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Bonomi M, Cangiano B, Cianfarani S, Garolla A, Gianfrilli D, Lanfranco F, Rastrelli G, Sbardella E, Corona G, Isidori AM, Rochira V. "Management of andrological disorders from childhood and adolescence to transition age: guidelines from the Italian Society of Andrology and Sexual Medicine (SIAMS) in collaboration with the Italian Society for Pediatric Endocrinology and Diabetology (SIEDP)-Part-1". J Endocrinol Invest 2024:10.1007/s40618-024-02435-x. [PMID: 39126560 DOI: 10.1007/s40618-024-02435-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE Andrological pathologies in the adulthood are often the results of conditions that originate during childhood and adolescence and sometimes even during gestation and neonatal period. Unfortunately, the reports in the literature concerning pediatric andrological diseases are scares and mainly concerning single issues. Furthermore, no shared position statement are so far available. METHODS The Italian Society of Andrology and Sexual Medicine (SIAMS) commissioned an expert task force involving the Italian Society of Pediatric Endocrinology and Diabetology (SIEDP) to provide an updated guideline on the diagnosis and management of andrological disorders from childhood and adolescence to transition age. Derived recommendations were based on the grading of recommendations, assessment, development, and evaluation (GRADE) system. RESULTS A literature search of articles in English for the term "varicoceles", "gynecomastia", "fertility preservation", "macroorchidism", "precocious puberty" and "pubertal delay" has been performed. Three major aspects for each considered disorder were assessed including diagnosis, clinical management, and treatment. Recommendations and suggestions have been provided for each of the mentioned andrological disorders. CONCLUSIONS These are the first guidelines based on a multidisciplinary approach that involves important societies related to the field of andrological medicine from pediatric to transition and adult ages. This fruitful discussion allowed for a general agreement on several recommendations and suggestions to be reached, which can support all stakeholders in improving andrological and general health of the transitional age.
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Affiliation(s)
- M Bonomi
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy.
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy.
| | - B Cangiano
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
| | - S Cianfarani
- Endocrinology and Diabetes Unit, Bambino Gesù Children's Hospital, Rome, Italy
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - A Garolla
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padua, Italy
| | - D Gianfrilli
- Section of Medical Pathophysiology and Endocrinology, Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
- Centre for Rare Diseases (Endo-ERN Accredited), Policlinico Umberto I, Rome, Italy
| | - F Lanfranco
- Division of Endocrinology, Andrology and Metabolism, Department of Medical Sciences, Humanitas Gradenigo, University of Turin, Turin, Italy
| | - G Rastrelli
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Careggi Hospital, University of Florence, Florence, Italy
| | - E Sbardella
- Section of Medical Pathophysiology and Endocrinology, Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
- Centre for Rare Diseases (Endo-ERN Accredited), Policlinico Umberto I, Rome, Italy
| | - G Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Azienda Usl, Bologna, Italy
| | - A M Isidori
- Section of Medical Pathophysiology and Endocrinology, Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
- Centre for Rare Diseases (Endo-ERN Accredited), Policlinico Umberto I, Rome, Italy
| | - V Rochira
- Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria Di Modena Policlinico Di Modena, Ospedale Civile Di Baggiovara, Via Giardini 1355, 41126, Modena, Italy.
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2
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Tenuta M, Mazzotta P, Sesti F, Angelini F, Gelibter AJ, Speranza I, Paoli D, Lombardo F, Anzuini A, Magliocca FM, Franco G, Cortesi E, Santini D, Lenzi A, Gianfrilli D, Isidori AM, Pozza C. Testicular ultrasonographic features predict future risk for bilateral testicular germ cell tumour: A long-term single centre follow-up study. Andrology 2024. [PMID: 39078248 DOI: 10.1111/andr.13704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 07/01/2024] [Accepted: 07/05/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND Bilateral testicular germ cell tumours (B-GCT) are rare, with an incidence of 2-5%, and can be classified as synchronous (sB-GCT) or metachronous (mB-GCT). Our study aimed to identify clinical, biochemical, and radiological risk factors for mB-GCT in a cohort of patients with GCT at a single tertiary referral centre. METHODS This retrospective case-control study included patients with GCT referred to Policlinico Umberto I-Sapienza University of Rome, from 2005 to 2023. We evaluated clinical history, testicular ultrasound features, hormone levels, semen analysis, histological characteristics, staging, and treatments. mB-GCTs were compared with unilateral GCT patients with a follow-up longer than the median time-to-onset of the second tumour. RESULTS Of 319 patients, 52 experienced B-GCT, with a median time-to-onset of the second tumour of 62 months (range: 8-229). The mB-GCT group showed higher gonadotropin levels (FSH 13.6mUI/mL vs. 7.4mUI/mL, p < 0.001; LH 6.6mUI/mL vs. 3.9mUI/mL, p = 0.004), lower sperm concentration (27 × 106/ejaculate vs. 78 × 106/ejaculate, p = 0.009), smaller residual testis volume (10.4 mL vs. 16.3 mL, p < 0.001), more inhomogeneous echotexture [57.5% vs. 14%, p < 0.001], and presence of microlithiasis (75% vs. 19.5%, p < 0.001). Kaplan-Meier curves confirmed that ultrasound features of the residual testis increased the cumulative risk of developing a second tumour. Microlithiasis was a strong independent predictor (OR 30.712, 95% CI 3.357-280.942, p = 0.002). CONCLUSIONS Histological features of the first tumour or its treatment do not influence the onset of a second tumour. However, low residual testis volume, inhomogeneous echotexture, and microlithiasis significantly increase this risk. A comprehensive evaluation of the residual testis at baseline is essential for developing a personalised surveillance programme in GCT survivors, with regular ultrasound follow-up recommended beyond the conventional 5-year limit.
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Affiliation(s)
- Marta Tenuta
- Division of Endocrinology and Andrology, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Paola Mazzotta
- Division of Endocrinology and Andrology, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Franz Sesti
- Division of Endocrinology and Andrology, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Francesco Angelini
- Division of Endocrinology and Andrology, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Alain J Gelibter
- Division of Oncology B, Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University, Rome, Italy
| | - Iolanda Speranza
- Division of Oncology A, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Donatella Paoli
- Division of Endocrinology and Andrology, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Francesco Lombardo
- Division of Endocrinology and Andrology, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Antonella Anzuini
- Division of Endocrinology and Andrology, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Fabio Massimo Magliocca
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University, Rome, Italy
| | - Giorgio Franco
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Rome, Italy
| | - Enrico Cortesi
- Division of Oncology B, Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University, Rome, Italy
| | - Daniele Santini
- Division of Oncology A, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Andrea Lenzi
- Division of Endocrinology and Andrology, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Daniele Gianfrilli
- Division of Endocrinology and Andrology, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Andrea M Isidori
- Division of Endocrinology and Andrology, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Carlotta Pozza
- Division of Endocrinology and Andrology, Department of Experimental Medicine, Sapienza University, Rome, Italy
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Mazzilli R, Petrucci S, Zamponi V, Golisano B, Pecora G, Mancini C, Salerno G, Alesi L, De Santis I, Libi F, Rossi C, Borro M, Raffa S, Visco V, Defeudis G, Piane M, Faggiano A. Seminological, Hormonal and Ultrasonographic Features of Male Factor Infertility Due to Genetic Causes: Results from a Large Monocentric Retrospective Study. J Clin Med 2024; 13:4399. [PMID: 39124666 PMCID: PMC11313503 DOI: 10.3390/jcm13154399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/12/2024] [Accepted: 07/21/2024] [Indexed: 08/12/2024] Open
Abstract
Objectives: Evaluate the prevalence of genetic factors in a large population of infertile subjects and define the seminological, hormonal, and ultrasonographic features for each alteration. Methods: This single-center retrospective study included male partners of infertile couples undergoing genetic investigations due to oligozoospermia or azoospermia evaluated from January 2012 to January 2022. The genetic investigations consist of karyotype, CFTR gene mutations plus variant of the IVS8-5T polymorphic trait, Y chromosome microdeletion, and Next Generation Sequencing panel to analyze genes implicated in congenital hypogonadotropic hypogonadism (CHH). Results: Overall, 15.4% (72/466) of patients received a diagnosis of genetic cause of infertility. Specifically, 23 patients (31.9%) harbor mutations in the CFTR gene, 22 (30.6%) have a 47, XXY karyotype, 14 (19.4%) patients show a Y chromosome microdeletion, 7 (9.7%) have structural chromosomal anomalies, and 6 (8.3%) have CHH. Overall, 80.6% of patients were azoospermic and 19.4% oligozoospermic (sperm concentration 3.5 ± 3.8 million/mL). Almost all patients presented hormonal alterations related to the specific genotype, while the main ultrasound alterations were testicular hypoplasia, calcifications/microcalcifications, and enlarged/hyperechoic epididymis. Conclusions: The prevalence of genetic abnormalities in males of infertile couples was 15.4% in our Center. CFTR gene disease-causing variants resulted in more frequent, with various clinical features, highlighting the complexity and heterogeneity of the presentation. Other investigations are needed to understand if conditions like ring chromosomes and other translocations are related to infertility or are incidental factors.
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Affiliation(s)
- Rossella Mazzilli
- Endocrinology and Andrology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant’Andrea Hospital, 00189 Rome, Italy; (R.M.); (V.Z.); (B.G.); (G.P.); (C.M.); (A.F.)
| | - Simona Petrucci
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant’Andrea Hospital, 00189 Rome, Italy; (G.S.); (M.B.); (S.R.); (V.V.); (M.P.)
| | - Virginia Zamponi
- Endocrinology and Andrology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant’Andrea Hospital, 00189 Rome, Italy; (R.M.); (V.Z.); (B.G.); (G.P.); (C.M.); (A.F.)
| | - Bianca Golisano
- Endocrinology and Andrology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant’Andrea Hospital, 00189 Rome, Italy; (R.M.); (V.Z.); (B.G.); (G.P.); (C.M.); (A.F.)
| | - Giulia Pecora
- Endocrinology and Andrology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant’Andrea Hospital, 00189 Rome, Italy; (R.M.); (V.Z.); (B.G.); (G.P.); (C.M.); (A.F.)
| | - Camilla Mancini
- Endocrinology and Andrology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant’Andrea Hospital, 00189 Rome, Italy; (R.M.); (V.Z.); (B.G.); (G.P.); (C.M.); (A.F.)
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Gerardo Salerno
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant’Andrea Hospital, 00189 Rome, Italy; (G.S.); (M.B.); (S.R.); (V.V.); (M.P.)
| | - Laura Alesi
- UOD Medical Genetics and Advanced Cell Diagnostics, Sant’Andrea Hospital, 00189 Rome, Italy; (L.A.); (I.D.S.); (F.L.); (C.R.)
| | - Ilaria De Santis
- UOD Medical Genetics and Advanced Cell Diagnostics, Sant’Andrea Hospital, 00189 Rome, Italy; (L.A.); (I.D.S.); (F.L.); (C.R.)
| | - Fabio Libi
- UOD Medical Genetics and Advanced Cell Diagnostics, Sant’Andrea Hospital, 00189 Rome, Italy; (L.A.); (I.D.S.); (F.L.); (C.R.)
| | - Carla Rossi
- UOD Medical Genetics and Advanced Cell Diagnostics, Sant’Andrea Hospital, 00189 Rome, Italy; (L.A.); (I.D.S.); (F.L.); (C.R.)
| | - Marina Borro
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant’Andrea Hospital, 00189 Rome, Italy; (G.S.); (M.B.); (S.R.); (V.V.); (M.P.)
| | - Salvatore Raffa
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant’Andrea Hospital, 00189 Rome, Italy; (G.S.); (M.B.); (S.R.); (V.V.); (M.P.)
- UOD Medical Genetics and Advanced Cell Diagnostics, Sant’Andrea Hospital, 00189 Rome, Italy; (L.A.); (I.D.S.); (F.L.); (C.R.)
| | - Vincenzo Visco
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant’Andrea Hospital, 00189 Rome, Italy; (G.S.); (M.B.); (S.R.); (V.V.); (M.P.)
- UOD Medical Genetics and Advanced Cell Diagnostics, Sant’Andrea Hospital, 00189 Rome, Italy; (L.A.); (I.D.S.); (F.L.); (C.R.)
| | - Giuseppe Defeudis
- Department of Theoretical and Applied Sciences, eCampus University, 22060 Novedrate, Italy
- Unit of Endocrinology and Diabetes, Department of Medicine, University Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Maria Piane
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant’Andrea Hospital, 00189 Rome, Italy; (G.S.); (M.B.); (S.R.); (V.V.); (M.P.)
- UOD Medical Genetics and Advanced Cell Diagnostics, Sant’Andrea Hospital, 00189 Rome, Italy; (L.A.); (I.D.S.); (F.L.); (C.R.)
| | - Antongiulio Faggiano
- Endocrinology and Andrology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant’Andrea Hospital, 00189 Rome, Italy; (R.M.); (V.Z.); (B.G.); (G.P.); (C.M.); (A.F.)
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Dittmar F, Rosellen J, Reiser L, Fritzenwanker M, Hauptmann A, Diemer T, Schuppe HC, Wagenlehner F, Pilatz A. Comprehensive evaluation of hematospermia in patients with acute epididymitis compared to patients with isolated hematospermia. Andrology 2024; 12:1001-1011. [PMID: 37401133 DOI: 10.1111/andr.13489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Among the most commonly known causes of hematospermia are infections in the genitourinary tract, but no study exists that has comprehensively investigated hematospermia in patients with acute epididymitis. OBJECTIVES To assess the impact of hematospermia in patients with acute epididymitis and its association with clinical, microbiological, and semen parameters. MATERIALS AND METHODS Since May 2007, a total of 324 sexually active patients with acute epididymitis were recruited in a prospective cohort study. Patients received a comprehensive medical and sexual history, and clinical, sonographic, laboratory, and microbiological diagnostics. Antibiotic therapy was given according to European Association of Urology guidelines. Semen analysis was offered 14 days after the first presentation and initiation of therapy. Since 2013, a separate control group of 56 patients presenting with isolated hematospermia (= no other urogenital symptoms) was prospectively recruited, and differences between the groups were statistically evaluated. RESULTS Of 324 patients with acute epididymitis, 50 patients (15%) had self-reported hematospermia. This occurred with a median of 24 h before the onset of scrotal symptoms and was associated with significantly elevated prostate-specific antigen levels compared to 274 patients without hematospermia (3.1 vs. 1.8 ng/ml, p < 0.01). The two most common etiological pathogens were Escherichia coli and Chlamydia trachomatis, and the bacterial spectrum was comparable in both epididymitis subgroups (p = 0.859). Semen analysis at 14 days still showed hematospermia in 24% of patients associated with massive leukocytospermia. Compared to the hematospermia control group, the two epididymitis subgroups showed significantly increased inflammation markers (pH, leukocytes, and elastase), reduced sperm concentration, and reduced levels of alpha-glucosidase and zinc (always p < 0.01). DISCUSSION AND CONCLUSION In sexually active patients who develop acute epididymitis, self-reported hematospermia is evident in 15% of patients as early as one day before the onset of scrotal symptoms. Conversely, none of the 56 patients presenting with isolated hematospermia developed epididymitis within the next 4 weeks.
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Affiliation(s)
- Florian Dittmar
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Jens Rosellen
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Leo Reiser
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Moritz Fritzenwanker
- Institute for Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany
| | - Arne Hauptmann
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Thorsten Diemer
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Hans-Christian Schuppe
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Florian Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
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5
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Pozzi E, Belladelli F, Corsini C, Boeri L, Capogrosso P, Fallara G, Candela L, Bertini A, Cattafi F, Raffo M, Cazzaniga W, Ventimiglia E, d'Arma A, Alfano M, Matloob R, Papaleo E, Candiani M, Montorsi F, Salonia A. Contemporary Diagnostic Work-Up for Male Infertility: Emphasizing Comprehensive Baseline Assessment. World J Mens Health 2024; 42:42.e63. [PMID: 39028127 DOI: 10.5534/wjmh.240069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 03/19/2024] [Accepted: 04/09/2024] [Indexed: 07/20/2024] Open
Abstract
Infertility is a prevalent issue affecting many couples during their reproductive years, with a significant number facing challenges in conceiving despite regular unprotected intercourse. Male factor infertility (MFI) contributes significantly to these cases, with a significant proportion of men lacking an identifiable etiology. As such, a thorough assessment of MFI has become increasingly vital for personalized management. This position paper from the Andrology team at IRCCS Ospedale San Raffaele emphasizes a comprehensive and individualized approach to MFI work-up, addressing the evolving challenges encountered in clinical practice. Our approach involves a thorough diagnostic work-up to identify the underlying causes of MFI, integrating insights from extensive literature review and our proprietary data. Our data demonstrates that an extensive diagnostic assessment allows us to identify at least one underlying cause of MFI in most infertile men. However, challenges persist in diagnosing less severe phenotypes with unclear etiology. We discuss the importance of individualized MFI work-up and its implications for developing rational therapeutic protocols. Lastly, this paper highlights the necessity for a personalized diagnostic assessment, addressing the daily clinical challenges and emphasizing tailored approaches to try to improve outcomes among couples seeking first medical help for infertility.
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Affiliation(s)
- Edoardo Pozzi
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federico Belladelli
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Christian Corsini
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Capogrosso
- Department of Urology, Circolo & Fondazione Macchi Hospital - ASST Sette Laghi, Varese, Italy
| | - Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luigi Candela
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Bertini
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Cattafi
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimiliano Raffo
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Walter Cazzaniga
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessia d'Arma
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Alfano
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Rayan Matloob
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Enrico Papaleo
- Department of Obstetrics and Gynaecology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Candiani
- University Vita-Salute San Raffaele, Milan, Italy
- Department of Obstetrics and Gynaecology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy.
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6
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Rosellen J, Dittmar F, Hauptmann A, Diemer T, Schuppe HC, Schagdarsurengin U, Fritzenwanker M, Wagenlehner F, Pilatz A. Impaired Semen Quality in Patients with Chronic Prostatitis. J Clin Med 2024; 13:2884. [PMID: 38792425 PMCID: PMC11122295 DOI: 10.3390/jcm13102884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Chronic prostatitis/chronic pelvic pain syndrome CP/CPPS is a rather common condition and in recent years many studies have shown contradictory results regarding its impact on semen quality. This prospective cohort study set out to investigate how CP/CPPS affected the parameters of semen in a prospective cohort of patients compared with the WHO 2021 reference group. Methods: From 2013 to 2022, a total of 1071 patients with suspicion of CP/CPPS received a comprehensive andrological examination. Complete semen analysis was carried out in compliance with WHO 2010 guidelines, comparing every study population semen variable to the WHO 2021 reference group (n~3500). Results: All evaluated semen parameters had median values that fell within a normal range. Nonetheless, approximately 25% of patients had values for each semen variable that were lower than the WHO reference group's fifth percentile. In particular, bacteriospermia was associated with a negative impact on semen volume. Conclusions: This is the largest study that compares all standard semen parameters in patients suffering from CP/CPPS to WHO 2021 reference values. It provides evidence of an impairment of conventional semen parameters.
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Affiliation(s)
- Jens Rosellen
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Rudolf-Buchheim-Strasse 7, 35392 Giessen, Germany; (F.D.); (A.H.); (T.D.); (H.-C.S.); (U.S.); (F.W.); (A.P.)
| | - Florian Dittmar
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Rudolf-Buchheim-Strasse 7, 35392 Giessen, Germany; (F.D.); (A.H.); (T.D.); (H.-C.S.); (U.S.); (F.W.); (A.P.)
| | - Arne Hauptmann
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Rudolf-Buchheim-Strasse 7, 35392 Giessen, Germany; (F.D.); (A.H.); (T.D.); (H.-C.S.); (U.S.); (F.W.); (A.P.)
| | - Thorsten Diemer
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Rudolf-Buchheim-Strasse 7, 35392 Giessen, Germany; (F.D.); (A.H.); (T.D.); (H.-C.S.); (U.S.); (F.W.); (A.P.)
| | - Hans-Christian Schuppe
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Rudolf-Buchheim-Strasse 7, 35392 Giessen, Germany; (F.D.); (A.H.); (T.D.); (H.-C.S.); (U.S.); (F.W.); (A.P.)
| | - Undraga Schagdarsurengin
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Rudolf-Buchheim-Strasse 7, 35392 Giessen, Germany; (F.D.); (A.H.); (T.D.); (H.-C.S.); (U.S.); (F.W.); (A.P.)
| | - Moritz Fritzenwanker
- Institute for Medical Microbiology, Justus Liebig University Giessen, 35390 Giessen, Germany;
| | - Florian Wagenlehner
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Rudolf-Buchheim-Strasse 7, 35392 Giessen, Germany; (F.D.); (A.H.); (T.D.); (H.-C.S.); (U.S.); (F.W.); (A.P.)
| | - Adrian Pilatz
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Rudolf-Buchheim-Strasse 7, 35392 Giessen, Germany; (F.D.); (A.H.); (T.D.); (H.-C.S.); (U.S.); (F.W.); (A.P.)
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Sonigo C, Robin G, Boitrelle F, Fraison E, Sermondade N, Mathieu d'Argent E, Bouet PE, Dupont C, Creux H, Peigné M, Pirrello O, Trombert S, Lecorche E, Dion L, Rocher L, Arama E, Bernard V, Monnet M, Miquel L, Birsal E, Haïm-Boukobza S, Plotton I, Ravel C, Grzegorczyk-Martin V, Huyghe É, Dupuis HGA, Lefebvre T, Leperlier F, Bardet L, Lalami I, Robin C, Simon V, Dijols L, Riss J, Koch A, Bailly C, Rio C, Lebret M, Jegaden M, Fernandez H, Pouly JL, Torre A, Belaisch-Allart J, Antoine JM, Courbiere B. [First-line management of infertile couple. Guidelines for clinical practice of the French College of Obstetricians and Gynecologists 2022]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:305-335. [PMID: 38311310 DOI: 10.1016/j.gofs.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To update the 2010 CNGOF clinical practice guidelines for the first-line management of infertile couples. MATERIALS AND METHODS Five major themes (first-line assessment of the infertile woman, first-line assessment of the infertile man, prevention of exposure to environmental factors, initial management using ovulation induction regimens, first-line reproductive surgery) were identified, enabling 28 questions to be formulated using the Patients, Intervention, Comparison, Outcome (PICO) format. Each question was addressed by a working group that had carried out a systematic review of the literature since 2010, and followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) methodology to assess the quality of the scientific data on which the recommendations were based. These recommendations were then validated during a national review by 40 national experts. RESULTS The fertility work-up is recommended to be prescribed according to the woman's age: after one year of infertility before the age of 35 and after 6months after the age of 35. A couple's initial infertility work-up includes a single 3D ultrasound scan with antral follicle count, assessment of tubal permeability by hysterography or HyFOSy, anti-Mullerian hormone assay prior to assisted reproduction, and vaginal swabbing for vaginosis. If the 3D ultrasound is normal, hysterosonography and diagnostic hysteroscopy are not recommended as first-line procedures. Chlamydia trachomatis serology does not have the necessary performance to predict tubal patency. Post-coital testing is no longer recommended. In men, spermogram, spermocytogram and spermoculture are recommended as first-line tests. If the spermogram is normal, it is not recommended to check the spermogram. If the spermogram is abnormal, an examination by an andrologist, an ultrasound scan of the testicles and hormonal test are recommended. Based on the data in the literature, we are unable to recommend a BMI threshold for women that would contraindicate medical management of infertility. A well-balanced Mediterranean-style diet, physical activity and the cessation of smoking and cannabis are recommended for infertile couples. For fertility concern, it is recommended to limit alcohol consumption to less than 5 glasses a week. If the infertility work-up reveals no abnormalities, ovulation induction is not recommended for normo-ovulatory women. If intrauterine insemination is indicated based on an abnormal infertility work-up, gonadotropin stimulation and ovulation monitoring are recommended to avoid multiple pregnancies. If the infertility work-up reveals no abnormality, laparoscopy is probably recommended before the age of 30 to increase natural pregnancy rates. In the case of hydrosalpinx, surgical management is recommended prior to ART, with either salpingotomy or salpingectomy depending on the tubal score. It is recommended to operate on polyps>10mm, myomas 0, 1, 2 and synechiae prior to ART. The data in the literature do not allow us to systematically recommend asymptomatic uterine septa and isthmoceles as first-line surgery. CONCLUSION Based on strong agreement between experts, we have been able to formulate updated recommendations in 28 areas concerning the initial management of infertile couples.
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Affiliation(s)
- Charlotte Sonigo
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Antoine-Béclère, 157, rue de la Porte-Trivaux, 92140 Clamart, France; Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - Geoffroy Robin
- Service d'assistance médicale à la procréation et préservation de la fertilité, CHU de Lille, Lille, France
| | - Florence Boitrelle
- Service de biologie de la reproduction, préservation de fertilité, CECOS, CHI de Poissy, Poissy, France; INRAe, ENVA, BREED, UVSQ, université Paris Saclay, Jouy-en Josas, France
| | - Eloïse Fraison
- Département médecine de la reproduction, CHU Lyon, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69500 Bron, France
| | - Nathalie Sermondade
- Service de biologie de la reproduction CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75020 Paris, France; Inserm US938, centre de recherche Saint-Antoine, Sorbonne université, 75012 Paris, France
| | - Emmanuelle Mathieu d'Argent
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Pierre-Emmanuel Bouet
- Service de gynécologie-obstétrique, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49000 Angers, France
| | - Charlotte Dupont
- Service de biologie de la reproduction - CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75012 Paris, France
| | - Hélène Creux
- Centre AMP, polyclinique Saint-Roch, 550, avenue du Colonel-André-Pavelet, 34070 Montpellier cedex, France
| | - Maeliss Peigné
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Jean-Verdier-Béclère, avenue du 14-Juillet, Bondy, France
| | - Olivier Pirrello
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Sabine Trombert
- Laboratoire Cerba, 6-11, rue de l'Équerre, 95310 Saint-Ouen L'Aumône, France
| | - Emmanuel Lecorche
- Laboratoire Cerba, 6-11, rue de l'Équerre, 95310 Saint-Ouen L'Aumône, France
| | - Ludivine Dion
- Département de gynécologie-obstétrique et reproduction humaine - CECOS, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - Laurence Rocher
- Service de radiologie diagnostique et interventionnelle, site Bicêtre, hôpitaux Paris Sud, 94270 Le Kremlin-Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, université Paris Sud, 4, place du Gal-Leclerc, 91401 Orsay cedex, France
| | - Emmanuel Arama
- Service de radiologie diagnostique et interventionnelle, site Bicêtre, hôpitaux Paris Sud, 94270 Le Kremlin-Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, université Paris Sud, 4, place du Gal-Leclerc, 91401 Orsay cedex, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU Pellegrin, Bordeaux, France
| | - Margaux Monnet
- Département de gynécologie médicale, maternité régionale de Nancy, hôpitaux universitaires de Nancy, Nancy, France
| | - Laura Miquel
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - Eva Birsal
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | | | - Ingrid Plotton
- Service d'hormonologie, endocrinologie moléculaire et maladies rares, CPBE, groupement hospitalier Lyon-Est, Lyon-Bron, France; Université Claude-Bernard, Lyon 1, Lyon, France; Unité Inserm 1208, Lyon, France
| | - Célia Ravel
- Département de gynécologie-obstétrique et reproduction humaine - CECOS, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - Véronika Grzegorczyk-Martin
- Centre d'assistance médicale à la procréation et de préservation de la fertilité, clinique Mathilde, 76100 Rouen, France
| | - Éric Huyghe
- Département d'urologie, hôpital de Rangueil, CHU de Toulouse, Toulouse, France; Service de médecine de la reproduction, hôpital Paule-de-Viguier, CHU de Toulouse, Toulouse, France; Inserm 1203, UMR DEFE, université de Toulouse, université de Montpellier, Montpellier, France
| | - Hugo G A Dupuis
- Service d'urologie et d'andrologie, CHU - hôpitaux de Rouen, CHU Charles-Nicolle, 76031 Rouen, France
| | - Tiphaine Lefebvre
- Service de médecine et biologie de la reproduction - gynécologie médicale, centre hospitalier universitaire de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - Florence Leperlier
- Service de médecine et biologie de la reproduction - gynécologie médicale, centre hospitalier universitaire de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - Léna Bardet
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Imane Lalami
- Service de gynécologie-obstétrique et de médecine de la reproduction, grand hôpital de l'Est Francilien - site de Meaux, 6-8, rue Saint-Fiacre, 77100 Meaux, France
| | - Camille Robin
- Service d'assistance médicale à la procréation et préservation de la fertilité, CHU de Lille, Lille, France
| | - Virginie Simon
- Unité fonctionnelle de gynécologie endocrinienne, service de gynécologie médicale, orthogénie et sexologie, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - Laura Dijols
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Bretonneau, CHU de Tours, Tours, France
| | - Justine Riss
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Antoine Koch
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Clément Bailly
- Service de biologie de la reproduction CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75020 Paris, France; Inserm US938, centre de recherche Saint-Antoine, Sorbonne université, 75012 Paris, France
| | - Constance Rio
- Service de gynécologie-obstétrique, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49000 Angers, France
| | - Marine Lebret
- Service de gynécologie-obstétrique, CHU Charles-Nicolle, 37, boulevard Gambetta, 76000 Rouen, France
| | - Margaux Jegaden
- Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Département de chirurgie gynécologique et obstétrique, hôpital Bicêtre, GHU-Sud, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Hervé Fernandez
- Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Département de chirurgie gynécologique et obstétrique, hôpital Bicêtre, GHU-Sud, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Jean-Luc Pouly
- Service de gynécologie chirurgicale, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France
| | - Antoine Torre
- Centre d'assistance médicale à la procréation clinicobiologique, centre hospitalier Sud Francilien Corbeil-Essonnes, 40, avenue Serge-Dassault, 91106 Corbeil-Essonnes, France
| | - Joëlle Belaisch-Allart
- Service de médecine de la reproduction, pôle Femme-Enfant, Centre hospitalier des 4 villes, rue Charles-Lauer, 92210 Saint-Cloud, France
| | - Jean-Marie Antoine
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Blandine Courbiere
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France; IMBE, CNRS, IRD, Aix-Marseille université, Avignon université, Marseille, France.
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8
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Wyrwoll MJ, van der Heijden GW, Krausz C, Aston KI, Kliesch S, McLachlan R, Ramos L, Conrad DF, O'Bryan MK, Veltman JA, Tüttelmann F. Improved phenotypic classification of male infertility to promote discovery of genetic causes. Nat Rev Urol 2024; 21:91-101. [PMID: 37723288 DOI: 10.1038/s41585-023-00816-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/20/2023]
Abstract
An increasing number of genes are being described in the context of non-syndromic male infertility. Linking the underlying genetic causes of non-syndromic male infertility with clinical data from patients is important to establish new genotype-phenotype correlations. This process can be facilitated by using universal nomenclature, but no standardized vocabulary is available in the field of non-syndromic male infertility. The International Male Infertility Genomics Consortium aimed at filling this gap, providing a standardized vocabulary containing nomenclature based on the Human Phenotype Ontology (HPO). The "HPO tree" was substantially revised compared with the previous version and is based on the clinical work-up of infertile men, including physical examination and hormonal assessment. Some causes of male infertility can already be suspected based on the patient's clinical history, whereas in other instances, a testicular biopsy is needed for diagnosis. We assembled 49 HPO terms that are linked in a logical hierarchy and showed examples of morphological features of spermatozoa and testicular histology of infertile men with identified genetic diagnoses to describe the phenotypes. This work will help to record patients' phenotypes systematically and facilitate communication between geneticists and andrologists. Collaboration across institutions will improve the identification of patients with the same phenotypes, which will promote the discovery of novel genetic causes for non-syndromic male infertility.
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Affiliation(s)
- Margot J Wyrwoll
- Institute of Reproductive Genetics, University of Münster, Münster, Germany
| | | | - Csilla Krausz
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, University Hospital of Careggi (AOUC), Florence, Italy
| | - Kenneth I Aston
- Andrology and IVF Laboratory, Department of Surgery (Urology), University of Utah, Salt Lake City, UT, USA
| | - Sabine Kliesch
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University of Münster, Münster, Germany
| | - Robert McLachlan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Liliana Ramos
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Donald F Conrad
- Department of Genetics, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, USA
| | - Moira K O'Bryan
- School of BioSciences and Bio21 Institute, The University of Melbourne, Parkville, Victoria, Australia
| | - Joris A Veltman
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Frank Tüttelmann
- Institute of Reproductive Genetics, University of Münster, Münster, Germany.
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9
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Pedersen MRV, Otto PO, Fredslund M, Smedegaard C, Jensen J, McEntee MF, Loft MK. Ultrasound assessment of testicular volume - An interobserver variability study. J Med Imaging Radiat Sci 2023; 54:692-698. [PMID: 37838500 DOI: 10.1016/j.jmir.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Ultrasonography measurement of the testicles and subsequent calculation of the testicular volume is recommended as a part of a standard scrotal ultrasound examination. The interobserver variability of testicular volume measurement has implications for surgical recommendations. Therefore, this study aimed to investigate the interobserver variability in the measurement of testicular volume. METHODS Interobserver variability was established by comparing testicular measurements performed by two observers on the same patient during the same clinical appointment. The observers were blinded to each other's measurements. Testicular volume was calculated using the Lambert formula: length x width x height x 0.71. A total of three observers, A, B and C, participated in the study. The observers had between 4 to 20 years' experience with scrotal ultrasound examinations. RESULTS In total, 24 patients' were included (48 testicles). The patient´s mean age was 43 years (range 19-75 years). The overall mean right testicular volume was 19.8 ml (range 7.3-31.6 ml), and the left was 20.1 ml (range 7.1-36.1 ml). The interclass correlation coefficient (ICC) between observer A and B was excellent (ICC= 0.98, CI:0.92-0.99), between observer A and C, was excellent (ICC=0.91, CI: 0.77-0.97) and between B and C good (ICC=0.82, CI:0.51-0.93). CONCLUSION Variability in estimating testicular volume is low, with interobserver agreement ranging from good to excellent. Ultrasound provides a highly reproducible tool to determine testicular volume.
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Affiliation(s)
- Malene Roland Vils Pedersen
- University Hospital of Southern Denmark, Department of Radiology, Vejle Hospital, Beriderbakken 4, Vejle, Denmark; University Hospital of Southern Denmark, Department of Radiology, Kolding hospital, Sygehusvej 24, Kolding, Denmark; University of Southern Denmark, Institute of Regional Health, Campusvej 55, Odense, Denmark.
| | - Peter Obel Otto
- University Hospital of Southern Denmark, Department of Radiology, Vejle Hospital, Beriderbakken 4, Vejle, Denmark
| | - Mads Fredslund
- University Hospital of Southern Denmark, Department of Radiology, Vejle Hospital, Beriderbakken 4, Vejle, Denmark
| | - Claus Smedegaard
- University Hospital of Southern Denmark, Department of Radiology, Vejle Hospital, Beriderbakken 4, Vejle, Denmark
| | - Janni Jensen
- Odense University Hospital, Department of Radiology, J. B Winsløwsvej 4, Odense, Denmark; Research and Innovation Unit of Radiology, University Hospital of Southern Denmark
| | - Mark F McEntee
- University Hospital of Southern Denmark, Department of Radiology, Vejle Hospital, Beriderbakken 4, Vejle, Denmark; University of Southern Denmark, Institute of Regional Health, Campusvej 55, Odense, Denmark; University College Cork, School of Medicine, Discipline of Medical Imaging and Radiation Therapy, Ireland
| | - Martina Kastrup Loft
- University Hospital of Southern Denmark, Department of Radiology, Vejle Hospital, Beriderbakken 4, Vejle, Denmark; University Hospital of Southern Denmark, Department of Radiology, Kolding hospital, Sygehusvej 24, Kolding, Denmark
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10
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Bracco C, Gloria A, Contri A. Ultrasound-Based Technologies for the Evaluation of Testicles in the Dog: Keystones and Breakthroughs. Vet Sci 2023; 10:683. [PMID: 38133235 PMCID: PMC10747277 DOI: 10.3390/vetsci10120683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/11/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
Ultrasonography is a valuable diagnostic tool extensively used in the andrology of human and domestic animals, including dogs. This review aims to provide an overview of various technologies based on ultrasound, from the basic B-Mode ultrasonography to the more recent advancements, such as contrast-enhanced ultrasonography (CEUS) and ultrasound elastography (UEl), all of which are utilized in the evaluation of canine testicles. The review outlines the principles behind each of these technologies and discusses their application in assessing normal and abnormal testicular conditions. B-mode canine testicular ultrasonography primarily focuses on detecting focal lesions but has limitations in terms of objectivity. Other technologies, including Doppler ultrasonography, B-Flow, and CEUS, allow for the characterization of vascular patterns, which could be further measured using specific applications like spectral Doppler or quantitative CEUS. Additionally, ultrasound elastography enables the assessment of parenchyma stiffness both qualitatively and quantitatively. These ultrasound-based technologies play a crucial role in andrology by providing valuable information for evaluating testicular function and integrity, aiding in the identification of pathological conditions that may impact the health and quality of life of male dogs.
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Affiliation(s)
| | - Alessia Gloria
- Department of Veterinary Medicine, University of Teramo, Località Piano d’Accio, 64100 Teramo, Italy; (C.B.); (A.C.)
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11
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Pozza C, Tenuta M, Sesti F, Bertolotto M, Huang DY, Sidhu PS, Maggi M, Isidori AM, Lotti F. Multiparametric Ultrasound for Diagnosing Testicular Lesions: Everything You Need to Know in Daily Clinical Practice. Cancers (Basel) 2023; 15:5332. [PMID: 38001591 PMCID: PMC10670367 DOI: 10.3390/cancers15225332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Ultrasonography (US) represents the gold standard imaging method for the assessment of testicular lesions (TL). The gray-scale (GSUS) and color-Doppler (CDUS) ultrasound examination allow sonographers to investigate the size, margins, echotexture, and vascular features of TLs with the aim to differentiate benign from malignant lesions. Recently, the use of contrast-enhanced US (CEUS) and sonoelastography (SE) has led to further improvements in the differential diagnosis of TL. Although GSUS and CDUS are often sufficient to suggest the benign or malignant nature of the TL, CEUS can be decisive in the differential diagnosis of unclear findings, while SE can help to strengthen the diagnosis. The contemporary combination of GSUS, CDUS, CEUS, and SE has led to a new diagnostic paradigm named multiparametric US (mp-US), which is able to provide a more detailed characterization of TLs than single techniques alone. This narrative and pictorial review aimed to describe the mp-US appearance of several TLs. METHODS An extensive Medline search was performed to identify studies in the English language focusing on the mp-US evaluation of TLs. RESULTS A practical mp-US "identity card" and iconographic characterization of several benign and malignant TLs is provided herein. CONCLUSIONS The mp-US characterization of TL reported herein can be useful in daily clinical practice.
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Affiliation(s)
- Carlotta Pozza
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Marta Tenuta
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Franz Sesti
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Michele Bertolotto
- Department of Radiology, Ospedale Di Cattinara, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Dean Y. Huang
- Department of Imaging Sciences, Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK; (D.Y.H.); (P.S.S.)
| | - Paul S. Sidhu
- Department of Imaging Sciences, Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK; (D.Y.H.); (P.S.S.)
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50139 Florence, Italy;
| | - Andrea M. Isidori
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Francesco Lotti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
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12
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Sinagra L, Orlandi R, Caspanello T, Troisi A, Iannelli NM, Vallesi E, Pettina G, Bargellini P, De Majo M, Boiti C, Cristarella S, Quartuccio M, Polisca A. Contrast-Enhanced Ultrasonography (CEUS) in Imaging of the Reproductive System in Dogs: A Literature Review. Animals (Basel) 2023; 13:ani13101615. [PMID: 37238045 DOI: 10.3390/ani13101615] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/26/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
The use of contrast-enhanced ultrasound (CEUS) has been widely reported for reproductive imaging in humans and animals. This review aims to analyze the utility of CEUS in characterizing canine reproductive physiology and pathologies. In September 2022, a search for articles about CEUS in canine testicles, prostate, uterus, placenta, and mammary glands was conducted on PubMed and Scopus from 1990 to 2022, showing 36 total results. CEUS differentiated testicular abnormalities and neoplastic lesions, but it could not characterize tumors. In prostatic diseases, CEUS in dogs was widely studied in animal models for prostatic cancer treatment. In veterinary medicine, this diagnostic tool could distinguish prostatic adenocarcinomas. In ovaries, CEUS differentiated the follicular phases. In CEH-pyometra syndrome, it showed a different enhancement between endometrium and cysts, and highlighted angiogenesis. CEUS was shown to be safe in pregnant dogs and was able to assess normal and abnormal fetal-maternal blood flow and placental dysfunction. In normal mammary glands, CEUS showed vascularization only in diestrus, with differences between mammary glands. CEUS was not specific for neoplastic versus non-neoplastic masses and for benign tumors, except for complex carcinomas and neoplastic vascularization. Works on CEUS showed its usefulness in a wide spectrum of pathologies of this non-invasive, reliable diagnostic procedure.
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Affiliation(s)
- Letizia Sinagra
- Department of Veterinary Sciences, University of Messina, Viale Palatucci, 13, 98168 Messina, Italy
| | - Riccardo Orlandi
- Anicura Tyrus Clinica Veterinaria, Via Bartocci 1G, 05100 Terni, Italy
| | - Tiziana Caspanello
- Department of Veterinary Sciences, University of Messina, Viale Palatucci, 13, 98168 Messina, Italy
| | - Alessandro Troisi
- School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione 93/95, 62024 Macerata, Italy
| | - Nicola Maria Iannelli
- Department of Veterinary Sciences, University of Messina, Viale Palatucci, 13, 98168 Messina, Italy
- Clinica Veterinaria Camagna-VetPartners, Via Fortunato Licandro 13, 89124 Reggio di Calabria, Italy
| | - Emanuela Vallesi
- Anicura Tyrus Clinica Veterinaria, Via Bartocci 1G, 05100 Terni, Italy
- Anicura CMV Clinica Veterinaria, Via G.B. Aguggiari 162, 21100 Varese, Italy
| | - Giorgia Pettina
- Department of Veterinary Sciences, University of Messina, Viale Palatucci, 13, 98168 Messina, Italy
| | - Paolo Bargellini
- Anicura Tyrus Clinica Veterinaria, Via Bartocci 1G, 05100 Terni, Italy
| | - Massimo De Majo
- Department of Veterinary Sciences, University of Messina, Viale Palatucci, 13, 98168 Messina, Italy
| | - Cristiano Boiti
- Tyrus Science Foundation, Via Bartocci 1G, 05100 Terni, Italy
| | - Santo Cristarella
- Department of Veterinary Sciences, University of Messina, Viale Palatucci, 13, 98168 Messina, Italy
| | - Marco Quartuccio
- Department of Veterinary Sciences, University of Messina, Viale Palatucci, 13, 98168 Messina, Italy
| | - Angela Polisca
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy
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Lotti F, Frizza F, Balercia G, Barbonetti A, Behre HM, Calogero AE, Cremers J, Francavilla F, Isidori AM, Kliesch S, La Vignera S, Lenzi A, Marcou M, Pilatz A, Poolamets O, Punab M, Godoy MFP, Quintian C, Rajmil O, Salvio G, Shaeer O, Weidner W, Maseroli E, Cipriani S, Baldi E, Degl'Innocenti S, Danza G, Caldini AL, Terreni A, Boni L, Krausz C, Maggi M. The European Academy of Andrology (EAA) ultrasound study on healthy, fertile men: An overview on male genital tract ultrasound reference ranges. Andrology 2022; 10 Suppl 2:118-132. [PMID: 35930758 PMCID: PMC9828651 DOI: 10.1111/andr.13260] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 07/29/2022] [Accepted: 07/29/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND So far, male genital tract color-Doppler ultrasound (MGT-CDUS) was not standardized. Recently, the European Academy of Andrology (EAA) published the results of a multicenter study assessing the CDUS characteristics of healthy-fertile men (HFM) to obtain normative parameters. OBJECTIVES To report the EAA US study (i) standard operating procedures (SOPs) for assessing MGT-CDUS, (ii) main MGT-CDUS normative parameters, and (iii) compare the EAA and previously published "normal" CDUS values. METHODS A cohort of 248 HFM (35.3 ± 5.9 years) was studied, evaluating MGT-CDUS before and after ejaculation following SOPs. RESULTS SOPs for MGT-CDUS assessment are summarized here. All subjects underwent scrotal CDUS and 188 men underwent transrectal ultrasound before and after ejaculation. The main CDUS reference ranges and characteristics of the HFM-MGT are reported here. The mean testicular volume was ∼17 mL. The lower limit for right and left testis was 12 and 11 mL, defining testicular hypotrophy. The upper limit for epididymal head, body, tail, and vas deferens was 11.5, 5, 6, and 4.5 mm, respectively. Testicular and epididymal arterial reference ranges are reported. The EAA varicocoele classification is reported. CDUS-varicocoele was detected in ∼37% of men. Prostate mean volume was ∼25 mL, while lower and upper limits were 15 and 35 mL, defining hypotrophy and enlargement, respectively. Prostate arterial reference ranges are reported. Prostate calcifications and inhomogeneity were frequent; midline prostatic cysts were rare and small. Ejaculatory duct abnormalities were absent. The upper limit for periprostatic venous plexus was 4.5 mm. Lower and upper limits of seminal vesicles (SV) anterior-posterior diameter were 6 and 16 mm, defining hypotrophy or dilation, respectively. Seminal vesicle volume and ejection fraction reference ranges are reported. SV-US abnormalities were rare. Deferential ampullas upper limit was 6 mm. A discussion on the EAA and previously published "normal" CDUS values is reported here. CONCLUSIONS The EAA findings will help in reproductive and general male health management.
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Affiliation(s)
- Francesco Lotti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
| | - Francesca Frizza
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
| | - Giancarlo Balercia
- Endocrinology Unit, Ospedali Riuniti AnconaPolytechnic University of MarcheAnconaItaly
| | - Arcangelo Barbonetti
- Andrology Unit, Department of Life, Health and Environmental SciencesUniversity of L'AquilaL'AquilaItaly
| | - Hermann M. Behre
- Center for Reproductive Medicine and AndrologyMartin Luther University Halle‐WittenbergHalleGermany
| | - Aldo E. Calogero
- Department of Clinical and Experimental MedicineUniversity of CataniaCataniaItaly
| | - Jann‐Frederik Cremers
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and AndrologyMünster University HospitalMünsterGermany
| | - Felice Francavilla
- Andrology Unit, Department of Life, Health and Environmental SciencesUniversity of L'AquilaL'AquilaItaly
| | - Andrea M. Isidori
- Department of Experimental MedicineSapienza University of RomeRomeItaly
| | - Sabine Kliesch
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and AndrologyMünster University HospitalMünsterGermany
| | - Sandro La Vignera
- Department of Clinical and Experimental MedicineUniversity of CataniaCataniaItaly
| | - Andrea Lenzi
- Department of Experimental MedicineSapienza University of RomeRomeItaly
| | - Marios Marcou
- Center for Reproductive Medicine and AndrologyMartin Luther University Halle‐WittenbergHalleGermany
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and AndrologyJustus Liebig UniversityGiessenGermany
| | | | - Margus Punab
- Andrology UnitTartu University HospitalTartuEstonia
| | - Maria Fernanda Peraza Godoy
- Andrology Department, Fundació Puigvert, Universitat Autònoma de BarcelonaInstituto de Investigaciones Biomédicas Sant Pau (IIB‐Sant Pau)BarcelonaSpain
| | - Claudia Quintian
- Andrology Department, Fundació Puigvert, Universitat Autònoma de BarcelonaInstituto de Investigaciones Biomédicas Sant Pau (IIB‐Sant Pau)BarcelonaSpain
| | - Osvaldo Rajmil
- Andrology Department, Fundació Puigvert, Universitat Autònoma de BarcelonaInstituto de Investigaciones Biomédicas Sant Pau (IIB‐Sant Pau)BarcelonaSpain
| | - Gianmaria Salvio
- Endocrinology Unit, Ospedali Riuniti AnconaPolytechnic University of MarcheAnconaItaly
| | - Osama Shaeer
- Department of Andrology, Kasr El Aini Faculty of MedicineCairo UniversityCairoEgypt
| | - Wolfgang Weidner
- Department of Urology, Pediatric Urology and AndrologyJustus Liebig UniversityGiessenGermany
| | - Elisa Maseroli
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
| | - Sarah Cipriani
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
| | - Elisabetta Baldi
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
| | - Selene Degl'Innocenti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
| | - Giovanna Danza
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
| | | | | | - Luca Boni
- Clinical Trials Coordinating CenterToscano Cancer InstituteUniversity Hospital CareggiFlorenceItaly
| | - Csilla Krausz
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
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