Percutaneous placement of Dacron-covered stents is a safe and effective procedure for salvage of a dialysis fistula. First results are promising, with a tendency to prolongation of the time interval between reinterventions.

Summary Scrotal sonography with a 7.5 MHz sector scanner was performed on 658 consecutive patients of our infertility clinic. The incidence of pathological findings was unexpectedly high. Forty per cent of the patients revealed pathological structures such as varicoceles (21%), hydroceles (7%), epididymal abnormalities (6%), spermatoceles (6%), intratesticular hyper‐ and hypoechoic changes (4.5%), intratesticular cysts (1%) and tumours or carcinoma in situ (CIS) (0.6%). Sonographic evaluation and measurement of the caput epididymidis was compared with palpation. Sonography distinguished size ranges of “normal” and “thickened” epididymides as diagnosed by palpation. Cystic structures were proven in 56% of cases with “thickened” epididymides. The sonographically determined diameters of doppler‐negative blood vessels were significantly smaller than those of doppler‐positive vessels. Sonography revealed a higher occurrence of varicoceles than diagnosed by palpation (76% by palpation). Only 58% of sonographically identified hydroceles and only 67% of sonographically detected spermatoceles were detected by palpation. One testicular tumour and one case with CIS were only seen by sonography and not suspected on palpation. The results demonstrate that sonography represents a valuable tool in the routine diagnosis of andrological patients. Zusammenfassung Bei 658 konsekutiven Patienten unserer Fertilitätssprechstunde wurde routinemäßig eine sonographische Untersuchung der Skrotalorgane mit einem 7, 5 MHz Sektor‐Schallkopf durchgeführt. Die Inzidenz pathologischer Befunde war überraschend hoch. Bei 40% der Patienten fanden sich pathologische Strukturen, wie Varikozelen (21%), Hydrozelen (7%), Anomalien des Nebenhodens (6%), Spermatozelen (6%), intratestikuläre hyper‐ und hypoechogene Veränderungen (4,5%), intratestikuläre Zysten (1%) und Tumoren oder Carcinoma‐in situ [CIS] (0,6%). Die sonographische Untersuchung und Vermessung des Nebenhodenkopfes wurde mit dem Palpationsbefund verglichen. Bei der Palpation wurde zwischen “normal großem” und “verdicktem” Nebenhoden unterschieden. Zystische Strukturen wurden in 56% der “verdickt” palpierten Nebenhoden nachgewiesen. Der sonographisch ermittelte Durchmesser von Doppler‐negativen Gefáßen war signifikant kleiner als der von Dopplerpositiven Gefäßen. Im Vergleich zur klinischen Untersuchung fand sich sonographisch eine höhere Inzidenz von Varikozelen (76% palpiert), von Hydrozelen (58% palpiert) und von Spermatozelen (67% palpiert). Ebenso wurden ein Tumor und das CIS nur auf Grund des sonographischen Bildes entdeckt und einer operativen Diagnose zugeführt. Diese Ergebnisse zeigen, daß die Sonographie eine wertvolle Bereicherung der andrologischen Routinediagnostik darstellt.

The influence of semen quality on fertilization rates in an in-vitro fertilization (IVF) programme was studied by analysing both conventional semen parameters and computerized movement characteristics. The study was based on 407 inseminated oocytes which were obtained from 50 patients in 113 laparoscopies. Sperm concentration did not correlate strongly with the fertilization rate. Sperm motility and morphology were the most meaningful parameters in predicting fertilization success. A drop in fertilization rate was found when sperm motility or normal morphology were below 40%. Sperm velocity measured in semen was the only sperm movement parameter which correlated with the fertilization rate, albeit weakly. The latter was reduced when average sperm velocity in semen was less than 50 microns/sec. Conventional semen parameters seem to be more predictive of the fertilizing potential of an ejaculate than movement characteristics obtained by computerized image analysis.