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Unilateral Idiopathic Hydrocele Has a Substantial Effect on the Ipsilateral Testicular Geometry and Resistivity Indices

Departments of Radiology (A.T.T., P.K., U.K.) and Urology (L.E.), Ankara Training and Research Hospital, Ankara, Turkey; Department of Radiology, Turkish Armed Forces Rehabilitation and Care Center, Ankara, Turkey (A.Ü.); Department of Radiology, School of Medicine, Adnan Menderes University, Aydin, Turkey (A.Ü.); and Department of Urology, School of Medicine, Ankara University, Ankara, Turkey (E.Ö.).

Address correspondence to Ahmet Tuncay Turgut, MD, 25. Cadde 362. Sokak Hüner Sitesi 18/30, TR-06530 Karakusunlar, Ankara, Turkey. E-mail: ahmettuncayturgut{at}yahoo.com

Objective. The purpose of this study was to determine whether hydrocele has any effect on the volume and shape of the ipsilateral testis and can be implicated as a cause of testicular ischemia. Methods. Group 1 consisted of 23 patients with unilateral idiopathic hydrocele, whereas 30 healthy men constituted group 2. All patients underwent scrotal ultrasonography by which testicular dimensions in craniocaudal (D_cc), anteroposterior (D_ap), and mediolateral axes were measured, followed by calculation of the D_cc/D_ap ratio and testicular volume. By color Doppler analysis, the resistivity index of the subcapsular artery (RI_sc) and the resistivity index of the intratesticular artery were determined. Results. The mean D_cc/D_ap ratio ± SD for group 1 was 1.7 ± 0.3 (range, 1.1–2.3), significantly lower than that of group 2, which was 1.9 ± 0.3 (range, 1.3–2.2) (P = .028). Mean testicular volume values of subjects having hydrocele for more than and less than 6 months were 13.4 ± 7.3 and 22.5 ± 5.1 cm³, respectively; the difference between the subgroups was significant (P = .003). For the ipsilateral testis, mean RI_sc values were 0.70 ± 0.06 (range, 0.60–0.80) in group 1 and 0.65 ± 0.06 (range, 0.59–0.83) in group 2. The mean RI_sc was significantly higher in group 1 (P = .006). Conclusions. Unilateral idiopathic hydrocele has a tendency for rounding rather than flattening the ipsilateral testis as well as elevating the RI_sc on the affected side. To the best of our knowledge, no strict spectral Doppler analysis criteria have been proposed for testicular ischemia yet. Therefore, the impact of the difference of the RI_sc should raise the suspicion for ischemia, and further research is needed to elucidate any effect on spermatogenesis.

Key Words: color Doppler ultrasonography • hydrocele • ultrasonography • testis

Abbreviations: D_ap, testicular dimension in the anteroposterior axis • D_cc, testicular dimension in the craniocaudal axis • RI, resistivity index • RI_it, RI for intratesticular arteries • RI_sc, RI for sub-capsular arteries • V_t, testicular volume

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