Use and misuse of testicular ultrasound in routine clinical practice in a UK teaching hospital

Testicular ultrasound is a non-invasive and accurate investigation for testicular abnormalities. However, the majority of testicular problems are amenable to diagnosis by clinical examination alone. Testicular USS requests and reports generated over an 18-month period (03/2006 to 09/2007) at Nottingham City Hospital were examined to determine the indication for the test and the ultrasound findings. 2475 scans were performed: 576 were requested by urologists; 1899 by GPs and other hospital specialists. The most common findings were a completely normal scan (825) and epididymal cyst (637). In the majority of cases, the ultrasound scan was not necessary to make a diagnosis and added nothing to the findings at clinical examination. Correlations of ultrasound findings with the clinical reason for the test are presented in order to suggest suitable indications for this investigation. The total cost of testicular scans performed was around £200,000. It is estimated that at least £130,000 per year could be saved in a single hospital by avoiding unnecessary testicular scans. However, where the clinical findings are equivocal, ultrasound remains an excellent diagnostic tool.