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Hubbard L, Rambhatla A, Colpi GM. Differentiation between nonobstructive azoospermia and obstructive azoospermia: then and now. Asian J Androl 2024:00129336-990000000-00247. [PMID: 39268812 DOI: 10.4103/aja202475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 07/02/2024] [Indexed: 09/15/2024] Open
Abstract
Male infertility has seen an increase in prevalence with cases of azoospermia estimated to affect 10%-15% of infertile men. Confirmation of azoospermia subsequently necessitates an early causal differentiation between obstructive azoospermia (OA) and nonobstructive azoospermia (NOA). Although less common when compared to NOA, OA can represent upward 20%-40% of cases of azoospermia. While there are a multitude of etiologies responsible for causing NOA and OA, correctly distinguishing between the two types of azoospermia has profound implications in managing the infertile male. This review represents an amalgamation of the current guidelines and literature which will supply the reproductive physician with a diagnostic armamentarium to properly distinguish between NOA and OA, therefore providing the best possible care to the infertile couple.
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Affiliation(s)
- Logan Hubbard
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI 48202-3450, USA
| | - Amarnath Rambhatla
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI 48202-3450, USA
| | - Giovanni M Colpi
- Andrology and IVF Center, Next Fertility Procrea, Lugano 6900, Switzerland
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2
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ElShibany AM, Taha EAER, Kamal DT, GamalEl Din SF, Abo El Yamen YM, Hasan HA, Bakry AR. Epididymal sonographic findings in infertile males with isolated asthenozoospermia and their correlation with seminal plasma l-carnitine: An observational study. Urologia 2024:3915603241273886. [PMID: 39268703 DOI: 10.1177/03915603241273886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
OBJECTIVES The present study aimed to show epididymal sonographic findings in infertile males with isolated asthenozoospermia as well as their correlation with seminal plasma l-carnitine. METHODS Eighty married men were recruited in the study. Fifty infertile men with isolated asthenozoospermia and 30 fertile controls with normal semen parameters were included. Semen analysis was done with estimation of seminal plasma l-carnitine level. Scrotal ultrasonography was used as the diagnostic method for assessing epididymal morphology. RESULTS Epididymal heterogeneous echogenicity was significantly higher in the infertile group compared to the controls. Whereas homogeneous epididymal echotexture and seminal plasma l-carnitine levels were significantly higher in the controls compared to the infertile patients. Interestingly, it was observed that within each group, seminal l-carnitine and sperm total motility were significantly higher in those with homogeneous rather than heterogeneous epididymal echotexture. CONCLUSIONS Our study demonstrated a significant association between epididymal echo-texture, seminal plasma l-carnitine and sperm motility. Thus, we recommend performing epididymal sonographic evaluation as one of the basic investigations for infertile men.
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Affiliation(s)
- Ahmed Mahmoud ElShibany
- Department of Andrology, Sexology and STDs, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Emad Abd El Raheem Taha
- Department of Andrology, Sexology and STDs, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Dalia Tarek Kamal
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Sameh Fayek GamalEl Din
- Department of Andrology, Sexology and STDs, Kasr Al-Ainy Faculty of Medicine, Cairo University, Giza, Egypt
| | - Yasser Mohamed Abo El Yamen
- Andrology & STDs Department, Egypt Ministry of Health and Population, Egypt Ministry of Health and Population, Sohag, Egypt
| | - Hosam A Hasan
- Department of Radio-diagnosis, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Abdel Rahman Bakry
- Department of Andrology, Sexology and STDs, Faculty of Medicine, Assiut University, Assiut, Egypt
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Tej P, Pareek C, Kalbande A, Bawaskar PA, Badge A, Nair N. Resolving Male Infertility: A Case Report on Treating Obstructive Azoospermia Using SpermMobil in Intracytoplasmic Sperm Injection Procedure. Cureus 2024; 16:e55323. [PMID: 38559533 PMCID: PMC10981844 DOI: 10.7759/cureus.55323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Infertility affects couples worldwide. Among these, obstructive azoospermia (OA) is a common cause. In some cases, the lack of spermatozoa in ejaculation results from blockages in the male reproductive tract. In this case study, we discuss an infertile male diagnosed with OA following three years of unsuccessful attempts at conception. The male had a history of bilateral inguinal hernia repair due to congenital bilateral absence of the vas deferens. Diagnostic assessments confirmed azoospermia. Microscopic epididymal sperm aspiration (MESA) was performed for sperm retrieval due to its efficacy and reduced postoperative pain, testicular atrophy, and decreased testosterone levels. The retrieved sperm was processed using SpermMobil media for intracytoplasmic sperm injection. Following successful fertilization, embryo transfers resulted in a positive pregnancy test. This case highlights the significance of specific treatment approaches for OA, specifically the effectiveness of MESA and SpermMobil in achieving successful outcomes in assisted reproduction technology for male infertility.
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Affiliation(s)
- Pavan Tej
- Clinical Embryology, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Charu Pareek
- Clinical Embryology, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Avanti Kalbande
- Obstetrics and Gynaecology, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pranita A Bawaskar
- Clinical Embryology, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ankit Badge
- Microbiology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nancy Nair
- Clinical Embryology, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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4
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Pareek C, Badge AK, Bawaskar PA, More A, Nair N. Reviving Spermatogenesis: A Case Report on an Approach to Treat Non-obstructive Azoospermia Using Theophylline, Pentoxifylline, and Hyaluronic Acid. Cureus 2023; 15:e50623. [PMID: 38226124 PMCID: PMC10788697 DOI: 10.7759/cureus.50623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/16/2023] [Indexed: 01/17/2024] Open
Abstract
In this report, we present the clinical management of a male patient diagnosed with non-obstructive azoospermia (NOA), a condition characterized by the absence of sperm in the ejaculate due to impaired spermatogenesis. A 37-year-old patient underwent two surgical procedures: testicular sperm aspiration (TESA) and percutaneous epididymal sperm aspiration (PESA). Surprisingly, the beta-human chorionic gonadotropins (β-HCG) testing that followed produced promising findings suggesting NOA syndrome may be reversible. Theophylline and pentoxifylline, phosphodiesterase inhibitors with immunomodulatory effects, were creatively used in this case study to increase sperm viability and activation after PESA. Hyaluronic acid was also used as an additional therapy because it is well known for aiding in sperm development and binding to oocytes. The patient underwent hyaluronic acid, which can potentially increase the fertilization rate and improve the selection of sperm. This in-depth case study offers insightful information on the effective management of NOA by combining theophylline, pentoxifylline, and hyaluronic acid. The results highlight the ability of these therapies to revive spermatogenesis, offering a cutting-edge method of treating male infertility. More research is required to clarify the underlying processes and confirm the effectiveness of this strategy in more successful reproductive medicine therapies.
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Affiliation(s)
- Charu Pareek
- Clinical Embryology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Ankit K Badge
- Microbiology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Pranita A Bawaskar
- Clinical Embryology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Akash More
- Clinical Embryology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Nancy Nair
- Clinical Embryology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
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5
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Kose SI. Imaging in Male Infertility. Curr Probl Diagn Radiol 2023; 52:439-447. [PMID: 37270300 DOI: 10.1067/j.cpradiol.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 04/04/2023] [Accepted: 05/08/2023] [Indexed: 06/05/2023]
Abstract
Infertility is defined as inability to conceive despite regular unprotected sexual intercourse for greater than 1 year. Conditions involving the male partner accounts for the infertility in approximately 50% of cases. The goals of imaging in male infertility are to detect treatable/ reversible causes, imaging for sperm retrieval from testis or epididymis for assisted reproductive techniques like in vitro fertilization or intracytoplasmic sperm injection and to provide appropriate genetic counselling for prevention of occurrence of disease in future offspring. The purpose of this article is to describe imaging features in various causes of male infertility to acquaint radiologists with various imaging appearances of causes of male infertility to avoid missing these pathologies.
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Affiliation(s)
- Snehal Ishwar Kose
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India.
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Udayakumar N, Smith E, Boone A, Porter KK. A Common Path: Magnetic Resonance Imaging of Müllerian and Wolffian Duct Anomalies. Curr Urol Rep 2023; 24:1-9. [PMID: 36595101 DOI: 10.1007/s11934-022-01138-1] [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] [Accepted: 06/02/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW This review summarizes the pathway of Mullerian and Wolffian duct development, anomalies that result from disruptions to this pathway, and the characteristics on advanced imaging that identify them. RECENT FINDINGS In-office evaluation for reproductive anomalies is usually inadequate for the diagnosis of congenital reproductive anomalies. Magnetic resonance imaging (MRI) has usurped invasive diagnostic methods including laparoscopy, hysteroscopy, and vasography as the new gold standard. Because of its superior soft-tissue delineation and the availability of advanced functional sequences, MRI offers a sophisticated method of distinguishing reproductive anomalies from one another, characterizing the degree of defect severity, and evaluating for concomitant urogenital anomalies non-invasively and without radiation exposure to the patient. Congenital anomalies of the Mullerian and Wolffian duct can be incredibly nuanced, requiring prompt and accurate diagnosis for management of infertility. Definitive diagnosis should be made early with MRI.
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Affiliation(s)
- Neha Udayakumar
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
| | - Elainea Smith
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amy Boone
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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7
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Kerr DM, Middleton WD. Ultrasound of the Normal and Abnormal Vas Deferens. Ultrasound Q 2022; 38:224-236. [PMID: 35129151 DOI: 10.1097/ruq.0000000000000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The extrapelvic portion of the vas deferens is readily visible with ultrasound but often overlooked. Several publications have described the scanning technique and the normal anatomy of the vas deferens. Sonographic evaluation of the vas deferens provides critical information in the workup of male infertility. Obstruction, inflammatory conditions, and neoplasms of the vas deferens can also be diagnosed with ultrasound. Knowledge of the normal and abnormal appearance of the vas deferens improves scans of the scrotum and expands the conditions that can be recognized and accurately diagnosed with ultrasound.
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Sihag P, Tandon A, Pal R, Bhatt S, Sinha A, Sumbul M. Sonography in male infertility: a useful yet underutilized diagnostic tool. J Ultrasound 2022; 25:675-685. [PMID: 35038143 PMCID: PMC9402860 DOI: 10.1007/s40477-021-00646-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/01/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess the utility of comprehensive sonographic examination including scrotal sonography, Testicular Doppler and Transrectal Ultrasound (TRUS) to evaluate the male reproductive system and differentiate between obstructive (OG) and non-obstructive (NOG) causes of azoospermia. METHODS 30 infertile men with azoospermia and 30 control subjects with normospermia underwent sonographic evaluation. FNAC/biopsy findings were used for assigning a final diagnosis of obstructive or non-obstructive azoospermia. Qualitative and quantitative imaging parameters were retrospectively compared between the groups using Chi-square/Fisher's exact test and unpaired t-test, respectively. P < 0.05 was considered significant. RESULTS Ectasia of rete testis/epididymal tubules, altered epididymal echogenicity, dilated terminal vas deferens were significantly more common in OG while inhomogeneous testicular echo-texture and reduced testicular vascularity were more common in NOG (P < 0.05). Testicular volume and epididymal head size were significantly higher in OG than in NOG and controls (18.2 ml/10 mm Vs 8.2 ml/7.2 mm and 13.4 ml/8.8 mm respectively; P < 0.05); while Resistive Index (RI) of intra-testicular vessels was higher in NOG as compared to OG and controls (0.65 vs 0.54 and 0.52 respectively; P < 0.05). On ROC curve analysis, cut-off values of testicular volume (AUC: 0.939; P < 0.001), epididymal head size (AUC: 0.772; P = 0.001) and testicular RI (AUC: 0.761; P = 0.001) to differentiate between the groups were 12.1 ml (sensitivity-94.4%; specificity-83.3%), 9 mm (sensitivity-66.7%; specificity-71%) and 0.62 (sensitivity-62%; specificity-100%) respectively. CONCLUSION Comprehensive sonographic evaluation can be used to differentiate obstructive from non-obstructive infertility and should be routinely incorporated in the diagnostic workup of infertile men with azoospermia.
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Affiliation(s)
- Prateek Sihag
- Department of Radio-Diagnosis, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India.
| | - Anupama Tandon
- Department of Radio-Diagnosis, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Raj Pal
- Department of Radio-Diagnosis, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Shuchi Bhatt
- Department of Radio-Diagnosis, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Arpita Sinha
- Department of Radio-Diagnosis, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Murtaza Sumbul
- Department of Radio-Diagnosis, University College of Medical Sciences and GTB Hospital, New Delhi, India
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9
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Calvert JK, Fendereski K, Ghaed M, Bearelly P, Patel DP, Hotaling JM. The male infertility evaluation still matters in the era of high efficacy assisted reproductive technology. Fertil Steril 2022; 118:34-46. [PMID: 35725120 DOI: 10.1016/j.fertnstert.2022.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/14/2022] [Accepted: 05/04/2022] [Indexed: 11/04/2022]
Abstract
Today's reproductive endocrinology and infertility providers have many tools at their disposal when it comes to achieving pregnancy. In the setting of highly efficacious assisted reproductive technology, it is natural to assume that male factor infertility can be overcome by acquiring sperm and then bypassing the male evaluation. In this review, we go through guideline statements and a stepwise male factor infertility evaluation to propose that a thorough male evaluation remains important to optimize pregnancy and live birth. The foundation of this parallel evaluation is referral to a reproductive urologist for the optimization of the male partner, for advanced diagnostics and interventions, and for the detection of other underlying male pathology. We also discuss what future developments might have an impact on the workup of the infertile male.
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Affiliation(s)
- Joshua K Calvert
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, Utah
| | - Kiarad Fendereski
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, Utah
| | - Mohammadali Ghaed
- Urology Department, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Priyanka Bearelly
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, Utah
| | - Darshan P Patel
- Department of Urology, University of California San Diego Health, San Diego, California
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, Utah.
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10
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Aybar MD, Turna O. Assessment of the Rigidity Changes of Corpus Cavernosum Penis in Vasculary Erectile Dysfunction (ED) Subtypes by Shear Wave Elastography (SWE). JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:629-636. [PMID: 33945173 DOI: 10.1002/jum.15741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) is a condition that is very common all over the world, concerns about men and causes very important social problems. The aim of this study is to perform quantitative penile corpus cavernosum (CC) stiffness measurements by using SWE for patients with both types of vascular ED. METHODS In our study, we handled the data of 101 participants in total. The average age of the participants was 56.36. We divided the participants after color Doppler US (CDUS) into three groups: normal group (n = 30), arterial insufficiency (n = 51), and venous insufficiency (n = 20). SWE measurements were made in both groups in the CC flaccid (f) and rigid (r) positions, and the results were noted. International Index of Erectile Function (IIEF-5) questionnaire and Erection score (ES) were evaluated. RESULTS The mean CC f SWE and r SWE measurement values were 20.2 ± 0.8 and 17.15 ± 0.54 kPa, 3.84 ± 0.13 and 2.78 ± 0.11 m/s in the arterial insufficiency group; 15.72 ± 0.58 and 12.52 ± 0.33 kPa, 2.88 ± 0.06 and 2.09 ± 0.11 m/s in the venous insufficiency group; 14.75 ± 0.51 and 13.41 ± 0.36 kPa, 2.63 ± 0.1 and 2.34 ± 0.11 m/s in the control group, respectively. The CC measurement of f SWE and r SWE values as kPa showed significant differences between the groups (P < .001). CONCLUSION SWE can provide quantitative data with high specificity and sensitivity while evaluating CC penile stiffness noninvasively. It seems to contribute to the radiological evaluation of ED cases with useful data.
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Affiliation(s)
| | - Onder Turna
- Radiology Department, Mehmet Akif Ersoy Training and Research Hospital, Istanbul, Turkey
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11
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Bertolotto M, Cantisani V, Drudi FM, Lotti F. Varicocoele. Classification and pitfalls. Andrology 2021; 9:1322-1330. [PMID: 34038625 PMCID: PMC8596817 DOI: 10.1111/andr.13053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/09/2021] [Accepted: 05/18/2021] [Indexed: 11/26/2022]
Abstract
Background Varicocoeles have been considered for a long time potentially correctable causes for male infertility, even though the correlation of this condition with infertility and sperm damage is still debated. Objective To present a summary of the evidence evaluation for imaging varicocoeles, to underline the need for a standardized examination technique and for a unique classification, and to focus on pitfalls in image interpretation. Methods Based on the evidence of the literature, the current role of ultrasound (US) imaging for varicocoeles has been reported and illustrated, with emphasis on examination technique, classification, and pitfalls. Results US is the imaging modality of choice. It is widely used in Europe, while in other countries clinical classification of varicocoeles is considered sufficient to manage the patient. A number of US classifications exist for varicocoeles, in which the examinnation is performed in different ways. Discussion An effort toward standardization is mandatory, since lack of standardization contributes to the confusion of the available literature, and has a negative impact on the understanding of the role itself of imaging in patients with varicocoeles. Conclusion Use of the Sarteschi/Liguori classification for varicocoeles is recommended, since it is the most complete and widely used US scoring system available today. Tubular extratesticular structures resembling varicocoeles, either at palpation or at US, should be identified and correctly characterized.
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Affiliation(s)
- Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Vito Cantisani
- Department of Radiology, University Sapienza of Rome, Policlinico Umberto I, Roma, Italy
| | - Francesco Maria Drudi
- Department of Radiology, University Sapienza of Rome, Policlinico Umberto I, Roma, Italy
| | - Francesco Lotti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Azienda Ospedaliero-Universitaria Carreggi, Firenze, Italy
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12
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Itani M, Kipper B, Corwin MT, Burgan CM, Fetzer DT, Shenoy-Bhangle AS, Althubaity A, Loehfelm TW, Middleton WD, Fananapazir G. Right-sided scrotal varicocele and its association with malignancy: a multi-institutional study. Abdom Radiol (NY) 2021; 46:2140-2145. [PMID: 33151361 DOI: 10.1007/s00261-020-02840-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine the prevalence of isolated right-sided varicocele due to an obstructing malignancy in patients with no other evidence of malignancy. METHODS This retrospective, multi-institutional study included a text search for right-sided varicocele in consecutive reports of scrotal ultrasound studies performed between 4/22/1999 and 06/24/2018. Diagnosis was confirmed by a radiologist based on the following criteria: pampiniform plexus vein diameter of ≥ 2 mm, which has augmented flow or increases by ≥ 1 mm on Valsalva. Inclusion criteria for adequate follow-up were (1) abdominopelvic CT or MRI performed within 3 months prior to, or any time after, the ultrasound study; or (2) presence of clinical documentation more than 2 years after the ultrasound date. Exclusion criteria were existing cancer diagnosis in the abdomen or pelvis, epididymo-orchitis, intratesticular or intrascrotal mass, and prior scrotal surgery. Images of available CT or MRI studies were reviewed for presence of any explanation of right-sided varicocele. RESULTS 210 patients with right-sided varicocele met inclusion and exclusion criteria. 118/210 had abdominopelvic CT or MRI in the assigned timeframe. Of these, no patients had malignancy that could account for right-sided varicoceles. Of the 92/210 patients without CT or MRI but with available clinical follow-up, none had a malignancy that could have caused an isolated right-sided varicocele. There was no underlying malignancy to explain the right-sided varicocele in any of the patients, 0/210, 95% CI [0.0-1.4%]. CONCLUSION No associated malignancy was found in patients with isolated right-sided varicoceles to support additional imaging for malignancy screening.
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Affiliation(s)
- Malak Itani
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Benjamin Kipper
- Department of Radiology, University of California Davis Medical Center, Sacramento, CA, USA
| | - Michael T Corwin
- Department of Radiology, University of California Davis Medical Center, Sacramento, CA, USA
| | | | - David T Fetzer
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Afnan Althubaity
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Thomas W Loehfelm
- Department of Radiology, University of California Davis Medical Center, Sacramento, CA, USA
| | - William D Middleton
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Ghaneh Fananapazir
- Department of Radiology, University of California Davis Medical Center, Sacramento, CA, USA.
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13
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AbdElnaser T, Elkhiat YI, El-Azizi HM, Fatah E, Abd M, Elshibany AM, GamalEl Din SF. A cross-sectional study of the genital duct and renal anomalies in Egyptian cases of congenital absence of the vas deferens. HUM FERTIL 2021; 25:738-744. [PMID: 33908325 DOI: 10.1080/14647273.2021.1918352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of the study was to detect the incidence and types of genital and renal duct anomalies associated with congenital absent vas deferens (CAVD). In 200 males with CAVD, the demographic characteristics, physical examination findings were evaluated. Scrotal ultrasonography and transrectal ultrasonography (TRUS) were used as the diagnostic methods for evaluating unilateral or bilateral CAVD with associated abnormalities or agenesis of the testes, epididymes, seminal vesicles and prostate. Abdominal ultrasound was performed to detect any associated renal anomalies. There were a total of 111 CBAVD and 89 CUAVD males. Eight cases (8.98%) of CUAVD were associated with contralateral cryptorchidism. In most cases there were agenesis in the epididymal body and tail and seminal vesicles. Different types of renal anomalies (32.50%) especially renal agenesis were observed mainly in cases of left CUAVD and were predominately on the left hand side. An important implication of our study is the importance of requesting ultrasound of males with CAVD to discover any associated anomalies especially renal agenesis that may be ignored by many physicians.
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Affiliation(s)
- Taha AbdElnaser
- Andrology & STDs department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasser Ibrahem Elkhiat
- Andrology & STDs department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | - Mohamed Abd
- Andrology & STDs department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Mahmoud Elshibany
- Andrology, Sexology &STDs unit at Department of Dermatology, Venereology & Andrology, Assiut University, Asyut, Egypt
| | - Sameh Fayek GamalEl Din
- Andrology & STDs department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
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14
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Antioxidant-Based Therapies in Male Infertility: Do We Have Sufficient Evidence Supporting Their Effectiveness? Antioxidants (Basel) 2021; 10:antiox10020220. [PMID: 33540782 PMCID: PMC7912982 DOI: 10.3390/antiox10020220] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/19/2022] Open
Abstract
Under physiological conditions, reactive oxygen species (ROS) play pivotal roles in various processes of human spermatozoa. Indeed, semen requires the intervention of ROS to accomplish different stages of its maturation. However, ROS overproduction is a well-documented phenomenon occurring in the semen of infertile males, potentially causing permanent oxidative damages to a vast number of biological molecules (proteins, nucleic acids, polyunsaturated fatty acids of biological membrane lipids), negatively affecting the functionality and vitality of spermatozoa. ROS overproduction may concomitantly occur to the excess generation of reactive nitrogen species (RNS), leading to oxidative/nitrosative stress and frequently encountered in various human pathologies. Under different conditions of male infertility, very frequently accompanied by morpho-functional anomalies in the sperm analysis, several studies have provided evidence for clear biochemical signs of damages to biomolecules caused by oxidative/nitrosative stress. In the last decades, various studies aimed to verify whether antioxidant-based therapies may be beneficial to treat male infertility have been carried out. This review analyzed the results of the studies published during the last ten years on the administration of low-molecular-weight antioxidants to treat male infertility in order to establish whether there is a sufficient number of data to justify antioxidant administration to infertile males. An analysis of the literature showed that only 30 clinical studies tested the effects of the administration of low-molecular-weight antioxidants (administered as a single antioxidant or as a combination of different antioxidants with the addition of vitamins and/or micronutrients) to infertile males. Of these studies, only 33.3% included pregnancy and/or live birth rates as an outcome measure to determine the effects of the therapy. Of these studies, only 4 were case–control studies, and only 2 of them found improvement of the pregnancy rate in the group of antioxidant-treated patients. Additionally, of the 30 studies considered in this review, only 43.3% were case–control studies, 66.7% enrolled a number of patients higher than 40, and 40% carried out the administration of a single antioxidant. Therefore, it appears that further studies are needed to clearly define the usefulness of antioxidant-based therapies to treat male infertility.
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Sushentsev N, Barrett T. The first magnetic resonance imaging-detected case of bilateral seminal vesicle duplication: An illustrative case report. Clin Imaging 2021; 74:1-3. [PMID: 33421696 DOI: 10.1016/j.clinimag.2020.12.026] [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: 11/04/2020] [Revised: 12/01/2020] [Accepted: 12/19/2020] [Indexed: 11/16/2022]
Abstract
Given the increasing use of prostate magnetic resonance imaging (MRI) for imaging suspected cancer and male infertility, understanding imaging features of congenital anomalies of the seminal vesicles (SVs) is of clinical importance. This case presents the first MRI-detected case of bilateral SV duplication with an isolated right SV cyst in the absence of other congenital genitourinary anomalies. In addition to illustrating imaging features of this rare anomaly, this case provides an overview of the role of MRI in providing accurate diagnosis and guiding management options of the most common SV anomalies.
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Affiliation(s)
- Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Hills Rd, Cambridge CB2 0QQ, United Kingdom.
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Hills Rd, Cambridge CB2 0QQ, United Kingdom
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Huang WL, Ding L, Yao JH, Hu HT, Gao Y, Xie XY, Lu MD, Deng CH, Xie Y, Wang Z. Testicular quantitative ultrasound: A noninvasive monitoring method for evaluating spermatogenic function in busulfan-induced testicular injury mouse models. Andrologia 2020; 53:e13927. [PMID: 33355959 DOI: 10.1111/and.13927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/08/2020] [Accepted: 11/12/2020] [Indexed: 12/19/2022] Open
Abstract
Busulfan-induced testicular injury mouse models are commonly used for experiments on spermatogonial stem cell transplantation, treatments for azoospermia due to spermatogenic failure and preserving male fertility after chemotherapy. Here, we investigated the value of testicular quantitative ultrasound for evaluating spermatogenic function in this model. In this study, testicular ultrasound was performed on mice from day 0 to 126 after busulfan treatment (n = 48), and quantitative data, including the testicular volume, mean pixel intensity and pixel uniformity, were analysed. The results revealed that from day 0 to 36, the testicular volume was positively associated with the testicle-to-body weight ratio (r = .92). On day 63, the pixel uniformity, which remained stable from day 0 to 36, declined significantly compared with that on day 36 (p < .01). On day 126, when the whole progression of spermatogenesis could be observed in most tubules, the mean pixel intensity also returned to normal (p > .05). In conclusion, testicular quantitative ultrasound could be used as a noninvasive and accurate monitoring method for evaluating spermatogenic function in busulfan-induced testicular injury mouse models.
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Affiliation(s)
- Wan-Ling Huang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Li Ding
- Department of Pathology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jia-Hui Yao
- Department of Andrology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hang-Tong Hu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yong Gao
- Reproductive Medicine Center, the Key Laboratory for Reproductive Medicine of Guangdong Province, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming-De Lu
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Chun-Hua Deng
- Department of Andrology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yun Xie
- Department of Andrology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhu Wang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Yang DM, Choi HI, Kim HC, Kim SW, Moon SK, Lim JW. Small testes: clinical characteristics and ultrasonographic findings. Ultrasonography 2020; 40:455-463. [PMID: 33455146 PMCID: PMC8217805 DOI: 10.14366/usg.20133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/03/2020] [Indexed: 11/09/2022] Open
Abstract
The purpose of this pictorial essay is to describe the ultrasonographic and clinical findings of patients with small testes due to a wide range of causes. We retrospectively reviewed the ultrasonographic and clinical findings of various causes of small testes. We present various causes of small testes on ultrasonography including Klinefelter syndrome, testicular torsion, mumps orchitis, inguinal hernia, cryptorchidism, varicocele, and trauma. On ultrasonography, small testes in patients with testicular torsion, mumps orchitis, and trauma usually showed heterogeneous echogenicity. Atrophic testes were homogeneously hypoechoic in patients with cryptorchidism and inguinal hernia and were isoechoic to the normal testis in patients with varicocele. Klinefelter syndrome patients had small hyperechoic or hypoechoic nodules, but the echogenicity of the remnant portion of the testes was homogeneous. Ultrasonography is helpful for detecting small testes and for the differential diagnosis of the various possible causes of small testes.
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Affiliation(s)
- Dal Mo Yang
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Hyeon-Il Choi
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Hyun Cheol Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sang Won Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sung Kyung Moon
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
| | - Joo Won Lim
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
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Song J, Gu L, Ren X, Liu Y, Qian K, Lan R, Wang T, Jin L, Yang J, Liu J. Prediction model for clinical pregnancy for ICSI after surgical sperm retrieval in different types of azoospermia. Hum Reprod 2020; 35:1972-1982. [PMID: 32730569 DOI: 10.1093/humrep/deaa163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/03/2020] [Indexed: 12/13/2022] Open
Abstract
Abstract
STUDY QUESTION
Can a counselling tool be developed for couples with different types of azoospermia to predict the probability of clinical pregnancy in ICSI after surgical sperm retrieval?
SUMMARY ANSWER
A prediction model for clinical pregnancy in ICSI after surgical sperm retrieval in different types of azoospermia was created and clinical type of azoospermia, testicular size, male FSH, male LH, male testosterone, female age, female antral follicle count (AFC) and female anti-Müllerian hormone (AMH) were used as predictors.
WHAT IS KNOWN ALREADY
Prediction models are used frequently to predict treatment success in reproductive medicine; however, there are few prediction models only for azoospermia couples who intend to conceive through surgical sperm retrieval and ICSI. Furthermore, no specific clinical types of azoospermia have been reported as predictors.
STUDY DESIGN, SIZE, DURATION
A cohort study of 453 couples undergoing ICSI was conducted between 2016 and 2019 in an academic teaching hospital.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Couples undergoing ICSI with surgically retrieved sperm were included, with 302 couples included in the development set and 151 couples included in the validation set. We constructed a prediction model using multivariable logistic regression analysis. The internal validation was based on discrimination and calibration.
MAIN RESULTS AND THE ROLE OF CHANCE
We found that for male patients involved in our model, different clinical types of azoospermia are associated with different clinical pregnancy outcomes after ICSI. Considering the clinical type of azoospermia, larger testicular volume and higher levels of FSH, LH and testosterone in the body are associated with higher clinical pregnancy success rates. For women involved in our model, younger age and higher AFC and AMH levels are associated with higher clinical pregnancy success rates. In the development set, the AUC was 0.891 (95% CI 0.849–0.934), indicating that the model had good discrimination. The slope of the calibration plot was 1.020 (95% CI 0.899–1.142) and the intercept of the calibration plot was −0.015 (95% CI −0.112 to 0.082), indicating that the model was well-calibrated. From the validation set, the model had good discriminative capacity (AUC 0.866, 95% CI 0.808–0.924) and calibrated well, with a slope of 1.015 (95% CI 0.790–1.239) and an intercept of −0.014 (95% CI −0.180 to 0.152) in the calibration plot.
LIMITATIONS, REASONS FOR CAUTION
We found that BMI was not an effective indicator for predicting clinical pregnancy, which was inconsistent with some other studies. We lacked data about the predictors that reflected sperm characteristics, therefore, we included the clinical type of azoospermia instead as a predictor because it is related to sperm quality. We found that almost all patients did not have regular alcohol consumption, so we did not use alcohol consumption as a possible predictor, because of insufficient data on drinking habits. We acknowledge that our development set might not be a perfect representation of the population, although this is a common limitation that researchers often encounter when developing prediction models. The number of non-obstructive azoospermia patients that we could include in the analysis was limited due to the success rate of surgical sperm retrieval, although this did not affect the establishment and validation of our model. Finally, this prediction model was developed in a single centre. Although our model was validated in an independent dataset from our centre, validation for different clinical populations belonging to other centres is required before it can be exported.
WIDER IMPLICATIONS OF THE FINDINGS
This model enables the differentiation between couples with a low or high chance of reaching a clinical pregnancy through ICSI after surgical sperm retrieval. As such it can provide couples dealing with azoospermia a new approach to help them choose between surgical sperm retrieval with ICSI and the use of donor sperm.
STUDY FUNDING/COMPETING INTEREST(S)
This work was supported by a grant from the National Natural Science Foundations of China (81501246 and 81501020 and 81671443). The authors declare no competing interest.
TRIAL REGISTRATION NUMBER
N/A.
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Affiliation(s)
- Jingyu Song
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Longjie Gu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Xinling Ren
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Yang Liu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Kun Qian
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Ruzhu Lan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Jun Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
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Catania R, Dasyam N, Furlan A, Borhani AA. Cross-sectional imaging of seminal vesicles and vasa deferentia. Abdom Radiol (NY) 2020; 45:2049-2062. [PMID: 31897685 DOI: 10.1007/s00261-019-02368-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A wide spectrum of pathologies, ranging from inconsequential degenerative and senile changes to clinically significant neoplasms, can affect seminal vesicles (SVs). With rapid rise in use of magnetic resonance imaging for evaluation of prostate in recent years an increasing number of cases of incidental SV pathologies are encountered by radiologists. Despite the high contrast resolution and high spatial resolution offered by multiparametric pelvic MRI, accurate diagnosis of SV processes can at times be challenging. In this article, we review the anatomy and embryology of the SVs and vasa deferentia and then explore the spectrum of diseases affecting them.
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Affiliation(s)
- Roberta Catania
- Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Intensive Medicine, Institute of Radiology, IRCCS Policlinico San Matteo Foundation, University of Parvia, Parvia, Italy
| | - Navya Dasyam
- University of Pittsburgh School of Medicine, UPMC Presbyterian, Radiology Suite 200 East Wing 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Alessandro Furlan
- University of Pittsburgh School of Medicine, UPMC Presbyterian, Radiology Suite 200 East Wing 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Amir A Borhani
- University of Pittsburgh School of Medicine, UPMC Presbyterian, Radiology Suite 200 East Wing 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
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20
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Peng Y, Ouyang L, Lin Z, Zhang F, Wang H, Guan J. MRI findings of nonobstructive azoospermia: lesions in and out of pelvic cavity. Abdom Radiol (NY) 2020; 45:2213-2224. [PMID: 31552463 DOI: 10.1007/s00261-019-02232-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Nonobstructive azoospermia (NOA) can be caused by various diseases, including congenital disorders, endocrine disorders, infections, tumor or tumor-like diseases, vascular diseases, etc. Diagnosis of the underlying cause of NOA is complicated and challenging. In this study, we introduce an MR examination protocol for the etiological diagnosis of NOA, and demonstrate a series of NOA patients with different causes and imaging findings. Except for lesions of testes, the patients may also combine abnormalities of adrenal glands and central nervous system. In such cases, the patients could benefit from additional abdominal and intracranial scans.
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Affiliation(s)
- Yang Peng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, Guangdong, People's Republic of China
| | - Longyuan Ouyang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, Guangdong, People's Republic of China
| | - Zhi Lin
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, Guangdong, People's Republic of China
| | - Fan Zhang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, Guangdong, People's Republic of China
| | - Huanjun Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, Guangdong, People's Republic of China
| | - Jian Guan
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, Guangdong, People's Republic of China.
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Abstract
Obstructive azoospermia (OA) is caused by excurrent duct obstruction, which can occur anywhere along the course of the male reproductive tract and is classically characterized by normal spermatogenesis. To be familiar with the imaging anatomy of normal and abnormal male genital ducts is essential to the diagnosis of OA. In some circumstances, OA can also be related to some specific syndromes; thus, making an accurate diagnosis may require an integral view of the whole abdomen and pelvis. MR is a great complementary imaging modality either for the detection of obstructive factors, especially for characterization of those indeterminate features on ultrasound, or for the identification of specific syndromes related to OA. In this article, a series of patients with OA caused by different kinds of lesions in and out of the pelvic cavity (abdomen) shown on MR imaging were included, and some cases of specific syndromes related to OA were also reviewed.
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22
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Penile Doppler Ultrasound for Erectile Dysfunction: Technique and Interpretation. AJR Am J Roentgenol 2020; 214:1112-1121. [PMID: 31990215 DOI: 10.2214/ajr.19.22141] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE. Erectile dysfunction (ED) is a common medical condition that has a high prevalence and incidence worldwide and may have a significant impact on both physical and psychosocial health. The purpose of this article is to review the role of penile Doppler sonography in the assessment of ED. CONCLUSION. Penile Doppler sonography is an essential tool for differentiating between vascular and nonvascular causes of ED; therefore, radiologists must be familiar with the imaging protocol, the limitations of the technique, and interpretation of its findings, to warrant an accurate diagnosis and appropriate patient management.
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Can Contrast-Enhanced Ultrasound Increase or Predict the Success Rate of Testicular Sperm Aspiration in Patients With Azoospermia? AJR Am J Roentgenol 2019; 212:1054-1059. [PMID: 30807223 PMCID: PMC7518717 DOI: 10.2214/ajr.18.20436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE. The objective of our study was to determine whether contrast-enhanced ultrasound (CEUS) perfusion measurements obtained before testicular sperm aspiration (TESA) can improve or predict sperm retrieval (SR) outcomes of TESA in patients with azoospermia. SUBJECTS AND METHODS. Between May 2017 and January 2018, 70 patients with azoospermia (mean age, 29 years; age range, 22-41 years) underwent testes CEUS within 10 days before TESA. Major perfusion areas were visually chosen, and their ranges were recorded. The other areas were defined as minor perfusion. CEUS quantitative features were acquired for both the main perfusion area and whole testis. Testis tissue biopsies were taken for both major and minor perfusion areas by cognitive fusion, and SR outcomes were compared. Associations between testicular volume, quantitative CEUS features, and SR outcomes were analyzed. RESULTS. Twenty-four men were found to have obstructive azoospermia (OA), and the remaining 46 had nonobstructive azoospermia (NOA). All patients with OA had spermatozoa in biopsy. Only one patient with NOA had spermatozoa in the major perfusion area but not the minor perfusion area; the other patients with NOA had the same SR outcomes in both major and minor perfusion areas. In patients with NOA, both wash-in and washout CEUS features were correlated with the success of SR in TESA. CONCLUSION. CEUS-guided TESA with cognitive fusion cannot yield improved SR outcomes of TESA in patients with NOA, possibly because of imprecise correlation between biopsy sites and main perfusion area analyzed by CEUS; however, quantitative CEUS features can be useful predictors of the success of SR.
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Huang IS, Wren J, Bennett NE, Brannigan RE. Clinical Consultation Guide on Imaging in Male Infertility and Sexual dysfunction. Eur Urol Focus 2018; 4:338-347. [PMID: 30327281 DOI: 10.1016/j.euf.2018.09.018] [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: 07/16/2018] [Revised: 08/23/2018] [Accepted: 09/28/2018] [Indexed: 10/28/2022]
Abstract
Imaging can benefit clinicians in evaluating men with infertility or sexual dysfunction by giving an overview of a patient's overall clinical condition before undertaking an invasive procedure. An understanding of the limitations and advantages of image modalities used in clinical practice will ensure that clinicians can optimize patient care with imaging when necessary. PATIENT SUMMARY: The objective of this article was to review the current literature on imaging modalities used for the diagnosis and management of male infertility and sexual dysfunction. An understanding of the advantages and limitations of these imaging modalities will ensure that clinicians can optimize patient care with imaging when necessary.
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Affiliation(s)
- I-Shen Huang
- Department of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Urology, School of Medicine, Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Male Reproductive Surgery and Men's Health, Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - James Wren
- Division of Male Reproductive Surgery and Men's Health, Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nelson E Bennett
- Division of Male Reproductive Surgery and Men's Health, Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert E Brannigan
- Division of Male Reproductive Surgery and Men's Health, Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Sonography in male infertility: a look beyond the obvious. J Ultrasound 2018; 21:265-276. [PMID: 29594932 DOI: 10.1007/s40477-018-0294-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 03/05/2018] [Indexed: 12/16/2022] Open
Abstract
Infertility affects 15-20% of the reproductive age range population; the male factor accounts for up to 40-60% of these. With female factor infertility catching most of the limelight in research, diagnosis and treatment, the other half of the problem has not been duly addressed. Imaging has an important role to play in the evaluation of male infertility, especially to identify correctible (obstructive) causes. We review the scrotal, trans-rectal sonographic and Doppler findings in infertile men to aid in the accurate diagnosis and proper management of such patients.
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