Ultrasonographic assessment of the scrotum.
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Humans↗
Biomedical subjects
G R Dohle
Publications and source records attributed to G R Dohle.
The advantages of standardized evaluation of male infertility.
Healthcare can be improved by standardization and by evaluation of diagnostic methods and treatments. In the field of andrology, in which large patient numbers are required for the evaluation of diagnostic procedures and treatments, structured data collection and multicentre studies are especially warranted. Concomitant with routine clinical practice, a large amount of clinical data are collected that may be used to evaluate andrological care. Structuring and electronic storage of data holds promise in terms of clarity and accessibility of the data and its use for validation studies. The aim of the present work was to study the merits of routine collection of a common dataset in a computer-based patient record (CPR) for standardization, quality of data and clinical research. It was studied whether the data were of sufficient quality and accessibility for much needed studies on aetiology, interventions and diagnostics in andrology. Data collection in a structured CPR promoted complete and comprehensive data. We describe the advantages, pitfalls and solutions with this approach. Data on the uniform examination of 1549 infertile men became readily accessible. Population characteristics, basal associations and original studies were enabled and provided insight into the efficiency of clinical practice. In 66% of men, a cause for their infertility was identified, which provides a better rationale for treatment than semen parameters alone. For more than 30% of the patients, a rational andrological treatment was available, which could be deployed before assisted reproductive technologies were resorted to. However, most treatments have not been properly validated. The thorough diagnostic evaluation identifies subgroups that require an evidence base for treatment and further study on aetiology and diagnosis. Structured collection of uniform patient data through a CPR was feasible and facilitated the evaluation of diagnostic and therapeutic modalities. The reported advantages, pitfalls and solutions with this approach may help other centres to decide on how to implement a CPR. Conscientious collection of a standard data set in infertility centres facilitates pooling of data and evidence-based multicentre research.
Adult↗
The complex relationships between cystic fibrosis and congenital bilateral absence of the vas deferens: clinical, electrophysiological and genetic data.
Congenital bilateral absence of the vas deferens (CBAVD) is found in 1-2% of infertile males and in most male cystic fibrosis (CF) patients. CF and some of the CBAVD cases were found to share the same genetic background. In this study, 21 males with CBAVD had extensive physical and laboratory testing for symptoms of CF. Possible defective cellular chloride transport was measured by interstitial current measurement of rectal suction biopsies. Cystic fibrosis transmembrane conductance regulator (CFTR) gene mutation analysis was performed for 10 common CFTR mutations. CF-related symptoms were found in six men. On laboratory testing slightly abnormal liver and pancreatic function was found in seven patients. The sweat test was found to be abnormal in four patients; interstitial current measurement showed defective chloride excretion in 11 patients. CFTR gene mutations were found in 66% of the patients: eight were compound heterozygotes; in six, only one common mutation could be detected. The 5T allele in one copy of intron 8 was found in four men. CBAVD appears to be a heterogeneous clinical and genetic condition. A CFTR gene mutation was found in both copies of the allele or interstitial current measurement showed defective chloride excretion in 14/21 cases. Genetic counselling is clearly indicated for couples seeking pregnancy through epididymal or testicular sperm aspiration and intracytoplasmic sperm injection.
Adult↗
Transurethral deroofing of midline prostatic cyst for subfertile men.
We evaluated the efficacy of transurethral deroofing of a midline prostatic cyst in subfertile men with one or more of the following semen abnormalities: decreased ejaculatory volume, decreased sperm motility and oligo- or azoospermia. Results from treatment of a series of 11 subfertile men with a midline prostatic cyst by transurethral deroofing of the cyst are presented. Five patients showed an improvement of seminal volume. Only one patient demonstrated an improvement of sperm count. Sperm motility was not influenced. No relationship was found between positive outcome following operation and either size of the cyst or dilatation of the seminal vesicles. Spontaneous pregnancies did not occur after transurethral deroofing of the midline prostatic cyst. In conclusion, our study suggests a poor efficacy of transurethral deroofing of a midline prostatic cyst in subfertile men with the above mentioned semen abnormalities.
Adult↗
Is routine scrotal ultrasound advantageous in infertile men?
PURPOSE: We determine the value of routine scrotal ultrasonography in the evaluation of male infertility. MATERIALS AND METHODS: Scrotal color Doppler ultrasonography reports of 1,372 infertile men were reviewed to assess the prevalence of scrotal abnormalities and compared to clinical findings. RESULTS: The prevalence of scrotal abnormalities was 38%. Testicular tumor was found in 0.5%, varicocele in 29.7%, testicular cyst in 0.7%, testicular microlithiasis in 0.9%, epididymal cyst in 7.6% and hydrocele in 3.2% of the cases. Overall, 67% of sonography findings were not evident on palpation, and only 1 of 7 testicular tumors was suspected. Of the varicoceles 60% were not found on physical examination. The rate of testicular tumors (1/200) was higher than that reported for the general European population (1/20,000). CONCLUSIONS: Routine scrotal ultrasound provides valuable information in the diagnostic evaluation of infertile men and substantially more pathological conditions are detected compared to clinical palpation. The high prevalence of testicular malignancies underlines the clinical relevance of routine scrotal ultrasonography in infertile men.
Adult↗
Improvement of sperm count and motility after ligation of varicoceles detected with colour Doppler ultrasonography.
The debate regarding the efficacy of varicocele ligation for improvement of semen parameters and pregnancy rates is ongoing. In addition, no consensus exists as to the benefit of treatment of subclinical varicoceles. The aim of this study was to investigate, retrospectively, the effect of high ligation of both subclinical and clinical varicoceles on sperm count and motility. The value of several factors from history-taking and physical examination for the prediction of successful varicocelectomy was analysed. A total of 139 patients, operated on for a unilateral varicocele on the left side, were studied. Varicoceles were subclinical in 73 patients, based on colour Doppler ultrasonography, and 66 varicoceles were clinical, based on palpation in addition to ultrasonography. Comparison of semen parameters before and after surgery revealed a significant improvement. The median sperm count increased from 10.0 to 14.7, and from 18.2 to 28.6 million/ejaculate, in patients with subclinical and clinical varicoceles, respectively (p < 0.001). The percentage improvement in median sperm count in subclinical varicoceles was not statistically different from the improvement in clinical varicoceles. Mean progressive motility improved significantly after ligation (p < 0.001). The improvement in motility in subclinical varicoceles, from 16 to 23%, was significantly larger than the 24 to 27% improvement in clinical varicoceles. The increase in sperm count was related positively to testicular volume before surgery (p < 0.05). The increase in sperm motility was significantly lower in patients with a history of cryptorchidism (n = 22, p < 0.05). The present data show that ligation of varicoceles detected using Doppler ultrasonography, whether palpable or not, results in an increase in sperm concentration and motility.
Adult↗
Surgical sperm retrieval and intracytoplasmic sperm injection as treatment of obstructive azoospermia.
Male genital tract obstructions may result from infections, previous inguinal and scrotal surgery (vasectomy) and congenital bilateral absence of the vas deferens (CBAVD). Microsurgery can sometimes be successful in treating the obstruction. In other cases and in cases of failed surgical intervention, the patient can be treated by microsurgical or percutaneous epididymal sperm aspiration (MESA, PESA) or testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI). We present the results of 39 ICSI procedures for obstructive azoospermia in 24 couples. The aetiology of the obstruction was failed microsurgery in 11 patients, CBAVD in nine and genital infections in four. Sperm retrieval was accomplished via MESA in four cases, PESA in 18 cases and via TESE in 11 cases. TESE was only applied when PESA failed to produce enough spermatozoa for simultaneous ICSI. In six patients, the ICSI procedure was performed with cryopreserved spermatozoa after an initial PESA procedure. Fertilization occurred in 47% of the metaphase II oocytes; embryo transfer was performed in 92% of procedures and resulted in a clinical pregnancy in 13/39 procedures. Ongoing pregnancy was achieved in 10/39 procedures. One pregnancy was terminated early after prenatal investigation showed a cytogenetic abnormality (47,XX+18, Edwards syndrome). The other nine pregnancies resulted in the live birth of 10 children, without any congenital abnormalities. Epididymal and testicular retrieved spermatozoa were successfully used for ICSI to treat obstructive azoospermia, and resulted in an ongoing pregnancy in 10 of 24 couples (41.6%) after 39 ICSI procedures, a success rate of 25.6% per treatment cycle and of 27.7% per embryo transfer.
Embryo Transfer↗
Nuclear protein as a prognostic factor of growth activity in prostatic adenocarcinoma.
The value of nuclear protein (NP) as a prognostic parameter in prostatic adenocarcinoma was investigated. The NP and DNA contents of two prostatic tumour lines with a well-documented hormonal dependency (PC-82, PC-EW) were compared to the NP and DNA contents of two xenografts with only partial or no response to androgen deprivation (LNCaP, PC-133). After hormonal treatment the PC-82 and PC-EW tumours showed a significant decrease in the NP/DNA ratio, which coincided with a decrease in the proliferative activity [anti-bromodeoxyuridine (BRDU) antibody-labelling index] of the same specimens. In the fast-growing LNCaP tumour an increased percentage of cells with high NP and DNA contents was found. The tumours PC-82, PC-EW, and PC-133 with lower proliferative activity showed lower nuclear protein and DNA contents. In a pilot study of 20 prostatic biopsies the amount of nuclear protein and DNA in grade 1-3 tumours as well as in dysplasia was measured. Statistically significant differences (P < 0.002) were found between grade 1 and grade 3 tumours. The mean NP/DNA ratio was increased in high-grade malignancies. Nuclear protein appeared to be a potential parameter in predicting growth activity in prostatic carcinoma.
Adenocarcinoma↗
Sexual arousal and the quality of semen produced by masturbation.
The influence of sexual arousal on the quality of semen produced by masturbation was investigated. One group of 29 patients referred to our andrology outpatient clinic (group A) and one group of 14 healthy potential sperm donors filled out a questionnaire after having produced two semen samples, at least 1 month apart, by masturbation. Changes in questionnaire scores between first and second visit were compared with changes in semen characteristics between those two occasions to identify statistically significant correlations. A second group of 23 subfertility patients (group B) were asked to produce a semen sample by masturbation in a designated room at the hospital without additional sexual stimulation, and a second sample while viewing a sexually explicit video. Differences in questionnaire scores and semen characteristics obtained with visual erotic stimulation (VES) and without VES were analysed. In group A, the change in sexual arousal and change in intensity of orgasm correlated with change in semen volume (r = 0.38, P < 0.05; r = 0.48, P < 0.01 respectively). In healthy donors and group B, however, no such correlation was found. With VES in group B, significantly higher scores were given for 'feeling at ease/relaxed' (P < 0.01), 'sexual arousal' (P < 0.001), 'quality of erection' (P = 0.01), 'intensity of orgasm' (P < 0.05), 'satisfaction after orgasm' (P < 0.05), and 'ease with which orgasm was achieved' (P < 0.001) with VES compared to without VES. There was no statistically significant improvement in semen quality with VES compared to without VES. It is concluded that sexual arousal has no significant influence on the quality of an ejaculate produced by masturbation. On the other hand, providing a patient with a sexually stimulating video is obviously a facilitative factor when the patient 'has to' produce a semen sample for analysis. The use of visual erotic stimulation is recommended when patients and donors have to produce a semen sample in the university surroundings of a fertility clinic.
Erotica↗
[Role of andrology in the diagnosis and treatment of fertility disorders].
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Adult↗
Urogenital malacoplakia treated with fluoroquinolones.
We report 2 cases of urogenital malacoplakia and discuss the problems associated with diagnosing and treating this rare disease. In 1 case extensive pelvic disease was successfully controlled with ciprofloxacin. In the other case the malacoplakia was localized in the distal ureter and was initially mistaken for urothelial carcinoma. Nephrectomy was performed due to persistent ureteral obstruction and renal dysfunction. In the management of urogenital malacoplakia it seems essential that urinary tract infections be effectively treated. The new fluoroquinolones appear to be potentially successful in managing this disorder due to their high uptake of macrophages.
Ciprofloxacin↗