Introduction: Scrotal ultrasound (US) is the most common imaging modality used to evaluate scrotal pathology. Previous studies demonstrate that US usually detects pathology that does not require surgical intervention. The American Urological Association guidelines do not recommend US to evaluate for varicocele.
Methods: Our study was approved by our Institutional Review Board. Indications for scrotal US were quantified from 2018 MarketScan data, with associated ICD-10 codes. MarketScan is one of the largest collections of privately and publicly insured de-identified patient data in the United States and obtains data from numerous sources and healthcare settings. For each encounter, up to four diagnostic codes are provided.
Results: Overall, 99,028 scrotal US encounters were identified. The most commonly associated ICD-10 codes were scrotal or testicular pain (26%), hydrocele (14.7%), varicocele (7.9%), other specified disorders of the male genital system (7.8%), epididymal cyst (7.1%), unspecified disorder of male genital organs (5.5%), epididymitis (5.1%), epididymo-orchitis (1.4%), and inguinal hernia (1.1%). Infertility was an associated diagnosis for 0.17% of ultrasound encounters. Overall, 51% of ultrasounds were performed for benign conditions including hydrocele, varicocele, epididymitis-orchitis, and epididymal cyst.
Conclusions: The majority of scrotal US are performed are for evaluation of benign conditions. A significant number of US studies had an associated diagnosis of varicocele. Whether the US study was performed for a palpable varicocele or to screen for varicocele with a normal scrotal examination cannot be determined from this data. Neither indication would be supported by guidelines. This finding suggests, though, that many providers believe that US is beneficial in this setting.
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