Urological Examination Compared to Ultrasonography in Testicular Lump Assessment: A Retrospective Cohort Study

Background General practitioners (GPs) often expedite indeterminate scrotal lumps for urological evaluation. While a scrotal examination by a urologist is crucial, ultrasound (US) has become a routine component of clinical assessment regardless of the clinical examination findings and the nature of the symptoms. This study aimed to evaluate the efficacy of clinical examination compared to scrotal ultrasound, even when the suspicion of cancer was low. Methodology A retrospective review of all fast-track testicular referrals seen in the clinic between January 2018 and January 2021 was conducted. Data on clinical examination findings, ultrasound results, and final diagnoses were analyzed. Patients for whom ultrasound scans were available before clinical examination were excluded from the study to avoid confounding the results. Results A total of 398 male subjects were referred for urological assessment, and 123 cases were excluded based on specified exclusion criteria. Two hundred seventy-five patients were identified who underwent clinical examination by urologists and subsequent ultrasound scans. Among 30 (11%) potentially malignant cases, 18 (60%) were confirmed malignancies. Sixty-eight (24.7%) cases were deemed unlikely to be malignant, and an ultrasound scan confirmed 40 (58.8%) cases as normal and four (5.9%) cases of unexpected malignancy. Ultrasonography confirmed 19 of 27 hydroceles (70.4%), 64 of 89 epididymal cysts (71.9%), and 5 of 9 varicoceles (55.6%). Of 51 epididymo-orchitis cases, 14 (27.5%) were confirmed. Conclusions Urological examinations demonstrated high reliability in most cases, with clinical diagnoses frequently corroborated by ultrasonographic findings. The results indicate that when there is no clinical indication for an ultrasound scan, it is more efficient to avoid unnecessary ultrasonography, as it can be time-consuming without providing additional diagnostic benefits. This underscores the value of thorough clinical assessment in guiding the need for further imaging.