Ultrasound of the prostate and testicles

Considerable advances have occurred in the sonographic imaging of small parts over recent years, including improved transducer technology and Doppler imaging. After reviewing briefly prostatic anatomy, including McNeal's concept of zonal anatomy, the techniques used for examining the prostate gland sonographically and for performing biopsy are discussed. Ultrasound (US) findings in the normal gland, in benign prostatic hyperplasia, and in prostatic cancer are described, with an emphasis on cancer. The role of targeted and random biopsy is assessed, as is the role of color Doppler in detecting prostatic cancer. An overview of the findings in inflammation and infertility also is provided. The technique used for examining the scrotum and testicles is discussed after a short review of scrotal anatomy. The sonographic appearances of the normal scrotal contents are described, followed by a discussion of findings in tumors, inflammatory conditions, and testicular torsion. A synopsis of the appearances of cysts and microlithiasis also is provided. Both the increased use and expectations by surgeons of US in the assessment of the prostate and testicles make it imperative to understand the techniques, range of findings, new developments, and limitations involved in using this modality.