Clinical assessment of scrotal contents in patients with infertility has relied mainly on physical examination.Color Doppler ultrasonography (US) is generally not performed as a routine examination. However, physical examination might miss many abnormalities readily detected by US, including testicular tumor and testicular microlithiasis (TM). We assessed the value of scrotal color Doppler ultrasonography as a routine examination in infertile men compared with findings by physical examination. Scrotal Color Doppler ultrasonography was performed in 314 infertile men with a mean age of (25±5.4) years to detect intrascrotal abnormalities. Findings were compared with those of physical examination. Intrascrotal abnormalities were detected by ultrasonography in 86.6% of patients. Of 374 abnormalities, 31% were undetected by physical examination. Left varicocele was found in 234 patients (74%); testicular microlithiasis in 10 (3.1%);epididymal cyst in 23 (7.3%); right varicocele in 7(2.2%); and testicular cysts in 2 (0.6%). One occurrence (0.3%) was found for testicular tumor, hypoechoic small testicles in 11(3.2%), and hydrocele in 45(14.3%).Compared to ultrasonography, sensitivity in detecting left varicocele by physical examination was 77%. Sensitivity of physical examination in detecting left varicocele compared with to US was decreased as grade of left varicocele decreased. The routine Color Doppler ultrasonography is valuable for diagnosing scrotal abnormalities in infertile men,frequently detecting non-palpable lesions that were missed by physical examination.
