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Condorelli R, Calogero AE, La Vignera S. Relationship between Testicular Volume and Conventional or Nonconventional Sperm Parameters. Int J Endocrinol 2013; 2013:145792. [PMID: 24089610 PMCID: PMC3780703 DOI: 10.1155/2013/145792] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 08/02/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Reduced testicular volume (TV) (<12 cm(3)) is associated with lower testicular function. Several studies explored the conventional sperm parameters (concentration, motility, and morphology) and the endocrine function (gonadotropins and testosterone serum concentrations) in the patients with reduction of TV. No other parameters have been examined. Aim. This study aims at evaluating some biofunctional sperm parameters by flow cytometry in the semen of men with reduced TV compared with that of subjects with normal TV. Methods. 78 patients without primary scrotal disease were submitted to ultrasound evaluation of the testis. They were divided into two groups according to testicular volume: A Group, including 40 patients with normal testicular volume (TV > 15 cm(3)) and B Group, including 38 patients with reduced testicular volume (TV ≤ 12 cm(3)). All patients underwent serum hormone concentration, conventional and biofunctional (flow cytometry) sperm parameters evaluation. Results. With regard to biofunctional sperm parameters, all values (mitochondrial membrane potential, phosphatidylserine externalization, chromatin compactness, and DNA fragmentation) were strongly negatively correlated with testicular volume (P < 0.0001). Conclusions. This study for the first time in the literature states that the biofunctional sperm parameters worsen and with near linear correlation, with decreasing testicular volume.
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Affiliation(s)
- Rosita Condorelli
- Section of Endocrinology, Andrology and Internal Medicine, Department of Medical and Pediatric Sciences, University of Catania, Policlinico “G. Rodolico”, Via S. Sofia 78, Building 4, Room 2C19, 95123 Catania, Italy
| | - Aldo E. Calogero
- Section of Endocrinology, Andrology and Internal Medicine, Department of Medical and Pediatric Sciences, University of Catania, Policlinico “G. Rodolico”, Via S. Sofia 78, Building 4, Room 2C19, 95123 Catania, Italy
| | - Sandro La Vignera
- Section of Endocrinology, Andrology and Internal Medicine, Department of Medical and Pediatric Sciences, University of Catania, Policlinico “G. Rodolico”, Via S. Sofia 78, Building 4, Room 2C19, 95123 Catania, Italy
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205
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A review of ultrasound imaging in scrotal emergencies. J Ultrasound 2013; 16:171-8. [PMID: 24432171 DOI: 10.1007/s40477-013-0033-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 08/01/2013] [Indexed: 02/01/2023] Open
Abstract
Scrotal emergencies represent a small proportion of admissions to the emergency department; however, the intimate nature and potential for serious outcome often cause great anxiety. Rapid assessment is required to exclude fertility-threatening conditions and expedite surgical management. Ultrasound is an essential tool in acute scrotal assessment as it allows rapid, radiation-free, high-resolution imaging and, importantly, assessment of vascularity with colour Doppler imaging. In the presentation of the acute scrotum, the "on-call" practitioner will frequently be asked to exclude pathology requiring surgical management, in particular torsion of the spermatic cord. To provide an accurate evaluation the individual is required to have an understanding of scrotal anatomy, sonographic technique and recognition of pathology. This review article will familiarise the reader with the sonographic findings of common acute scrotal pathology.
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206
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D'Andrea A, Coppolino F, Cesarano E, Russo A, Cappabianca S, Genovese EA, Fonio P, Macarini L. US in the assessment of acute scrotum. Crit Ultrasound J 2013; 5 Suppl 1:S8. [PMID: 23902859 PMCID: PMC3711727 DOI: 10.1186/2036-7902-5-s1-s8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The acute scrotum is a medical emergency . The acute scrotum is defined as scrotal pain, swelling, and redness of acute onset. Scrotal abnormalities can be divided into three groups , which are extra-testicular lesion, intra-testicular lesion and trauma. This is a retrospective analysis of 164 ultrasound examination performed in patient arriving in the emergency room for scrotal pain. The objective of this article is to familiarize the reader with the US features of the most common and some of the least common scrotal lesions. Methods Between January 2008 and January 2010, 164 patients aged few month and older with scrotal symptoms, who underwent scrotal ultrasonography (US), were retrospectively reviewed. The clinical presentation, outcome, and US results were analyzed. The presentation symptoms including scrotal pain, painless scrotal mass or swelling, and trauma. Results Of 164 patients, 125 (76%) presented with scrotal pain, 31 (19%) had painless scrotal mass or swelling and 8 (5%) had trauma. Of the 125 patients with scrotal pain, 72 had infection,10 had testicular torsion, 8 had testicular trauma, 18 had varicocele, 20 had hydrocele, 5 had cryptorchidism, 5 had scrotal sac and groin metastases, and 2 had unremarkable results. In the 8 patients who had history of scrotal trauma, US detected testicular rupture in 1 patients, scrotal haematomas in 2 patients . Of the 19 patients who presented with painless scrotal mass or swelling, 1 6 had extra-testicular lesions and 3 had intra-testicular lesions. All the extra-testicular lesions were benign. Of the 3 intra-testicular lesions, one was due to tuberculosis epididymo-orchitis, one was non-Hodgkin’s lymphoma, and one was metastasis from liposarcoma Conclusions US provides excellent anatomic detail; when color Doppler and Power Doppler imaging are added, testicular perfusion can be assessed
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MILES G, FREEMAN SJ. Ultrasound imaging of the “on call” acute scrotum. IMAGING 2013. [DOI: 10.1259/imaging.20120025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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211
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De Zordo T, Stronegger D, Pallwein-Prettner L, Harvey CJ, Pinggera G, Jaschke W, Aigner F, Frauscher F. Multiparametric ultrasonography of the testicles. Nat Rev Urol 2013; 10:135-48. [DOI: 10.1038/nrurol.2012.255] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
Ultrasonography is currently the imaging modality of choice when assessing scrotal lesions. Ultrasound findings are sometimes inconclusive, in which case magnetic resonance (MR) imaging might yield additional important information. This article reviews ultrasound and MR imaging features of various intratesticular and extratesticular lesions including acute and nonacute conditions of the scrotum. Nonneoplastic lesions that can mimic scrotal malignancy are discussed. Normal anatomy and imaging techniques are also presented.
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Affiliation(s)
- Lejla Aganovic
- Department of Radiology, VA Hospital, University of California San Diego, San Diego, CA 92161, USA.
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213
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Lubner MG, Simard ML, Peterson CM, Bhalla S, Pickhardt PJ, Menias CO. Emergent and Nonemergent Nonbowel Torsion: Spectrum of Imaging and Clinical Findings. Radiographics 2013; 33:155-73. [DOI: 10.1148/rg.331125016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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214
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Solución del caso 45. Sarcoidosis con afectación testicular. RADIOLOGIA 2013. [DOI: 10.1016/j.rx.2011.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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215
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Pezzella A, Barbonetti A, Micillo A, D'Andrea S, Necozione S, Gandini L, Lenzi A, Francavilla F, Francavilla S. Ultrasonographic determination of caput epididymis diameter is strongly predictive of obstruction in the genital tract in azoospermic men with normal serum FSH. Andrology 2012; 1:133-8. [DOI: 10.1111/j.2047-2927.2012.00010.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 07/18/2012] [Accepted: 08/02/2012] [Indexed: 11/30/2022]
Affiliation(s)
- A. Pezzella
- Andrology Unit; Department of Life, Health and Environment Sciences; University of L'Aquila; L'Aquila; Italy
| | - A. Barbonetti
- Andrology Unit; Department of Life, Health and Environment Sciences; University of L'Aquila; L'Aquila; Italy
| | - A. Micillo
- Andrology Unit; Department of Life, Health and Environment Sciences; University of L'Aquila; L'Aquila; Italy
| | - S. D'Andrea
- Andrology Unit; Department of Life, Health and Environment Sciences; University of L'Aquila; L'Aquila; Italy
| | - S. Necozione
- Epidemiology Unit; Department of Life, Health and Environment Sciences; University of L'Aquila; L'Aquila; Italy
| | - L. Gandini
- Department of Experimental Medicine; University of “La Sapienza”; Rome; Italy
| | - A. Lenzi
- Department of Experimental Medicine; University of “La Sapienza”; Rome; Italy
| | - F. Francavilla
- Andrology Unit; Department of Life, Health and Environment Sciences; University of L'Aquila; L'Aquila; Italy
| | - S. Francavilla
- Andrology Unit; Department of Life, Health and Environment Sciences; University of L'Aquila; L'Aquila; Italy
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217
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Zengin K, Sener NC, Alisir I. Magnetic resonance imaging of paratesticular inflammatory pseudotumor: a case report. Clin Genitourin Cancer 2012; 11:204-6. [PMID: 22995225 DOI: 10.1016/j.clgc.2012.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 07/18/2012] [Accepted: 08/16/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Kursad Zengin
- Diskapi Yildirim, Beyazid Teaching and Research Hospital, Urology Clinic, Ankara, Turkey
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218
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Frøen H, Brennhovd B, Abeler VM, Madsbu UE, Lehne G. [Young man with severe back pain]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:1626-9. [PMID: 22875130 DOI: 10.4045/tidsskr.11.1059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Hege Frøen
- Avdeling for kreftbehandling, Radiumhospitalet, Oslo universitetssykehus, Norway.
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219
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Ammar T, Sidhu PS, Wilkins CJ. Male infertility: the role of imaging in diagnosis and management. Br J Radiol 2012; 85 Spec No 1:S59-68. [PMID: 22763036 DOI: 10.1259/bjr/31818161] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The investigation of male infertility is assuming greater importance, with male factors implicated as a causal factor in up to half of infertile couples. Following routine history, examination and blood tests, imaging is frequently utilised in order to assess the scrotal contents for testicular volume and morphology. Additionally, this may give indirect evidence of the presence of possible reversible pathology in the form of obstructive azoospermia. Further imaging in the form of transrectal ultrasound and MRI is then often able to categorise the level of obstruction and facilitate treatment planning without resort to more invasive imaging such as vasography. Ultrasound guidance of therapy such as sperm or cyst aspiration and vasal cannulation may also be performed. This article reviews the imaging modalities used in the investigation of male infertility, and illustrates normal and abnormal findings that may be demonstrated.
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Affiliation(s)
- T Ammar
- Department of Radiology, King's College Hospital, Denmark Hill, London, UK
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220
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Shaida N, Berman LH. Percutaneous testicular biopsy for indeterminate testicular lesions. Br J Radiol 2012; 85 Spec No 1:S54-8. [PMID: 22674703 DOI: 10.1259/bjr/30496032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Ultrasound forms an important part of the assessment of the testicle. Nevertheless, there are a number of situations in which clinical and radiological assessment is unable to provide a definitive diagnosis of a testicular lump. In these situations, historically, either open biopsy or orchidectomy has been performed. Ultrasound-guided percutaneous testicular biopsy is an alternative, less invasive method of obtaining histological diagnosis. Here we describe the rationale, technique and potential uses of the technique.
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Affiliation(s)
- N Shaida
- Department of Radiology, Addenbrookes Hospital, Cambridge, UK. nadeem.shaida@addenbrookes
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221
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Liniger B, Fleischmann A, Zachariou Z. Benign cystic lesions in the testis of children. J Pediatr Urol 2012; 8:226-33. [PMID: 21742558 DOI: 10.1016/j.jpurol.2011.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 06/15/2011] [Indexed: 11/26/2022]
Abstract
Cystic lesions in the testis of children are rare and in most cases benign tumors. However, a preoperative diagnostic work-up could contribute to planning the surgical procedure: orchiectomy in the case of potential malignancy or otherwise a testis-sparing approach. In this study we reviewed our recent cases of benign cystic testicular tumors and the corresponding literature. The different entities are presented with details of the diagnostic work-up, pathology and treatment of these lesions. In all presented cases, organ-preserving treatment was performed. This practice is to be recommended in the case of all prepubertal cystic testicular lesions.
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Affiliation(s)
- B Liniger
- Department of Pediatric Surgery, Inselspital, University of Berne, Freiburgstrasse, 3010 Berne, Switzerland.
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222
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Schouten N, van Dalen T, Smakman N, Elias SG, van de Water C, Spermon RJ, Mulder LS, Burgmans IPJ. Male infertility after endoscopic Totally Extraperitoneal (Tep) hernia repair (Main): rationale and design of a prospective observational cohort study. BMC Surg 2012; 12:7. [PMID: 22612995 PMCID: PMC3414734 DOI: 10.1186/1471-2482-12-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 05/21/2012] [Indexed: 04/29/2023] Open
Abstract
Background To describe the rationale and design of an observational cohort study analyzing the effects of endoscopic Totally Extraperitoneal (TEP) hernia repair on male fertility (MAIN study). Methods and design The MAIN study is an observational cohort study designed to assess fertility after endoscopic TEP hernia repair. The setting is a high-volume single center hospital, specialized in TEP hernia repair. Male patients of 18-60 years of age, with primary, reducible, bilateral inguinal hernias and no contraindications for endoscopic TEP repair are eligible for inclusion in this study. Patients with an ASA-classification ≥ III and patients with recurrent and/or scrotal hernias and/or a medical history of pelvic surgery and/or radiotherapy, known fertility problems, diabetes and/or other diseases associated with a risk of fertility problems, will be excluded. The primary outcome is the testicular perfusion before and 6 months after TEP hernia repair (assessed by means of a scrotal ultrasonography). Secondary endpoints are the testicular volume (Ultrasound), semen quality and quantity and the endocrinological status, based on serum levels of the sexual hormones follicle-stimulating hormone (FSH), luteinizing hormone (LSH), testosterone and inhibin B before and 6 months after TEP hernia repair. Discussion The use of polypropylene mesh is associated with a strong foreign body reaction which could play a role in chronic groin pain development. Since the mesh in (endoscopic) inguinal hernia repair is placed in close contact to the vas deferens and spermatic vessels, the mesh-induced inflammatory reaction could lead to a dysfunction of these structures. Relevant large and prospective clinical studies on the problem are limited. This study will provide a complete assessment of fertility in male patients who undergo simultaneous bilateral endoscopic TEP hernia repair, by analyzing testicular perfusion and volume, semen quantity and quality and endocrinological status before and 6 months after TEP repair. Trial registration The MAIN study is registered in the Dutch Trial Register (NTR2208)
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Affiliation(s)
- Nelleke Schouten
- Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Utrecht, The Netherlands.
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223
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Yang DM, Kim HC, Lim SJ. Sonographic findings of fibrous pseudotumor of the tunica vaginalis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:252-254. [PMID: 22031022 DOI: 10.1002/jcu.20888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 08/26/2011] [Indexed: 05/31/2023]
Abstract
We report the sonographic findings in a case of fibrous pseudotumor of the tunica vaginalis. Scrotal gray-scale sonography revealed a well-margined, hypoechoic mass with an onion ring appearance and central calcifications in the left scrotum. Color Doppler sonography showed no blood flow within the mass. The pathological examination revealed a fibrous pseudotumor with a paucicellular and fibroblastic proliferation of cells within a hyalinized collagenous stroma.
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Affiliation(s)
- Dal Mo Yang
- Department of Radiology and Pathology, Kyung Hee University Hospital at Gangdong, 149 Sangil-Dong, Gangdong-Gu, Seoul, South Korea
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224
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Brunereau L, Bruyère F, Linassier C, Baulieu JL. The role of imaging in staging and monitoring testicular cancer. Diagn Interv Imaging 2012; 93:310-8. [PMID: 22464993 DOI: 10.1016/j.diii.2012.01.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The prognosis for testicular cancer is excellent, with a 5-year survival rate greater than 95%. Patients affected can therefore expect to be cured after treatment. Successful treatment requires assessment of the condition at the various stages of its management. Imaging plays a major role in initial analysis of the lymphatic extension and in looking for metastases. It is essential for evaluating the response to treatment and during follow-up after treatment. CT is the most commonly used imaging method in this context, but the role of PET is currently developing. The purpose of this paper is to review the role of the imaging methods commonly used in the management of testicular cancer.
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Affiliation(s)
- L Brunereau
- UFR médecine, Departement of Diagnostic and Interventional Radiology-Neuroradiology, Center for Medical Imaging, CHU de Tours, université François-Rabelais, 37044 Tours cedex 9, France.
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225
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Aigner F, De Zordo T, Pallwein-Prettner L, Junker D, Schäfer G, Pichler R, Leonhartsberger N, Pinggera G, Dogra VS, Frauscher F. Real-time sonoelastography for the evaluation of testicular lesions. Radiology 2012; 263:584-9. [PMID: 22396607 DOI: 10.1148/radiol.12111732] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the feasibility of using real-time sonoelastography (RTE) for the differentiation and characterization of testicular lesions. MATERIALS AND METHODS Institutional review board approval was obtained for this retrospective study, and the requirement to obtain informed consent was waived. Fifty patients (mean age, 42 years; age range, 18-81 years) with testicular lesions detected with gray-scale ultrasonography (US) and color and/or power Doppler US were evaluated with RTE between December 2004 and August 2010 to assess tissue elasticity of the testes. Stiff or "hard" lesions were suspected of being malignant. Testicular lesions with normal or decreased tissue stiffness ("soft" lesions) were considered benign. Findings from surgery and histopathologic examination were used as the reference standard in 34 cases, and findings from clinical and US follow-up were used as the reference standard in 16 cases. Sensitivity, specificity, negative predictive value, positive predictive value, and diagnostic accuracy were calculated. RESULTS Thirty-four of the 50 lesions (68%) were testicular tumors and 16 (32%) were of nontumorous origin. RTE showed the presence of hard lesions in all cases of testicular tumors and three cases of nontumorous lesions. Four lesions with an uncertain diagnosis when tested with gray-scale US and color and/or power Doppler US alone were soft at RTE and showed nontumorous character at follow-up. RTE showed a sensitivity of 100%, a specificity of 81%, a negative predictive value of 100%, a positive predictive value of 92%, and an accuracy of 94% in the diagnosis of testicular tumors. CONCLUSION RTE demonstrated all testicular tumors as lesions with increased tissue stiffness. Because of its higher specificity, RTE can provide additional information in cases with indeterminate US findings.
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Affiliation(s)
- Friedrich Aigner
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
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226
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Iaccarino V, Venetucci P. Interventional Radiology of Male Varicocele: Current Status. Cardiovasc Intervent Radiol 2012; 35:1263-80. [DOI: 10.1007/s00270-012-0350-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 12/22/2011] [Indexed: 10/28/2022]
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227
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Akhter W, Khan S, Khan F, Younis A, Khan SZ. Testicular microlithiasis: Case report and literature review. AFRICAN JOURNAL OF UROLOGY 2012. [DOI: 10.1016/j.afju.2012.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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229
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Tsili AC, Argyropoulou MI, Giannakis D, Tsampalas S, Sofikitis N, Tsampoulas K. Diffusion-weighted MR imaging of normal and abnormal scrotum: preliminary results. Asian J Androl 2012; 14:649-54. [PMID: 22367182 DOI: 10.1038/aja.2011.172] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Magnetic resonance (MR) imaging of the scrotum represents an important supplemental diagnostic tool in the evaluation of scrotal diseases. Diffusion-weighted (DW) MR imaging is a developing technique, proved to improve tissue characterization. We evaluated the feasibility and diagnostic performance of DW MR imaging in the detection and characterization of scrotal lesions. We retrospectively evaluated 31 scrotal lesions (23 intratesticular and 8 extratesticular) in 26 men. All MR examinations were performed on a 1.5-T unit, using a pelvic-phased array coil. DW sequences were obtained using a single shot, multislice spin echo planar diffusion pulse sequence and a b factor of 0 and 900 s mm(-2). The DW MR characteristics and the apparent diffusion coefficient (ADC) values of normal scrotal contents and scrotal diseases were evaluated. Comparison between the ADC values of normal scrotum, benign lesions and scrotal malignancies was performed. The accuracy of conventional sequences, DW images alone and DW imaging combined with conventional images in differentiating benign from malignant scrotal lesions was calculated. The ADC values of testicular malignancies were different from those of normal testis and benign intratesticular lesions, and the ADC values of benign extratesticular lesions from those of normal epididymis (P<0.05). The overall accuracy of conventional imaging, DW imaging alone and DW MR combined with conventional sequences in the characterization of intratesticular lesions was 91%, 87% and 100%, respectively. Our findings suggest that DW MR imaging and ADC values may provide valuable information in the diagnosis and characterization of scrotal diseases.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, University Hospital of Ioannina, Ioannina 45500, Greece.
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230
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Singh R, Hamada AJ, Bukavina L, Agarwal A. Physical deformities relevant to male infertility. Nat Rev Urol 2012; 9:156-74. [DOI: 10.1038/nrurol.2012.11] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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231
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Mouradi R, Desai N, Erdemir A, Agarwal A. The use of FDTD in establishing in vitro experimentation conditions representative of lifelike cell phone radiation on the spermatozoa. HEALTH PHYSICS 2012; 102:54-62. [PMID: 22134078 DOI: 10.1097/hp.0b013e3182289bfb] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Recent studies have shown that exposing human semen samples to cell phone radiation leads to a significant decline in sperm parameters. In daily living, a cell phone is usually kept in proximity to the groin, such as in a trouser pocket, separated from the testes by multiple layers of tissue. The aim of this study was to calculate the distance between cell phone and semen sample to set up an in vitro experiment that can mimic real life conditions (cell phone in trouser pocket separated by multiple tissue layers). For this reason, a computational model of scrotal tissues was designed by considering these separating layers, the results of which were used in a series of simulations using the Finite Difference Time Domain (FDTD) method. To provide an equivalent effect of multiple tissue layers, these results showed that the distance between a cell phone and semen sample should be 0.8 cm to 1.8 cm greater than the anticipated distance between a cell phone and the testes.
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Affiliation(s)
- Rand Mouradi
- Center for Reproductive Medicine, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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232
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AIUM practice guideline for the performance of an ultrasound examination in the practice of urology. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:133-144. [PMID: 22215782 DOI: 10.7863/jum.2012.31.1.133] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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233
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McDonald MW, Reed AB, Tran PT, Evans LA. Testicular Tumor Ultrasound Characteristics and Association with Histopathology. Urol Int 2012; 89:196-202. [DOI: 10.1159/000338771] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 04/07/2012] [Indexed: 11/19/2022]
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234
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Phillips GS, Paladin A. Essentials of genitourinary disorders in children: imaging evaluation. Semin Roentgenol 2011; 47:56-65. [PMID: 22166231 DOI: 10.1053/j.ro.2011.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Grace S Phillips
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA 98105, USA.
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Venkatanarasimha N, Hilmy S, Freeman S. Case 175: Testicular lipomatosis in Cowden disease. Radiology 2011; 261:654-8. [PMID: 22012908 DOI: 10.1148/radiol.11091151] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nanda Venkatanarasimha
- Department of Radiology, Level 6, Derriford Hospital, Derriford Rd, Plymouth PL6 8DH, England.
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236
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Bonardi M, Dellabianca C, Alessi S. Post-traumatic hematoma of the epididymis: Case-report. J Ultrasound 2011; 14:196-8. [PMID: 23396685 DOI: 10.1016/j.jus.2011.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Scrotal trauma accounts for less than 1% of all trauma-related injuries. Traumatic injuries of the epididymis are extremely rare.Here we report a rare case of hematoma of the epididymis, diagnosed with US, in a 10-year-old boy after a sport injury.
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Affiliation(s)
- M Bonardi
- IRCCS Foundation, San Matteo Medical Center, Institute of Radiology, University of Pavia, Italy
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237
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Valentino M, Bertolotto M, Ruggirello M, Pavlica P, Barozzi L, Rossi C. Cystic lesions and scrotal fluid collections in adults: Ultrasound findings. J Ultrasound 2011; 14:208-15. [PMID: 23396379 DOI: 10.1016/j.jus.2011.10.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The widespread use of scrotal ultrasonography (US) has led to increased detection of testicular and extratesticular pathologies. Cystic or encapsulated fluid collections are relatively common benign lesions that usually present as palpable testicular lumps. Most cysts arise in the epidydimis, but all anatomical structures of the scrotum can be the site of their origin. US may suggest a specific diagnosis for a wide variety of intrascrotal cystic and fluid lesions and appropriately guide therapeutic options. US should be used as an adjunctive diagnostic modality after clinical evaluation of a scrotal lesion associated or not with the presence of a lump.
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Affiliation(s)
- M Valentino
- Urgency and Emergency Radiology, Department of Radiology and Diagnostic Imaging, Hospital of Parma, Italy
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238
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La Vignera S, Vicari E, Condorelli R, D'Agata R, Calogero AE. Hypertrophic-congestive and fibro-sclerotic ultrasound variants of male accessory gland infection have different sperm output. J Endocrinol Invest 2011; 34:e330-5. [PMID: 22234181 DOI: 10.1007/bf03346729] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Male accessory gland infection (MAGI) exerts a negative influence on male fertility which depends upon its extension. Indeed, we have shown that patients with MAGI involving prostate, seminal vesicles and epididymis have worse sperm parameters compared with patients with prostatitis alone or prostate-vesiculitis. Similarly, MAGI extending bilaterally is associated with a worse sperm output. The aims of this study were to evaluate the prevalence of two different additional ultrasound (US) findings (hypertrophic- congestive and a fibro-sclerotic US form) and to evaluate their semen quality. MATERIALS AND METHODS One hundred infertile patients with MAGI, diagnosed according to the World Health Organization (WHO) 1993 criteria, were evaluated by scrotal and transrectal ultrasound scans. The control group consisted of 100 healthy, age-matched men. RESULTS The ultrasound examination confirms two separate US variants of MAGI: a hypertrophic-congestive (prevalence of 56%) and a fibro-sclerotic form (prevalence of 29%). Patients with hypertrophic-congestive MAGI showed higher sperm concentration, motility and normal forms, but also higher sperm leukocytes concentration and seminal reactive oxygen species compared to patients with fibro-sclerotic MAGI. However, all these parameters were significantly worse than those observed in the control group. DISCUSSION Infertile patients with hypertrophic-congestive MAGI have a better sperm quality compared with patients with fibrosclerotic MAGI; however, they showed higher oxidative stress in semen.
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Affiliation(s)
- S La Vignera
- Section of Endocrinology, Andrology and Internal Medicine, and Master in Andrological, Human Reproduction and Biotechnology Sciences, Department of Internal Medicine and Systemic Diseases, University of Catania, 95123 Catania, Italy.
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239
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Maki D, Watanabe Y, Nagayama M, Ishimori T, Okumura A, Amoh Y, Nakashita S, Terai A, Dodo Y. Diffusion-weighted magnetic resonance imaging in the detection of testicular torsion: Feasibility study. J Magn Reson Imaging 2011; 34:1137-42. [DOI: 10.1002/jmri.22698] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 05/26/2011] [Indexed: 12/27/2022] Open
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240
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La Vignera S, Calogero AE, Condorelli RA, Vicari LO, Catanuso M, D'Agata R, Vicari E. Ultrasonographic evaluation of patients with male accessory gland infection. Andrologia 2011; 44 Suppl 1:26-31. [PMID: 21919940 DOI: 10.1111/j.1439-0272.2010.01132.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
MAGI is the inflammation of the accessory male glands that notoriously exerts a negative influence on male fertility. The diagnosis is integrated by clinical, laboratory and ultrasound evaluation. In particular, the ultrasound criteria were published in 1999. The aim of this study was to analyse the sensitivity and specificity of additional diagnostic ultrasound criteria as well as of conventional criteria in a selected category of infertile patients with MAGI. To accomplish this, 100 patients with MAGI were evaluated by scrotal and transrectal ultrasound by three different operators. The control group consisted of 100 age-matched healthy men. Statistical analysis was performed to evaluate sensitivity, specificity, positive and negative predictive values, and ROC curve analysis. The results showed that additional ultrasound criteria had a diagnostic accuracy similar to traditional criteria. The threshold value of two criteria for each diagnostic category (traditional and additional criteria) obtained high values of sensitivity and specificity. In conclusion, this study confirms the validity of the ultrasound criteria of MAGI previously published; in addition, it suggests the clinical utility of other indicators in clinical practice with good diagnostic accuracy and finally it establishes a clear threshold ultrasonographic value for the diagnosis of MAGI.
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Affiliation(s)
- S La Vignera
- Section of Endocrinology, Andrology and Internal Medicine and Master in Andrological, Human Reproduction and Biotechnology Sciences, Department of Internal Medicine and Systemic Diseases, Catania University, Catania, Italy.
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241
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Pauroso S, Di Leo N, Fulle I, Di Segni M, Alessi S, Maggini E. Varicocele: Ultrasonographic assessment in daily clinical practice. J Ultrasound 2011; 14:199-204. [PMID: 23396816 DOI: 10.1016/j.jus.2011.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Varicoceles are abnormal dilatations of the pampiniform venous plexus. They are classified as primary or secondary, depending on their cause, and staged clinically on the basis of their extension and on the presence or the absence of spontaneous or induced reversal of blood flow. MATERIALS AND METHODS We examined 95 patients (age range: 3-77 years) using Color Doppler ultrasound with settings optimized for the study of slow flow. All patients found to have varicoceles underwent ultrasonographic assessment of the kidneys and retroperitoneum. Findings were classified with a simplified version of the Sarteschi system. RESULTS 41 (43.1%) of the patients were found to have varicoceles, which were classified as grade 1 in 11 cases, grade 2 in 13, grade 3 in 10, and grade 4 in 7 according to the simplified Sarteschi classification. DISCUSSION Our results are with those reported in the literature. They confirm that varicoceles are a frequent finding and ultrasonography is currently the best imaging technique for its diagnosis and also for the post-surgery follow-up.
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Affiliation(s)
- S Pauroso
- Foundation IRCCS, Policlinico San Matteo, Institute of Radiology, University of Pavia, Italy
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242
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Parelkar SV, Oak S, Bachani MK, Sanghvi B, Prakash A, Patil R, Sahoo S, Patel J. Laparoscopic repair of pediatric inguinal hernia--is vascularity of the testis at risk? A study of 125 testes. J Pediatr Surg 2011; 46:1813-6. [PMID: 21929995 DOI: 10.1016/j.jpedsurg.2011.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 04/11/2011] [Accepted: 05/09/2011] [Indexed: 10/17/2022]
Abstract
AIM The aim of this study was to study the effects of laparoscopic inguinal hernia repair on testicular perfusion and size. MATERIALS AND METHODS A prospective study concerning laparoscopic inguinal hernia repair was performed for an 18-month period to evaluate testicular perfusion and size in the preoperative, early postoperative (within 48 hours of surgery), and late postoperative periods (6 months after surgery) using Doppler ultrasound (DUS) (both duplex and power Doppler mode). Laparoscopic closure of the deep inguinal ring was accomplished with a purse string suture (Nylon 3-0) using standard 3-port technique. The testis units were divided in 2 groups: group 1 comprising testis units in which a resistive index (RI) could be calculated and group 2 with instances in which an RI could not be calculated but showed blood flow consistently on DUS. RESULTS A total of 112 boys underwent laparoscopic inguinal hernia repair with 100 available for complete follow-up and data analysis. One hundred twenty-five inguinal (25 bilateral) hernia repairs were performed. Group 1 had 80 testis units. There was no significant difference in values of RI between preoperative, early postoperative, and late postoperative periods. Group 2 had 45 testis units. Resistive index could not be calculated. Seventy-five percent showed only systolic blood flow on spectral analysis; hence, RI, 1; and the rest showed the presence of blood flow on power Doppler scan. All testis units consistently showed blood flow in the early and late postoperative period. No testicular atrophy was found at 6-month follow-up examination on DUS. CONCLUSION Laparoscopic repair of inguinal hernia in children does not affect testicular perfusion or growth.
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Affiliation(s)
- Sandesh V Parelkar
- Department of Pediatric Surgery, King Edward Memorial Hospital, Parel, Mumbai 400 012, India.
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243
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Cervelli V, Brinci L, Palla L, Spallone D, Izzo V, Curcio CB, Lucarini L, De Angelis B. Skin necrosis of scrotum due to endovascular embolisation: a case report. Int Wound J 2011; 9:70-5. [PMID: 21883935 DOI: 10.1111/j.1742-481x.2011.00847.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The aim of our case report was to analyse the results obtained with the Matriderm® system and autologous skin grafting for the surgical treatment of skin necrosis of scrotum as a result of endovascular embolisation. We recruited one patient with scrotum skin necrosis as a result of endovascular embolisation admitted at the department of Plastic and Reconstructive Surgery, University of Rome 'Tor Vergata'. The patient underwent Matriderm® system and autologous skin grafting for skin necrosis treatment. After a single treatment, reduction of the skin necrosis was obtained, after 30 days from the surgical treatment. Patient experienced a reduction in pain and a complete restoration of the loss in volume and quality of skin was noticed. Matriderm® system and autologous skin grafting is a simple, safe and feasible technique. When comparing this treatment with others, Matriderm® is a simpler, more economic and less time-consuming method, and does not require sophisticated laboratory facilities.
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Affiliation(s)
- Valerio Cervelli
- Department of Plastic and Reconstructive Surgery at the University of Rome 'Tor Vergata', Rome, Italy
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244
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Tsili AC, Argyropoulou MI, Giannakis D, Zioga E, Koukos S, Sofikitis N, Tsampoulas K. Isolated granulomatous orchitis: MR imaging findings. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.ejrex.2011.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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245
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Testicular arteriovenous malformation: gray-scale and color Doppler ultrasonography features. Case Rep Med 2011; 2011:876206. [PMID: 21785607 PMCID: PMC3139914 DOI: 10.1155/2011/876206] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 05/21/2011] [Indexed: 11/17/2022] Open
Abstract
Intratesticular arteriovenous malformations (AVMs) are extremely rare benign incidental lesions of the testis. Ultrasonography (US) generally reveals a hypoechoic solid mass within the testicular parenchyma. We describe a patient with intratesticular AVM which was found incidentally during workup for infertility. The gray-scale and Doppler US appearance of an intratesticular AVM and the differential diagnosis have been presented. Based on the gray-scale, US appearance differentiation from malignant testicular tumors is difficult. Doppler US examination aids in the diagnosis by demonstrating the vascular nature of the tumor.
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246
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O’Connor WG, Bianchi GD, Willis MS, McCudden CR. Testicular Mass in a 40-Year-Old Man. Lab Med 2011. [DOI: 10.1309/lm0qfesymx42nlxb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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247
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Yilmaz O, Yilmaz S, Kisacik B, Aydogdu M, Bozkurt Y, Erdem H, Pay S, Saglam M, Dinc A. Varicocele and epididymitis in Behcet disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:909-913. [PMID: 21705723 DOI: 10.7863/jum.2011.30.7.909] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Behçet disease is a systemic disease with protean manifestations. Vasculitis is a hallmark of the disease and may involve arteries, veins, and capillaries. Varicocele is dilatation of the pampiniform plexus veins. We aimed to investigate the incidence of varicocele in patients with Behçet disease. METHODS The study included 47 male patients with Behçet disease and 31 healthy control participants. All underwent a clinical evaluation including a medical history and systemic and scrotal examinations. Subsequently, 2 investigators blinded to the clinical data performed sonographic examinations and measured pampiniform plexus vein diameters. RESULTS The mean age of the patients ± SD was 23.4 ± 3.2 years; disease durations ranged from 3 to 120 months (46 ± 31 months). Scrotal pain or a palpable mass was detected by clinical examination in 24 patients with Behçet disease (51.1%) and 5 healthy participants (16.1%; P = .002). By color Doppler examination, left varicocele was diagnosed in 26 patients with Behçet disease (55.3%) and 9 healthy participants (29%; P = .02). All patients with right varicocele also had left varicocele; that condition was detected in 10.6% (5 patients) of the Behçet disease group and 6.4% (2 patients) of the control group (P > .05). Eight patients with Behçet disease (17%) had epididymitis, whereas none of the healthy participants did (P = .019, Fisher exact test). Genital ulcers and erythema nodosum lesions were more common among patients with varicocele (P = .034 and .058, respectively). There were no differences in smoking, epididymitis, arthritis, uveitis, or other clinical parameters for distinguishing varicocele in patients with Behçet disease. CONCLUSIONS The incidence of varicocele was increased in Behçet disease. Whether varicocele confers fertility problems in patients with Behçet disease and the underlying mechanism for a possible association are yet to be determined.
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Affiliation(s)
- Omer Yilmaz
- Division of Radiology, Gulhane School of Medicine, Etlik, 06018 Ankara, Turkey.
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248
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Valentino M, Bertolotto M, Derchi L, Bertaccini A, Pavlica P, Martorana G, Barozzi L. Role of contrast enhanced ultrasound in acute scrotal diseases. Eur Radiol 2011; 21:1831-40. [PMID: 21633826 DOI: 10.1007/s00330-010-2039-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 10/21/2010] [Accepted: 10/28/2010] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the efficacy of contrast-enhanced ultrasound (CEUS) in patients with acute scrotal pain not defined at ultrasound (US) with colour Doppler . METHODS CEUS was carried out in 50 patients with acute scrotal pain or scrotal trauma showing testicular lesion of undefined nature at US. The accuracy of US and CEUS findings versus definitive diagnosis (surgery or follow-up) was calculated. RESULTS Twenty-three patients had a final diagnosis of testicular tumour, three abscess, eight focal infarction, seven trauma, three testicular torsion, one haematoma. Five patients were negative. Thirty-five patients were operated (23 testicular tumours, six trauma, three testicular torsion, one abscess, one focal infarction, and one haematoma) and 15 underwent medical treatment or were discharged. US provided a definitive diagnosis in 34/50 as compared to the 48/50 patients diagnosed at CEUS. Sensitivity and specificity were 76% and 45% for US and 96% and 100% for CEUS respectively. CONCLUSIONS CEUS was more accurate in the final diagnosis compared to US, potentially reducing the need for further imaging. In particular CEUS can be proposed in emergency in cases where US diagnosis remains inconclusive, namely in infarction, and trauma, when testicular torsion cannot be ruled out, and in identifying testicular mass.
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Affiliation(s)
- Massimo Valentino
- Department of Diagnostic Imaging-Emergency Radiology Unit, University Hospital of Parma, Via Gramsci 14, 43100 Parma, Italy.
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249
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Role of US in acute scrotal pain. World J Urol 2011; 29:639-43. [DOI: 10.1007/s00345-011-0698-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 05/05/2011] [Indexed: 11/26/2022] Open
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250
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Lock G, Schmidt C, Helmich F, Stolle E, Dieckmann KP. Early Experience With Contrast-enhanced Ultrasound in the Diagnosis of Testicular Masses: A Feasibility Study. Urology 2011; 77:1049-53. [PMID: 21334049 DOI: 10.1016/j.urology.2010.12.035] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 12/15/2010] [Accepted: 12/21/2010] [Indexed: 10/18/2022]
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