Introduction

Diagnostic ultrasound has become the standard for medical imaging of soft tissue. The genital tract is an obvious target for this diagnostic modality and while ultrasound is routinely employed for evaluation of the female genital system, its use in male domestic animals remains much less common. In the bull, for example, the routine breeding soundness evaluation (BSE) as recommended by the Society for Theriogenology does not include ultrasonographic assessment of the genital system.¹ In most cases of infertility in the bull, adequate diagnostic and prognostic information is obtained without the use of ultrasonography. A major advantage of ultrasonography, however, is the ability to localize and objectively assess morphologic changes in tissue.

A thorough history, complete physical examination, and a BSE should precede an ultrasound examination of the bull’s genital system. We routinely perform ultrasound evaluations for bulls with palpable or visible abnormalities of the genital system; those with pyospermia, hemospermia, azoospermia, or oligospermia; those with low semen volume; and bulls that persistently produce high numbers of morphologically abnormal or immotile sperm. As with any medical technology, the use of ultrasonography for examination of the bull will expand as veterinarians become more familiar with the modality and its application.

Equipment and general methodology

A wide variety of ultrasound equipment is available for diagnostic imaging. Most veterinary clinics providing service to cattle owners will already have a portable, real-time, B-mode system with a linear intrarectal probe that is used for reproductive examination of cows. All illustrations in this chapter were obtained with this type of system. Typical probe frequencies range from 5 to 7.5 MHz and are more than adequate for imaging the bull’s reproductive tract. More detailed images of the epididymis and penile tissues can be obtained using probes with a smaller footprint and higher frequency. Representative images may be captured, labeled, measured, and saved for inclusion in the medical record. These applications are available with most ultrasound systems. In order to adequately assess a system you intend to purchase, it is advisable to use it in an actual clinical setting so you can critically evaluate functionality and image quality under real-world conditions. Beyond the primary issue of image quality, durability and resistance to damage from dirt and moisture are important considerations when purchasing an ultrasound unit to be used in cattle environments.

Operator safety is always a concern when working with bulls. A chute or stock with a head catch and squeeze option is ideal. For added security, the bull’s head should be secured with a halter. Most bulls will tolerate scrotal, perineal, and rectal examinations with little restraint beyond confinement in the chute. If a kick bar is used behind the bull, extreme caution is needed to avoid placing the arms and hands in a dangerous position. For fractious bulls or for examination of the prepuce and penis cranial to the scrotum, we prefer sedation (xylazine 0.01–0.02 mg/kg i.v.).

While it is beyond the scope of this chapter, a fundamental understanding of ultrasound principles and an appreciation for common image artifacts are essential for anyone offering diagnostic ultrasonography services. For those requiring a more expansive treatment of the basic principles of veterinary ultrasonography, excellent texts are available.^2,3 A bovine reproductive anatomy monograph is available from the National Association of Animal Breeders⁴ and McEntee⁵ is an excellent resource for those seeking a review of the pathology of the male genital system.

Images are obtained by either a transcutaneous or transrectal scan depending on the anatomical location of the tissue to be examined. If long or dense hair covers the area, the quality of the transcutaneous image is improved by first shaving the skin. Shaving is usually not required for examination of the scrotum and testes. Image quality is enhanced when the scrotal skin is stretched tightly over the testes. To do this, firmly grasp the scrotal neck dorsal to the testes and pull the testes ventrally while conducting the examination. In all cases of transcutaneous ultrasonography, a coupling agent is required to achieve good contact between the probe and skin. Any air or gas between the probe and the tissue to be examined will interfere with the acquisition of an image. The use of ultrasonic coupling gel as a coupling agent has the advantage of long duration, since it does not evaporate. Additionally, it is approved by most manufacturers for contact with the probe surface. Alcohol (70% isopropyl) also makes a good coupling agent, with the advantage that it does not have to be cleaned from the probe or patient after the examination is completed. A disadvantage of alcohol is that it evaporates and often needs to be reapplied to complete the examination. Additionally, not all probe surfaces are approved for contact with alcohol or other solvents. Placing a protective cover containing a small amount of coupling gel over the probe will prevent alcohol from contacting the probe surface. A disposable examination glove works well for this purpose.

For transrectal examination of the pelvic organs, the probe is covered with an examination sleeve containing just enough coupling gel to provide good contact between the probe and sleeve. Most probes designed for transrectal use in horses and cattle will fit snugly within a finger of a glove or sleeve. The feces are evacuated from the rectum and a manual examination is conducted before the covered probe is inserted. In our experience, no coupling agent is necessary to maintain contact between the sleeve and rectal mucosa beyond the lubricant normally used for palpation per rectum. If a protective cover is not used, the probe should be cleaned and disinfected between examinations following the recommendations of the probe manufacturer.

While diagnostic ultrasonography is generally regarded as safe for examination of reproductive tissues and fetuses,³ few published data exist in the veterinary literature. Coulter and Bailey⁶ exposed yearling beef bulls to ultrasound (3 min for each testis, one time, using a 5-MHz linear transducer) and found no discernible effects on sperm numbers, morphology, or motility during a 70-days period after the examination. They concluded that diagnostic ultrasonography should be safe for examination of the bull scrotum and testes. A reasonable approach is to use the minimum power and contact time necessary to complete your examination.