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Kizilgoz V, Kantarci M, Tonkaz G, Levent A, Ogul H. Incidental findings on prostate MRI: a close look at the field of view in this anatomical region. Acta Radiol 2022; 64:1676-1693. [PMID: 36226365 DOI: 10.1177/02841851221131243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Magnetic resonance imaging (MRI) has been widely used as an advanced imaging modality to detect prostate cancer and indicate suspicious areas to guide biopsy procedures. The increasing number of prostate examinations with MRI has provided an opportunity to detect incidental lesions, and some might be very significant to elucidate patient symptoms or occult neoplastic process in the early stages. These incidental lesions might be located in the prostate gland, adjacent tissues, or organs around the prostate gland or out of the genitourinary system. The field of view of prostate MRI includes not only the prostate gland but also other critical pelvic organs in this specific anatomical region. Some of these incidental lesions might cause the same symptoms as prostate cancer and might explain the symptoms of the patient, and some might indicate early cancer stages located outside the prostate. Reporting these lesions might be life-saving by initiating early disease treatment. Awareness of the predicted locations of congenital anomalies would also be beneficial for the radiologists to mention these incidental findings.
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Affiliation(s)
- Volkan Kizilgoz
- Faculty of Medicine, Department of Radiology, 162315Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Mecit Kantarci
- Faculty of Medicine, Department of Radiology, 162315Erzincan Binali Yıldırım University, Erzincan, Turkey.,Faculty of Medicine, Department of Radiology, 37503Atatürk University, Erzurum, Turkey
| | - Gokhan Tonkaz
- Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Akin Levent
- Faculty of Medicine, Department of Radiology, 162315Erzincan Binali Yıldırım University, Erzincan, Turkey.,Faculty of Medicine, Department of Radiology, 37503Atatürk University, Erzurum, Turkey
| | - Hayri Ogul
- Faculty of Medicine, Department of Radiology, Düzce University, Düzce, Turkey
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Kerr DM, Middleton WD. Ultrasound of the Normal and Abnormal Vas Deferens. Ultrasound Q 2022; 38:224-236. [PMID: 35129151 DOI: 10.1097/ruq.0000000000000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The extrapelvic portion of the vas deferens is readily visible with ultrasound but often overlooked. Several publications have described the scanning technique and the normal anatomy of the vas deferens. Sonographic evaluation of the vas deferens provides critical information in the workup of male infertility. Obstruction, inflammatory conditions, and neoplasms of the vas deferens can also be diagnosed with ultrasound. Knowledge of the normal and abnormal appearance of the vas deferens improves scans of the scrotum and expands the conditions that can be recognized and accurately diagnosed with ultrasound.
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Carr G. The Sonographic Appearance of Seminal Megavesicles, an Association With Autosomal Dominant Polycystic Kidney Disease: A Series Review. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/8756479321998005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Megavesicles are an uncommon diagnostic finding during sonography of the bladder, especially when the examination is performed transabdominally. Although megavesicles are more likely seen with transrectal ultrasonography, computed tomogram (CT), vesiculography, or magnetic resonance imaging (MRI), it has been noted during transabdominal sonography for patients suffering from autosomal dominant polycystic kidney disease (ADPKD). When seminal vesicles become dilated, they are often visualized during transabdominal sonography. Two patient cases are provided of seminal megavesicles, associated with ADPKD and have documented sonographic findings. Both patient cases of megavesicles were discovered incidentally during the course of a renal sonogram. The importance of these diagnostic findings and the possible pathogenesis are provided.
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Affiliation(s)
- Georgia Carr
- Diagnostic Medical Sonography Program, University of Colorado Hospital, Aurora, CO, USA
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Ultrasound evaluation of varicoceles: systematic literature review and rationale of the ESUR-SPIWG Guidelines and Recommendations. J Ultrasound 2020; 23:487-507. [PMID: 32720266 PMCID: PMC7588576 DOI: 10.1007/s40477-020-00509-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/11/2020] [Indexed: 02/02/2023] Open
Abstract
Although often asymptomatic and detected incidentally, varicocele is a relatively common problem in patients who seek medical attention for infertility problems. Ultrasound (US) is the imaging modality of choice for evaluation, but there is no consensus on the diagnostic criteria, classification, and examination technique. In view of this uncertainty, the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology (ESUR-SPIWG) undertook a systematic review of the available literature on this topic, to use as the basis for evidence-based guidelines and recommendations. This paper provides the results of the systematic review on which guidelines were constructed.
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Bellurkar A, Patwardhan S, Patil B, Kanbur A, Jain H, Velhal R. Role of Testicular Size as a Parameter for Predicting Infertility in Indian Males. J Hum Reprod Sci 2020; 13:114-116. [PMID: 32792759 PMCID: PMC7394088 DOI: 10.4103/jhrs.jhrs_7_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/04/2020] [Accepted: 04/05/2020] [Indexed: 12/02/2022] Open
Abstract
Context (Background): While the semen analysis appears to be the cornerstone in the evaluation of male fertility, the testicular size is a cheap, easy, and convenient to measure yet an ignored parameter for predicting the same. There is insufficient literature for identifying the testicular size cutoff among the Indian men. Aims: The study is aimed to correlate between the testicular volume and length with exocrine testicular function and to set a cutoff size for infertility in Indian men. Settings and Design: The study examined 354 cases over a period of 2 years. The cases comprised 258 men presenting with infertility as well as 96 fertile men as control. Materials and Methods: All the patients had their testes examined using Seager's calipers and Prader's orchidometer, infertile men had their semen analysis. Statistical Analysis: SPSS software and Chi-square test were applied, keeping P < 0.05 statistically significant. Results: The mean testicular volume and length in azoospermic patients were 10.3 ml and 2.4 cm, respectively, whereas in oligoasthenospermic patients they were 13.2 ml and 3.2 cm, respectively. The mean testicular volume, length among cases, and controls were 12.6 ml, 3.2 cm, 18.3 ml and 3.81 cm, respectively. Conclusion: Testicular size correlates significantly with severity of exocrine and endocrine functions. The testicular volume and length average for predicting infertility among Indian men should be 18 ml and 3.8 cm, respectively, unlike the international standards of 20 ml and 4.6 cm.
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Affiliation(s)
- Amit Bellurkar
- Department of Urology, Seth GSMC and KEMH, Mumbai, Maharashtra, India
| | - Sujata Patwardhan
- Department of Urology, Seth GSMC and KEMH, Mumbai, Maharashtra, India
| | - Bhushan Patil
- Department of Urology, Seth GSMC and KEMH, Mumbai, Maharashtra, India
| | - Ajay Kanbur
- Department of Urology, Seth GSMC and KEMH, Mumbai, Maharashtra, India
| | - Hitesh Jain
- Department of Urology, Seth GSMC and KEMH, Mumbai, Maharashtra, India
| | - Rishikesh Velhal
- Department of Urology, Seth GSMC and KEMH, Mumbai, Maharashtra, India
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Freeman S, Bertolotto M, Richenberg J, Belfield J, Dogra V, Huang DY, Lotti F, Markiet K, Nikolic O, Ramanathan S, Ramchandani P, Rocher L, Secil M, Sidhu PS, Skrobisz K, Studniarek M, Tsili A, Tuncay Turgut A, Pavlica P, Derchi LE. Ultrasound evaluation of varicoceles: guidelines and recommendations of the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) for detection, classification, and grading. Eur Radiol 2019; 30:11-25. [DOI: 10.1007/s00330-019-06280-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/19/2019] [Accepted: 05/20/2019] [Indexed: 02/07/2023]
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Reesink DJ, Huisman PM, Wiltink J, Boeken Kruger AE, Lock TMTW. Sneeze and pop: a ruptured varicocele; analysis of literature, guided by a well-documented case-report. BMC Urol 2019; 19:14. [PMID: 30704438 PMCID: PMC6357415 DOI: 10.1186/s12894-019-0442-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/21/2019] [Indexed: 11/23/2022] Open
Abstract
Background An acute scrotal hematoma, secondary to a spontaneous rupture of a varicocele is still a rare presentation in daily practice. However, multiple case reports have been reported. Sudden increase in abdominal pressure, resulting to an increased venous pressure can lead to a rupture of the varicocele. Literature search shows that due to uncertainty of the diagnosis, explorative surgery is often performed, sometimes resulting in unnecessary orchiectomies. The objective of this study was to determine classical clinical presentation of patients with a spontaneous rupture of a varicocele, determine the diagnostic procedure, and give an insight in the follow-up. Case presentation We present a case of a 24-year old male with acute scrotal swelling after sneezing. Subsequently, we carried out a systematic literature search to identify all eligible studies to determine classic clinical presentation of spontaneous ruptures of a varicocele. Conclusion The literature search shows that clinical presentation of idiopathic spontaneous scrotal hematomas is similar to testicular torsion, epididymo-orchitis, malignancy, or (incarcerated) inguinal hernia making differential diagnosis difficult. Especially when there has been increased abdominal pressure or strenuous activity preceding the symptoms, and the swelling is left sided, it should be included in the differential diagnosis for patient with acute inguinoscrotal swelling. Colour Doppler-Ultrasonography is recommended to distinguish between other causes of acute scrotum. The hematoma is usual self-limiting, justifying conservative treatment. Early surgical intervention is indicated with signs of ischaemia due to obstruction, infection of the hematoma, or uncertain diagnosis (i.e. malignancy). However, physicians should be cautious with direct exploration, as it led to unnecessary orchiectomy in 25% of patients. The hematoma can increase in size up to 3 months post-event, and it can take up to 15 months to completely resolve.
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Affiliation(s)
- Daan J Reesink
- Department of Urology, Tergooi Hospital Hilversum, Rijksstraatweg 1, 1261 AN, Blaricum, The Netherlands.
| | - Peter M Huisman
- Department of Radiology, Tergooi Hospital, Rijksstraatweg 1, 1261 AN, Blaricum, The Netherlands
| | - Judith Wiltink
- Department of Urology, Tergooi Hospital Hilversum, Rijksstraatweg 1, 1261 AN, Blaricum, The Netherlands
| | - Arto E Boeken Kruger
- Department of Urology, Tergooi Hospital Hilversum, Rijksstraatweg 1, 1261 AN, Blaricum, The Netherlands
| | - Tycho M T W Lock
- Department of Urology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Mathur M, Mills I, Spektor M. Magnetic resonance imaging of the scrotum: pictorial review with ultrasound correlation. Abdom Radiol (NY) 2017; 42:1929-1955. [PMID: 28401283 DOI: 10.1007/s00261-017-1127-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The purpose of this review is to showcase the added value of scrotal magnetic resonance imaging (MRI) in the workup of neoplastic and non-neoplastic entities. While ultrasound (US) remains the first-line imaging modality for evaluating scrotal pathology, MRI may add valuable information, particularly when US findings are equivocal. The inherent soft tissue resolution characteristics of MRI, as well as the ability to detect subtle enhancement and provide wider field-of-view imaging, can prove useful in evaluating inconclusive US findings. The added value of MR in these instances is critical as it may have a significant impact on patient management.
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Affiliation(s)
- Mahan Mathur
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA.
| | - Ian Mills
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA
| | - Michael Spektor
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA
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10
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Imaging and angiography in male factor infertility. Fertil Steril 2016; 105:1432-42. [DOI: 10.1016/j.fertnstert.2016.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 02/07/2023]
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Tijani K, Oyende B, Awosanya G, Ojewola R, Lawal A, Yusuf A. Scrotal abnormalities and infertility in west African men: A comparison of fertile and sub-fertile men using scrotal ultrasonography. AFRICAN JOURNAL OF UROLOGY 2014. [DOI: 10.1016/j.afju.2014.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
Varicocele is a common treatable cause of testicular pain, male infertility, and Leydig cell dysfunction. Scrotal ultrasonography has become the modality of choice in the diagnosis and post-treatment follow-up of varicocele. Visualization of dilated veins and reflux into the pampiniform plexus enables accurate diagnosis. Although the pathophysiology of varicocele in testicular dysfunction remains unclear, numerous studies have established significant improvement in the seminal parameters and pregnancy rates after varicocele repair. Interventional therapy is a minimally invasive effective treatment option for primary and salvage varicocele repair. This review discusses sonographic criteria used in the pre- and post-procedural evaluation of varicocele and various interventional techniques for varicocele treatment.
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Affiliation(s)
- No Kwak
- Department of Radiology, North Shore-LIJ Health System, Manhasset, NY, USA,
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Tijani K, Oyende B, Awosanya G, Ojewola R, Yusuf A. Assessment of testicular volume: A comparison of fertile and sub-fertile West African men. AFRICAN JOURNAL OF UROLOGY 2014. [DOI: 10.1016/j.afju.2014.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
Sonography is the ideal modality for evaluation and characterization of a scrotal mass. Extratesticular masses are usually benign, whereas intratesticular masses are generally malignant until proved otherwise. However, it is important to recognize the benign intratesticular conditions, thus possibly preventing orchiectomy when unwarranted, while appreciating the more significant findings of extratesticular masses that may warrant further intervention. This article reviews the anatomy and sonographic findings of scrotal masses. Normal anatomy, general imaging techniques, and assessment of intratesticular and extratesticular disorders will be discussed.
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Lotti F, Maggi M. Ultrasound of the male genital tract in relation to male reproductive health. Hum Reprod Update 2014; 21:56-83. [DOI: 10.1093/humupd/dmu042] [Citation(s) in RCA: 189] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Lotti F, Corona G, Mondaini N, Maseroli E, Rossi M, Filimberti E, Noci I, Forti G, Maggi M. Seminal, clinical and colour-Doppler ultrasound correlations of prostatitis-like symptoms in males of infertile couples. Andrology 2013; 2:30-41. [DOI: 10.1111/j.2047-2927.2013.00156.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/10/2013] [Accepted: 10/11/2013] [Indexed: 11/29/2022]
Affiliation(s)
- F. Lotti
- Sexual Medicine and Andrology Unit; Department of Experimental and Clinical Biomedical Sciences; University of Florence; Florence Italy
| | - G. Corona
- Sexual Medicine and Andrology Unit; Department of Experimental and Clinical Biomedical Sciences; University of Florence; Florence Italy
- Endocrinology Unit; Maggiore-Bellaria Hospital; Bologna Italy
| | - N. Mondaini
- Santa Maria Annunziata Hospital; Florence Italy
| | - E. Maseroli
- Sexual Medicine and Andrology Unit; Department of Experimental and Clinical Biomedical Sciences; University of Florence; Florence Italy
| | - M. Rossi
- Sexual Medicine and Andrology Unit; Department of Experimental and Clinical Biomedical Sciences; University of Florence; Florence Italy
| | - E. Filimberti
- Sexual Medicine and Andrology Unit; Department of Experimental and Clinical Biomedical Sciences; University of Florence; Florence Italy
| | - I. Noci
- Department of Obstetrics and Gynecology; University of Florence; Florence Italy
| | - G. Forti
- Sexual Medicine and Andrology Unit; Department of Experimental and Clinical Biomedical Sciences; University of Florence; Florence Italy
| | - M. Maggi
- Sexual Medicine and Andrology Unit; Department of Experimental and Clinical Biomedical Sciences; University of Florence; Florence Italy
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Moldenhauer JS, Ostermeier GC, Johnson A, Diamond MP, Krawetz SA. Diagnosing Male Factor Infertility Using Microarrays. ACTA ACUST UNITED AC 2013; 24:783-9. [PMID: 14581498 DOI: 10.1002/j.1939-4640.2003.tb03122.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Julie S Moldenhauer
- Department of Obstetrics and Gynecology, Center for Molecular Medicine, Institute for Scientific Computing, Wayne State University, Detroit, Michigan, USA
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Lotti F, Corona G, Colpi GM, Filimberti E, Innocenti SD, Mancini M, Baldi E, Noci I, Forti G, Maggi M. Seminal vesicles ultrasound features in a cohort of infertility patients. Hum Reprod 2012; 27:974-82. [DOI: 10.1093/humrep/des032] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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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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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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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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Middleton WD, Dahiya N, Naughton CK, Teefey SA, Siegel CA. High-resolution sonography of the normal extrapelvic vas deferens. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:839-846. [PMID: 19546325 DOI: 10.7863/jum.2009.28.7.839] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the reliability of sonographic visualization of the normal extrapelvic vas deferens and to analyze its appearance and dimensions. METHODS Scans of the scrotum and spermatic cords were obtained in 25 fertile volunteers. Identification of the vas deferens was attempted bilaterally in the scrotal, suprascrotal, and prepubic segments in all volunteers. When possible, the total thickness and the diameter of the lumen were measured. Visualization and dimensions were correlated with the body mass index (BMI) and abstinence interval. RESULTS All segments of the vas deferens were identified bilaterally in all volunteers. In all cases, it appeared as an anechoic or very hypoechoic tubular structure that was noncompressible and contained no detectable blood flow. It was convoluted inferiorly and became straight as it progressed from the scrotum to the suprascrotal and prepubic segments. The lumen was seen in the suprascrotal segment in all of the volunteers except the one with the highest BMI. The total thickness of the vas ranged from 1.5 to 2.7 mm (mean, 1.89 mm). The lumen of the vas ranged from 0.2 to 0.7 mm (mean, 0.43 mm). There was no correlation between the luminal diameter and the abstinence interval. CONCLUSIONS The extrapelvic portion of the vas deferens is reliably visualized sonographically. Its appearance is characteristic and reproducible. The lumen can be measured in almost all cases.
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Affiliation(s)
- William D Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri 63110, USA
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Robin G, Marcelli F, Mitchell V, Marchetti C, Lemaitre L, Dewailly D, Leroy-Billiard M, Rigot JM. [Why and how to assess hypospermia?]. ACTA ACUST UNITED AC 2008; 36:1035-42. [PMID: 18801689 DOI: 10.1016/j.gyobfe.2008.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Accepted: 04/15/2008] [Indexed: 11/28/2022]
Abstract
Hypospermia is a semen volume lower than 2 mL on at least two semen analyses. The etiologies of hypospermia are many and may be divided into two pathophysiologic sub-groups: disturbances of ejaculation reflex leading to partial retrograde ejaculation and seminal glands and ducts anatomic and functional anomalies. In this last pathologic mechanism, the mutations of CFTR gene, involved in many different forms of cystic fibrosis, represent a possible cause of hypospermia. The molecular anomaly of CFTR gene's screening is very important for the potential descendents and for the patient himself. It must be considered any time clinic and/or paraclinic context is evocative.
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Affiliation(s)
- G Robin
- Service d'andrologie, hôpital Albert-Calmette, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
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La Vignera S, Calogero AE, Arancio A, Castiglione R, De Grande G, Vicari E. Transrectal ultrasonography in infertile patients with persistently elevated bacteriospermia. Asian J Androl 2008; 10:731-40. [DOI: 10.1111/j.1745-7262.2008.00425.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Iaccarino V. A proposed anatomical typing of the right internal spermatic vein: importance for percutaneous sclerotherapy of varicocele. Cardiovasc Intervent Radiol 2007; 31:1042-4; author reply 1045. [PMID: 18095018 DOI: 10.1007/s00270-007-9248-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Accepted: 11/09/2007] [Indexed: 10/22/2022]
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Puttemans T, Delvigne A, Murillo D. Normal and variant appearances of the adult epididymis and vas deferens on high-resolution sonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2006; 34:385-92. [PMID: 16944482 DOI: 10.1002/jcu.20257] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
PURPOSE To describe the appearance, anatomic position, and size of the normal adult epididymis and vas deferens using high-resolution sonography. METHODS The sonographic appearance, anatomic position, and size of the epididymal head (EH), epididymal body (EB), epididymo-deferential loop (EDL), and vas deferens (VD) were evaluated in 112 consecutive infertile men (infertile group), and the data were compared with those from 84 consecutive men without history of infertility (reference group). RESULTS Compared with the testis, the EH was isoechoic, the EB hypoechoic, and the VD anechoic. In 88.4% of cases in the infertile group and 97.6% of cases in the reference group, the EH was located above the upper pole of the testis, with the EB lateral to the testis and the EDL below the lower pole of the testis. In 9% of cases in the infertile group and 6% of cases in the reference group, the EB was located posterior to the body of the testis, with the EDL inverted and the VD anterior to the ET. In 11.6% of cases in the infertile group and 2.4% of cases in the reference group, the epididymis was inverted, with the EH located below the lower pole of the testis. The mean (+/-SD) normal sizes were as follows: EH, 7.6 +/- 1.6 mm; EB, 3.2 +/- 0.8 mm; EDL, 7.7 +/- 1.3 mm; VD, 1.9 +/- 0.2 mm. No statistically significant differences in size were found between the 2 groups. CONCLUSIONS We describe the normal and variant appearance, position, and size of the adult epididymis and VD on high-resolution sonography.
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Affiliation(s)
- Thierry Puttemans
- Imagerie Médicale, Hôpital Iris Sud, Site Etterbeek-Ixelles, Rue Jean Paquot 63, 1050 Brussels, Belgium
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Vicari E, La Vignera S, Castiglione R, Calogero AE. Sperm parameter abnormalities, low seminal fructose and reactive oxygen species overproduction do not discriminate patients with unilateral or bilateral post-infectious inflammatory prostato-vesiculo-epididymitis. J Endocrinol Invest 2006; 29:18-25. [PMID: 16553029 DOI: 10.1007/bf03349172] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We have shown that patients with prostato-vesiculo-epididymitis (PVE) have the worst sperm output compared to patients with prostato-vesiculitis or prostatitis alone. The present study was undertaken to closely examine whether unilateral or bilateral PVE had a different impact on sperm parameters, seminal fructose levels and reactive oxygen species (ROS) overproduction. To accomplish this, 78 patients with persistent post-infectious inflammatory PVE, clearly identified by scrotal and transrectal ultrasonography, and 30 patients with asymptomatic post-infectious inflammatory prostatitis (control group) underwent semen analysis (including seminal leukocyte concentration and number of spermiophagies), seminal fructose measurement and sperm ROS production from 45 and 90% Percoll fractions. Fifty patients turned out to have PVE bilaterally, whereas the remaining 28 had unilateral PVE. Patients with bilateral PVE had sperm concentration and total sperm number significantly lower than those found in patients with unilateral PVE. The other sperm parameters, the physicochemical properties (hyperviscosity, the presence of nonspecific agglutination, delayed liquefaction), seminal fructose levels and ROS production in both 45 and 90% Percoll fractions turned out similar between the two groups. Patients with bilateral or unilateral PVE had sperm parameters, seminal fructose levels and ROS production significantly worst than those found in patients with prostatitis alone. In conclusion, although patients with bilateral PVE had a decreased number of spermatozoa, the other sperm parameters and seminal fructose levels did not reflect the extension of PVE. Therefore, the diagnosis of unilateral or bilateral involvement of this complicated form of male accessory gland infection relies on scrotal and transrectal ultrasonography.
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Affiliation(s)
- E Vicari
- Section of Endocrinology, Andrology and Internal Medicine, Department of Biomedical Sciences, and Master in Andrological and Human Reproduction Sciences, University of Catania, Catania, Italy
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Abstract
The ability of US to diagnose the pathogenesis of the acute scrotum is unsurpassed by any other imaging modality. It is the first imaging performed in patients with acute scrotum. Knowledge of the normal and pathologic sonographic appearance of the scrotum and proper sonographic technique is essential for accurate diagnosis of acute scrotum. High-frequency transducer sonography combined with color flow Doppler sonography provides the information essential to reach a specific diagnosis in patients with testicular torsion, epididymo-orchitis, and testicular trauma.
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Affiliation(s)
- Vikram Dogra
- Department of Radiology, Case Western Reserve University, University Hospitals, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
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Woodward PJ, Schwab CM, Sesterhenn IA. From the archives of the AFIP: extratesticular scrotal masses: radiologic-pathologic correlation. Radiographics 2003; 23:215-40. [PMID: 12533657 DOI: 10.1148/rg.231025133] [Citation(s) in RCA: 204] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The extratesticular scrotal contents consist of the epididymis, spermatic cord, and fascia derived from the embryologic descent of the testis through the abdominal wall. As opposed to intratesticular masses, most extratesticular masses are benign. Cystic masses (including hydroceles, epididymal cysts, and varicoceles) are easily diagnosed with ultrasonography (US) and are benign. Epididymitis is a common extratesticular lesion as well as the most frequent cause of an acute scrotum. It may be either acute or chronic and can be potentially complicated by epididymo-orchitis or scrotal abscess. Findings include epididymal enlargement, skin thickening, hydroceles, and hyperemia. The epididymis can also be affected by sarcoidosis, a noninfectious granulomatous disorder. The most common extratesticular neoplasms are lipomas (most often arising from the spermatic cord) and adenomatoid tumors (most often found in the epididymis). Despite their relative rarity, malignant neoplasms do occur and include rhabdomyosarcoma, liposarcoma, leiomyosarcoma, malignant fibrous histiocytoma, mesothelioma, and lymphoma. These tumors are often large at the time of presentation. The US findings of solid masses are often nonspecific. Magnetic resonance imaging can be very helpful in the evaluation of some of these disorders, allowing for a more specific diagnosis in cases of lipoma, fibrous pseudotumor, and polyorchidism.
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Affiliation(s)
- Paula J Woodward
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, 14th and Alaska NW, Bldg 54, Rm M-121, Washington, DC 20306-6000, USA.
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Biagiotti G, Cavallini G, Modenini F, Vitali G, Gianaroli L. Spermatogenesis and spectral echo-colour Doppler traces from the main testicular artery. BJU Int 2002; 90:903-8. [PMID: 12460354 DOI: 10.1046/j.1464-410x.2002.03033.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess whether the peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistive index (RI) of testicular arteries may be useful in distinguishing the various causes of dyspermia when compared with follicle-stimulating hormone (FSH) and testicular volume. PATIENTS, SUBJECTS AND METHODS The study included nine men with obstructive and 20 with unobstruc-tive azoospermia, 17 with oligoasthenospermia and clinical varicoceles, with male accessory glans inflammation (MAGI), 38 with undetermined oligoasthenospermia, 19 with MAGI, 11 with clinical varicoceles, 32 subjects with normal sperm analysis and recent paternity (fertile controls), and 15 with normal sperm analysis and a varicocele with recent paternity (fertile + varicoceles). Testicular volume, FSH, PSV, EDV and RI were compared among the dyspermic and/or control groups using analysis of variance. RESULTS The PSV and RI were useful for identifying the different groups of patients, while EDV, FSH and testicular volume were not. Men with varicoceles, varicoceles + MAGI or fertile with varicoceles had the highest PSV and RI; fertile controls, those with obstructive azoospermia and MAGI had similar PSVs and RIs, those with unexplained oligoasthenospermia had a significantly lower PSV and RI, and men with unobstructive azoospermia had the lowest PSV and RI. CONCLUSIONS The RI and PSV are reliable indicators for routine clinical use to identify infertile/dyspermic men, while EDV, FSH and testicular volume are not. The RI and especially PSV clearly differentiated obstructive from unobstructive azoospermia.
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Affiliation(s)
- G Biagiotti
- Reproductive Medicine Unit, Società Italiana Studi di MEdicina della Riproduzione (SISMER), Bologna, Italy
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Ragheb D, Higgins JL. Ultrasonography of the scrotum: technique, anatomy, and pathologic entities. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2002; 21:171-185. [PMID: 11833873 DOI: 10.7863/jum.2002.21.2.171] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To review the ultrasonographic technique, anatomy, and pathologic entities found in the scrotum during evaluation of scrotal masses, acute scrotal pain, and male infertility. METHOD A pictorial review of cases with diagrams of pertinent anatomic features and findings is presented. RESULTS Ultrasonography in conjunction with color and pulsed Doppler imaging has supplanted other imaging modalities in the evaluation of scrotal diseases and disorders. Ultrasonography is valuable in the evaluation of the acutely painful scrotum in addition to scrotal masses and male infertility. Advances in ultrasonographic spatial and low-contrast resolution have improved our ability to more clearly define diagnoses for the referring urologist and have led to new observations that are currently being investigated and have yet to be fully understood. Microlithiasis and the mottled appearance of seminiferous tubule sclerosis and atrophy are 2 such entities. This article reviews the pertinent normal scrotal anatomy and the use of ultrasonography in the evaluation and classification of acute scrotal pain, scrotal masses, male infertility, and trauma. This review article also discusses pitfalls of color Doppler imaging in assessment of the scrotum and how to avoid them. CONCLUSION The use of ultrasonography in the evaluation of the scrotum benefits from an understanding of scrotal anatomy and familiarity with potential pitfalls of color Doppler and pulsed Doppler evaluation.
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Affiliation(s)
- Dina Ragheb
- Louisiana State University Medical Center, New Orleans 70112, USA
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Battaglia C, Giulini S, Regnani G, Di Girolamo R, Paganelli S, Facchinetti F, Volpe A. Seminal plasma nitrite/nitrate and intratesticular Doppler flow in fertile and infertile subjects. Hum Reprod 2000; 15:2554-8. [PMID: 11098025 DOI: 10.1093/humrep/15.12.2554] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objective of the present study was prospectively to evaluate the role of nitric oxide (NO) in modulating intratesticular blood flow and sperm function. A total of 56 males, undergoing assisted reproduction, were divided into three groups according to semen analysis: (i) normozoospermic (n = 16); (ii) oligozoospermic (n = 21); and (iii) azoospermic (n = 19). All the subjects were submitted to hormone analysis [luteinizing hormone, follicle stimulating hormone (FSH), growth hormone, testosterone, androstenedione, insulin], and to ultrasonographic (testicular volume) and Doppler (transmediastinal artery) evaluations. Plasma and seminal plasma nitrite/nitrate concentrations, and plasma insulin-like growth factor-I were assayed. All 56 patients completed the study. In normozoospermic patients, significantly greater testicular volume, lower transmediastinal resistances, and higher seminal plasma nitrite/nitrate concentrations were observed in comparison with both oligo- and azoospermic subjects. Testicular volume was inversely correlated with plasma FSH (r = -0.589; P = 0.005) and pulsatility index of transmediastinal artery (r = -0.402; P = 0.049). Furthermore, the seminal plasma nitrite/nitrate concentrations were inversely correlated with pulsatility index of transmediastinal artery (r = -0.511; P = 0.015). It was concluded that NO is involved in vascular modulation of testicular vessels and ultimately in sperm output.
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Affiliation(s)
- C Battaglia
- Department of Obstetrics and Gynecology, University of Modena, Italy.
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Abstract
PURPOSE To determine the ultrasonographic (US) abnormalities that may be encountered after testicular biopsy. MATERIALS AND METHODS Testicular US studies in 33 patients (64 testes) who had undergone unilateral or bilateral testicular biopsy were retrospectively reviewed for evidence of postbiopsy changes. Biopsy had been performed in 55 testes. RESULTS US abnormalities were found in 49 (89%) of 55 testes. These abnormalities included focal, hypoechoic, round lesions in five (9%) testes; focal hypoechoic lesions with linear margins in 27 (49%); ill-defined, localized, hypoechoic areas in four (7%); peritesticular echogenic foci in 40 (73%); linear hypoechoic striations in five (9%); and focal contour defects in three (5%). CONCLUSION A range of US findings are encountered after testicular biopsy. The US appearance of a round hypoechoic lesion seen after biopsy can overlap with that of testicular malignancy. Other findings, such as hypoechoic lesion with linear margins, peritesticular echogenic foci, linear hypoechoic striations, and testicular contour defect, can be regarded as the benign sequelae of biopsy. In a patient with a focal, nonpalpable, hypoechoic, intratesticular lesion, a history of testicular biopsy should remind the radiologist of the increased likelihood of a benign change after biopsy, in which case follow-up US may be performed.
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Affiliation(s)
- N Yagan
- Department of Radiology, New York Presbyterian Hospital-Cornell Medical Center, New York, NY 10021, USA.
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Abstract
The primary role of Doppler ultrasound of the acute testicle and scrotum is for the diagnosis of spermatic cord torsion or epididymitis. The utility of Doppler in other conditions such as testicular neoplasm is limited, and in general does not increase diagnostic specificity. The application of color Doppler imaging and power Doppler imaging increases sensitivity for the detection of orchitis and testicular neoplasms in which the gray scale findings may be subtle. Power Doppler imaging is more sensitive for the identification of slowly flowing blood than color Doppler imaging. As a result, power Doppler imaging may be particularly helpful for the diagnosis or exclusion of spermatic cord torsion as a cause of acute scrotal pain in the prepubescent male.
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Affiliation(s)
- J B Feole
- Department of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, Madison, WI 53792-3252, USA
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36
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Kim ED, Lipshultz LI. Advances in the evaluation and treatment of the infertile man. World J Urol 1998; 15:378-93. [PMID: 9436289 DOI: 10.1007/bf01300187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Numerous advances in technology have been made in the last several years in the diagnosis and treatment of the infertile man. Using case presentations, this article highlights these important new developments and reviews the basics of a comprehensive male infertility evaluation. The use of ultrasound as a critical, indispensable, yet noninvasive tool in the evaluation of possible male reproductive tract obstruction is discussed. Since assisted reproductive techniques (ARTs) have become increasingly important in the management of the otherwise untreatable infertile man, specialized testing of sperm function, e.g., the sperm penetration assay (SPA), and strict morphology assessment are often useful prior to the initiation of some of these assisted reproductive procedures such as intrauterine insemination (IUI) or in vitro fertilization (IVF). Testicular touch preparation cytology and image analysis are also important additions to routine testicular biopsy for quantifying the extent of spermatogenesis. Finally, the revolutionary micromanipulation procedure of intracytoplasmic sperm injection (ICSI) has forever changed the practice of andrology by enabling men previously thought to be irreversibly infertile the chance to initiate their own biologic pregnancy.
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Affiliation(s)
- E D Kim
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
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