As an experienced sonographer owning my own clinic Sonoworld in London, I often see male patients coming in for ultrasounds to help diagnose various conditions related to their health and wellbeing. In this article, I'll provide an overview of some of the main conditions ultrasounds can help detect in men.

Testicular Conditions

One of the most common reasons men come in for a scrotal ultrasound is to evaluate testicular lumps, pain or swelling. Using high-frequency transducers, ultrasound can provide excellent visualization of the testes and surrounding structures. It is an ideal imaging tool for differentiating the cause of testicular abnormalities.

Testicular ultrasounds are frequently used to determine if a lump or mass is concerning for cancer or if it is benign. Testicular cancer commonly presents as a painless lump or swelling. Ultrasound allows characterization of solid testicular lesions versus simple fluid-filled cysts. Things we look for on ultrasound that may indicate testicular cancer include solid hypoechoic (dark) masses, hypervascularity on color Doppler, and microcalcifications.

Ultrasound is also an excellent way to evaluate epididymitis, a common cause of scrotal pain and swelling. We can visualize enlarged, inflamed epididymis and detect increased blood flow on Doppler which can help differentiate epididymitis from testicular torsion, another cause of acute scrotal pain that is a surgical emergency.

Other benign testicular conditions readily assessed by ultrasound include hydroceles (fluid collection around the testes), varicoceles (enlarged scrotal veins), and spermatoceles (cysts containing semen).

In summary, ultrasound is a useful first-line imaging tool for evaluating testicular masses, pain and swelling. It can reliably differentiate urgent conditions like testicular cancer and torsion from benign processes.

Prostate Issues

The prostate gland can be optimally visualized with ultrasound given the high-frequency transrectal probes used. Ultrasound is commonly used to evaluate prostate enlargement, also known as benign prostatic hyperplasia (BPH). BPH presents as a symmetric prostate enlargement compressing the urethra, which can cause urinary symptoms. Ultrasound allows accurate measurements of prostate volume as well as assessment of bladder wall thickness.

Ultrasound is also an excellent way to detect prostate cancer, especially when used in conjunction with PSA testing and digital rectal exams. Suspicious findings include hypoechoic lesions, calcifications, and distortion of the usual prostate symmetry. Doppler ultrasound showing increased vascularity raises suspicion for cancer.

Prostatitis, an inflammation or infection of the prostate, can also be evaluated by ultrasound. Signs include prostate enlargement, fluid in the seminal vesicles or prostate, and sometimes gas or abscess formation.

So in prostate imaging, ultrasound provides a detailed look at the actual prostate tissue and surrounding anatomy. It serves an important role in evaluating prostate abnormalities in men.

Abdominal Conditions

The abdominal cavity contains many organs and structures that can be affected by disease processes. Ultrasound is commonly used as an initial imaging test for abdominal complaints since it provides an overview of the organs and is radiation-free.

Some examples of abdominal conditions ultrasound helps diagnose include:

• Gallstones: Gallstones present as echogenic foci with shadowing within the gallbladder. Ultrasound has very high sensitivity for detecting even tiny gallstones.
• Kidney stones: Stones in the kidneys or ureters appear as bright echogenic foci causing shadowing. Hydronephrosis (enlarged kidney) may also be seen if a stone is obstructing urine flow.
• Abdominal aortic aneurysm: The abdominal aorta normally measures around 2cm. Ultrasound can detect aneurysmal dilation, characterized by an abdominal aorta measuring greater than 3cm. Ruptured aneurysms appear as an anechoic (dark) area surrounding the aorta.
• Liver conditions: Fatty liver, cirrhosis, and liver masses can be characterized on ultrasound. We look for a bright, enlarged liver with irregular contours and nodular surface in cirrhosis.
• Pancreatic abnormalities: Ultrasound can detect pancreatic cysts, calcifications concerning for chronic pancreatitis, or hypoechoic solid pancreatic masses suspicious for cancer.
• Spleen enlargement or masses

So in summary, abdominal ultrasound allows visualization of the solid organs, vasculature, abdominal wall and peritoneal cavity. It serves as an excellent initial study for abdominal complaints and may detect unexpected findings like aneurysms.

Urinary and Bladder Issues

There are a variety of urinary and bladder conditions that ultrasound can help evaluate.

Bladder ultrasound is performed to measure bladder volume and assess the bladder walls. Thickening of the bladder wall along with trabeculation (irregular contour) is concerning for a chronic bladder condition like interstitial cystitis. Hydronephrosis seen on kidney ultrasound may provide clues to an obstructive process like bladder stones or strictures.

Bladder ultrasound is also used to assess for urinary retention, often in patients with difficulty urinating or incomplete bladder emptying. Large bladder volume is indicative of urinary retention.

Additionally, ultrasound can detect bladder masses, which often present as focal bladder wall thickening or protruding masses within the bladder lumen.

So for urinary symptoms, bladder ultrasound provides useful information about the state of the bladder itself, as well as clues about potential kidney obstruction.

Hernias

There are several types of hernias that can occur in men, most commonly inguinal, femoral, umbilical, and incisional hernias after surgery. The benefit of using ultrasound to evaluate hernias is that it provides dynamic imaging, so we can assess the hernia both at rest and while the patient performs maneuvers like coughing or Valsalva.

Ultrasound can detect protrusion of bowel, omentum or fat through the abdominal wall fascial defect that constitutes a hernia. Additionally, it can distinguish simple fat herniation from more concerning bowel herniation, especially with hernia incarceration. Incarcerated hernias have a higher risk for ischemia and infarction, so this distinction is valuable.

The characteristics of tissue passing through the hernia defect on ultrasound can help determine if urgent surgical consultation is needed or if the hernia is more of an elective repair.

Fertility and Sexual Health

There are a few key ways ultrasound can be used to evaluate fertility and sexual health in men.

• Epididymal and vas deferens patency: During a scrotal ultrasound we carefully examine the epididymis and vas deferens for dilatation, cysts or other abnormalities that could indicate obstruction. Obstruction can cause low sperm count and decreased motility.
• Varicoceles: Enlarged veins called varicoceles are a treatable cause of reduced fertility and subfertility in men. They are readily visualized on scrotal ultrasound.
• Penile Doppler: This specialized ultrasound looks at arterial blood flow into the penis. It can help diagnose erectile dysfunction caused by vascular insufficiency.

So in summary, ultrasound serves an important role in evaluating some of the anatomical factors related to male fertility and sexual dysfunction that can potentially be treated.

Conclusion

As we have seen, ultrasound is a versatile, non-invasive imaging modality that provides key diagnostic information about a variety of conditions that affect men. From acute scrotal emergencies, to prostate and abdominal diseases, to hernias and sexual dysfunction - ultrasound offers valuable insights.

Here at my Sonoworld clinic, we take great care in performing thorough male ultrasounds using high-quality equipment and experienced technicians. If you have any concerns or need imaging for a men's health condition, we are glad to provide compassionate, expert care. Please don't hesitate to make an appointment for an ultrasound evaluation.