УЗИ яичек у мужчин – это процедура ультразвукового исследования формы и состава мошонки и яичек. УЗИ позволяет получить информацию о наличии изменений в исследуемых органах для постановки диагноза или контроля эффективности лечения.
Возможные патологии
Крипторхизм (отсутствие яичек в мошонке)
Если яички не прощупываются с одной или двух сторон, ребенка направляют на УЗИ. Обнаружить у ребенка скрытое яичко можно, если его линейный размер больше 10 миллиметров. Для крипторхизма характерна однородность структуры органа, а потому при наличии каких-либо включений нужно исключить злокачественное образование. Если яичко отсутствует в мошонке, у новорожденного ребенка изучается паховый канал, область возле корня пениса. Если половые железы не найдены, ребенок направляется к врачам-генетикам для проведения биохимического исследования и определения кариотипа.
Поводом для назначения УЗИ яичек у ребенка может быть не только крипторхизм. УЗИ назначается и при таких расстройствах, как: карликовость, гигантизм, лишний вес, патологический рост волос, задержка физического или психического развития ребенка, врожденные пороки сердца.
Опухоли
Ультразвуковое исследование дает возможность выявить образования на первичных этапах. Обычно опухоли относятся к доброкачественным. У мальчиков до 15-летнего возраста злокачественная опухоль яичка, как правило, – результат метастазирования при лимфомах и лейкозах. Способствуют возникновению опухоли яичка крипторхизм, травмы, патологическое выделение гонадотропинов, синдром Карнея.
Поскольку болевой синдром при данном виде опухолей обычно появляется на поздних стадиях, УЗИ рекомендовано при малейших подозрениях, даже при отсутствии изменений в органе, которые можно пальпировать.
Конкременты
Состояние может развиваться как следствие крипторхизма, химиотерапии, хромосомного заболевания. Во время ультразвукового исследования кальцинаты определяются как эхопозитивные включения высокой видимости.
Орхит
При этом заболевании яички увеличены в связи с их отечностью. Обычно орхит возникает в результате травмы или инфицирования ткани яичка. Инфекция проникает в половые железы из предстательной железы или мочевого пузыря. До наступления половозрелости у ребенка вероятен изолированный орхит, когда инфицирование ткани осуществляется с кровотоком.
При остром воспалении ультразвуковое исследование показывает увеличенный орган при однородной внутренней структуре. Сильное воспаление вызывает выраженную отечность и неоднородность или гомогенное снижение эхо-плотности.
Водянка
При гидроцеле между оболочками скапливается жидкость. Признаком патологии считается накопление в мошоночной полости эхонегативного содержимого с однородной структурой, с явственно различимым яичком, придатком и перегородкой мошонки.
Травма
Ультразвуковое исследование позволяет выявить состояния, требующие экстренной хирургической помощи. В случае разрыва органа, при обширном кровоизлиянии, это дает возможность предотвратить ишемическую атрофию или абсцесс.
Сперматоцеле
Ретенционная киста представляет собой безболезненное образование на семенном канатике мужчины. УЗИ проводится, чтобы исключить злокачественную опухоль (если она невелика по размеру) или водянку (если образование крупное).
Эпидидимит
Острый воспалительный процесс в придатке яичка – распространенная причина сильного болевого синдрома и увеличения мошонки. Болезнь развивается после поступления инфекции в придаток из предстательной железы или мочевого пузыря. В первые часы после возникновения боли можно найти только изменения в придатке, но не в яичке. Большую информативность несет допплерографическое исследование, которое позволяет выявить диффузную или локальную интенсификацию кровотока в тканях придатка или яичке.
Перекрут яичка
Результат перекрута – сдавливание семенного канатика, что приводит к отечности и сильной боли. Состояние возникает в результате травм, физического напряжения, сексуального возбуждения, генетической предрасположенности. У мальчиков грудного возраста риск возникновения перекрута наиболее велик. Второй пик встречается у подростков в возрасте 13-18 лет.
При перекруте органы на УЗИ неоднородны, но жизнеспособны. Также возможно бессистемное чередование областей с разной эхогенностью, что относится к негативным прогностическим признакам. В случае подострого перекрута потребуется допплерографическое исследование. В случае подтверждения подозрений обнаруживается обеднение, остановка или реактивное усиления кровотока.
УЗИ яичек позволяет дифференцировать перекрут с паховыми грыжами, васкулитами и идиопатическими кровоизлияниями.
Показатели нормы
Если по результатам обследования мужчины не обнаружено патологий, в заключении делаются следующие записи.
- определяются;
- контуры: четкие и ровные;
- размер: длина – 3-5 сантиметров, ширина – 2-3 сантиметра;
- эхоструктура: изоэхогенная, однородная (у мальчиков эхо-плотность ниже, чем у мужчин);
- дополнительные образования – не обнаружены.
- размер головки: до 10-15 миллиметров;
- хвост и тело: не обнаружены;
- эхоструктура: изоэхогенная и однородная;
- контуры: четкие и ровные;
- дополнительные образования – не обнаружены.
- однородная;
- количество в пределах нормы (1-2 миллилитра).
- толщина стенок: до 8 миллиметров.
Подготовка к процедуре и проведение УЗИ
Проведение ультразвукового исследования яичек не требует особой подготовки. Во время процедуры мужчина находится в лежачем положении, поэтому понадобится пеленка. Также нужна салфетка для удаления остатков геля. Рекомендуется обрить область половых органов, так как гель сложно убирать с волос.
Непосредственно перед проведением УЗИ яичек доктор опрашивает мужчину и проводит осмотр исследуемой области. При наличии болевого синдрома возможно использовании местной анестезии. Общее время, необходимое на ультразвуковое исследование – примерно 10 минут.
7 минут Автор: Ирина Бредихина 3682
УЗИ органов мошонки – простой не инвазивный метод исследования, позволяющий выявить практически все заболевания как врожденного, так и приобретенного характера. Обследование считается первичной диагностикой – в большинстве случаев ее назначают после осмотра и пальпации, если появляются подозрения в присутствии патологического процесса.
Когда назначается УЗИ мужских половых органов
Исследование мошонки с использованием ультразвуковых волн будет рекомендовано пациенту:
- при болевых ощущений различного характера;
- наличии признаков воспалительного процесса;
- травматических повреждениях открытого или закрытого вида;
- изменении внешнего вида или формы – покраснение, отек, уплотнение;
- подозрении на новообразования и грыжи:
- увеличении паховых и забрюшинных лимфоузлов;
- изменении показателей спермограммы;
- гемоспермии – наличии крови в сперме;
- замедленном либо раннем половом созревании;
- нарушении эректильной функции, бесплодии.
Возможность проведения процедуры в реальном времени позволяет контролировать проведение биопсии предстательной железы. УЗИ органов мошонки и малого таза незаменимо для оценки назначенной терапии, а также в послеоперационный период.
Какие патологии выявляет УЗИ?
Ультразвуковое исследование органов мошонки позволяет обнаружить большое количество заболеваний у лиц мужского пола как в детском, так и во взрослом возрасте. Так, процедура дает возможность определить отсутствие яичек (тестикул) в мошонке, что может быть результатом крипторхизма (неопущения яичка в мошонку) либо другого вида эктопии (аномалий в развитии). В процессе диагностики можно установить место нахождения тестикула, проведя изучение пахового канала, промежности и близлежащего участка бедра, так как орган может располагаться в этих необычных для его локализации областях.
Современная аппаратура позволяет отыскать неопустившееся яичко, даже при условии его малых размеров и нечетких контуров. Если при осмотре новорожденного мальчика было выявлено неопущение яичка, то в обязательном порядке назначается УЗИ, так как после него необходимо провести операцию по низведению тестикула в мошонку либо удалению его. Без надлежащей медицинской помощи могут развиться негативные последствия – грыжи, перекрут тестикула, бесплодие и даже злокачественные новообразования.
Процедура позволяет определить состояние венозных сосудов семенного канатика и диагностировать варикоцеле – их варикозное расширение. Это довольно распространенная патология, способная негативно влиять на сперматогенез (развитие мужских половых клеток). Также при УЗИ яичек у мужчин выявляется гидроцеле – водянка оболочек тестикула. Заболевание может быть как врожденного характера, так и приобретенного в результате травматических повреждений либо воспалительных процессов.
Такие же причины могут привести к возникновению кистозных образований в яичках – сперматоцеле. Их развитие может быть спровоцировано и эмбриональными остатками. К болезням воспалительного характера, выявляемым ультразвуком, относятся орхит – воспаление семенника и эпидидимит – воспаление придатка яичка. В некоторых случаях воспалительный процесс распространяется сразу на оба органа, что носит название эпидидимоорхит.
При отсутствии надлежащего лечения эти патологии могут привести к серьезным осложнениям. Ультразвуковая диагностика мужских половых органов показывает новообразования как доброкачественного так злокачественного характера, позволяя на ранних стадиях принять соответствующие меры. Современная методика ЦДК (цветовое доплеровское картирование) дает возможность изучить особенности кровообращения в органах мошонки и выявить отклонения в работе сосудов данной области.
Подготовка к обследованию и проведение
Взрослому мужчине особая подготовка не потребуется, а вот ребенку нужно будет уделить время и объяснить необходимость предстоящих действий или даже уговорить на прохождение процедуры. Единственное что нужно будет сделать, если обследование назначено в плановом порядке – это произвести туалет наружных половых органов. Для проведения исследования пациенту предлагается удобно расположиться на кушетке, предварительно сняв с себя нижнее белье, потому как делают УЗИ мошонки на голое тело.
В отдельных случаях, при проведении УЗИ с допплером, когда необходимо оценить работу кровеносных сосудов органа, процедура может проводиться в положении стоя. Затем врач наносит специальный гель на водной основе, способствующий более плотному, качественному и безболезненному для пациента контакту с поверхностью кожи. В ходе исследования мошонка изучается в продольной, поперечной и косой плоскости, что позволяет тщательно осмотреть все составляющие ее структуры и выявить патологические элементы. Процедура не занимает много времени – в большинстве случаев она длится не более 15–20 минут, и лишь в спорных ситуациях может немного затянуться.
Анатомические особенности органов мошонки
Тестикулы взрослого мужчины в норме имеют размеры в длину 3–5 см, толщину и ширину – 2–3 см. Сама мошонка является своеобразным футляром для яичек, и образована она соединительной и мышечной тканью приблизительно 8 мм шириной. Посередине проходит шов, разделяя ее на две части. В норме между мошоночной стенкой и тестикулом может находиться небольшое количество жидкости (1–2 мл).
В верхне-боковом краю яичка расположен придаток, состоящий из головки, тела и хвоста. Хвост постепенно переходит в семявыносящий проток, и в составе семенного канатика минуя паховый канал, попадает в брюшную полость.
Соединившись с семенными протоками, проходит через простату и открывается у мочеиспускательного канала. В норме при исследовании ультразвуком хорошо видна структура тестикула, головка придатка (тело и хвост при отсутствии патологий не визуализируются) и семенного канатика. При расшифровке обязательно сравнивается правое и левое яичко, а также толщина мошоночной стенки.
Тестикул в нормальном состоянии имеет однородную консистенцию с четко обозначенным сегментом плотной ткани, расположенной к его задне-наружной части – средостением. При допплеровском УЗИ можно рассмотреть артерии, питающие органы мошонки и венозную сеть семенного канатика.
Как выглядят патологии органов мошонки на УЗИ?
О наличии патологических изменений в органах мошонки свидетельствует неоднородность эхоструктуры, неровность и нечеткость органов, увеличение размеров и количества жидкости. Присутствие заболеваний определяется по увеличению размера придатков, и особенно хвостовой части. Эпидидимит на УЗИ диагностируется увеличением головки придатка и изменением его тканей. Иногда просматриваются тело и хвост органа, и наблюдается снижение эхогенности.
Если при этом в мошонке накапливается жидкость, то речь идет о реактивном гидроцеле. Водянка на УЗИ определяется довольно большой анэхогенной зоной, окружающей тестикул, а иногда распространяется на паховый канал. Воспалительные процессы в яичке и его придатке зачастую могут быть похожи на проявления при перекруте яичка. Перекрут характеризуется пережиманием артерии тестикула, и при диагностике доплером не будет просматриваться пульсация в сосудах органа. Данная патология считается очень опасной и требует немедленной помощи – в противном случае может привести к потере тестикула.
Если же УЗИ показывает увеличенный в размерах придаток, структурные изменения в нем, но тело и хвост не визуализируются, то инфекция, скорее всего, гематогенного или лимфогенного характера. Такая локализация не присуща для инфекций, полученных половым путем, попадающих в придаток через семявыносящий проток, из-за чего первостепенно поражается хвост придатка. Запущенные случаи таких заболеваний могут стать причиной пиоцеле – формированию гнойной полости в мошонке, опасной развитием абсцесса, инфаркта тестикула и даже гангрены Фурнье.
Варикоцеле характеризуется застоем крови, и в большинстве случаев приводит к атрофии тестикула. Как правило, образуется в левом яичке. Для выявления патологии при УЗИ применяется проба Вальсальвы – она дает возможность определить наличие обратного тока в венах семенного канатика. Варикоцеле диагностируется по расширенным венозным сосудам семенного канатика – более чем 3 мм и анэхогенности структур в его проекции.
Процедура является первичной диагностикой для выявления новообразований, так как органы мошонки легкодоступны для проведения исследования. Пораженный тестикул, как правило, увеличен в размерах, а опухоль имеет неправильную форму и неоднородную структуру. Обычное УЗИ яичек дает возможность выявить наличие заболеваний, а вот дифференциации клеток новообразования ему неподвластна.
Без УЗИ не обходится ни один поиск причины мужского бесплодия. Диагностика позволяет определить фактор, влияющий на изменение количества сперматозоидов. В процессе делается вывод, основанный на нарушениях структуры яичек и семявыносящих путей, приводящих к бесплодию. Одной из патологий, ведущей к снижению репродуктивной функции у мужчин, является сперматоцеле (семенные кисты). На УЗИ они выглядят как темные анэхогенные участки небольшого размера (не более 2 см) и округлой формы с четко выраженными и ровными границами.
Все перечисленные заболевания можно обнаружить при проведении короткой диагностики, которая займет не более 20 минут. Сравнительно невысокая цена и простота исследования даст возможность оградить себя в дальнейшем от серьезных осложнений, благодаря вовремя установленному диагнозу и назначенному лечению.
Ультразвуковая диагностика яичек — это один из современных способов, которые позволяют получить всю информацию о мошонке и её органах, в число которых входят и яички. УЗИ яичек у мужчин позволяет поставить диагноз, который будет точен на 99 процентов.
Анатомия яичек
Яичко — это мужской орган, который обладает овальной формой. Этот железистый орган фиксируется при помощи специального семенного канатика. В состав яичка входят: головка, тело и хвост. Анатомия человека устроена так, что левое яичко располагается немного ниже, чем правое. Мошонка обладает весьма богатым кровоснабжением.
Когда назначают?
Предписаний для проведения УЗИ может быть огромное количество:
- при подозрениях опухолей;
- при воспалительных процессах;
- агенезия (состояние, когда отсутствует одно или оба яичка);
- при изменении размеров регионарных лимфатических узлов;
- бесплодие;
- при возникновении пальпируемого новообразования в яичке;
- при необходимости контроля в динамике;
- при проведении биопсии;
- в случае изменения размеров и формы яичка;
- атрофия и гипотрофия;
- болевые ощущения в зоне мошонки;
- при нарушениях яичка в результате перекрута семенного канатика;
- при травмах мошонки.
Мальчикам
Есть несколько вариантов, в случае которых детям назначают УЗИ яичек:
- несвоевременное психоэмоциональное созревание;
- проблемы с весом;
- при слишком низком или высоком росте;
Эхоплотность яичек в детском возрасте приобретается в момент наступления полового созревания. Стоит отметить, что оно наступает у всех мальчиков в разный период из-за разных факторов генетического характера, экологии, а также правильного питания и возможных патологий.
Видео 1. Когда проходят УЗИ органов мошонки?
Что показывает диагностика?
- какие размеры имеют яички (нормальные, увеличенные или наоборот уменьшенные);
- какие размеры имеют придатки и их головки;
- контуры (ровные, размытые или нет);
- проверка тканей на эхогенность;
- оценка новых образований (их размер и плотность);
- наличие свободной жидкости, её объём;
- характеристика симметричности и сосудистого рисунка.
Также для диагностики в отдельных случаях применяют допплерографию. Необходимость в нём возникает:
- при варикозном расширении вен (варикоцеле);
- при различных травмах;
- при подозрениях на перекрут семенного канала;
- при опухолях.
Подготовка
Перед тем как приступить к проведению УЗИ предварительно проводится целый ряд гигиенических процедур половых органов. Для УЗИ необходимо подготовить пелёнку одноразового использования и салфетки.
Но в том случае, если запланирована процедура исследования предстательной железы непосредственно через прямую кишку, пациенту необходимо придерживаться некоторых правил.
Как делают?
УЗИ мошонки и её органов осуществляется (как и УЗИ члена) в несколько этапов:
- Пациент оголяет часть туловища внизу.
- Ложится.
- На его кожу наносится гель, который улучшает скольжение датчика по поверхности и не даёт попасть воздуху, так как он способен повлиять на достоверность результатов исследования.
Испытывать боль в процессе проведения УЗИ пациент может лишь в том случае, если у него имеются заболевания яичек и придатков, носящие воспалительный характер.
Если пациент испытывает болезненные ощущения при УЗИ, то назначается анестезия местного назначения.
Специалист, проводящий УЗИ, последовательно обследует вначале одно яичко и только потом другое. В обязательном порядке производится оценка размеров и структуры.
Норма результатов
В нормальном состоянии яички имеют ровные и чёткие контуры.
Наблюдается однородная паренхима.
Возможно наличие серой жидкости, но лишь в малом количестве.
Нормальным считается, если просматривается только головка придатка яичка.
Размеры у мужчин
Основываясь на результатах УЗИ, установлены средние размеры, которые имеют яички у мужчин:
Средние показания:
- в длину 4 или 5 см;
- в ширину от 3 до 3,5 см;
- толщина от 2 до 2,5 см.
Размеры у мальчиков в зависимости от возраста
При проведении УЗИ у детей эхогенность как правило понижена, а у мужчин имеет среднее значение.
Патологии
Благодаря ультразвуковому исследованию стало возможным диагностирование множества патологий мошонки и её органов. Что показывает ультразвук в случае ненормальных состояний яичек?
Крипторхизм
УЗИ при наличии данной патологии назначается для более детальной информации об “исчезнувшем” яичке.
Крипторхизм — это отклонение от нормы расположения, в результате которого половая железа мужчины присутствует, но по каким либо факторам не успела вовремя покинуть брюшную полость. В большинстве случаев (90%) яичко которое было “потеряно” находится в канале паха. Яичко, которое имеет не правильную зону расположения, обладает меньшими размерами, структурой неоднородного характера, а его придатки, как правило, не просматриваются.
Варикоцеле
Варикозное расширение вен в семенном канале у мужчин требует безотлагательного лечения, так как оно может стать причиной бесплодия.
При варикоцеле на УЗИ четко просматриваются вены, которые расширены, и немного изменён их вид, а диаметр превышает 3 мм.
Есть несколько стадий варикозной болезни:
- Первая. Вены визуализируются только при повышенном давлении или при проведении обследования в вертикальном положении.
- Вторая. Вены, изменившие свой вид, не пропадают даже в горизонтальном положении.
- Третья. Вены визуализируются в зоне, расположенной ниже яичка, которое уменьшилось в размерах.
Гидроцеле
В случае возникновения данной патологии в зоне, расположенной между двумя листками оболочки яичка, накапливается жидкость.
В результате проведения УЗИ без труда происходит диагностика жидкости, которая накопилась между оболочками.
Кистозные новообразования
Сперматоцеле или, по-другому, семенные кисты могут носить врождённый характер или приобретённый. При врождённой кисте наблюдаются её маленькие размеры, а жидкость внутри неё имеет прозрачный вид.
По итогам УЗИ можно заметить, что киста имеет округлую форму, чёткий и ровный контур, а также анэхогенную структуру.
Орхит и орхоэпидидимит
Данные аномалии возникают в результате поражения тканей микробами из-за пониженного иммунитета. На УЗИ придаток яичка имеет увеличенные размеры, пониженную эхогенность и неоднородную структуру.
Половая железа мужчин сильно увеличивается в своих объёмах, а её эхогенность снижается. Очень часто данная аномалия связана с реактивной водянкой.
Хронические орхоэпидидимит
Яичко имеет любые размеры, неоднородную структуру и неровные контуры. Просматривается придаток, который немного увеличен. В случае такой аномалии назначается дифференциальная диагностика.
Туберкулёз
На УЗИ определить туберкулёз можно по воспалённым придаткам яичка, но всё же специалист обращает внимание и на другие факторы во время проведения процедуры. При туберкулёзе яичка и его придатков наблюдается процесс в обе стороны и накапливаются соли.
Онкологические процессы
Как и какие бы то ни было опухоли в других органах и частях тела, онкологические образования в яичках, разумеется, требуют срочного изучения и дальнейшего лечения. Не проходящий дискомфорт и ощущение того, что есть новообразование, являются достаточной причиной для посещения врача. По результатам УЗИ будет понятно, нужен ли визит к онкологу.
Семинома
Очень редко можно встретить рак яичка, и в основном в 95% случаях это опухоли, возникающие ещё внутри утробы. Учитывая строение семиномы, выделяют гомогенную и не гомогенную структуру.
Новообразования патологического характера в основном находят в правом яичке. Опухоли сразу с двух сторон встречаются очень редко (до 3 случаев из 100).
На УЗИ опухоль имеет неправильную форму и в некоторых случаях состоит сразу из нескольких образований, имеющих неоднородную структуру. Больное яичко имеет размеры, немного отклоненные от нормы.
В том случае если подозревается рак яичка, проводится исследование забрюшинной зоны. Также проводится в обязательном порядке биопсия.
Абсцесс
Яичко имеет вид локализованного образования, чёткие контуры.
Перекрут
Это ненормальное состояние, при котором яичко повернулось вокруг вертикальной или горизонтальной осей. В результате могут быть сдавлены сосуды и/или нервы, что часто приводит к развитию ишемии и угнетению функции железы или даже некрозу.
Микролиты
Одной из патологий при обследовании яичек являются мелкие кальцинаты. Они носят характер первичного процесса, причина появления изучена недостаточно. Кальцинат может диагностироваться совместно с раком, туберкулезом или при проблемах с обменными процессами.
Противопоказания
Не существует таких противопоказаний, которые могут помешать проведению УЗИ. Исключением может быть лишь травма мошонки.
Стоимость и где сделать?
Стоимость проведения исследования составляет 900 рублей, а применение допплера — 1500 рублей. Пациенты, которые уже проводили УЗИ, делятся лишь положительными отзывами.
Заключение
УЗИ яичек — это один из самых достоверных способов исследования, применяющийся в урологии, он обладает высокой точностью и низкой стоимостью.
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