WHY WOULD I NEED A SCROTUM ULTRASOUND?

The scrotum is a pouch of skin containing the testicles, nerves, and blood vessels. Your health care practitioner might request a scrotum ultrasound to investigate an abnormality within the scrotum or the cause for symptoms like lumps, swelling, or pain. It could also be used to help diagnose trauma to the scrotal area, evaluate the cause of infertility, or look for an undescended testicle.

Ultrasound imaging uses high-frequency, real-time sound waves to create an image. A small transducer (probe) both transmits sound waves into the body and records the waves that echo back. The shape and intensity of the echoes depend on whether the area absorbs or transmits the sound waves. For example, most waves pass through a fluid-filled cyst and send back very few or faint echoes, which look black on the display screen. On the other hand, waves will bounce off a solid tumor, creating a pattern of echoes that the computer will interpret as a lighter-colored image. Air and bone also reflect sound waves.

Most scrotal lesions are benign. Ultrasound can usually help differentiate between benign and malignant lesions. If ultrasound identifies a lesion suspicious for malignancy, the findings are immediately conveyed to the referring physician. In these cases, the recommendation is for referral to the Urological Surgical Service for further management, which is usually surgical biopsy

WHAT IS TESTICULAR CANCER?

Testicular cancer starts as an abnormal growth or tumour that develops in the cells of one or both of the testicles. These cells can change and no longer grow or behave normally, leading to benign or cancerous tumours. There are several types of testicular cancer, but the most common is a germ cell tumour.

Testicular cancer is the most common cancer in young Canadian men aged 15-35, but when caught and treated early the average survival rate is 97%, according to the Canadian Cancer Society. The incidence of testicular cancer diagnoses has been slowly increasing since 1984, but the mortality rate has been steadily decreasing. An estimated 1,200 Canadian men will be diagnosed with testicular cancer in 2022. An estimated 35 will die from the disease.

Because it’s one of the more survivable cancers, it’s important to be aware of your risk factors:

• Men from 15-40 years.
• Men with a family history of cancer, such as a brother or father diagnosed with testicular cancer.
• Men who have had a previous occurrence of testicular cancer.
• Men who have undescended testes at birth.

It’s also important to find out what’s normal for you and be aware of any changes. Find a warm environment and roll your testicles between your thumb and fingers to check for lumps or swelling. They should be smooth, firm, and comfortable to touch. It’s normal if one testicle is slightly bigger than the other, or if one hangs lower than the other. However, if your testicles feel heavier than usual, have changed in shape or size, or are painful, you should speak to your doctor.

WHAT HAPPENS DURING A SCROTUM ULTRASOUND?

Most lumps and bumps on your testicles are not cancer, but to investigate your doctor may book a scrotum ultrasound appointment for you, or provide you with a number to call to book your appointment. You will also be given a requisition form. There is no preparation required for your exam.

The exam usually takes 15-20 minutes. You will be asked to wear comfortable clothes. Once you arrive for your exam, you will be asked to remove your pants and underwear and lie down on the exam. A sheet will be draped across your lower body and the sonographer will apply a warm, non-scented, hypo-allergenic ultrasound gel. The scrotal area needs to be visible to the sonographer for correct orientation of the images.

You may experience mild to moderate pressure while the sonographer scans the right and left side of the scrotum. You may also be asked to indicate the area of concern by pointing out the lump or area of pain if it is localized to one spot. This will ensure that the correct area is properly assessed.

WHAT HAPPENS AFTER MY EXAM?

Once your exam is completed, your images will be reviewed by a specialized radiologist who will compile a report that is sent to your doctor within 24 hours, sooner for urgent requests. Mayfair Diagnostics is owned and operated by over 50 specially trained radiologists which allows for an expert review of your imaging by the applicably trained radiologist.

Your doctor will review your images and the report from the radiologist and discuss next steps with you, such as a treatment plan or the need for further diagnostic imaging or lab tests to ensure an accurate diagnosis.

Mayfair Diagnostics has 13 locations across Calgary, one in Cochrane and one in Regina, which offer ultrasound services. For more information about our clinic services, please visit our services page.

REFERENCES

Canadian Cancer Society (2022) “What is testicular cancer?” www.cancer.ca. Accessed November 5, 2022.

Canadian Cancer Society (2021) “Risk for testicular cancer.” www.cancer.ca. Accessed November 5, 2022.

Radiological Society of North America (2022) “Ultrasound – Scrotum.” www.radiologyinfo.org. Accessed October 10, 2019.