Effect of varicocele on testicular artery blood flow in men--color Doppler investigation

Effect of pentoxifylline on the testicular hemodynamic, volume, testosterone, nitric oxide levels and semen quality in Ossimi rams during non breeding-season

During the non-breeding season, Ossimi rams have testicular regression, including reductions in blood flow, size and spermatogenesis. The objective was to determine the effect of pentoxifylline (PTX) on Ossimi rams during the non-breeding season. Fifteen sexually mature Ossimi rams were allotted to three groups: (1) G0 (n = 5) control group (basic diet, no PTX); (2) G1 (n = 5) 10 mg/kg BW PTX; and (3) G2 (n = 5) 20 mg/kg BW PTX. The PTX was given orally once daily for 7 weeks (wk1 to wk7), whereas ultrasonographic assessment of testes, and collection of semen and blood started 1 week before PTX and were done weekly for 8 weeks (wk0 to wk7). In G2, there was a decrease(P < 0.05) in both Doppler indices (resistive index, pulsatility index) in G2 from wk2 to wk4 and an increase(P < 0.05) in ultrasonographic testicular coloration from wk2 to wk7. Moreover, G2 had the highest (P < 0.05) testicular volume (wk5 to wk7), individual motility, sperm viability and acrosome integrity (wk4 to wk7) and sperm cell concentration (wk6 and wk7). Blood concentrations of testosterone and nitric oxide were increased (P < 0.05) concurrent with decreased Doppler indices. In conclusion, PTX enhanced testicular blood flow and volume, semen quality, and concentrations of testosterone and nitric oxide potential in Ossimi rams during the non-breeding season, with potential to ameliorate deleterious effects of heat stress and perhaps enhance ram fertility.

Oxidative Stress and Cell Cycle Arrest in Seminiferous Tubules Nearby Varicose Vessels: New Perspectives from Experimental Varicocele

Varicocele (VCL) has been shown to induce severe oxidative stress in the testicular tissue resulting in 35% of males with primary infertility. To compare the exacerbating impacts of varicose on oxidative DNA damage and homeostatic antioxidant reactions in the seminiferous tubules (ST), enclosed and far from varicose vessels. Thirty mature Wistar rats were divided into control and VCL-induced groups. To approve VCL, the testicular diameters, volume, and blood circulation were measured using B-mode and Doppler ultrasonography. Next, to confirm oxidative stress (OS), the global homeostatic antioxidant biomarkers were evaluated. Moreover, the OS-induced oxidative DNA damage and homeostatic antioxidant reactions were compared between STs nearby and far from varicose vessels. Finally, to clarify the DNA damage-induced impact on the cell cycle progression, the global and local expressions of Cyclin D1, Cdk4, and p21 were examined. The VCL-induced group exhibited diminished global antioxidant status (marked with TAC, GPX, SOD, and CAT) and UNG and MPG expression levels. Moreover, the cross-sections of the VCL group represented a prominent reduction in the UNG, MPG, Cyclin D1, and cdk4, and upregulation in the p21 expression levels, more prominently in the STs nearby varicose vessels. Concerning severe oxidative DNA damage and intensive molecular changes in the STs nearby the varicose vessels, they can be considered the main cause of oxidative DNA damage in enclosed tubules. Thus, the varicose-mediated oxidative DNA damage negatively impacts the cell cycle progression in the tubules more intensively in the subcapsular area.

The Use of Doppler Ultrasonography in the Examination of Testicles in Dogs

Doppler ultrasonography is method suitable for observing and measuring the blood supply of many organs. Its principle is the change in the frequency of wave blood that moves with respect to the source of the wave (probe). In a testicular examination, the use of Doppler can also be very useful for detecting abnormalities or pathological conditions. The aim is just to characterize the flow in arteria testicularis in clinically healthy dogs aged 1-5 years. Twelve dogs were included in the study, of which 6 were rough collies weighing approximately 23 kg and 6 were standard dachshunds weighing approximately 9 kg. The pulsatility index (PI) and resistance index (RI) of a.testicularis, as well as the dimensions of the testicles - height and depth, were assessed by ultrasonographic examination using the ALOKA ProSound Alpha 6 ultrasonographic device (Hitachi-Aloka, Japan). The statistical evaluation of the results shows that the differences between the averages of both measurements of PI and RI indices are highly significant, so the weight of the individual had a high effect on the measured values of PI and RI indices. The depth of the testicles was also directly related to the increasing values of PI and RI indices and to the weight of the dogs, in contrast to their height, which did not show any statistical significance in this respect. The measured values and findings may in the future also serve as a basis for determining reference values in testicular ultrasonography according to the weight of dogs, which may be beneficial in clinical status assessment, diagnosis of various pathological conditions, or predicting spermatogenesis and fertility of the individuals.

Effects of space flight on sperm function and integrity: A systematic review

With the advancement in space exploration and the intention to establish an inhabitable human settlement on Mars, it is important to investigate the effects of exposure to space/microgravity and the associated radiations on procreation. Sperm function and integrity are fundamental to male reproduction and can potentially be affected by the environmental changes experienced in space. Therefore, this study was conducted to systematically gather, filter, and collate all the relevant information on the effects of spaceflight on male reproductive parameters and functions. A search was performed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted from the major electronic databases including PubMed, and other credible literature sources. MeSH search terms that were employed included “spermatozoa”, “microgravity”, and “ionizing radiation”. The literature search did not discriminate against papers published before a certain date due to the very limited number of articles available. However, there was a restriction on the male gender and language (English). The parameters included in this study are sperm motility, total sperm count, sperm DNA fragmentation hormonal levels and testicular histology. Following a comprehensive literature search, a total of 273 articles were retrieved and screened, 252 articles were excluded due to the irrelevance to the topic, duplication, and non-original articles. A total of 21 articles met the inclusion criteria and are included in the current study. Findings from these studies showed that sperm motility was decreased after exposure to microgravity and ionizing radiation. Total sperm count was also found to be reduced by microgravity only. Sperm DNA fragmentation was increased by both ionizing radiation and microgravity. Testosterone levels and testicular weight were also decreased by microgravity. Although there is a dearth in the literature regarding the effects of microgravity and ionizing radiation on male reproductive parameters, the available findings showed that exposure to microgravity poses a risk to male reproductive health. Therefore, it is essential to develop countermeasures to either manage, treat, or prevent these consequential adverse effects. Hence, this review also highlights some potential countermeasure approaches that may mitigate the harmful effects of microgravity and associated exposures on male reproductive health.

Testicular haemodynamics, plasma testosterone and oestradiol concentrations, and serum nitric oxide levels in the Egyptian buffalo bull after a single administration of human chorionic gonadotropin

This current study aimed for the first time to evaluate the effect of a single intravenous administration of human chorionic gonadotropin hormone (hCG) on the testicular artery haemodynamics measurements (resistance [RI], and pulsatility indices [PI]), plasma steroids (estradiol-17β and testosterone) and nitric oxide (NO) levels in buffalo bulls. Twelve Egyptian buffalo bulls weighted 450 ± 20 kg were randomly divided into the hCG group (n = 6) and injected a single dose with Ovogest (EPIFASI; 5,000 IU, iv), whereas the others (n = 6) were injected with normal saline and served as controls. Doppler evaluation and blood sampling were performed just before the administration (hour 0) and at 1, 2, 4, 6, 8, 10, 24 and 28 hr after administration. Bulls in the control group did not show any alterations in hormonal levels and blood flow parameters (p > .05). In the hCG group, RI was declined (p < .05) in 6 hr post-administration (0.31 ± 0.01 versus 0.45 ± 0.01), while PI was declined (p < .05) later in 10 hr (0.74 ± 0.01 versus 1.23 ± 0.02). Additionally, testicular blood flow was increased (p < .05) 8 hr (42.02 ± 1.02 ml/min/100 g versus 31.34 ± 0.88 ml/min/100 g) after administration. Testosterone and NO levels were (p < .05) increased at 4 and 6 hr post-administration (3.55 ± 0.03 ng/ml versus 2.84 ± 0.01 ng/ml, and 55.32 ± 4.25 µmol/L versus 32.21 ± 1.55 µmol/L), whereas oestradiol levels were elevated (p < .05) in 6 hr (31.25 ± 0.08 pg/ml) only post-administration then declined. In conclusion, the single intravenous administration of hCG triggered many alterations in the supratesticular artery vascularization and hormonal profile that could affect positively on steroidogenesis and testicular function in buffalo bull.

Effects of buserelin administration on testicular blood flow and plasma concentrations of testosterone and estradiol-17β in rams

This research aimed to examine for the first time the impact of single dose administration of gonadotropin-releasing hormone (GnRH) analog buserelin acetate on the testicular blood flow measurements (peak systolic velocity [PSV], end-diastolic systolic velocity [EDV], resistive index [RI], and pulsatility index [PI]) and the plasma steroids (testosterone and estradiol-17β) concentrations in rams. For this purpose, twelve adult Ossimi rams were randomly assigned into the buserelin group (n = 8) and were injected intravenously (iv) with buserelin acetate (0.008 mg/ram), whereas the remaining rams (n = 4) were injected with normal saline iv and served as a control group. Blood sampling and testicular pulsed-wave Doppler scanning were conducted immediately before (0) and 1, 3, 6, 24, 48, 72, 120, and 168 h after treatment. The control group did not reveal any substantial changes (P > 0.05) in the examined parameters, except for the EDV (P < 0.05). In the buserelin-treated group, a marked reduction in RI and PI values (P < 0.05) occurred 1 to 3 h after administration of buserelin. Besides, there was a significant increase in testosterone plasma concentrations following buserelin treatment. In conclusion, the administration of buserelin triggered a series of substantial changes in the testicular blood perfusion and steroidogenesis that could have a positive effect on testicular function in rams.

Melatonin improves testicular haemodynamics, echotexture and testosterone production in Ossimi rams during the breeding season

The objective was to determine effects of a single parenteral dose of melatonin on testicular blood flow indices, testicular echogenicity and plasma testosterone concentrations in rams during the physiological breeding season. We hypothesized that melatonin enhances testicular blood flow, echogenicity and plasma testosterone concentrations during the breeding season in rams. During the breeding season, 12 sexually mature Ossimi rams were randomly allocated to either a melatonin group (n = 8) that received 18 mg of melatonin in 1 ml of corn oil (injected SC) or a control group (n = 4) that received 1 ml corn oil only. Blood collection and ultrasonographic assessment of the testes and supratesticular arteries were conducted immediately before treatment (W0) and once weekly for 6 weeks after melatonin injection (W1-W6). Mean plasma testosterone concentrations were greater (p < .05; at least 1 ng/ml) in the melatonin-treated group compared to the control group from W4 to W6 after treatment. A decrease (p < .05) in both resistive index (RI) and pulsatility index (PI) began 1 week after melatonin injection (W1) and persisted until the end of the experiment, with mean RI and PI values in the melatonin group lower (p < .05) than those in the control group on W3 and W4. Furthermore, plasma testosterone concentrations in melatonin-treated rams were inversely correlated to both RI and PI (r = -.7 and -.6, respectively, p < .01). Testicular echogenicity decreased (p < .05) 1 week after melatonin injection (W1) and remained lower (p < .05) in the melatonin-treated group compared to the control group until the end of the study (W6). In conclusion, melatonin administration significantly altered testicular blood flow and echogenicity and increased plasma testosterone concentrations in Ossimi rams during the breeding season.

Exogenous oxytocin administration improves the testicular blood flow in rams

The current research aimed to examine the effects of single-dose oxytocin administration on testicular blood flow measurements peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI) and pulsatility index (PI) and plasma steroid (testosterone and oestradiol-17β) concentrations in rams. In the treated group, eight mature Ossimi rams during the breeding season were injected intravenously (iv) with 20 IU oxytocin, while the other eight male rams were administered normal saline (2 ml) iv as a control group. Venous blood samples and testicular blood flow in the left and right testes were examined immediately before (0) and 5, 30, 60 and 120 min after injections. The control group did not show significant changes in the variables examined (p > .05), except for the EDV (p < .05). In the treated group, the administration of oxytocin led to a significant decrease in RI and PI values starting 5 min after oxytocin administration until 60 min after its application (p < .05). The plasma concentrations of testosterone and oestradiol-17β raised from 5 to 30 min after oxytocin injection (p > .05) and then declined significantly until 120 min (p < .05). In conclusion, oxytocin is a potent testicular vasodilator affecting the testicular vascular tone and steroid concentrations in rams.

The Comparison of Resistance Index of Testicular Artery Using Color Doppler Ultrasound in Infertile Men Undergoing Varicocelectomy

Background:

Varicocele is one of the leading causes of infertility in men. Resistance index (RI) in testis is a parameter indicating parenchymal perfusion and microvascular functions. Increased RI in the testis of patients with varicocele might be a sign of impairments in microvascularization and a significant decrease in testicular perfusion. In the present study, RI in capsular and intraparenchymal testicular arteries was evaluated in patients with varicocele who underwent varicocelectomy.

Methods:

This prospective cohort study was performed in 2019–2020 in Guilan, Iran. Sixty-six patients were included. Semen analysis was also done before surgeries. Patients with at least one disorder in semen analysis entered the study. RI in testicular arteries was measured by an experienced radiologist before surgeries. Six months after varicocelectomy, all patients underwent the same semen analysis and ultrasound imaging. Data were analyzed using SPSS software. The tests for analysis included McNemar Test and Wilcoxon and p<0.005 was considered as the significance level.

Results:

According to the results, 42 patients (63.6%) had positive changes in sperm analysis after surgeries. Sperm analysis showed a significant increase in number, concentration, morphology, and motility of sperm after surgeries (p<0.001). Further measurements of capsular and intratesticular RI in all patients also indicated a significant decrease (p<0.001).

Conclusion:

Increased RI might be associated with impaired microperfusion in testis followed by impairments in semen. Moreover, mean capsular and intratesticular RI in patients decreased after surgeries and this decrease was significantly more in patients who had improvement in their semen parameters.

Assessment of the accuracy of testicular dysfunction detection in male donkey (Equus asinus) with the aid of colour-spectral Doppler in relation to plasma testosterone and serum nitric oxide levels

This study aimed to determine the usefulness of colour and pulsed Doppler modes for the accurate diagnosis of donkeys suffering from subfertility to determine whether testicular vascularity assessment could be an indicator for sperm functionality. The study sample was composed of 10 male donkeys with normospermia (control group) and 10 donkeys with hypospermia. Animals underwent scrotal circumference measurement, testicular Doppler examination, seminal evaluation, blood sampling and hormonal assay. Semen volume and concentration were significantly (p ≤ .05) lower in the subfertile group (30.25 ± 1.22 ml and 89.44 ± 2.55 × 10⁶ /ml) as compared with the control group (82.76 ± 1.65 ml and 452.78 ± 1.25 × 10⁶ /ml), and total sperm/ejaculation was significantly (p ≤ .05) higher in the normal donkeys (28.30 ± 2.32 × 10⁹ /total ejaculated) as compared with the subfertile group. Intratesticular coloured area showed a marked decline in the hypospermic males. There was no significant difference between the two groups in testosterone level, although the normal group showed an increase in nitric oxide metabolites. Both Doppler indices of the three branches of the testicular artery were elevated significantly (p ≤ .05) in abnormal donkeys, whereas Doppler peak systolic and end-diastolic velocities were increased in the normal group. Male donkeys with subfertility demonstrated lower arterial vascularity parameters in the form of intratesticular coloured area and blood flow rate; therefore, the most optimal parameters for differentiating subfertile hypospermic from normospermic donkeys were found to be the two Doppler indices, velocities parameters, testicular blood flow rate and nitric oxide levels.

Should Scrotal Color Doppler Ultrasound Be Routinely Indicated in Fertility Evaluation of Non-Azoospermic Men?

Objective

Scrotal ultrasound is not a routine investigation in the clinical approach to male infertility analysis. This study aims to identify the role of testicular Doppler ultrasound in male infertility assessment and its relation to semen parameters in non-azoospermic men.

Methods

Cross-sectional descriptive analysis of 558 men from infertile couples were examined at the Hue Center for Reproductive Endocrinology and Infertility, Hue University Hospital from June 2016 to May 2018. Some cohort characteristics, semen analysis and testicular Doppler ultrasound were analyzed. Men with acute systemic diseases, acute urinary tract infection, hepatic dysfunction, malignant diseases, retrograde ejaculation, cryptorchidism or azoospermia were excluded.

Results

The mean volumes of the right and left testicles were 8.87 and 8.77 ml, respectively. The total volume of the 2 sides was 17.63 ± 4.34 ml (95% confidence interval 17.27-18.00 ml). The mean right resistive index (RI) was 0.61 ± 0.23, and the mean left RI was 0.59 ± 0.01. The rate of normal semen quality was 23.2% in group with varicocele and 30.6% in group with non-varicocele. The ultrasound results from the normal semen group were much different from those of the abnormal semen group regarding testicular volume: mean right testis volume: 9.67 ± 1.88 vs. 8.75 ± 2.34 ml, p = 0.0096; mean left testis volume: 9.54 ± 1.78 vs. 8.51 ± 2.44 ml, p = 0.0047; mean total volume of 2 sides: 19.21 ± 3.60 vs. 17.26 ± 4.59 ml, p = 0.005 (varicocele group); mean right testis volume: 9.21 ± 2.21 vs. 8.63 ± 2.21 ml, p = 0.029 (non-varicocele group). The other indexes of color Doppler ultrasound (peak systolic velocity, end diastolic velocity, RI) were not found to correlate with semen quality.

Conclusions

Testicular volume which has a close relation to the semen parameters could be used as a clinical prediction factor for the quality of semen.

The European Academy of Andrology (EAA) ultrasound study on healthy, fertile men: Scrotal ultrasound reference ranges and associations with clinical, seminal, and biochemical characteristics

BACKGROUND

Scrotal color Doppler ultrasound (CDUS) still suffers from lack of standardization. Hence, the European Academy of Andrology (EAA) has promoted a multicenter study to assess the CDUS characteristics of healthy fertile men (HFM) to obtain normative parameters.

OBJECTIVES

To report and discuss the scrotal organs CDUS reference ranges and characteristics in HFM and their associations with clinical, seminal, and biochemical parameters.

METHODS

A cohort of 248 HFM (35.3 ± 5.9years) was studied, evaluating, on the same day, clinical, biochemical, seminal, and scrotal CDUS following Standard Operating Procedures.

RESULTS

The CDUS reference range and characteristics of the scrotal organs of HFM are reported here. CDUS showed a higher accuracy than physical examination in detecting scrotal abnormalities. Prader orchidometer (PO)- and US-measured testicular volume (TV) were closely related. The US-assessed TV with the ellipsoid formula showed the best correlation with the PO-TV. The mean TV of HFM was ~ 17 ml. The lowest reference limit for right and left testis was 12 and 11 ml, thresholds defining testicular hypotrophy. The highest reference limit for epididymal head, tail, and vas deferens was 12, 6, and 4.5 mm, respectively. Mean TV was associated positively with sperm concentration and total count and negatively with gonadotropins levels and pulse pressure. Subjects with testicular inhomogeneity or calcifications showed lower sperm vitality and concentration, respectively, than the rest of the sample. Sperm normal morphology and progressive motility were positively associated with epididymal head size/vascularization and vas deferens size, respectively. Increased epididymis and vas deferens sizes were associated with MAR test positivity. Decreased epididymal tail homogeneity/vascularization were positively associated with waistline, which was negatively associated with intratesticular vascularization. CDUS varicocele was detected in 37.2% of men and was not associated with seminal or hormonal parameters. Scrotal CDUS parameters were not associated with time to pregnancy, number of children, history of miscarriage.

CONCLUSIONS

The present findings will help in better understanding male infertility pathophysiology, improving its management.

Comparison of testicular vascularity via superb microvascular imaging in varicocele patients with contralateral normal testis and healthy volunteers

PURPOSE

In this study, we aimed to determine vascular changes in the testes in patients with varicocele using the two-dimensional color superb microvascular imaging vascular index (2DcSMIVI) and compared them with those of the normal contralateral testes of the same patients as well as the normal testes of control subjects without varicocele.

METHODS

A total of 114 participants and 228 testes were included in the study. 63 patients with varicocele and 51 asymptomatic volunteers were included. In total, 70 testes with varicocele (group A), 56 normal contralateral testes (Group B), and 102 bilateral normal testes were classified (Group C). Participants' testicular volume and 2DcSMIVI values were obtained via superb microvascular imaging. Testes with varicocele were graded according to Sarteschi classification.

RESULTS

Statistically significant differences in mean testicular volume were observed among the three groups. The volume and 2DcSMIVI values of the varicocele side testes were significantly lower than those of groups B and C. Significant differences were also observed between Sarteschi grade and 2DcSMIVI values in group A.

CONCLUSION

We can determine impaired microcirculation of varicocele side testes quantitatively with the 2DcSMIVI technique, and obtained VI values can be used effectively in diagnosis and follow-up of the damage in testes. Our results show that 2DcSMIVI values can play a significant role in the evaluation of testicular blood flow as a predictive sign of testicular damage.

Advances in applications of color Doppler ultrasonography in the andrological assessment of domestic animals: A review

Compared to human cases, potential applications of Doppler imaging technology in farm animals' practice are still limited and are mostly concerned with females. Testicular blood perfusion (TBP) is the pathway through which all nutrients, oxygen, and regulatory agents pass through to the testis. TBP is crucial to the testis function because of the high metabolic rate and very low concentration of oxygen in the seminiferous tubules, which constitute about 70%-80% of the testicular mass. Color Doppler ultrasonography is one of the recent non-invasive technologies, which plays a vital role in the assessment of blood flow to the testis in various animal species. In the past 20 years, a significant number of studies have highlighted the importance of assessments of TBP using color Doppler ultrasonography to illustrate its potential uses for breeding soundness examination, diagnosis, and monitoring of infertility problems in farm animals. This review was aimed at providing, for the first time, updated knowledge on the potential clinical uses of color Doppler ultrasonography for the assessment of TBP in domestic animals. Additionally, a few essential details on the relationship between TBP and male fertility are discussed in this review. Furthermore, a number of caveats relating to the use of color Doppler ultrasonography are discussed, which collectively appear to constrain its routine, on-farm application for breeding soundness assessments, at least at the present. The new perspectives related to animal reproduction that researchers claim to do in further investigations are also discussed.

Incorporating Pharmacological Target-Mediated Drug Disposition (TMDD) in a Whole-Body Physiologically Based Pharmacokinetic (PBPK) Model of Linagliptin in Rat and Scale-up to Human

Linagliptin demonstrates substantial nonlinear pharmacokinetics due to its saturable binding to its pharmacological target dipeptidyl peptide 4 (DPP-4), a phenomenon known as target-mediated drug disposition (TMDD). In the current study, we established a novel whole-body physiologically-based pharmacokinetic (PBPK)-TMDD model for linagliptin. This comprehensive model contains plasma and 14 tissue compartments, among which TMDD binding process was incorporated in 9 of them, namely the plasma, kidney, liver, spleen, lung, skin, salivary gland, thymus, and reproductive organs. Our final model adequately captured the concentration-time profiles of linagliptin in both plasma and various tissues in both wildtype rats and DPP4-deficient rats following different doses. The association rate constant (k_on) in plasma and tissues were estimated to be 0.943 and 0.00680 nM^-1 h^-1, respectively, and dissociation rate constant (k_off), in plasma and tissues were estimated to be 0.0698 and 0.00880 h^-1, respectively. The binding affinity of linagliptin to DPP-4 (Kd) was predicted to be higher in plasma (0.0740 nM) than that in tissue (1.29 nM). When scaled up to a human, this model captured the substantial and complex nonlinear pharmacokinetic behavior of linagliptin in human adults that is characterized by less-than dose-proportional increase in plasma exposure, dose-dependent clearance and volume of distribution, as well as long terminal half-life with minimal accumulation after repeated doses. Our modeling work is not only novel but also of high significance as the whole-body PBPK-TMDD model platform developed using linagliptin as the model compound could be applied to other small-molecule compounds exhibiting TMDD to facilitate their optimal dose selection. Graphical abstract.

Ultrasound evaluation of varicoceles: systematic literature review and rationale of the ESUR-SPIWG Guidelines and Recommendations

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.

Seasonal variation in testicular blood flow dynamics and their relation to systemic and testicular oxidant/antioxidant biomarkers and androgens in rams

The environmental temperature increased during summer and decreased during winter to the limits that might negatively affect animal and human reproduction. The responses of Egyptian rams to either hot or cold climatic conditions were studied in six mature rams subjected to weekly testicular Doppler ultrasonographic examination, blood sampling, seminal plasma collection and semen evaluation. The maximum environmental temperature and the relative humidity were used to classify the climatic condition according to the heat stress equation of sheep into hot months where temperature-humidity index (THI) was >26 (31.67 ± 0.54), and cold months where THI was <22 (18.39 ± 0.41). Testosterone, estradiol, superoxide dismutase (SOD), glutathione peroxidase (GPX) and lipid peroxide product (malondialdehyde, MDA) were measured in both blood and seminal plasma, while catalase (CAT) and reduced glutathione (GSH) were measured in blood and seminal plasma, respectively. Results revealed that, during the hot months, rams displayed significantly decreased testicular blood flow, increased seminal plasma MDA, decreased seminal plasma (SOD, GPx and GSH) and blood CAT antioxidant enzymes. The present study evidenced two novel findings: (a) the marked decrease in testicular blood flow volume, that is remarkable increase in both resistive index (RI) and pulsatility index (PI) values, during hot months could be negatively affected both seminal plasma enzymatic activities and seminal attributes, and (b) the SOD and GPx activities in seminal plasma of such animals were suitable predictive markers for seminal attribute evaluation.

The Relationship Between Widespread Pollution Exposure and Oxidized Products of Nucleic Acids in Seminal Plasma and Urine in Males Attending a Fertility Center

Background: In recent decades, there has been an increase in male infertility, and in many cases, the etiology remains unclear. Several studies relate male hypo-fertility to xenobiotic exposure, even if no data exist about multiple exposure at the environmental level. Methods: The study involved 86 males with diagnosis of idiopathic male infertility (IMI), and 46 controls with no alteration in sperm characteristics. Seminal plasma (SP) and urine samples were analyzed by liquid chromatography tandem mass spectrometry (LC-MS/MS) to quantify biomarkers of exposure (the main metabolites of benzene, toluene, 1,3-butadiene, 3-monochloropropanediol, styrene, and naphthol) and effect (oxidized products of nucleic acids).Results: Biomarker concentrations were similar in subjects with IMI and controls even if a stronger correlation between biomarkers of exposure and effects were observed in SP. Data show that, both in SP and urine, most metabolites were inter-correlated, indicating a simultaneous co-exposure to the selected substances at the environmental level. Principal component analysis showed in SP the clustering of mercapturic acids indicating a preferential metabolic pathway with Glutathione (GSH) depletion and, consequently, an increase of oxidative stress. This result was also confirmed by multivariable analysis through the development of explanatory models for oxidized products of nucleic acids. Conclusions: This study highlights how oxidative stress on the male reproductive tract can be associated with a different representation of metabolic pathways making the reproductive tract itself a target organ for different environmental pollutants. Our results demonstrate that SP is a suitable matrix to assess the exposure and evaluate the effects of reproductive toxicants in environmental/occupational medicine. The statistical approach proposed in this work represents a model appropriate to study the relationship between multiple exposure and effect, applicable even to a wider variety of chemicals.

Bilateral disease and intratesticular haemodynamics as markers of dyspermia in patients with subclinical varicocele: A prospective study

Objective: To study scrotal ultrasonographic characteristics in patients with subclinical varicocele (SV) and investigate their relationship with semen parameters.

Patients and methods: In all, 56 men with SV were recruited and divided into two groups, according to their semen characteristics. Group A, comprised 34 men with normal semen analysis; and Group B, comprised 22 men who carried at least one abnormality, regarding sperm concentration, motility and morphology. Between the two groups we compared: age; body mass index (BMI); semen pH and semen volume; total testicular volume (TTV); maximal vein diameter (MVD) and degree of reflux; mean values of peak-systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) of the intratesticular arteries; whether bilateral SV; and serum testosterone and follicle-stimulating hormone (FSH) levels.

Results: Asthenospermia was present in all patients in Group B; 10 patients had asthenospermia only, six patients were astheno-oligospermic and six patients had astheno-oligo-teratospermia. Age, BMI, semen pH and volume, TTV, MVD and degree of reflux did not differ significantly between the two groups (P > 0.05). However, EDV, PSV and RI were significantly different (P < 0.05). Bilateral SV was significantly more frequent in patients in Group B (P < 0.05). Finally, FSH was elevated in Group B (P < 0.05), whereas testosterone was normal in both groups, albeit significantly lower in men with abnormal semen analyses (P < 0.05).

Conclusion: Classic ultrasonographic characteristics in men with SV, such as venous size or degree of reflux, were insufficient to distinguish patients with abnormal semen analysis. However, bilateral disease and intratesticular haemodynamics differed significantly in patients with SV and abnormal semen analysis.

Abbreviations: BMI: body mass index; CDU: colour Doppler ultrasonography; EDV: end-diastolic velocity; MVD: maximal vein diameter; PSV: peak-systolic velocity; RI: resistive index; SV: subclinical varicocele; TTV: total testicular volume; US: ultrasonography

Zeta and hyaluronic acid assessments, novel sperm selection procedures, in animal model for male infertility

Considering varicocele (VCL)-induced severe, progressive DNA damage, histone-protamine anomalies and low sperm production, in the current study, the experimental VCL was induced and the efficiency of hyaluronic acid (HA)-binding method (HABM) and zeta preparation procedure (ZPP) in selection of appropriate spermatozoa was compared with those spermatozoa from intact animals. Following 2 and 4 months, the histological alterations in testicular tissue, sperm count and viability were assessed to prove the VCL condition. The spermatozoa were undergone simple wash, HABM and ZPP. The chromatin condensation, active caspase-3 expression, DNA fragmentation and apoptosis index were analysed after applying selection techniques and compared with the spermatozoa from intact and VCL-induced animals, which were undergone a simple wash. Observations showed that both HABM and ZPP effectively prepared the spermatozoa with higher chromatin condensation and lower DNA damage. Meanwhile, the ZPP exerted a more preferable effect by preparing the spermatozoa with higher chromatin condensation, and lower caspase-3 expression, and DNA disintegrity versus the HABM, especially after 4 months. In conclusion, ZPP seems to exert much more reliable efficiency in selecting appropriate spermatozoa for ICSI processes, while more studies are needed to find out which one is more useful in the clinical assisted reproductive technique (ART) process.

Ultrasensitive Doppler as a tool for the diagnosis of testicular ischemia during the Valsalva maneuver: a new way to explore varicoceles?

Background

Varicocele is among the most common causes of male infertility because of various mechanism, including hypoxia.

Purpose

To evaluate testicular vascularization (TV) with ultrasensitive Doppler before and during the Valsalva maneuver (VM) and correlate TV changes to varicocele’s spermatic venous reflux graduated by color Doppler.

Material and Methods

From January to February 2016, 69 men (135 testis) referred for scrotal ultrasound were prospectively enrolled. An institutional review board approved the study. As gold standard, the spermatic venous reflux in the supratesticular region was assessed with color Doppler ultrasound and graded from 0 to III. A new ultra-sensitive Doppler (USD) sequence was performed on testicular parenchyma in an axial view. The TV changes before and during the VM were qualitatively graded from 0 to 2 using a visual scale by consensus. The vessels surface was quantified using customized MATLAB® software, and compared to the testicular delineated surface, resulting in a vessels surface ratio (VSR). The absolute and relative VSR difference before and during the VM was calculated. The qualitative scale and the quantitative VSR changes were compared with the spermatic venous reflux grade using an analysis of variance.

Results

A strong correlation has been found between the spermatic venous reflux grade and TV decrease during the VM using USD, for qualitative graduation as well as for quantitative measurement ( P < 0.0001).

Conclusion

TV assessed by USD decreased significantly during the VM in patients with varicocele; this decrease was significantly associated with spermatic venous reflux grade.

Systemic arterial hypertension leads to decreased semen quality and alterations in the testicular microcirculation in rats

Arterial hypertension is a cardiovascular disease that leads to important systemic alterations and drastically impairs normal organ function over time. Hypertension affects around 700 million men of reproductive age and hypertensive men present increased risk for reproductive disorders, such as erectile dysfunction. However, the link between arterial hypertension and male reproductive disorders is associative at best. Moreover, many studies have reported associations between decreased male fertility and/or semen quality and alterations to general male health. In this study we aim to investigate the effect of systemic high blood pressure in sperm quality, sperm functional characteristics and testicular physiology in a rat model. Hypertensive rats presented altered testicular morphology – mainly vascular alterations and impaired testicular vasomotion. Hypertensive rats also presented decrease in sperm concentration, DNA integrity and increased percentages of sperm with dysfunctional mitochondria, intracellular superoxide anion activity and abnormal morphology. This study provides mechanistic insights by which arterial hypertension affects the testes, evidencing the testes as another target organ for hypertension as well as its impact on sperm quality.

Correlation between Testicular Hemodynamic and Semen Quality Indices in Clinical Varicocele Patients in Pakistan

Varicocele, a vascular event, is associated with infertility due to testicular damage that causes abnormal spermatogenesis in males. The goal of this study is to ascertain the diagnostic significance of scrotal color Doppler ultrasonography (CDUS) by measuring peak systolic value (PSV) and resistive index (RI) of the arteries supplying blood to the testis and their association with semen quality attributes. Sixty prospective patients (age: 20-50 years) undergoing microsurgical varicocelectomy at a teaching hospital were included in the study. Semen parameters and CDUS were recorded and testicular blood flow was determined as PSV and RI of subcapsular artery and intraparenchymal artery of the testes. Nonparametric statistics was applied to test the correlation/association of the semen quality with the PSV, RI, and other variables. Results revealed a significant negative correlation (r = -0.28; p < 0.05) between progressive motility of spermatozoa and resistive index of the intraparenchymal arterial blood flow. Furthermore, it was noticed that the progressive motility of spermatozoa was tended to be negatively correlated (r = -0.236) with resistive index of subcapsular arterial blood flow. In conclusion, this study has revealed that progressive motility of sperms has correlation with the intraparenchymal blood flow of testes. The progressive motility of sperms could be correlated with RI of testicular blood flow. The apparent lack of association between diameter of varicocele vein and semen quality signifies the need of investigating some other factors that may be involved in pathogenicity of varicocele. The diagnostic value of CDUS may be carefully interpreted and clinically correlated in assessment of severity of varicocele.

Pressure flow pattern of varicocele veins and its correlation with testicular blood flow and semen parameters

The pressure pattern in varicocele veins of infertile patients and its correlation with semen quality and testicular blood flow was determined. Consecutive patients at andro-urology clinic of a teaching hospital undergoing microsurgical varicocelectomy were included. Their semen quality and testicular blood flow were determined. Peak systolic velocity (PSV) and resistive index (RI) of subcapsular and intraparenchymal branches of testicular artery were noted by colour Doppler ultrasonography. During surgery before ligation of varicocele veins, intravenous pressures of internal spermatic (ISV) and external spermatic (ESV) veins were determined at baseline and after Valsalva manoeuvre. Thirty patients, 20-45 years old, were evaluated. Baseline pressure for maximum dilated ISV (A), less dilated ISV (B) and ESV was 15.93 ± 6.34, 12.38 ± 4.60 and 12.92 ± 5.65 mm. Hg, respectively, which increased after Valsalva by 104.4%, 116.2% and 38.22% respectively. Correlation (r = -.71; p < .05) was appreciated between percentage increase in pressure of ISV B with PSV of intraparenchymal testicular arteries and progressive motility (r = -.759; p < .05), nonprogressive motility (r = -.738; p < .05) and morphology (r = -.653; p = .07) of spermatozoa. In conclusion, ISV develops higher pressure on Valsalva as compared to ESV and has correlation with semen quality and testicular blood flow.

Perspectives in Pediatric Pathology, Chapter 20. Adolescent Varicocele

Varicocele is characterized by elongation, dilatation, and tortuosity of the veins draining the testis and its covers, causing circulatory reflux along the inner spermatic vein [ 1 ]. Varicocele results in progressive testicular lesions and, if untreated, can lead to testicular atrophy [ 2 ]. Varicocele is considered the most frequently identified cause of male infertility [ 3 ]. The mechanisms involved in varicocele formation are not well known and probably are multiple, differing from one patient to another.

Pulse Doppler ultrasound as a tool for the diagnosis of chronic testicular dysfunction in stallions

Testicular function is particularly susceptible to vascular insult, resulting in a negative impact on sperm production and quality of the ejaculate. A prompt diagnosis of testicular dysfunction enables implementation of appropriate treatment, hence improving fertility forecasts for stallions. The present research aims to: (1) assess if Doppler ultrasonography is a good tool to diagnose stallions with testicular dysfunction; (2) to study the relationship between Doppler parameters of the testicular artery and those of sperm quality assessed by flow cytometry and (3) to establish cut off values to differentiate fertile stallions from those with pathologies causing testicular dysfunction. A total of 10 stallions (n: 7 healthy stallions and n: 3 sub-fertile stallions) were used in this study. Two ejaculates per stallion were collected and preserved at 5°C in a commercial extender. The semen was evaluated at T0, T24 and T48h by flow cytometry. Integrity and viability of sperm (YoPro®-1/EthD-1), mitochondrial activity (MitoTracker® Deep Red FM) and the DNA fragmentation index (Sperm Chromatin Structure Assay) were assessed. Doppler parameters were measured at three different locations on the testicular artery (Supratesticular artery (SA); Capsular artery (CA) and Intratesticular artery (IA)). The Doppler parameters calculated were: Resistive Index (RI), Pulsatility Index (PI), Peak Systolic Velocity (PSV), End Diastolic Velocity (EDV), Time Average Maximum Velocity (TAMV), Total Arterial Blood Flow (TABF) and TABF rate. The capsular artery was the most reliable location to carry out spectral Doppler assessment, since blood flow parameters of this artery were most closely correlated with sperm quality parameters. Significant differences in all the Doppler parameters studied were observed between fertile and subfertile stallions (p ≤ 0.05). The principal components analysis assay determined that fertile stallions are characterized by high EDV, TAMV, TABF and TABF rate values (high vascular perfusion). In contrast, subfertile stallions tend to present high values of PI and RI (high vascular resistance). The ROC curves revealed that the best Doppler parameters to predict sperm quality in stallions were: Doppler velocities (PSV, EDV and TAMV), the diameter of the capsular artery and TABF parameters (tissue perfusion parameters). Cut off values were established using a Youden´s Index to identify fertile stallions from stallions with testicular dysfunction. Spectral Doppler ultrasound is a good predictive tool for sperm quality since correlations were determined among Doppler parameters and markers of sperm quality. Doppler ultrasonography could be a valuable diagnostic tool for use by clinical practitioners for the diagnosis of stallions with testicular dysfunction and could be a viable alternative to invasive procedures traditionally used for diagnosis of sub-fertility disorders.

Potential role of imaging in assessing harmful effects on spermatogenesis in adult testes with varicocele

Varicocele is characterized by an abnormal dilatation and retrograde blood flow in the spermatic veins. Varicocele is the leading correctable cause of male infertility. Although it is highly prevalent in infertile men, it is also observed in individuals with normal fertility. Determining which men are negatively affected by varicocele would enable clinicians to better select those men who will benefit from treatment. To assess the functional status of the testes in men with varicocele, color Doppler sonographic parameters were evaluated. Testicular arterial blood flow was significantly reduced in men with varicocele, reflecting an impairment of spermatogenesis. An improvement in the testicular blood supply was found after varicocelectomy on spectral Doppler analysis. Testicular contrast harmonic imaging and elastography might improve our knowledge about the influence of varicocele on intratesticular microcirculation and tissue stiffness, respectively, providing possible information on the early damage of testicular structure by varicocele. Magnetic resonance imaging (MRI), with measurement of apparent diffusion coefficient has been used to assess the degree of testicular dysfunction and to evaluate the effectiveness of varicocele repair. Large prospective studies are needed to validate the possible role of functional sonography and MRI in the assessment of early defects of spermatogenesis in testes with varicocele.

Comparison of response to treatment of unilateral and bilateral varicocelectomy

BACKGROUND/AIM

We aimed to compare the results of unilateral and bilateral varicocele surgery.

MATERIALS AND METHODS

In two referral hospitals, the data of 180 patients who were treated with unilateral and bilateral microscopic varicocelectomy were retrospectively analyzed. Sperm parameters and spontaneous pregnancy rates were compared in patients who underwent bilateral and unilateral microscopic varicocelectomy.

RESULTS

The mean age was 29.6 (17-46) years. While 82 patients underwent unilateral varicocelectomy (Group I), 98 patients underwent bilaterally varicocelectomy (Group II). Forty (48.8%) spontaneous pregnancies occurred in Group I and 59 (60.2%) in Group II. When we analyzed sperm parameters, the rate of increase in the number of sperm in spermiograms was 17% in Group I and 27.5% in Group II. The rate of increase in sperm mobility was 58.5% and 50% in Group I and II, respectively. The improvement rate in sperm morphology was 46.3% in Group I and 56.1% in Group II. There were no significant differences between all these parameters.

CONCLUSION

In light of our results, although pregnancy rates seemed to be higher in patients who underwent bilateral varicocelectomy, these results were not statistically significant. Improvement rates in sperm parameters were similar between the patients who underwent unilateral and bilateral varicocelectomy.

Randomised clinical trial of comparing effects of acupuncture and varicocelectomy on sperm parameters in infertile varicocele patients

The aim of the study was to evaluate the effect of the acupuncture treatment on sperm parameters and pregnancy rates in patients with primary infertility. Between January 2008 and May 2010, 30 men with the primary infertility (one year of unprotected intercourse, healthy wife) and varicocele with normal hormone levels and abnormal semen analysis were randomised into two groups. Group 1 underwent subinguinal microscopic varicocelectomy, and Group 2 underwent acupuncture treatment twice a week for 2 months. Both groups were evaluated with semen analysis at 6 months after the treatment. Patients in both groups evaluated with telephone calls and e-mail in terms of pregnancy. The mean age of the patients was 27.2, and groups were comparable regarding the age (P = 0.542). The pre-treatment sperm concentration, motility and morphological characteristics were similar in both groups. Sperm concentration and motility improved significantly in both groups after the treatment. Increase in sperm concentration was higher in the acupuncture group compared to the varicocelectomy group (P = 0.039). The average follow-up was 42 months, and pregnancy rates were emphasised 33% in both groups. Acupuncture treatment in primary infertile varicocele patients with semen abnormalities seems to be effective and has comparable results with the varicocelectomy treatment.

Testicular perfusion after standing laparoscopic peritoneal flap hernioplasty in stallions

Acquired inguinal herniation is a very common condition in stallions, usually leading to unilateral or bilateral castration to prevent future recurrence. Recently, several surgical techniques such as the standing laparoscopic peritoneal flap hernioplasty (SLPFH) have been developed to avoid herniation recurrence and also preserve the breeding activity of high economic value stallions. However, studies on SLPFH lack more comprehensive and systematic data about reproductive-related adverse effects and outcomes. The aim of this study was to evaluate whether SLPFH of the internal inguinal rings produces changes in the testicular blood flow in a 1-year follow-up. For that purpose, six healthy stallions were used and testicular blood flow was assessed before, 3, 6, and 12 months (T0, T3, T6, and T12) after the procedure. Blood flow was evaluated ultrasonographically, using the pulsed-wave color Doppler mode. Peak systolic velocity, end-diastolic velocity, the time-averaged maximum velocity, and the derived indexes (resistive index) and pulsatility index) of the testicular artery were measured in two localizations: in the spermatic cord and on the caudal epididymal edge of the testicle. On the spermatic cord, the peak systolic velocity of the testicular artery increased significantly at T12. However, on the epididymal edge location of the artery, the pulsatility and resistive indexes were decreased at T12 (P < 0.05). This pattern of blood flow was related to a hyperemic process. Furthermore, SLPFH might have compressed the spermatic cord, causing a slight occlusion of the testicular artery and triggering a compensatory hyperemia to compensate the deficit of blood flow that supplies the testes. The SLPFH of the internal inguinal ring affected the testicular perfusion in stallions in a 1 year follow-up, although there was no effect on sperm production during this time. The spectral Doppler ultrasound is a useful tool to asses the testicular perfusion after reproductive surgical procedure and provides information which anticipates vascular supply compromise of the stallion testicles.

The investigation of correlation between semen analysis parameters and intraparenchymal testicular spectral Doppler indices in patients with clinical varicocele

OBJECTIVES

Our aim was to evaluate the effect of clinical varicocele on testicular microcirculation measured by spectral Doppler analysis and investigate the correlation between Doppler ultrasonographic findings and semen parameters.

METHODS

Fifty patients who received a diagnosis of clinical varicocele in the Urology Department of our university hospital were enrolled in this prospective study. Varicocele grades were determined according to sonographic parameters, and a scrotal vein with a diameter of 2.5 mm or greater on color Doppler ultrasonography was included in the study. Spectral Doppler measurements of testicular arteries (peak systolic [PSV]/end-diastolic velocity [EDV], resistivity index [RI], pulsatility index [PI]) were measured from capsular and intratesticular branches of testicular arteries. All the patients were also assessed by semen analysis.

RESULTS

Mean age was 29.08 ± 5.42 years (range, 18-45 years). Among the whole study population, 22 men had isolated left varicocele, and 28 had bilateral varicoceles. No statistically significant correlation was found between the Doppler parameters: RI, PI, and EDV, and semen analysis parameters: count, motility, volume, and morphology. On the other hand, both in unilateral and bilateral varicocele cases, PSV was found to be significantly correlated with sperm count (P < 0.05).

CONCLUSIONS

Spectral Doppler analysis can provide valuable information as a noninvasive method to assess the hemodynamic changes and testicular microcirculation status in cases of clinical varicocele. However, RI, PI, and EDV values of capsular and intraparenchymal branches of testicular arteries may not be used as indicators of semen parameter deterioration. Hopefully, PSV measurement may give more conclusive data to predict sperm count. In addition, the cutoff value for this index has to be determined for future studies.

Varicocele and infertility: Role of pressure flow dynamics

Varicocele is prevalent in infertile individuals as well as in normal adolescents and adults. It has an increasing trend with growing age. Infertile individuals with varicocele, develop varying degrees of sperm abnormalities that range from mild to severe semen abnormalities, even azoospermia may develop. The main proposed features of these abnormalities are incompetence of one-way valves of the draining veins of testes, that allow backflow of blood into testes. This backflow produces abnormally high intra-testicular pressure and temperature, that has been confirmed by thermography and pressure estimation in various studies. Microsurgical varicocelectomy may reverse the pathologic effects on spermatogenesis in most patients, which points towards the cause and effect relationship of varicocele with testicular damage. We propose that the prolonged effect of gravity might or may not be the initiating factor for varicocele, as in our experience, around 1/4^th of hypogonadotropic hypogonadism patients who had no varicocele before treatment, developed varicocele within 3 to 6 mo of treatment with gonadotropins. Occasionally varicocele is produced by “Nutcracker phenomenon”, which is compression of left renal vein between the abdominal aorta and superior mesenteric artery. The deleterious effects of varicocele may develop slowly, causing delayed secondary infertility or rapidly, leading to azoospermia or individual may be spared of damage due to unknown factors that need further research.

Determination of testicular blood flow in camelids using vascular casting and color pulsed-wave Doppler ultrasonography

We describe the vasculature of the camelid testis using plastic casting. We also use color pulsed-wave Doppler ultrasonography to measure testicular blood flow and compare the differences between testicular blood flow in fertile and infertile camelids. The testicular artery originates from the ventral surface of the aorta, gives rise to an epididymal branch, and becomes very tortuous as it approaches the testis. Within the supratesticular arteries, peak systolic velocity (PSV) was higher in fertile males compared to infertile males (P = 0.0004). In addition, end diastolic velocity (EDV) within the supratesticular arteries was higher for fertile males when compared to infertile males (P = 0.0325). Within the marginal arteries, PSV was also higher in fertile males compared to infertile males (P = 0.0104). However, EDV within the marginal arteries was not significantly different between fertile and infertile males (P = 0.121). In addition, the resistance index was not significantly different between fertile and infertile males within the supratesticular (P = 0.486) and marginal arteries (P = 0.144). The significance of this research is that in addition to information obtained from a complete reproductive evaluation, a male camelid's fertility can be determined using testicular blood flow measured by Doppler ultrasonography.

Acute segmental testicular infarction at contrast-enhanced ultrasound: early features and changes during follow-up

OBJECTIVE

The purpose of this retrospective study was to assess whether contrast-enhanced ultrasound is useful for characterization of acute segmental testicular infarction.

MATERIALS AND METHODS

Twenty men with acute scrotal pain and suspected segmental testicular infarction underwent contrast-enhanced ultrasound. Three patients underwent orchiectomy. For the other patients, the final diagnosis was based on the absence of tumor markers and a change in the size or shape of the tumor during follow-up. Forty-nine color Doppler ultrasound studies (16 within 24 hours of the onset of pain; 14, 2-17 days after pain onset; 19 after 1 month or more), and 38 contrast-enhanced ultrasound studies (13 within 24 hours after pain onset; nine, 2-17 days; 16 after 1 month or more) were performed.

RESULTS

Fourteen of 16 lesions examined within 24 hours were oval, and two were wedge shaped. Eight lesions were isoechoic to the testis, six were hypoechoic, and two had mixed echogenicity. Twelve lesions were avascular and four were hypovascular at color Doppler examination. Contrast-enhanced ultrasound showed avascular parenchymal lobules in all cases and without perilesional rim enhancement in 12 of 13 studies. Two to 17 days after the symptoms appeared, contrast-enhanced ultrasound showed avascular lobules in all cases and perilesional rim enhancement in eight examinations. After 1 month or more, contrast-enhanced ultrasound depicted intralesional vascular spots in 12 of 14 infarcts. Perilesional enhancement was absent.

CONCLUSION

Recognition of lobular morphologic characteristics and the presence of perilesional rim enhancement at contrast-enhanced ultrasound can increase confidence in the diagnosis of segmental testicular infarction compared with reliance on gray-scale and color Doppler findings. Changes in lesion features during follow-up confirm the differential diagnosis from other testicular lesions and allow conservative management.

High origin of a testicular artery: a case report and review of the literature

Introduction

Although variations in the origin of the testicular artery are not uncommon, few reports about a high origin from the abdominal aorta exist in the literature. We discuss the case of a high origin of the testicular artery, its embryology, classification systems, and its clinical significance.

Case presentation

We report a very rare case of high origin of the left testicular artery in a 68-year-old Caucasian male cadaver. The artery originated from the anterolateral aspect of the abdominal aorta, 2 cm cranially to the ipsilateral renal artery. Approximately 1 cm after its origin, it branched off into the inferior suprarenal artery. During its course, the artery crossed anterior to the left renal artery.

Conclusions

A knowledge of the variant origin of the testicular artery is important during renal and testicular surgery. The origin and course must be carefully identified in order to preserve normal blood circulation and prevent testicular atrophy. A reduction in gonadal blood flow may lead to varicocele under circumstances. A knowledge of this variant anatomy may be of interest to radiologists and helpful in avoiding diagnostic errors.

The role of ultrasound in assessment of male fertility

Ultrasonography (US) is a widely used and well tolerated imaging modality for evaluation of pathologic conditions of the testes. Recent technical advances of US applications and post processing developments have enabled new aspects in the structural and functional analysis of testicular tissue and therefore male fertility. This review covers the most relevant approaches due to recent technical advances. Testicular volume measured by B-mode US correlated significantly with testicular function. Increased resistive index (RI) and pulsatility index (PI) of capsular branches of testicular arteries on unenhanced color Doppler US examination may be an indicator of impaired testicular microcirculation in patients with clinical varicocele. FSH was inversely correlated with testicular volume and directly correlated with testicular vascularization, suggesting that ultrasonographic and color Doppler scanning of the testes may be used, if a sperm count is not available, to indirectly assess the gonadal function. Perfusion mapping, performed with the use of color Doppler ultrasound, has shown for the first time that in patients suffering from azoospermia, sperm quality and quantity depend on tissue perfusion within the testicle. Testicular arterial blood flow was found to be significantly decreased in men with varicocele. This may be a reflection of the impaired microcirculation. Following decreased testicular arterial blood flow, impaired spermatogenesis may result from defective energy metabolism in the microcirculatory bed. Contrast-enhanced ultrasound (CEUS) imaging is potentially applicable to the investigation of vascular disorders of the testis. Pulse inversion (PI) US data can correctly determine relative testicular perfusion based on nonlinear curve fitting of the US backscatter intensity as a function of time and spectral analysis of the intensity time trace. PI imaging, compared with conventional Doppler US methods, provides superior assessment of perfusion in the setting of acute testicular ischemia. New contrast-enhanced US techniques like microvessel imaging (proposed by Philips) and CPS (proposed by Siemens-Acuson) allow for a better determination of tissue perfusion based on time intensity curves and an illustration of vessel distribution inside the testis. First results show a lower vessel density in atrophic testes and a difference in contrast dynamics in testes with impaired function. Real-time elastography, a method for illustration of tissue stiffness under real-time conditions, demonstrates different elasticity values dependent on testicular volume and function. Further studies will prove if these techniques can evolve into clinical practice.

Testicular blood flow and plasma concentrations of testosterone and total estrogen in the stallion after the administration of human chorionic gonadotropin

The goal of this study was to investigate for the first time a possible association between plasma concentrations of testosterone and total estrogen and testicular blood flow in the stallion. Correlations between these variables were calculated before and after administration of human chorionic gonadotropin (hCG). Eight mature warmblood stallions received 5,000 IU hCG intravenously, and four stallions received solvent only. Testicular blood flow in the left and right testicular arteries was assessed using colour Doppler sonography by measuring blood flow volume (BFV) and pulsatility index (PI) immediately before (time 0) and 1, 3, 6, 12, 24, 72, 120 and 168 h after hCG administration. EDTA blood samples were collected after each examination from a jugular vein to measure plasma testosterone and total estrogen concentrations. After treatment, the BFV increased and was elevated at 1 h and between 12 and 24 h. The profile of the PI was contrary to that of the BFV throughout the study period. Following hCG, there was a biphasic increase in testosterone concentration with maxima between 1 and 3 h and between 24 and 72 h, and there was a monophasic increase in the total estrogen concentration with a maximum between 6 and 24 h. At time 0, the total estrogen concentration correlated significantly with BFV (r=0.90; P<0.05) but the testosterone concentration did not (P>0.05). The testosterone and total estrogen concentrations did not correlate with PI (P>0.05). The total estrogen concentration, but not testosterone, correlated well with BFV after injection of hCG (P<0.05). The results of this study indicated that the testicular blood flow volume of the stallion may be regulated by estrogens, but additional studies are necessary to investigate whether there is a causal relationship.

Long-term effect of varicocele repair on intratesticular arterial resistance index

PURPOSE

To investigate the long-term effect of varicocele repair on ipsilateral intratesticular arterial resistance index (RI) using color Doppler sonography (CDS).

METHODS

A total of 26 infertile patients with left varicocele who underwent a testicular artery and lymphatic-sparing subinguinal varicocelectomy were examined with CDS for intratesticular flow parameters before and at least 6 months after surgery. We also evaluated preoperative and postoperative semen parameters.

RESULTS

The mean values of RI, end-diastolic velocity and pulsatility index decreased significantly after surgery, whereas no significant change was observed in peak systolic velocity. Repair of the varicocele resulted in a statistically significant increase in the total sperm count, motility, morphology, and total motile sperm count. However, no significant correlation was found between sperm parameters and RI values (p > 0.05).

CONCLUSIONS

Our data show that a significant improvement occurs in testicular blood supply and sperm parameters after surgical varicocele repair, without significant correlation between these 2 changes.

Experimental anatomic modeling of venous dyshemocirculation in the scrotal organs

Disorders in venous outflow from the testis and epididymis lead to the formation of pathological compensatory hemodynamics, development of high intratesticular pressure with impairment of the integrity of the intra-organ vessels, up to extravasation (testicular venous infarction), to local arterial hypertension, inter-arterial shunting of stained solutions through the intersystem fusion of the testicular arteries (shunting of arterial blood under vital conditions), and hence, trigger the mechanism of secondary arterial ischemization of the testis and epididymis. The severity of circulatory disorders depends on the volume of venous collectors excluded from circulation: from pronounced disorders in case of testicular venous outflow blockade to extremely severe ones in case of combined testicular-cremasteric venous block (hemodynamic collapse).