CASE REPORT Scrotal ultrasonography: should it be used in routine evaluation of infertile men? M. R. Onur 1 , F. Firdolas 2 , R. Onur 2 , E. Kocakoc 3 , N. Akpolat 4 & I. Orhan 2 1 Department of Radiology, Kovancılar Government Hospital, Elazig, Turkey; 2 Department of Urology, Firat University, Elazig, Turkey; 3 Department of Radiology, Firat University, Elazig, Turkey; 4 Department of Pathology, Firat University, Elazig, Turkey Introduction Recently developed assisted reproductive techniques con- tribute much for the treatment of infertile couples. Con- tinuous increase of in vitro fertilisation and successful pregnancy outcomes made some physicians bypass the male factor assessment in the evaluation of infertile cou- ples. This will not only prevent the treatment of correct- able causes of male infertility but also bring the problem of underdiagnosing some of the life-threatening male diseases, such as testicular tumours. Several studies have suggested that male infertility and testicular cancer may share important aetiological factors (Pryor et al., 1983; Logarakis et al., 1998). Jacobsen et al. (2000) reported that among couples with male fertility problems men are 1.6 times more likely to develop testicular cancer than the male population in general. Thus, it was suggested that the evaluation of infertile men for a possible testicular cancer may be important. Scrotal ultrasonography (US) has a significant role in the diagnosis of testicular tumours when these are not palpable by physical exami- nation. In this report, we present two cases among the 1250 patients presented to our clinic with infertility, aimed at emphasising the importance of scrotal US to detect testicular tumour during the evaluation period of infertile men. Subjects and methods Case 1 A 30-year-old male patient presented to our clinic with infertility. He had a mild right groin pain. His past his- tory revealed a left varicocelectomy surgery 2 years ago. Physical examination was normal. Semen analysis and scrotal US were performed. Also, hormonal measurements were made. After clinical evaluation according to scrotal US findings, a right orchiectomy was performed. Case 2 A 28-year-old man presented to our clinic with a 4-year history of infertility. He had no other complaint and operation history. Physical examination was normal. Keywords Infertility—scrotal ultrasonography—semen analysis—testis cancer Correspondence Mehmet Ruhi Onur, MD, Department of Radiology, Kovancilar Government Hospital, Kovancilar Devlet Hastanesi Kovancilar, Elazig, Turkey. Tel.: +90 424 611 4643; Fax: +90 424 611 4650; E-mail: ruhionur@yahoo.com Accepted: October 16, 2007 Summary Several studies have suggested that male infertility and testicular cancer may have common aetiological factors. Scrotal ultrasonography (US) has an impor- tant role in the diagnosis of testicular tumours when not palpable by physical examination. In this study, we present two infertile men referred to our clinic. Patients were evaluated by a detailed physical examination, semen analyses and hormonal assessment. Both patients underwent scrotal US examination. Semen analysis of the patients revealed oligoasthenospermia in both patients. Scrotal US revealed hypoechoic masses in the left and right testes of both patients, which were nonpalpable by physical examination. Scrotal exploration and sub- sequent orchidectomy were performed. Histopathological examination revealed mixed germ cell tumour and Sertoli–Leydig cell tumour in case 1 and case 2 respectively. With these cases, we discussed the role of scrotal US in the routine diagnostic evaluation of infertile men. ª 2008 The Authors 58 Journal Compilation ª 2008 Blackwell Publishing Ltd Æ Andrologia 40, 58–61