Ultrasound, Scrotal

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Ultrasound, Scrotal

Synonym/acronym: Scrotal sonography, ultrasound of the testes, testicular ultrasound.

Common use

To visualize and assess scrotum structure and function toward diagnosing disorders such as tumor, cancer, undescended testes, and chronic inflammation.

Area of application

Scrotum.

Contrast

Done without contrast.

Description

Ultrasound (US) procedures are diagnostic, noninvasive, and relatively inexpensive. They take a short time to complete, do not use radiation, and cause no harm to the patient. High-frequency sound waves of various intensities are delivered by a transducer, a flashlight-shaped device, pressed against the skin. The waves are bounced back off internal anatomical structures and fluids, converted to electrical energy, amplified by the transducer, and displayed as images on a monitor. US is often used as a diagnostic and therapeutic tool for guiding minimally invasive procedures such as needle biopsies and fluid aspiration. The contraindications and complications for biopsy and fluid aspiration are discussed in detail in the individual monographs.

Scrotal US is used to evaluate the structure, size, and position of the contents of the scrotum and for the evaluation of disorders of the scrotum. It is valuable in determining the internal components of masses (solid versus cystic) and for the evaluation of the testicle, extratesticular and intrascrotal tissues, benign and malignant tumors, and other scrotal pathology. Scrotal US can be performed before or after a radionuclide scan for further clarification of a testicular mass. Extratesticular lesions such as hydrocele, hematocele (blood in the scrotum), and pyocele (pus in the scrotum) can be identified, as can cryptorchidism (undescended testicles).

This procedure is contraindicated for

    N/A

Indications

  • Aid in the diagnosis of a chronic inflammatory condition such as epididymitis
  • Aid in the diagnosis of a mass and differentiate between a cyst and a solid tumor, as evidenced by specific waveform patterns or the absence of sound waves respectively
  • Aid in the diagnosis of scrotal or testicular size, abnormality, or pathology
  • Aid in the diagnosis of testicular torsion and associated testicular infarction
  • Assist guided needle biopsy of a suspected testicle tumor
  • Determine the cause of chronic scrotal swelling or pain
  • Determine the presence of a hydrocele, pyocele, spermatocele, or hernia before surgery
  • Evaluate the effectiveness of treatment for testicular infections
  • Locate an undescended testicle

Potential diagnosis

Normal findings

  • Normal size, position, and shape of the scrotum and structure of the testes

Abnormal findings related to

  • Abscess
  • Epididymal cyst
  • Epididymitis
  • Hematoma
  • Hydrocele
  • Infarction
  • Microlithiasis
  • Orchitis
  • Pyocele
  • Scrotal hernia
  • Spermatocele
  • Testicular torsion
  • Tumor, benign or malignant
  • Tunica albuginea cyst
  • Undescended testicle (cryptorchidism)
  • Varicocele

Critical findings

  • Testicular torsion
  • It is essential that a critical finding be communicated immediately to the requesting health-care provider (HCP). A listing of these findings varies among facilities.

  • Timely notification of a critical finding for lab or diagnostic studies is a role expectation of the professional nurse. Notification processes will vary among facilities. Upon receipt of the critical value the information should be read back to the caller to verify accuracy. Most policies require immediate notification of the primary HCP, Hospitalist, or on-call HCP. Reported information includes the patient’s name, unique identifiers, critical value, name of the person giving the report, and name of the person receiving the report. Documentation of notification should be made in the medical record with the name of the HCP notified, time and date of notification, and any orders received. Any delay in a timely report of a critical finding may require completion of a notification form with review by Risk Management.

Interfering factors

  • Factors that may impair clear imaging

    • Incorrect placement of the transducer over the desired test site; quality of the US study is very dependent upon the skill of the ultrasonographer
    • Metallic objects (e.g., jewelry, body rings) within the examination field, which may inhibit organ visualization and cause unclear images
    • Inability of the patient to cooperate or remain still during the procedure because of age, significant pain, or mental status

Nursing Implications and Procedure

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this procedure can assist in assessing the scrotum.
  • Obtain a history of the patient’s complaints or clinical symptoms, including a list of known allergens, especially allergies or sensitivities to latex.
  • Obtain a history of the patient’s reproductive system, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Note any recent procedures that can interfere with test results (i.e., surgery or biopsy).
  • Colonoscopy and computed tomography (CT) of the abdomen, if ordered, should be scheduled after this procedure.
  • Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
  • Review the procedure with the patient. Address concerns about pain related to the procedure and explain that some pain may be experienced during the test, and there may be moments of discomfort. Inform the patient that the procedure is performed in a US department, by an HCP who specializes in this procedure, with support staff, and takes approximately 30 to 60 min.
  • Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Instruct the patient to remove jewelry and other metallic objects from the area to be examined.
  • Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

  • Potential complications: N/A
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient.
  • Ensure that the patient has removed all external metallic objects from the area to be examined prior to the procedure.
  • Instruct the patient to void and change into the gown, robe, and foot coverings provided.
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Instruct the patient to cooperate fully and to follow directions. Ask the patient to remain still throughout the procedure because movement produces unreliable results.
  • Place the patient in the supine position on an examination table; other positions may be used during the examination.
  • Expose the abdomen/pelvic area and drape the patient.
  • Lift the penis upward and gently tape it to the lower part of the abdomen. Elevate the scrotum with a rolled towel or sponge for immobilization.
  • Conductive gel is applied to the skin, and a transducer is moved over the skin to obtain images of the area of interest.
  • Ask the patient to breathe normally during the examination. If necessary for better organ visualization, ask the patient to inhale deeply and hold his breath.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
  • When the study is completed, remove the gel from the skin.
  • Recognize anxiety related to test results. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate.
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be needed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

  • Related tests include AFP, CT pelvis, KUB study, MRI pelvis, and semen analysis.
  • Refer to the Reproductive System table at the end of the book for related tests by body system.