The Infertile Male-3: Endocrinological Evaluation

Ultrasound of the male genital tract in relation to male reproductive health

“…The mean TV difference when comparing US and PO is 4-5 ml (Carlsen et al, 2000;Sakamoto et al, 2007a. Hence, assuming that a normal TV by PO is .14 -15 ml (Takihara et al, 1987;Forti and Krausz, 1998), the normal US-TV should be .10-11 ml (Lotti et al, 2012b). However, so far, testicular hypotrophy by US has been defined as a TV ,12 ml (see Condorelli et al (2013)).…”

“…Not reported Calcifications -MAGI,CP/CPPS (Doble and Carter, 1989;Purvis and Christiansen, 1993;Vicari, 1999) -Elevated sIL8 (Lotti et al, 2011a;Lotti and Maggi, 2013) -Overweight/obesity (Lotti et al, 2012b) and MetS (Lotti et al, 2014a) -PLS (Lotti et al, 2014b) -Maintenance of CP, bacterial colonization (Meares, 1974;Shoskes et al, 2007) -Corpora amylacea (Sfanos et al, 2009) Macro-calcifications: .3 mm (Isidori and Lenzi, 2008) Hyperemia -Tissue inflammation and clinical activity (Cho et al, 2000) ≥15 Doppler spots (Cho et al, 2000) -measure before ejaculation to avoid post-ejaculatory vascular flow changes (Keener et al, 2000) Arterial prostatic peak systolic velocity -Tissue inflammation and clinical activity (Lotti et al, 2011a(Lotti et al, , 2012c(Lotti et al, , 2014bLotti and Maggi, 2013) and PLS (Lotti et al, 2014b) -Moderate-severe PLS in young men: 11 cm/s (Lotti et al, 2014b) -BPH: .15 cm/s (Berger et al, 2006) Resistive index BPH and LUTS (Berger et al, 2006;Shinbo et al, 2010) Not reported (proposed . 0.725, see Berger et al, 2006) Dilation of the prostatic venous plexus -MAGI and CP/CPPS (Di Trapani et al, 1988;Vicari, 1999;Lotti et al, 2009) -Varicocele (Lotti et al, 2009) Not well defined/not replicable -.150 mm 2 (Di Trapani et al, 1988) -diameter .3 mm (Kamoi, 1996) or .4 mm (La Vignera et al, 2011e)…”

“…Color Doppler ultrasound clinical utility and impact on male reproductive health management Table I summarizes our view on the clinical utility of MGT-CDUS evaluation in clinical decision-making (ranking from mild to high relevance) in male infertility according to the different sites and types of abnormalities. In many circumstances, clinical, hormonal and semen parameters are informative enough for the management of infertile men (Krausz, 2011;Lotti et al, 2012b). However, MGT-CDUS shows a critical role in specific conditions.…”

“…Transrectal and scrotal US are useful in detecting CBAVD or CUAVD (EAU Guidelines on Male Infertility, Jungwirth et al, 2013), suggesting more specific examinations (CFTR gene evaluation, urinary tract evaluation by US and surgical sperm extraction) (see Krausz, 1998 andLotti et al, 2012b). TRUS may detect SV cysts, usually associated with other genitor-urinary abnormalities (Patel et al, 2002), and should prompt other investigations.…”