Male partners of infertile couples with congenital unilateral absence of the vas deferens are mainly non-azoospermic

BACKGROUND

Men with congenital unilateral absence of vas deferens were reported to be mainly azoospermic, with both unilateral renal absence and mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) but some have neither.

OBJECTIVES

To assess whether in infertile couples the male partners with congenital unilateral absence of vas deferens are mainly azoospermic men.

MATERIAL AND METHODS

Retrospective study in a unique university hospital; reproductive, clinical, CFTR analysis and seminal data of male partners of infertile couples (from 1998 to 2018) were analysed. Diagnosis of congenital unilateral absence of vas deferens was based on transrectal ultrasounds (TRUS): complete or partial absence of one vas deferens with complete contralateral vas deferens confirmed in 63 men. Distribution of sperm count in three classes: azoospermia, oligozoospermia or normozoospermia. Ultrasound determination of renal status; seminal biomarkers assays; and search for CFTR mutations.

RESULTS

Among the 63 men, 39.7% displayed azoospermia, 27% oligozoospermia and 33.3% normozoospermia; 42% of the non-azoospermic men (16/38) had previously obtained a natural pregnancy. We found unilateral renal absence in 17/59 patients (29%). Among 50 men with CFTR testing, five carried an allele associated with cystic fibrosis belonging to the 29 men without renal anomalies, indicating a high allelic frequency (8.6%). The 63 patients displayed high rates of surgical histories for undescended testicles or inguinal hernia, low values of semen volume and of total seminal glycerophosphocholine.

CONCLUSIONS

Our results indicate that men with congenital unilateral absence of vas deferens mainly display oligozoospermia or normozoospermia and that they were previously fertile. They clearly confirm, first, that CFTR testing is recommended in congenital unilateral absence of vas deferens men and it should be mandatory for those with normal kidneys; and, second, that TRUS is needed for the diagnosis of congenital unilateral absence of vas deferens. As congenital unilateral absence of vas deferens may be present whatever the sperm count, biological warnings are represented by semen volume and seminal epididymal markers and clinical warnings by surgical histories of undescended testes or inguinal hernia.

The spectrum of renal involvement in male patients with infertility related to excretory-system abnormalities: phenotypes, genotypes, and genetic counseling

BACKGROUND

While reproductive technologies are increasingly used worldwide, epidemiologic, clinical and genetic data regarding infertile men with combined genital tract and renal abnormalities remain scarce, preventing adequate genetic counseling.

METHODS

In a cohort-based study, we assessed the prevalence (1995-2014) and the clinical characteristics of renal disorders in infertile males with genital tract malformation. In a subset of 34 patients, we performed a detailed phenotype analysis of renal and genital tract disorders.

RESULTS

Among the 180 patients with congenital uni- or bilateral absence of vas deferens (CU/BAVD), 45 (25 %) had a renal malformation. We also identified 14 infertile men with combined seminal vesicle (SV) and renal malformation but no CU/BAVD. Among the 34 patients with detailed clinical description, renal disease was unknown before the assessment of the infertility in 27 (79.4 %), and 7 (20.6 %) had chronic renal failure. Four main renal phenotypes were observed: solitary kidney (47 %); autosomal-dominant polycystic kidney disease (ADPKD, 0.6 %); uni- or bilateral hypoplastic kidneys (20.6 %); and a complex renal phenotype associated with a mutation of the HNF1B gene (5.8 %). Absence of SV and azoospermia were significantly associated with the presence of a solitary kidney, while dilatation of SV and necroasthenozoospermia were suggestive of ADPKD.

CONCLUSION

A dominantly inherited renal disease (ADPKD or HNF1B-related nephropathy) is frequent in males with infertility and combined renal and genital tract abnormalities (26 %). A systematic renal screening should be proposed in infertile males with CU/BAVD or SV disorders.

Cystadenocarcinoma of the parotid: case report of a BRAF inhibitor treatment

Background

Mutations of the proto-oncogene BRAF have been described in many cancers. Mutated BRAF causes overactive downstream signaling via MEK and ERK leading to excessive cell proliferation and survival. Their identification is of real interest because specific inhibitors have been developed.

Methods and results

We report the case of a patient with an aggressive cystadenocarcinoma of the parotid with synchronous metastases. Cisplatine/5FU chemotherapy associated with palliative radiation therapy was used first without any efficency nor clinical improvement. A molecular analysis revealed a BRAF mutation. A compassionate treatment with a BRAF inhibitor showed very good results from the first month. The patient reported real improvement in clinical condition and pain. From an imaging point of view, computed tomographies reported a complete response on mediastinal lymph nodes and regeneration on bone metastases.

Conclusion

This first report suggests BRAF could be a potent oncogenic driver in salivary gland carcinoma. It deserves a multicenter academic prospective trial to provide proof of efficiency with BRAF inhibitors in theses tumors.

[Role of MRI in the presurgical work-up of breast cancer: appropriate utilization of MRI as a complement to mammography and ultrasound]

The role of MRI for presurgical local staging of breast cancers amenable to conservative treatment has been the subject of multiple publications and tends to become a "validated" indication in routine practice. The purpose of the paper is to review the advantages and limitations of this imaging modality that is part of a comprehensive management that must be validated by clinical data especially with regards to local recurrence and survival. Knowledge of these elements combined with more precise indications should result in improved patient management while avoiding overtreatment or unnecessary anxiety-producing examinations.

[Imaging of chronic and intermittent adult upper urinary tract obstruction]

State-of-the-art analysis of non invasive diagnostic imaging techniques to demonstrate upper urinary tract obstruction. Advances in imaging techniques are illustrated (sonography, CT scan, MRI). The imaging features of different presentations of chronic and intermittent obstruction are described with reference to current imaging modalities. New strategies for evaluation of chronic and intermittent upper urinary tract obstruction are proposed using ultrasonography as the first line examination. The role of MRI is illustrated. Causes of obstruction are classified based from the intraluminal, parietal or extrinsic location of the lesion.

[Diagnostic and therapeutic approach of angiomyolipoma]

Renal angiomyolipoma is a benign tumour, composed of three different tissue components: muscle, vascular and fat, with a variable distribution. The frequency of haemorrhagic changes of this type of lesion and the importance of the differential diagnosis with a malignant renal lesion, require the definition of an adapted diagnostic and therapeutic strategy, the major elements of which are discussed herein.