Retrospective Analysis of Scrotal Ultrasound and Duplex Findings among Infertile Men in Egypt

Background: Infertility affects approximately 15% of couples worldwide, with male factors contributing significantly but often remain underdiagnosed. Scrotal ultrasound offers a low-cost, non-invasive, and highly effective method to uncover hidden pathologies that routine evaluations may overlook. Aim of the Work: This study aims to shed light on the spectrum of scrotal ultrasound and duplex findings in infertile males, providing crucial insights into their role in identifying underlying conditions and guiding targeted treatments. Patients and Methods: A total of 3959 records from infertile men eligible by our inclusion criteria attending (Assiut andrology center) were retrospectively studied. Grayscale and color-coded duplex sonography (CCDS) of scrotal content using a high-frequency linear transducer (7.5 -MHz) performed by an experienced examiner, both in supine and standing positions. Testicular volume and pampiniform plexus were scanned before and after the Valsalva maneuver, and any other abnormalities were recorded. Results: The mean age was 34.46 ± 5.44 years; most were urban residents (97.3%) and 59% were smokers. Testicular abnormalities were uncommon overall. Heterogeneous echogenicity was detected in 0.28% of right testes and 0.38% of left testes. Hydrocele was the most frequent abnormality, observed in 6.1% of both testes. Varicocele was highly prevalent, with venous reflux detected in 44.5% of right and 76.8% of left testes. Severe grades (III–V) were more frequent on the left, whereas mild grades (I–II) were predominant on the right. Increasing reflux severity correlated with reduced testicular volume bilaterally, a relationship that was statistically significant for both testes (right: p=0.034; left: p<0.001). Conclusion: Scrotal US is a valuable tool in the evaluation of sub-fertile men. Sub-fertile men had a significantly higher prevalence of scrotal abnormalities, with varicoceles mainly responsible for this. There is, however, a need for a standardization of the criteria for the US diagnosis of testicular abnormalities.