Male Pelvis: Scrotal & Prostate

1. 1

   Position patient supine with a towel supporting the scrotum. Use high-frequency linear probe (10–18 MHz).

2. 2

   Begin with the right testis in transverse: evaluate echogenicity, size, and any focal lesions. Measure length, width, height.

3. 3

   Rotate to longitudinal for right testis — full sweep superior to inferior.

4. 4

   Evaluate right epididymis (head at superior pole, body and tail posterolaterally). Note any enlargement or hyperemia.

5. 5

   Apply color Doppler to right testis — document vascularity. Switch to split-screen to compare both sides simultaneously.

6. 6

   Repeat all steps for left testis and epididymis. Any absent flow compared to contralateral = torsion until proven otherwise.

7. 7

   Transabdominal prostate (full bladder): measure AP, transverse, and length. Calculate volume (0.523 × L × W × H).

• Right testis — longitudinal
• Right testis — transverse (superior, mid, inferior)
• Left testis — longitudinal
• Left testis — transverse
• Bilateral epididymis (head, body, tail)
• Color/power Doppler — bilateral testes
• Transabdominal prostate (transverse + sagittal)

• Testicular echogenicity and size
• Epididymis echogenicity
• Vascularity by Doppler
• Prostate size and echogenicity
• Intratesticular lesion

• Absent testicular flow on Doppler: torsion until proven otherwise — urgent urology referral
• Doppler settings must be optimized for low-flow states
• Compare both sides simultaneously with split-screen

Split-screen color Doppler comparison is essential for torsion evaluation — side-by-side is the standard.