Scrotal ultrasound is a non-invasive imaging diagnostic technique that produces real-time images of scrotal tissues using high-frequency sound waves. Its primary purpose is to assess structural abnormalities of the testes, vas deferens, and accessory glands. Common applications include diagnosing testicular torsion, tumors, hydroceles, and other issues. This examination involves no radiation exposure and is suitable for all age groups. It can quickly provide diagnostic information in emergency settings, assisting physicians in formulating treatment plans.
In addition to diagnostic functions, advanced ultrasound techniques such as Doppler imaging can analyze blood flow changes, such as detecting blood flow interruption during testicular torsion. This technology is often combined with other tests (e.g., tumor marker blood tests) to improve diagnostic accuracy.
Scrotal ultrasound mainly falls into two categories: "diagnostic" and "therapeutic assistance." Diagnostic ultrasound uses sound wave reflection principles to convert tissue density differences into two- or three-dimensional images, clearly showing cysts, solid tumors, and vascular abnormalities. Therapeutic assistance may involve low-intensity ultrasound to promote tissue repair, but this application is less common and requires clinical judgment based on the patient's condition.
In the imaging mechanism, sound waves emitted by the probe encounter different tissue interfaces, producing echoes. The computer system converts these signals into grayscale images. Doppler mode focuses on frequency changes in blood flow, using color coding to display flow direction and velocity, which is crucial for assessing acute testicular ischemia.
Main indications include acute testicular pain (such as torsion), unexplained swelling, abnormal findings on physical examination, suspected tumors or cysts, and monitoring post-treatment changes. For example, in follow-up of testicular cancer patients after surgery, ultrasound can detect residual lesions or signs of recurrence.
Other applications include evaluating the severity of varicocele, assessing infectious inflammation (such as orchitis), locating congenital abnormalities (such as cryptorchidism), and guiding biopsy procedures to improve sampling accuracy.
During the examination, the patient lies supine with the scrotum exposed. The technician applies gel and moves the probe across the area. The entire process is painless and takes approximately 15-30 minutes. Doppler mode requires adjustment of frequency parameters (usually 2-5 MHz), while high-resolution modes may use higher frequency probes for detailed imaging.
Regarding dosage control, ultrasound energy is far below the threshold for thermal effects. The total energy density in a single examination is usually less than 100 mW/cm². However, in emergency cases such as suspected testicular torsion, physicians may request dynamic blood flow analysis, which requires specific scanning modes.
The main advantages are real-time imaging and zero radiation exposure, making it suitable for children or patients requiring repeated monitoring. Compared to CT scans, ultrasound offers higher spatial resolution for small tissue structures and is more cost-effective.
The vast majority of patients may only experience a sensation of pressure from the probe contact, with severe complications being extremely rare. Theoretical risks include long-term tissue heating from exposure, but actual examination doses are well below safety standards.
Before the examination, the bladder should be emptied, and the scrotal skin cleaned. Patients should avoid wearing tight underwear to facilitate probe contact. Severe obesity or skin ulcers may affect image clarity and should be reported to the physician in advance.
Contraindications include:
This examination has no direct interactions with medication treatments, but results may influence subsequent treatment choices. For example, discovering a testicular tumor may necessitate chemotherapy or surgical removal, with ultrasound findings being key evidence for decision-making.
Compared to other imaging modalities, MRI offers superior soft tissue contrast but involves longer scan times and higher costs. X-ray cannot effectively visualize soft tissue structures in the scrotum. Ultrasound's advantages include cost, speed, and sensitivity.
Clinical studies show that scrotal ultrasound has a diagnostic accuracy of over 95% for testicular torsion, capable of distinguishing ischemic changes within less than 6 hours from those exceeding 6 hours. Doppler ultrasound's ability to assess blood flow dynamics is endorsed by urological guidelines in multiple countries.
In tumor diagnosis, ultrasound-guided fine-needle aspiration biopsy improves tissue sampling accuracy, with a misdiagnosis rate below 5%. In emergency settings, this technology shortens the time from diagnosis to treatment, improving prognosis.
Possible alternatives include:
Ultrasound's real-time capability and cost-effectiveness make it the first-line choice, with other techniques reserved for complex cases. MRI has limitations with metal implants, whereas ultrasound remains safer in such situations.
Do I need to prepare before treatment? Are there any important details to note?
Generally, no special fasting or medication cessation is required before scrotal ultrasound. It is recommended to wear loose clothing for easy access. If you are taking anticoagulants or have specific medical conditions, inform your doctor in advance for safety assessment. The bladder should be emptied before the exam, and the use of metal or chemical-based topical medications should be avoided to prevent interference with image clarity.
Will there be discomfort during or after the procedure? How should I respond?
Scrotal ultrasound is non-invasive and usually painless. However, contact with the probe may cause a cool or pressing sensation. If Doppler blood flow measurement is used, some patients might experience brief discomfort from pressure. If severe tension or pain occurs, inform the technician immediately to adjust the position or pause the exam.
Do I need to modify daily activities or clothing during or after treatment?
Generally, no activity restrictions are necessary. It is recommended to wear supportive underwear after treatment to reduce scrotal movement. If there is swelling or trauma, avoid heavy lifting or vigorous exercise for 24 hours post-treatment, and refrain from hot compresses or excessive activity that increases local blood flow.
When can I receive the report after treatment? If results are abnormal, do I need immediate intervention?
The ultrasound images can be viewed immediately, but detailed reports require physician analysis and are usually available within 1-3 working days. If the report indicates thrombosis, tumor, or other urgent conditions, the doctor will arrange further examinations or treatment immediately. For benign structural abnormalities (e.g., edema, cysts), follow-up can be scheduled as advised by the physician.
If the ultrasound results are abnormal, do I need additional tests?
If ultrasound detects suspicious tumors, abnormal blood flow, or tissue destruction, additional tests such as blood tests (e.g., tumor markers) or CT scans may be needed to confirm the extent of the lesion. Complex cases might require angiography or tissue biopsy, with subsequent evaluation based on clinical judgment.
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