels are not related to fertilization or pregnancy rates after IVF or IVF/ICSI. J Reprod Immunol. 2011;88(1):80–4.CrossRefPubMedGoogle Scholar
  140. 140.
    Deurdulian C, et al. US of acute scrotal trauma: optimal technique, imaging findings, and management. Radiographics. 2007;27(2):357–69.CrossRefPubMedGoogle Scholar
  141. 141.
    Cubillos J, et al. A conservative approach to testicular rupture in adolescent boys. J Urol. 2010;184(4 Suppl):1733–8.CrossRefPubMedGoogle Scholar
  142. 142.
    Bhatt S, Dogra VS. Role of US in testicular and scrotal trauma. Radiographics. 2008;28(6):1617–29.CrossRefPubMedGoogle Scholar
  143. 143.
    Buckley JC, McAninch JW. Use of ultrasonography for the diagnosis of testicular injuries in blunt scrotal trauma. J Urol. 2006;175(1):175–8.CrossRefPubMedGoogle Scholar
  144. 144.
    Guichard G, et al. Accuracy of ultrasonography in diagnosis of testicular rupture after blunt scrotal trauma. Urology. 2008;71(1):52–6.CrossRefPubMedGoogle Scholar
  145. 145.
    Kim SH, et al. The efficacy of magnetic resonance imaging for the diagnosis of testicular rupture: a prospective preliminary study. J Trauma. 2009;66(1):239–42.CrossRefPubMedGoogle Scholar
  146. 146.
    Chandra RV, et al. Rational approach to diagnosis and management of blunt scrotal trauma. Urology. 2007;70(2):230–4.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Rao S. Mandalapu
    • 1
  • Peter N. Tiffany
    • 2
  • Bruce R. Gilbert
    • 3
    Email author
  1. 1.Department of Urology, Fox Chase Cancer CenterTemple University HospitalElkins ParkUSA
  2. 2.Department of Urology, Winchester HospitalTufts University School of MedicineStonehamUSA
  3. 3.Hofstra North Shore LIJ School of MedicineThe Arthur Smith Institute for UrologyNew Hyde ParkUSA

Personalised recommendations