Ultrasonic Testicular Texture and Size in 444 Men from the General Population: Correlation to Semen Quality

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Abstract
Scrotal ultrasonography was performed in 888 testes of 444 randomly selected men appearing before the medical board prior to military service (Mili group, 287 men, median age 18.8 years), and in employees from an industrial company (Empl group, 157 men, median age 35.6 years). The ultrasonic volume of each testis was calculated from 3 perpendicular measurements. The ultrasonic texture on sectional planes was scored using a scale from 1 to 5,1 being very regular, 2 slightly irregular, 3 moderately irregular, 4 very irregular or with bright echogenic points, and 5 with demarcated tumor suspicious areas. Orchidometer measurements were performed in 258 men in Mili group, and semen samples were obtained from 121 men in Empl group. The ultrasonic volume of the right testis (median 14.1 ml, range 3.0-31.4 ml) was bigger than that of the left testis (median 13.0 ml, range 3.5-35.2). The volume was dependent on age for men under 20 years, but not for men aged 20 years or more. The subgroup of men with a history of cryptorchidism had a smaller average testicular volume (median 10.5 ml) compared with men with normal descent (median 14.1 ml). Ultrasonic volume was positively correlated to the total sperm count in the ejaculate, to sperm penetration in egg white, and to normal sperm morphology. The echo score distribution showed slightly higher scores in Empl for both the right and the left testis. Men in Empl group were older, and it could not be precluded that this difference was due to age. The individual echo score was negatively correlated to ultrasonic volume, to sperm penetration in egg white, and to normal sperm morphology. Men with a history of cryptorchidism had higher scores compared with the rest. Orchidometer measurement was higher both for the right (median 24.3 ml) and the left testis (median 22.6 ml) compared with ultrasonic volume. A positive correlation was found between orchidometer measurement and ultrasonic volume for both testes. Ultrasonic volume estimation was tested in 5 patients subjected to subcapsular orchiectomy. Ultrasonic volume was slightly larger than both weight and volume of the removed testes. In conclusion, the study shows that the normal testis has an almost regular echo pattern. A very irregular echo pattern is rare and it can be correlated to reduced quality of the testis, the ultrasonically measured volume of the testis is smaller than that obtained by the use of an orchidometer, but it seems to be closer to the true volume of the testis.

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