We divided the pathologic findings depending on the location: intratesticular or extratesticular ( epididymis, appendages, cordon )

TESTIS

The sonographic appearance of the testis was practically unchanged after vasectomy . We found a benign findings no typically associated to vasectomizated patients

2 intratesticular cyst

3 testicular microlithiasis

2 dilatation of rete testis

3 focal heterogeneas areas of congestion

1.MICROLITHIASIS

.

Fig.

Fig 1. Microlithiasis intratesticular in a 67years old man vasectomyzed. US scan shows a punctate foci of calcifition .

Fig.

Fig 2.Microlithiasis in a 54 years old man. US shows a enlarged and heterogeneous epididymal tail, more hypoechoic than the parenchymal testes with a dilated plexus.

2. FOCALS AREAS OF CONGESTION

Fig.

Fig 3. Heterogeneous teste with hypoechoics focal areas in the inferior pole and an enlarged epididymal body.

Fig.

Fig.

Fig.4. Heterogeneous teste in a 48 years old man vasectomized with antecedents of torsion testicular. Note on the inferior pole of the testis an heterogeneous and nodular area hypoechoic with punctate calcification

3. CYSTS

Fig.

Fig 5. Intratesticular cyst in then superior and inferior border of the rigth teste with a tunical calcification

4. TUBULAR ECTASIA OF THE RETE TESTIS

Fig.

Fig 6. Tubular ectasis of the rete testis in a 51 years old man. US scan shows a dilated rete testis intratesticular. Also note a gigant epididymal cyst.

Fig.

Fig 7. Dilated rete testis in a 40 years old man. US shows a dilated rete testis and an enlarged tail of the epididymis with dilated plexus

APPENDAGE TESTIS

1.CALCIFIED APPENDAGE

Fig.

Fig 8 US shows a calcified hydatide and a small hydrocele in a 74 years old.

2.CYSTIC APPENDIX TESTIS

Fig.

Fig 9. Small cystic appendix testis

EPIDIDYMIS

In 14 men (45%), there were persistent changes in the epididymis. These consisted of enlargement (14 patients), development of cysts (11 patients), and an inhomogeneous echo pattern (five patients). The presence of these sonographic changes was unrelated to symptoms.

1.ENLARGED of the EPIDIDYMIS

Thickened of the epididymis is when a head thicker than 1.5cm and a body and tail ticker than 0.5 cm..

In our vasectomy group, the thickened portion of the epididymis was the head in 6, epididymal body in 14 and epididymal tail in 10.

A. Head

Fig.

Fig 10. Note a enlarged and heterogeneous epididymal head with a small cystic lesion.

Fig.

Fig 11. Enlarged epididymal head in a 46 years old man. Us shows and enlarged head and a small calcification inside.

B. Epididymal body

Fig.

Fig 12. Thickened epididymal body in a 67 years old man. Us shows the enlarged and hypoechoic body with a calcified foci inside.

Fig.

Fig 13. Another case of thickened epididymal body in a 51 years ols man. Note an enlarged and hypoechoic epididymal body and a heterogeneous testis.

C. epididymal tail

Fig.

Fig 14. Enlarged epididymal tail in a 47 years old man.

Fig.

Fig.

Fig 15. Enlarged epididymal tail in a 43 years old man. Enlarged and heterogeneous tail with a foci of calcification inside. Note also tubular ectasia. ectasia

2. EPIDIDYMAL TUBULES OR TUBULAR ECTASIA

Epididymal tubules are not normallly seen on sonograms. We defined " tubular ectasia" when these tubules became visible. In our group we found 7 tubular ectasia.

Fig.

Fig 16. Tubular ectasia in a 40 years old man. Us shows and enlarged , heterogeneous and hypoechoic epididymal tail with several small cysts and a tubular ectasia

Fig.

Fig 17. Us shows the body of epididymis thickened and inhomogeneous echo pattern and tubular ectasia.

Fig.

Fig.18. Winding tubular ectasia in a 49 years old man.

3. CYSTS AND SPERMATOCELE

Spermatoceles are form from obstruction and dilatation of the efferent ductal system and are filled with thicker, milky fluid containing spermatozoa, lymphocytes, and cellular debris. On US scans, both epididymal cysts and spermatoceles appear as anechoic, well-defined masses with increased through-transmission and are indistinguishable with US. Epididymal cysts are more common in the general population, accounting for approximately 75% of lesions Spermatoceles are more common in postvasectomy patients. Larger cysts (either true cysts or spermatoceles) may have septations and be confused with hydroceles.

Fig.

Fig.

Fig 19-20. Spermatocele in a 49 years old man. US shows a great cystic mass in the head of the epididymis without septations

SPERM GRANULOMA

Sperm granuloma is a granulomatous reaction to extravasated sperm. Occurs after vasectomy in up to 40% of patients. The sonographic findings are nonspecifics, but, usually, they appear as a small (less than 1 cm) well-defined, hypoechoic, solid masses. Others US findings include epididymal enlargement, cystic changes, and alteration in echo pattern. Although they can occur anywhere in the ductal system, they are most common at the cut ends of the vas deferens and can be multiple.We found 3 sperm granulomas in our group

Fig.

Fig 21. Sperm granuloma in a 42 years old man. Us shows a hypoechoic mass with a focus of calcification in the epididymal head.

Fig.

Fig 22. Sperm granuloma in a 47 years old man. Us shows and hypoechoic nodular mass in the spermatic cord.

Hydroceles and varicoceles were also found with similar frequency in both the vasectomy group and non vasectomy patients.