Azoospermies à FSH plasmatique normale et carnitine séminale non abaissée : une double signification. Implications diagnostiques et thérapeutiques

Soufir, J. C.; Szerman-Joly, E.; Vieillefond, Annick; Weber, Patrick J.

doi:10.1051/rnd:19880817

Cited by 8 publications

(4 citation statements)

References 14 publications

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“…US is of great value in azoospermic men when epididymal markers, which are secreted at the junction of the head and body of the epididymis, have a normal level. When a more proximal obstruction (fibrosis of the efferent ducts or even of the rete testis) is suspected [15], only scrotal sonography can detect isolated dilation of the rete testis (Fig. 2c) [16].…”

Section: Epididymal Obstructionmentioning

confidence: 99%

US findings in male hypofertility and impotence

et al. 2001

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IntroductionUltrasonography of the male genital tract is routinely performed to assess several diseases in man. A major field is prostate transrectal sonography combined with US-guided biopsies used to improve, in combination with PSA assay, early detection and staging of prostate cancer. Two other fields have gained clinical importance. The first is male hypofertility. Improvement of in vitro fertilization techniques has led to a huge increase in pretreatment investigation by imaging of hypofertile men, with emphasis on azoospermic patients, to try to find the cause of infertility, before contemplating invasive techniques for only diagnostic purposes, such as testicular biopsy or surgical deferentography. It also concerns non-azoospermic patients in whom the search for a deleterious factor is more and more routinely conducted to improve the quality of the semen. Scrotal and transrectal ultrasonography with high-frequency probes and use of color Doppler imaging have proved to be very reliable adjuncts to clinical examination to assess the presence of an obstruction (total or partial) of the seminal tract, to detect inflammatory changes in the deep genital tract and to detect and quantify a venous reflux in the spermatic veins. The second field is male sexual impotence. Initial enthusiasm concerning noninvasive investigation of impotent men by color Doppler sonography to detect a vascular abnormality (arterial or venous) of the penile vasculature has been tempered by the fact that surgical or interventional treatments used to treat penile artery stenoses or incompetence of the veno-occlusive system were found to give poor results, and now these treatments have been superseded by the advent of medical treatments based on intracavernosal injection of vasoactive drugs and more recently by the possibility of circumventing vasculogenic impotence by a peroral treatment, namely Viagra. US has thus become useful in only highly selected patients presenting with sexual impotence.

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Section: Epididymal Obstructionmentioning

confidence: 99%

US findings in male hypofertility and impotence

et al. 2001

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“…Imaging is thus of limited value when the epididymides show palpable enlargement and when epididymal marker levels are low. However, as markers are secreted at the junction of the head and body of the epididymis, a more proximal obstruction (fibrosis of the efferent ducts or even of the rete testis) causes azoospermia and is accompanied by normal levels of biochemical epididymal markers [3]. Physical examination is normal and only scrotal sonography can detect isolated dilation of the rete testis ( Fig.…”

Section: Azoospermia and Severe Oligozoospermia With A Normal Volume mentioning

confidence: 99%

Imaging of obstructive azoospermia

Cornud

Belin²,

Delafontaine

et al. 1997

Eur Radiol

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Obstructive azoospermia represents approximately 10 % of cases of male hypofertility. It is classified according to the volume of ejaculate. When the latter is normal a proximal obstruction is suspected. Scrotal sonography can help to detect dilation of the epididymal head when clinical findings are equivocal. Ejaculatory duct obstruction (EDO) is suspected when the volume of ejaculate is low. The use of transrectal ultrasonography (TRUS) plays a major role in the investigation of these patients, and endorectal MRI is a very useful adjunct in selected cases. The most common cause of EDO is congenital bilateral absence of vas deferens, which is now thought to be a genital form of cystic fibrosis in 80 % of cases. Consequently, a definitive diagnosis must be made before any attempt at in vitro fertilization. TRUS accurately visualizes abnormalities of the caudal junction of the vas deferens and seminal vesicles, yielding a definitive diagnosis without scrototomy. Other causes of EDO are congenital cysts compressing the distal part of the ejaculatory ducts and inflammatory distal stenosis. The former are accurately identified by TRUS, but the latter give more or less marked signs of obstruction which are only of value in azoospermic patients with a low-volume ejaculate. More invasive imaging is required to diagnose partial obstruction of the ED. Surgical vasography is still the reference, but puncture of the seminal vesicles under TRUS guidance is an attractive alternative, as it permits aspiration of seminal fluid (to seek motile sperm) and vasography without scrototomy. Lastly, endorectal MRI well assesses the relationships between the proximal prostatic urethra and the posterior wall of the ejaculatory ducts, which need to be precisely known when endoscopic resection of the ejaculatory ducts is planned.

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“…Glucosidase is demonstrable on the microvilli of the mucosa of the proximal human vas (C. H. Yeung, unpublished data) but is it released from the vas after bypass surgery? After bypass of swollen (obstructed) caput epididymides, carnitine appears in smaller amounts in semen than before the operation (Soufir et al, 1988); is this secreted by the remaining caput tissue or by the vas under luminal stimulation by proximal secretions? If the latter is the case, other secretions important for fertility may also be released and contact the spermatozoa, initiating their maturation within the vas deferens.…”

Section: Interpretation Of Data Obtained From Epididymal Bypassmentioning

confidence: 99%

“…They are being employed to provide information on the functional state of the epididymis (Cooper et al, 1990a;Guerin et al, 1990) in the same way that fructose and zinc are used as markers of the function of the seminal vesicles and prostate, respectively. Together with normal testicular volume and serum testosterone and FSH they provide diagnostic criteria indicative of distal excretory azoospermia (Cooper et al, 1988(Cooper et al, , 1990bGuCrin et al, 1986;Soufir et al, 1988). Apart from this useful indication of tubule patency, the biological role of glucosidase (and other markers) is not known.…”

Section: Epididymal Markers In Andrologymentioning

confidence: 99%