A retrospective study of bipedal lymphography (BL), computed tomography (CT) and ultrasonography (US) of retroperitoneal lymph nodes has been carried out in 95 patients with newly diagnosed testicular cancer. Twenty-one patients had abnormal lymph nodes at the time of staging. The diagnostic accuracies of CT and US were almost identical with a sensitivity of 80% and 76% respectively and a specificity for both of 100%. BL was performed in 84 patients and was in accordance with US and CT in 66 cases. In 2 cases only BL was positive, while 16 had equivocal results of lymphography, of whom 5 had metastases. Nine patients relapsed to the retroperitoneal lymph nodes during observation, reducing CT/US sensitivity for macroscopic and microscopic disease to 63%. US-guided biopsy was performed in a total of 28 patients at the time of staging or during follow-up. Twenty-three patients had malignant findings and 5 verified benign lesions. US represents a cheap and accurate alternative to CT in the detection of metastatic retroperitoneal lymph nodes. US and US-guided biopsy is indicated supplementary to CT in cases with borderline enlarged nodes on CT. Furthermore, US-guided biopsy should always be performed to verify or exclude relapse, when follow-up examinations reveal abnormal abdominal findings.