New diagnostic techniques in the evaluation of anatomic abnormalities of the infertile male.

New diagnostic imaging modalities have taken on a major role in the diagnosis of disease entities related to male infertility. Ultrasonography, MR imaging, and new operative diagnostic maneuvers will continue to define anatomy, physiology, and pathology of the male reproductive system. When any disease process affects the male in the reproductive or prereproductive years, potential repercussions on subsequent male factor fertility should always be addressed in the treatment plans of such patients. Scrotal ultrasonography is extremely helpful in identification of abnormalities of the testis parenchyma, paratesticular structures, and blood flow in the region of the testes. TRUS has replaced the vasogram as the initial diagnostic test for evaluation of the prostate, ejaculatory duct, and seminal vesicles in the infertile male. It may also be used as an adjunct to treatment in these patients. MR imaging may become a useful adjunct to TRUS in defining male genital ductal anatomy prior to surgical exploration. Vasal exploration, including subjective vasal injection pressure, vasal fluid examination, and vasography, is an important diagnostic tool in the diagnosis and treatment of male genital disorders.