Testicular epidermoid cyst: A rare entity - Case report.

INTRODUCTION AND IMPORTANCE: Epidermoid cysts (ECs) of the testicle are rare benign lesions that can mimic more serious testicular masses. Accurate diagnosis is essential for proper management, often requiring surgical intervention to confirm the nature of the mass. CASE PRESENTATION: A 21-year-old male presented with chronic pain in his right scrotum. Physical examination revealed a firm mass within the right testis. Ultrasound and MRI findings were consistent with an intratesticular EC. The patient underwent partial orchidectomy for further evaluation and treatment. CLINICAL DISCUSSION: Histopathological analysis confirmed the diagnosis of an epidermoid cyst, characterized by a well-defined lesion with keratin-filled cystic spaces. The differential diagnosis for testicular masses includes both benign and malignant conditions. Imaging alone may not be sufficient to distinguish between these possibilities, making surgical exploration and histopathological examination necessary for definitive diagnosis. CONCLUSION: This case highlights the importance of considering epidermoid cysts in the differential diagnosis of testicular masses in young males. Surgical intervention, such as partial orchidectomy, not only provides a definitive diagnosis but also serves as a therapeutic measure. The patient had an uneventful postoperative recovery, emphasizing the efficacy and safety of the surgical approach in such cases.

Epididymal cysts in children: frequency, clinical characteristics, and management strategies.

Background: Epididymal cysts (ECs) are uncommon in the pediatric population. The objective of this study was to evaluate the frequency, clinical characteristics, and management strategies of ECs in children. Methods: We performed a retrospective review of pediatric scrotal ultrasounds between January 2014 and August 2022 to identify children with ECs. Results: One hundred and forty-three children boys were found to have ECs, with 95 being pre-pubertal and 48 post-pubertal. The age of the patients ranged from 1 day to 18 years, with a mean age of 10.64 ± 4.55 years. The size of the cysts varied from 2 mm to 35 mm. The most common comorbidities observed were hydrocele, testicular microlithiasis and varicocele. The majority of ECs were detected through routine physical examination. Conservative management was employed for all patients, except for one who required surgical excision. Resolution of ECs occurred in 12 patients, while a reduction in cyst size was observed in 6 cases. Conversely, 2 patients experienced an increase in cyst size, and 6 patients exhibited an increase in cyst number during the follow-up period. Conclusion: Conservative management is the preferred approach for the majority of cases, with surgical intervention reserved for specific instances.

Contrast-enhanced ultrasound (CEUS) for the characterization of intra-scrotal lesions.

Contrast-enhanced ultrasound (CEUS) has emerged as a promising imaging modality for the characterization of hepatic and renal lesions. However, there is a paucity of data describing the use of CEUS for the evaluation of intra-scrotal pathology. In the following review, we describe the clinical utility of CEUS for the characterization and differentiation of common and uncommon intra-scrotal conditions, including testicular torsion, infection, trauma, and benign and malignant intratesticular and extratesticular neoplasms. In addition, we outline key principles of CEUS and provide case examples from our institution.

Tubular ectasia of the rete testis: A benign yet unrecognized condition.

Tubular ectasia of the rete testis (TERT) presents as multiple cystic structures within the rete testis, often incidentally detected on ultrasound as echo-free intratesticular cystic lesions. Despite its benign nature, assessing testicular cystic lesions can sometimes be challenging. The primary importance of identifying this uncommon condition lies in its distinction from cystic testicular malignancies and thus avoiding further radical procedures. We report an instance of TERT within the right testis discovered incidentally in a patient with a medical background of epididymitis, presenting for management of left testis cryptorchidism, and bilateral inguinal hernia.

[First-line management of infertile couple. Guidelines for clinical practice of the French College of Obstetricians and Gynecologists 2022]. / Prise en charge de première intention du couple infertile : mise à jour des RPC 2010 du CNGOF.

OBJECTIVE: To update the 2010 CNGOF clinical practice guidelines for the first-line management of infertile couples. MATERIALS AND METHODS: Five major themes (first-line assessment of the infertile woman, first-line assessment of the infertile man, prevention of exposure to environmental factors, initial management using ovulation induction regimens, first-line reproductive surgery) were identified, enabling 28 questions to be formulated using the Patients, Intervention, Comparison, Outcome (PICO) format. Each question was addressed by a working group that had carried out a systematic review of the literature since 2010, and followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) methodology to assess the quality of the scientific data on which the recommendations were based. These recommendations were then validated during a national review by 40 national experts. RESULTS: The fertility work-up is recommended to be prescribed according to the woman's age: after one year of infertility before the age of 35 and after 6months after the age of 35. A couple's initial infertility work-up includes a single 3D ultrasound scan with antral follicle count, assessment of tubal permeability by hysterography or HyFOSy, anti-Mullerian hormone assay prior to assisted reproduction, and vaginal swabbing for vaginosis. If the 3D ultrasound is normal, hysterosonography and diagnostic hysteroscopy are not recommended as first-line procedures. Chlamydia trachomatis serology does not have the necessary performance to predict tubal patency. Post-coital testing is no longer recommended. In men, spermogram, spermocytogram and spermoculture are recommended as first-line tests. If the spermogram is normal, it is not recommended to check the spermogram. If the spermogram is abnormal, an examination by an andrologist, an ultrasound scan of the testicles and hormonal test are recommended. Based on the data in the literature, we are unable to recommend a BMI threshold for women that would contraindicate medical management of infertility. A well-balanced Mediterranean-style diet, physical activity and the cessation of smoking and cannabis are recommended for infertile couples. For fertility concern, it is recommended to limit alcohol consumption to less than 5 glasses a week. If the infertility work-up reveals no abnormalities, ovulation induction is not recommended for normo-ovulatory women. If intrauterine insemination is indicated based on an abnormal infertility work-up, gonadotropin stimulation and ovulation monitoring are recommended to avoid multiple pregnancies. If the infertility work-up reveals no abnormality, laparoscopy is probably recommended before the age of 30 to increase natural pregnancy rates. In the case of hydrosalpinx, surgical management is recommended prior to ART, with either salpingotomy or salpingectomy depending on the tubal score. It is recommended to operate on polyps>10mm, myomas 0, 1, 2 and synechiae prior to ART. The data in the literature do not allow us to systematically recommend asymptomatic uterine septa and isthmoceles as first-line surgery. CONCLUSION: Based on strong agreement between experts, we have been able to formulate updated recommendations in 28 areas concerning the initial management of infertile couples.

Partial Epididymal Obstruction as a Cause of Idiopathic Oligozoospermia: A Reproductive Urologist's Perspective following 35 Years of Surgical and Clinical Experience.

The role of partial epididymal obstruction as contributing to the development of oligozoospermia has been neglected for decades. In the early 1970s, however, Robert Schoysman, a gynecological surgeon devoted to the surgical and medical management of male factor infertility, dedicated many efforts to study such a pathology and its possible effects on male fertility. Following the studies of this pioneer in the field, we concentrated our attention to the patterns of partial and complete epididymal obstruction during surgical scrotal exploration, once made possible even in oligozoospermic men by diagnostic and therapeutic interventions, such as vasovesciculography or seminal tract washout test, at present considered obsolete and no longer feasible in light of the current guidelines. Interestingly, we found signs of partial epididymal obstruction in about 30% of oligozoospermic men with normal testicular volume and serum FSH level as well as normal spermatogenesis at testis biopsy. We, then, compared the findings of scrotal ultrasound with those of scrotal exploration and found that the ultrasound abnormalities of the epididymis were highly predictive of anatomic alteration of the gland. In the present study, we report our experience, together with a historical review of the literature, on this topic.

Male Infertility and the Risk of Developing Testicular Cancer: A Critical Contemporary Literature Review.

Background and Objectives: The relationship between male infertility (MI) and testicular cancer (TC) is bilateral. On one hand, it is well-established that patients diagnosed with TC have a high risk of pre- and post-treatment infertility. On the other hand, the risk of developing TC in male infertile patients is not clearly defined. The objective of this review is to analyze the histopathological, etiological, and epidemiological associations between MI and the risk of developing testicular cancer. This review aims to provide further insights and offer a guide for assessing the risk factors for TC in infertile men. Materials and Methods: A comprehensive literature search was conducted to identify relevant studies discussing the relationship between MI and the risk of developing TC. Results: The incidence rates of germ cell neoplasia in situ (GCNIS) appear to be high in infertile men, particularly in those with low sperm counts. Most epidemiological studies have found a statistically significant risk of developing TC among infertile men compared to the general or fertile male populations. The concept of Testicular Dysgenesis Syndrome provides an explanatory model for the common etiology of MI, TC, cryptorchidism, and hypospadias. Clinical findings such as a history of cryptorchidism could increase the risk of developing TC in infertile men. Scrotal ultrasound evaluation for testis lesions and microlithiasis is important in infertile men. Sperm analysis parameters can be useful in assessing the risk of TC among infertile men. In the future, sperm and serum microRNAs (miRNAs) may be utilized for the non-invasive early diagnosis of TC and GCNIS in infertile men. Conclusions: MI is indeed a risk factor for developing testicular cancer, as demonstrated by various studies. All infertile men should undergo a risk assessment using clinical examination, ultrasound, and semen parameters to evaluate their risk of TC.

A Review of Scrotal Ultrasonography in Uyo, Nigeria.

BACKGROUND: Scrotal ultrasonography is a useful, sensitive, readily available and safe imaging modality in the investigation of scrotal pathologies, including those possibly contributory to male infertility. The aim of this study was to review the scrotal ultrasound scans (SUSS) done in the University of Uyo Teaching Hospital over a period of 18 months from July 2018 to December 2019. METHODOLOGY: This was a retrospective study of all the SUSS performed in the Department of Radiology of University of Uyo Teaching Hospital (UUTH) within an 18-month period. All subjects who presented for scrotal ultrasound with adequately filled request forms which included the biodata and clinical information were included in the study. RESULTS: A total of 79 scans were reviewed during the period. The age range of study patients was 4 - 78 years, with a mean of 41.2 ±15 years. The modal age group was 30-39 years, made up of 20 cases (25.6%). Primary and secondary infertility were the major indications for referrals, in 17 cases (21.8%) and 13 cases (16.7%) respectively. Following SUSS, the findings were normal in 11 patients (14.1%), while hydrocele, and varicocele accounted for 19 cases (24.3%) and 9 cases (11.5%) respectively. Microlitiasis was seen in 7 cases (9%) while a diagnosis of testicular tumor was made in 5 (6.4%) of cases. Three (3) of the 5 testicular tumors, were confirmed histologically. CONCLUSION: Infertility was the main indication for SUSS and hydrocele the commonest finding. Ultrasound is recommended as first line imaging modality in the investigation of scrotal lesions.

CONTEXTE: L'échographie scrotale est une modalité d'imagerie utile, sensible, facilement accessible et sûre pour l'examen des pathologies scrotales, y compris celles qui peuvent contribuer à l'infertilité masculine. L'objectif de cette étude était d'examiner les échographies scrotales (SUSS) effectuées à l'hôpital universitaire de l'Université d'Uyo sur une période de 18 mois, de juillet 2018 à décembre 2019. MÉTHODOLOGIE: Il s'agissait d'une étude rétrospective de toutes les SUSS réalisées dans le département de radiologie de l'hôpital universitaire d'Uyo (UUTH) au cours d'une période de 18 mois. Tous les sujets qui se sont présentés pour une échographie scrotaleavec des formulaires de demande adéquatement remplis qui comprenaient des données biologiques et des informations cliniques ont été inclus dans l'étude. RÉSULTATS: Au total, 79 échographies ont été examinées au cours de la période. L'âge des patients étudiés était compris entre 4 et 78 ans, avec une moyenne de 41,2 ±15 ans. La tranche d'âge modale était de 30 à 39 ans, soit 20 cas (25,6 %). L'infertilité primaire et secondaire était la principale indication de consultation, dans 17 cas (21,8 %) et 13 cas (16,7 %) respectivement. Après le SUSS, les résultats étaient normaux chez 11 patients (14,1 %), tandis que l'hydrocèle et la varicocèle représentaient 19 cas (24,3 %) et 9 cas (11,5 %) respectivement. La microlitiasis a été observée dans 7 cas (9 %) tandis qu'un diagnostic de tumeur testiculaire a été posé dans 5 cas (6,4 %). Trois (3) des 5 tumeurs testiculaires ont été confirmées histologiquement. CONCLUSION: L'infertilité était la principale indication de SUSS et l'hydrocèle la constatation la plus fréquente. la plus fréquente. L'échographie est recommandée comme modalité d'imagerie de première ligne dans l'investigation des lésions scrotales. Mots-clés: Échographie scrotale, infertilité masculine, hydrocèle, varicocèle.

Radiological features characterising indeterminate testes masses: a systematic review and meta-analysis.

CONTEXT: The use of scrotal ultrasonography (SUS) has increased the detection rate of indeterminate testicular masses. Defining radiological characteristics that identify malignancy may reduce the number of men undergoing unnecessary radical orchidectomy. OBJECTIVE: To define which SUS or scrotal magnetic resonance imaging (MRI) characteristics can predict benign or malignant disease in pre- or post-pubertal males with indeterminate testicular masses. EVIDENCE ACQUISITION: This systematic review was conducted in accordance with Cochrane Collaboration guidance. Medline, Embase, Cochrane controlled trials and systematic reviews databases were searched from (1970 to 26 March 2021). Benign and malignant masses were classified using the reported reference test: i.e., histopathology, or 12 months progression-free radiological surveillance. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool (QUADAS-2). EVIDENCE SYNTHESIS: A total of 32 studies were identified, including 1692 masses of which 28 studies and 1550 masses reported SUS features, four studies and 142 masses reported MRI features. Meta-analysis of different SUS (B-mode) values in post-pubertal men demonstrated that a size of ≤0.5 cm had a significantly lower odds ratio (OR) of malignancy compared to masses of >0.5 cm (P < 0.001). Comparison of masses of 0.6-1.0 cm and masses of >1.5 cm also demonstrated a significantly lower OR of malignancy (P = 0.04). There was no significant difference between masses of 0.6-1.0 and 1.1-1.5 cm. SUS in post-pubertal men also had a statistically significantly lower OR of malignancy for heterogenous masses vs homogenous masses (P = 0.04), hyperechogenic vs hypoechogenic masses (P < 0.01), normal vs increased enhancement (P < 0.01), and peripheral vs central vascularity (P < 0.01), respectively. There were limited data on pre-pubertal SUS, pre-pubertal MRI and post-pubertal MRI. CONCLUSIONS: This meta-analysis identifies radiological characteristics that have a lower OR of malignancy and may be of value in the management of the indeterminate testis mass.

Meconium Periorchitis is Amenable to Prompt Radiological Diagnosis.

Scrotal swellings in neonates are very common. A 25-day-old male child had right-sided firm, nontender scrotal swelling. Ultrasound scan (USS) diagnosed as meconium periorchitis (MPO). At 70 days of age, repeat USS and plain abdominoscrotal radiograph confirmed MPO, and surgery was avoided. Radiological diagnosis and management of MPO are discussed.

Segmental testicular infarct with an associated testicular artery aneurysm: Case report of a rare clinical entity.

Segmental testicular infarct is a rare clinical entity and can be a diagnostic challenge. Although cases are often idiopathic, underlying etiologies can include testicular torsion, epididymo-orchitis, trauma, vasculitis, and hypercoagulable states. Once suspected, an underlying testicular neoplasm should be excluded. We present a case of a 43-year-old male who developed acute onset left sided scrotal pain. A diagnostic scrotal ultrasound showed a focal, heterogeneous region in left testicle with absent focal Doppler signal, concerning for a segmental testicular infarction. There was no history of trauma, urinary symptoms, sexually transmitted diseases, or constitutional symptoms. Work up for associated underlying etiologies was negative. A computed tomography angiogram scan of the abdomen and pelvis revealed an incidental left testicular artery aneurysm. The patient's consulting multidisciplinary care teams included urology and vascular surgery. Urology deemed surgical intervention inappropriate for the segmental testicular infarct, and vascular surgery elected not to intervene on the testicular artery aneurysm due to risk of completing testicular infarct and damaging blood supply to the testis. The patient was discharged after achieving adequate pain control, and completion of inpatient work up. No underlying malignancy was diagnosed on follow up, and pain symptoms resolved. To the authors' knowledge, no literature exists describing the concurrent incidence of a segmental testicular infarct and an ipsilateral testicular artery aneurysm. In this report, we aim to further describe both diagnoses, and explore the association between the 2 entities.

Obstructive oligospermia: the role of interventional radiology in its diagnosis and treatment.

PURPOSE: According to the latest World Health Organization guidelines (2010), oligo-sperm it is due to a sperm concentration of less than 15 million/ml of seminal fluid. The cause can be obstructive and non-obstructive. Interventional radiology allows diagnosis and, in some cases, minimally invasive treatment. CASE PRESENTATION: A 28-year-old man with oligospermia (7 million/ml of seminal fluid), surgically treated 2 years ago for clinical grade III bilateral varicocele (according to Dubin's classification), was admitted to the Urology Department for suspected accidental surgical ligation of the left vas deferens. The patient underwent several diagnostic tests including phlebography of the left pampiniform plexus, bilateral vesico-deferentography. The steno-occlusion of the ejaculatory ducts was diagnosed, which was resolved through an innovative interventional radiology treatment. CONCLUSIONS: Interventional radiology has played a decisive role in the diagnosis and treatment of the causes of male infertility. In our experience, it has considerable potential in the minimally invasive treatment of steno-obstructive pathologies of the vesico-deferential system.

Historical trends for the standards in scrotal ultrasonography: What was, what is and what will be normal.

BACKGROUND: Ultrasonography is the gold standard imaging method for scrotal investigation. Colour Doppler ultrasonography, contrast-enhanced ultrasonography and sonoelastography allow sonographers to assess size, echotexture, vascular features and stiffness of the scrotal organs and abnormalities. Scrotal ultrasonography has been used to investigate male reproductive health, scrotal pain, masses and trauma. However, ultrasonography thresholds/classifications used to distinguish normal and pathologic features of the scrotal organs have changed over time, and have not yet been fully standardized. OBJECTIVES: To evaluate historical trends for the standards in scrotal ultrasonography: what was, what is and what will be normal. METHODS: An extensive Medline search was performed identifying the most relevant studies in the English language from inception to date. RESULTS: We provide here (i) a brief overview of the history of ultrasonography, (ii) current indications for scrotal ultrasonography and (iii) previous and current normal values, cut-offs and classifications of the main colour-Doppler ultrasonography parameters/characteristics of the scrotal organs, as derived from recent guidelines and evidence-based studies. In addition, we report recommendations and the clinical utility of contrast-enhanced ultrasonography and sonoelastography. Finally, we discuss critical issues needing further evidence and future directions to fill in the current gaps. DISCUSSION: Several studies on scrotal ultrasonography are available. However, guidelines/recommendations dealing with specific ultrasonography applications have been published only in recent years. More recently, the European Academy of Andrology published evidence-based scrotal colour-Doppler ultrasonography reference ranges/normative parameters derived from a cohort of healthy, fertile men. In addition, a standardization of the methodology to evaluate qualitative and quantitative colour-Doppler ultrasonography parameters was reported. Other international societies reported indications, methodological standards, clinical utility and limitations of contrast-enhanced ultrasonography and sonoelastography. CONCLUSIONS: To date, colour-Doppler ultrasonography normative values for the scrotal organs are available. However, a wide international consensus on assessment and classification of several ultrasonography parameters is still lacking. An alignment of the world societies on these issues is advocated.

Ultrasound evaluation of patients with male accessory gland inflammation: a pictorial review.

Male accessory gland infection/inflammation (MAGI) is a major cause of male infertility. The importance of ultrasound evaluation in these patients is highly controversial, although evidence of its relevance has increased in recent years. Ultrasound criteria are an important element for confirming the clinical diagnosis. Furthermore, they help to localize the anatomical site or sites of the inflammatory process and in assessing its extension which, in turn, have different consequences on the seminological and symptomatic aspects. This article summarizes the clinical interpretations related to ultrasound aspects in patients with MAGI and the possible effects on the seminological, microbiological, endocrinologic, urological, sexological, and internist aspects.

Torsion of the Epididymal Appendage in a Child.

The epididymal appendage, or the appendix epididymis, is a developmental remnant of the mesonephric duct that sprouts from the head of the epididymis. Due to its pedunculated anatomical configuration, the epididymal appendage is prone to torsion and can become a rare cause of an acute scrotum. Given its often challenging and atypical presentation, high clinical suspicion and Doppler ultrasonography are needed to guide diagnosis. We report a challenging case of epididymal appendage torsion that required prompt surgical exploration to accurately diagnose. Awareness of this condition and its radiological findings can play an important role in reaching an accurate diagnosis and avoiding surgical intervention.

Clinical and seminal parameters associated with testicular microlithiasis and its severity in males from infertile couples.

STUDY QUESTION: Is there an association of testicular microlithiasis (TM) and its severity with testicular dysfunction in men from infertile couples? SUMMARY ANSWER: The presence of ≥5 testis microcalcifications per sonogram at the scrotal ultrasonography (US) of infertile males was associated with a more severe testicular dysfunction as compared to males with limited, or without, TM. WHAT IS KNOWN ALREADY: TM, representing an incidental finding in the scrotal US, is associated with male infertility and a higher risk for testicular cancer as compared to that in infertile males without TM. Still, there are unresolved questions on the relation between TM severity and testicular dysfunction in infertile men, as well as on the identification of risk factors for TM. STUDY DESIGN, SIZE, DURATION: This study was an observational, retrospective, case-control investigation involving males who underwent clinical evaluation, measurement of reproductive hormones, seminal analysis and scrotal US as part of diagnostic work-up for couple infertility at an andrology clinic, between January 2004 and December 2018. One hundred patients, out of the 2112 scored men, were found to have TM during the US evaluation. One hundred male partners from 100 infertile couples without TM, comprising the control group, were selected through a matched analysis by age and date of evaluation to reduce the confounding effect of both age and technique variability all along the long period of observation. PARTICIPANTS/MATERIALS, SETTING, METHODS: TM was defined as limited TM (LTM) or classical TM (CTM), when the maximum number of hyperecogenic spots per sonogram was <5 or ≥5, respectively. CTM, LTM and control groups were compared for clinical variables, serum levels of FSH, LH, and total testosterone, as well for semen parameters and scrotal US features. MAIN RESULTS AND THE ROLE OF CHANCE: After the exclusion of cases with testicular nodules to eliminate the possible confounding effect of testis cancer on testicular dysfunction, cases with CTM showed a lower mean testis volume (P = 0.03) and a lower sperm concentration (P = 0.03) as compared to the other two groups. A higher FSH level was observed in the CTM group compared to the LTM group (P = 0.02) and in controls (P = 0.009). The multiple logistic regression analysis showed that only a smaller testicle volume exhibited an independent significant association with a higher odds of detecting CTM (odds ratio = 0.84, 95% CI: 0.75-0.94; P = 0.02). No significant differences were observed between groups in the prevalence of risk factors for testicular cancer, or in the prevalence of conditions associated with TM. LIMITATIONS, REASONS FOR CAUTION: The retrospective design of the study did not allow conclusions to be drawn about the possible underlying links in the associations of TM with defective spermatogenesis. WIDER IMPLICATIONS OF THE FINDINGS: Males from infertile couples who exhibit a reduced testicular volume should undergo scrotal US, independent of sperm parameters, to exclude CTM and, eventually, testis cancer, although the association of CTM and current or future testis cancer risk is not yet clear. Evidence is provided here demonstrating that the presence of LTM has no clinical relevance in males from infertile couples. STUDY FUNDING/COMPETING INTEREST(S): Investigation was funded by Ministero dell'Università e della Ricerca, PRIN 2018, Italy. The authors have not declared any competing interests. TRIAL REGISTRATION NUMBER: N/A.

[Juvenile granulosa cell tumor-Testicular tumor of the very young : Report of three cases and contemporary recommendations]. / Der juvenile Granulosazelltumor ­ der Hodentumor der Kleinsten : Aktuelle Handlungsempfehlungen anhand von drei Kasuistiken.

Juvenile granulosa cell tumor of the testis is a relevant differential diagnosis regarding testicular neoplasia of the very young. This benign lesion requires surgical treatment. Metastases or recurrences have not been described in literature. We present three different cases and give recommendations for diagnosis and treatment.

The European Academy of Andrology (EAA) ultrasound study on healthy, fertile men: Scrotal ultrasound reference ranges and associations with clinical, seminal, and biochemical characteristics.

BACKGROUND: Scrotal color Doppler ultrasound (CDUS) still suffers from lack of standardization. Hence, the European Academy of Andrology (EAA) has promoted a multicenter study to assess the CDUS characteristics of healthy fertile men (HFM) to obtain normative parameters. OBJECTIVES: To report and discuss the scrotal organs CDUS reference ranges and characteristics in HFM and their associations with clinical, seminal, and biochemical parameters. METHODS: A cohort of 248 HFM (35.3 ± 5.9years) was studied, evaluating, on the same day, clinical, biochemical, seminal, and scrotal CDUS following Standard Operating Procedures. RESULTS: The CDUS reference range and characteristics of the scrotal organs of HFM are reported here. CDUS showed a higher accuracy than physical examination in detecting scrotal abnormalities. Prader orchidometer (PO)- and US-measured testicular volume (TV) were closely related. The US-assessed TV with the ellipsoid formula showed the best correlation with the PO-TV. The mean TV of HFM was ~ 17 ml. The lowest reference limit for right and left testis was 12 and 11 ml, thresholds defining testicular hypotrophy. The highest reference limit for epididymal head, tail, and vas deferens was 12, 6, and 4.5 mm, respectively. Mean TV was associated positively with sperm concentration and total count and negatively with gonadotropins levels and pulse pressure. Subjects with testicular inhomogeneity or calcifications showed lower sperm vitality and concentration, respectively, than the rest of the sample. Sperm normal morphology and progressive motility were positively associated with epididymal head size/vascularization and vas deferens size, respectively. Increased epididymis and vas deferens sizes were associated with MAR test positivity. Decreased epididymal tail homogeneity/vascularization were positively associated with waistline, which was negatively associated with intratesticular vascularization. CDUS varicocele was detected in 37.2% of men and was not associated with seminal or hormonal parameters. Scrotal CDUS parameters were not associated with time to pregnancy, number of children, history of miscarriage. CONCLUSIONS: The present findings will help in better understanding male infertility pathophysiology, improving its management.