Color doppler sonography of the male genital tract

Abstract Color Doppler sonography (CDS) of the male genital tract includes imaging of the prostate gland, of the cavernosal arteries and of the scrotum. It represents a unique means of significantly increasing the predictive positive value of hypoechoic nodules originating in the peripheral zone. In patients with a normal DRE and a PSA level between 4 and 10 ng/ml, it permits selection of patients with significant hypervascular cancers from those with hypovascular nodules or without TRUS/CDS abnormalities harbouring cancers of significantly lower Gleason score. CDS of the cavernosal arteries is the most accurate means of detecting impotence of vascular origin. Intermediate values of peak systolic velocities (25–35 cm/s) are not conclusive for arterial insufficiency and measurement of other Doppler parameters (systolic rise time and acceleration) are required to confirm arterial insufficiency. End diastolic velocity of below 5 cm/s is a reliable means of guaranteeing a normally functioning veno-occlusive system avoiding the need for cavernometry. Scrotal CDS is useful in evaluating acute scrotal disorders and permits the differentiation of acute torsions from epididymitis when the clinical examination is equivocal. Partial torsions are difficult to identify as they do not impair testicular arterial blood flow. Using spectral analysis may improve the sensitivity of color imaging in these cases. CDS of the spermatic veins is useful for quantifying the importance of non-palpable varicoceles by measuring the length and the pattern of the Doppler curve.