Bilateral Testicular Volume Research Articles

Can we preserve the necrotic testis caused by incarcerated inguinal hernia in infants under 3months?

This study aims to investigate whether necrotic testis resulting from incarcerated inguinal hernias can be preserved in infants under 3months old. A retrospective analysis was conducted on data collected from infants under 3months old who had necrotic testis caused by incarcerated inguinal hernias between 2016 and 2020. They were divided into two groups: the orchiectomy group and the testicular preservation group. The control group consisted of normal male children of the same age. Data regarding bilateral testicular volume, dihydrotestosterone, inhibin B, and antisperm antibodies were collected. The study included 42 cases, with 18 patients being followed up for 6-54months after the operation. In the testicular preservation group, 2 children did not experience testicular atrophy. There was no significant difference in the volume of the contralateral testes between the testicular preservation group and the control group; however, both groups had smaller testicular volumes compared to the orchiectomy group. There was no significant difference in the levels of inhibin B between the testicular preservation group and the orchiectomy group, although both were lower than the control group. Furthermore, no significant difference was observed in the levels of dihydrotestosterone and the positivity rate of antisperm antibodies among the three groups. Preserving the necrotic testis may allow it to survive without impacting the contralateral testis. Therefore, a more conservative approach should be considered for orchiectomy when dealing with testicular necrosis caused by incarcerated inguinal hernias in infants.

#85 : Microdissection Testicular Sperm Extraction (Micro-Tese) in Men Non-Obstructive Azoospermia with Very Small Testicular Volume: A Case Series Report

Background and Aims: Testicular atrophy is a common clinical manifestation of NOA, with a rate of 79.1%. The results of sperm retrieval using the mTESE method in a special NOA for testicular atrophy with volume [Formula: see text]5ml are currently inconsistent. As a result, we present the results of sperm retrieval using the mTESE method to patient NOA, who has a bilateral testicular volume [Formula: see text]5ml. Methods: A case series report of NOA with bilateral testicular volume [Formula: see text]5ml that indicated mTESE surgery to collect sperm at the assisted reproductive technology center of Tam Anh Ha Noi General Hospital between January 2022 and December 2022. Results: Four of seven NOA patients (57.1%) had successful sperm retrieval using the mTESE method, with bilateral testicular volume [Formula: see text]5 ml and a mean FSH level of 40,5 ± 21,9 (24,1-87,6) mIU/mL. In which case, 3/4 of patients simply require surgery on the monolateral testicular is sufficient sperm. Conclusions: Testicular atrophy does not appear to impair sperm retrieval results by the mTESE method, even the sperm retrieval rate tends to be higher in NOA patients with bilateral testicular volume [Formula: see text] 5ml.

Effects of TAPP Combined with Biological Mesh on Reproductive Function in Male Inguinal Hernia Patients of Reproductive Age: A Single-Center Retrospective Study

Objective. To explore the effect of laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) combined with biological mesh on the reproductive function of male inguinal hernia patients during the reproductive period. Methods. Sixty male inguinal hernia patients during the reproductive period admitted to our department from October 2015 to October 2021 were selected for retrospective analysis. All patients were treated with TAPP combined with biological mesh by the same team. Bilateral testicular volume, testicular temperature, testicular blood perfusion, peripheral serum testosterone concentration, and semen analysis were examined before surgery, 3 months after surgery, 6 months after surgery, and 12 months after surgery. Results. The preoperative testicular volume, temperature, and blood perfusion were compared between the healthy side and the affected side; the testicular volume, temperature, blood perfusion of the affected side, peripheral blood testosterone concentration, and semen analysis were compared among the four time points, which were before operation, 3 months after operation, 6 months after operation, and 12 months after operation. All p values were >0.05. Conclusions. The presence of inguinal hernia had no significant effect on the volume and blood perfusion of male testis. In addition, TAPP combined with biological mesh has no negative effect on postoperative reproductive function of male inguinal hernia patients of childbearing age, which manifested as a safe and feasible surgical method.

Assessment of testicular volume in neonates in the tropical province of China

BackgroundTesticular volume in neonates is a potential indicator of testicular development during the fetal period, particularly the masculinization programming window. Reliable measurements of testicular volume provide an opportunity for early detection of testicular abnormalities. This study aimed to assess the testicular volume in neonates and evaluate its relationship with gestational week and birth weight in Hainan Province, China.MethodsData on 458 neonates who underwent ultrasonography examinations at our institution from 2018 to 2022 were collected. The neonates were categorized by gestational week, birth weight, and presence of cryptorchidism. We evaluated the testicular volume among different groups and its relationship to gestational week and birth weight.ResultsThere was no significant difference between the right and left testicular volume in neonates without cryptorchidism. However, a significant difference was observed between normal birth weight and low birth weight neonates in terms of testicular volume. Similarly, there was a significant difference between premature and full-term neonates in testicular volume. Bilateral testicular volume showed positive and significant correlations with gestational week and birth weight. Additionally, a significant difference was noted in testicular volume between the affected side in neonates with cryptorchidism and the same side in normal birth weight full-term neonates.ConclusionsWe established the normal range of testicular volume for neonates in Hainan Province and demonstrated that testicular volume is positively correlated with both birth weight and gestational week. Cryptorchidism also affects testicular volume during the neonatal period, likely due to reduced androgenic exposure in utero, particularly during the masculinization programming window. The findings of this study have significant implications for assessing testis development during fetal development.

Testosterone to Luteinizing Hormone Ratio as a Potential Predictor of Sperm Retrieval in Non-Obstructive Azoospermia Patients.

This study assessed the outcomes of microsurgical testicular sperm extraction (mTESE) and potential preoperative predictors of sperm retrieval (SR) in patients with non-obstructive azoospermia (NOA). Clinical data of 111 NOA patients who underwent mTESE was reviewed retrospectively. Baseline patient characteristics, including age, body mass index (BMI), testicular volumes, and preoperative endocrine levels, such as testosterone (T), follicle-stimulating hormone (FSH), serum-luteinizing hormone (LH), prolactin, sex hormone-binding globulin (SHBG), FSH/LH ratio along with T/LH ratio, were analyzed. After categorizing the patients into two groups based on SR success or failure, logistic regression analysis was performed to identify the preoperative predictors of successful SR. Sixty-eight patients had successful SR (61.3%), whereas 43 patients (38.7%) showed negative results. Failed SR group had elevated serum FSH and LH levels, whereas successful SR patients had a significantly larger testicular volume (p<0.001). Moreover, the successful group had a higher T/LH ratio (p<0.001). Multivariate logistic analysis showed that the T/LH ratio, serum FSH levels, and bilateral testicular volumes were significantly associated with successful sperm extraction. In addition to traditional predictors, such as testicular volume and preoperative FSH levels, the T/LH ratio is a potential independent predictor of successful SR in infertile patients with NOA.

Male reproductive health after 3 months from SARS-CoV-2 infection: a multicentric study

PurposeWhile SARS-CoV-2 infection appears not to be clinically evident in the testes, indirect inflammatory effects and fever may impair testicular function. To date, few long-term data of semen parameters impairment after recovery and comprehensive andrological evaluation of recovered patients has been published. The purpose of this study was to investigate whether SARS-CoV-2 infection affect male reproductive health.MethodsEighty patients were recruited three months after COVID-19 recovery. They performed physical examination, testicular ultrasound, semen analysis, sperm DNA integrity evaluation (TUNEL), anti-sperm antibodies (ASA) testing, sex hormone profile evaluation (Total testosterone, LH, FSH). In addition, all patients were administered International Index of Erectile Function questionnaire (IIEF-15). Sperm parameters were compared with two age-matched healthy pre-COVID-19 control groups of normozoospermic (CTR1) and primary infertile (CTR2) subjects.ResultsMedian values of semen parameters from recovered SARS-CoV-2 subjects were within WHO 2010 fifth percentile. Mean percentage of sperm DNA fragmentation (%SDF) was 14.1 ± 7.0%. Gelatin Agglutination Test (GAT) was positive in 3.9% of blood serum samples, but no positive semen plasma sample was found. Only five subjects (6.2%) had total testosterone levels below the laboratory reference range. Mean bilateral testicular volume was 31.5 ± 9.6 ml. Erectile dysfunction was detected in 30% of subjects.ConclusionOur data remark that COVID-19 does not seem to cause direct damage to the testicular function, while indirect damage appears to be transient. It is possible to counsel infertile couples to postpone the research of parenthood or ART procedures around three months after recovery from the infection.

Effect of Recombinant Gonadotropin on Testicular Function and Testicular Sperm Extraction in Five Cases of NR0B1 (DAX1) Pathogenic Variants.

Background NR0B1 pathogenic variants can cause congenital adrenal hypoplasia or primary adrenal insufficiency in early childhood usually associated with hypogonadotropic hypogonadism. NR0B1 is necessary for organogenesis of the adrenal cortex and to maintain normal spermatogenesis. In humans, restoration of fertility in patients carrying NR0B1 pathogenic variants is challenging.ObjectiveThe aim of the study was to investigate the clinical, hormonal, histological, spermiological, and molecular genetic characteristics of a cohort of patients with NR0B1 pathogenic variants, monitored for fertility preservation.PatientsWe included five patients, including four teenagers, with NR0B1 pathogenic or likely pathogenic variants. They all had primary adrenal insufficiency and were receiving replacement therapy with glucocorticoids and mineralocorticoids. Patients received recombinant follicle-stimulating hormone and recombinant human chorionic gonadotropin in order to induce spermatogenesis. Combined gonadotropin treatment was initiated between 13 years and 15 years and 6 months for the four teenagers and at 31 years and 2 months for the only adult. Physical and hormonal assessments were performed just before starting gonadotropin treatment. After 12 months of gonadotropin treatment, physical examination and hormonal assessments were repeated, and semen analyses were performed. If no sperm cells were observed in at least 2 semen collections at 3-month interval, testicular biopsy for testicular sperm extraction was proposed.ResultsBilateral testicular volume increased from 8 ml (interquartile range, 6–9) to 12 ml (10–16) after gonadotropin treatment. Inhibin B levels were relatively stable: 110 ng/L (46–139) before and 91 ng/L (20–120) at the end of gonadotropin treatment. Azoospermia was observed in all semen analyses for all cases during gonadotropin treatment. Three patients agreed to testicular biopsy; no mature sperm cells could be retrieved in any.ConclusionWe characterized a cohort of patients with NR0B1 pathogenic or likely pathogenic variants for fertility preservation by recombinant gonadotropin treatment, which began either at puberty or in adulthood. No sperm cells could be retrieved in semen samples or testicular biopsy even after gonadotropin treatment, indicating that gonadotropin treatment, even when started at puberty, is ineffective for restoring fertility.

Abstract 106: Hypogonadism due to isolated luteinizing hormone receptor defect

Background: The human luteinizing hormone/chorionic gonadotropin receptor (LHCGR) belongs to G-protein coupled class A receptor with 12 Exons, 699 amino acids and molecular weight of 85-95KDa, the gene is located on chromosome 2p21. Mutations of LHCGR have been divided into two types based on the severity of the disease. Type 1 LCH (most severe form) causes male to female DSD, absence of sexual maturation at puberty, milder forms of resistance can present with micropenis and/or hypospadias or only infertility called type 2 LCH.Aims and Objectives: In this study we aim to describe a case with type 2 LCH and systematically review the literature of type 2 LCH cases with available genotype data.Results: Mr. AS presented from southern India born of third degree consanguineous marriage presented with micropenis at the age of 18 years. He had uneventful birth and was reared as a male. External genitalia showed Pubic hair stage 2, stretched penile length of 3.5 cm, bilateral testicular volume of 8 cc with no breast development. Karyotype of the patient was 46 XY and Hormonal evaluation (18 years) showed luteinizing hormone (LH) 19.92 mIU/ml, Follicular stimulating hormone (FSH) 7.62 mIU/ml, testosterone (T) 0.114 ng/ml, stimulated T 0.118 ng/ml, dihydrotestosterone (DHT) 0.199 ng/ml. Imaging showed small sized bilateral testes in the scrotum (right 2.5x1.6 cm, left 2.6x1.9 cm), with visible prostate gland, epididymis and no mullerian structures. Genetic analysis by next generation sequencing showed homozygous pathogenic mutation c.391T>C (p.Cys131Arg) in Exon 5 suggestive of leydig cell hypoplasia. He was treated with Inj testosterone and Inj Human chorionic gonadotropin (HCG) with which he had clinical improvement in terms of virilization and increase in testicular volume.Conclusion: Leydig cell hypoplasia is a rare cause of hypogonadism.

Chronic exposure to delta-9-tetrahydrocannabinol impacts testicular volume and male reproductive health in rhesus macaques

To determine the dose-dependent effect of delta-9-tetrahydrocannabinol (THC) exposure on male testes and reproductive health in a nonhuman primate model. Research animal study. Research institute. Adult male rhesus macaques 8-10 years of age (n = 6). Daily edible THC at medically and recreationally relevant doses. Testicular volume and epididymal head width, serum levels of inhibin B, albumin, total testosterone, prolactin, follicle-stimulating hormone, estradiol, and luteinizing hormone; semen volume; and sperm motility, morphology, and concentration. For each 1 mg/7 kg/day increase in THC dosing, there was a marked loss in total bilateral testicular volume of 11.8 cm3 (95% confidence interval [CI]: 8.3-15.4). In total, average bilateral testicular volume decreased by 58%. Significant dose-response decreases in mean total testosterone level by 1.49 ng/mL (95% CI: 0.83-2.15) and in estradiol level by 3.8 pg/mL (95% CI: 2.2-5.4) were observed, but significant increases in the levels of follicle-stimulating hormone by 0.06 ng/mL (95% CI: 0.02-0.10), luteinizing hormone by 0.16 ng/mL (95% CI: 0.08-0.25), and prolactin by 7.4 ng/mL (95% CI: 3.4-11.3) were observed. There were no statistically significant changes in semen parameters. In rhesus macaques, chronic exposure to THC resulted in significant dose-response testicular atrophy, increased serum gonadotropin levels, and decreased serum sex steroids, suggestive of primary testicular failure. Further studies are needed to determine if reversal of these observed adverse effects would occur if THC was discontinued and for validation of thefindings in a human cohort.

A clinical trial on the consistency of bilateral testicular tissue histopathology and Johnsen score: single side or bilateral side biopsy?

To evaluate and compare left and right testicular tissue histopathology and Johnsen score, and to investigate the necessity for bilateral testicular biopsy. We recruited180 patients with non-obstructiveazoospermia (NOA) on testicular biopsy who had undergonetesticular sperm aspiration (TESA). Pathological sections of testicular tissue were diagnosed by specially-assigned doctors, who evaluated pathological findings, determined the Johnsen score and confirmed for the presence or absence of sperm. Sperm positive rates for left and right testicular histopathology were 55.0% and 51.7% respectively, and the proportion of Johnsen scores≥8 for left and right testes were 53.3% and 50.0%, respectively. Cohen kappa values revealed that the identification of sperm in bilateral testicular samples was not consistent and was related to random effects; Optimized cut-off value for bilateral testicular volume was 11ml (Johnsen score ≥8), and optimized cut-off values of E2 on left and right testes were 144.5pmol/L and 133.5 pmol/L (Johnsen score≤7). However, age, serum prolactin (PRL), follicle stimulating hormone (FSH), luteinizing hormone (LH) and total testosterone (TT) levels were not accurate predictors for the existence of testicular sperm. There was nostatistical significance between left and right testicular histopathology in terms of sperm positive rates or Johnsen score; the Johnsen score were caused entirely by random effects and a score from one side could not represent the other side. Therefore, we recommend that both testes need to undergo surgery when NOA patients undergo testicular biopsy or sperm retrieval.

Right testicular volume is a dominant predictor of testicular function determined by sperm parameters and total testosterone.

This study aims to evaluate the predictive value of left testicular volume (LTV) and right testicular volume (RTV) for testicular function respectively. Men who requested fertility testing for any reason were enrolled from December 2012 to November 2015. Subjects with primary scrotal diseases or a condition interfering reproductive system were excluded. Testicular volume (TV) was evaluated by scrotal ultrasound. Sex hormone and semen analysis including sperm concentration (SC) and sperm motility rate (SMR) were performed. Statistical analysis including comparison, stepwise linear regression and logistic regression was used. Two hundred and seventy-four patients with oligoasthenozoospermia/low testosterone and 27 control subjects were enrolled. Both LTV and RTV positively correlated with testicular function, and no differences were found between bilateral TV. RTV is the best independent factor associated with testicular function determined by SC (β=.292, p<.001), SMR (β=.227, p<.001) and total testosterone (TT) (β=.245, p<.001). Using a RTV value of 15.47ml, the highest discriminating sensitivity and specificity were 66.7% and 62.4% respectively. RTV (<15ml) was the only positive predictor for low testicular function (odds ratio=2.79, 95% confidence interval: 1.18-6.66; p=.020). RTV rather than LTV is the independent factor of overall testicular function determined by semen quality and TT levels. Further studies are needed to support and elucidate the difference in volume-function between bilateral testes.

Bilateral is superior to unilateral varicocelectomy in infertile males with left clinical and right subclinical varicocele: a prospective randomized controlled study.

The purpose of this study is to compare the effect of bilateral versus unilateral varicocelectomy on seminal response and spontaneous pregnancy rates in infertile male patients with left clinical and right subclinical varicocele. A total of 358 infertile men with left clinical and right subclinical varicocele were randomized to group that underwent bilateral (n=179) and group that underwent unilateral microsurgical subinguinal varicocelectomy (n=179). Baseline data regarding male age, female partner age, grade of varicocele body mass index, bilateral testicular volume and serum follicle-stimulating hormone, luteinizing hormone, total testosterone levels and infertility duration and semen parameters were gathered. One year after the surgery, semen parameters including sperm volume, sperm concentration, normal sperm morphology, progressive motility and sperm DNA fragmentation index were recorded and any pregnancy was also documented via telephone calls and hospital visits. We found the baseline characteristics were comparable between the two groups. The seminal parameters had significant improvements 1year postoperatively in both groups. However, the bilateral group showed significantly greater improvements than the unilateral group in sperm concentration, normal sperm morphology and progressive motility. Besides, the pregnancy rate was statistically higher in the bilateral group after the surgery (42.5 versus 26.0%, bilateral versus unilateral group). In conclusion, our study indicated that bilateral is superior to unilateral varicocelectomy in infertile males with left clinical and right subclinical varicocele, which is associated with greater improvements in sperm concentration, normal sperm morphology and progressive motility and spontaneous pregnancy rate after the surgery.

Idiopathic hypogonadotropic hypogonadism reversal after testosterone replacement in a 34-year-old male

A 34-year-old male presented to the endocrinology clinic with the complaint of the absence of facial, axillary and pubic hairs. Further history revealed absent ejaculations and decreased early morning erections....

Silent Crooke's cell corticotroph adenoma of the pituitary gland presenting as delayed puberty.

SummaryCorticotroph adenomas are extremely rare in children and adolescents. We present a 15-year-old boy who was investigated for delayed puberty (A1P2G1, bilateral testicular volumes of 3 mL each). There was no clinical or laboratory evidence suggestive of chronic illness, and the initial clinical impression was constitutional delay in puberty. Subsequently, MRI scan of the brain revealed the presence of a mixed cystic and solid pituitary lesion slightly displacing the optic chiasma. The lesion was removed by transphenoidal surgery and the biopsy confirmed the lesion to be pituitary adenoma. Furthermore, the adenoma cells also had Crooke’s hyaline changes and were intensely positive for ACTH. However there was no clinical/biochemical evidence of ACTH excess. There was a spontaneous pubertal progression twelve months after the surgery (A2P4G4, with bilateral testicular volume of 8 mL). Crooke’s cell adenoma is an extremely rare and aggressive variant of corticotroph adenoma that can uncommonly present as a silent corticotroph adenoma in adults. We report for the first time Crooke’s cell adenoma in an adolescent boy presenting with delayed puberty.Learning points:Constitutional delay of growth and puberty (CDGP) is a diagnosis of exclusion; hence a systematic and careful review should be undertaken while assessing boys with delayed puberty.Crooke’s cell adenomas are a group of corticotroph adenomas that can rarely present in childhood and adolescence with delayed puberty.Crooke’s cell adenomas can be clinically silent but are potentially aggressive tumours that require careful monitoring.

English

A 21-year-old male presented to us with delayed development of secondary sexual characteristics. Based on examination and investigations, a diagnosis of idiopathic hypogonadotropic hypogonadism was made and the patient was started on testosterone therapy. After around a year of therapy the patient had an increase in bilateral testicular volume with increased serum luteinizing hormone (LH) values. The patient was advised to stop treatment. On follow-up there was persistence of increase in LH values with maintenance of normal serum testosterone values. Thus the case highlights the importance of regular follow-up in cases of idiopathic hypogonadotropic hypogonadism to watch for reversal. &nbsp; Key words: Puberty, hypogonadism, reversal.

FSH-Producing Pituitary Macroadenoma: Report of 2 Cases with Clinical Manifestations of Hormone Excess

ABSTRACT Objective: Gonadotropinomas with signs related to hypergonadotropinemia have been rarely published. We report 2 clinical cases of follicle-stimulating hormone (FSH)-producing macroadenomas showing manifestations of hormone hypersecretion. Methods: The clinical, laboratory, and imaging findings are presented with a review of the literature. Results: A 51-year-old man was admitted to the hospital because of cranioencephalic trauma following seizures. He reported previous altered behavior, depression, sphincter incontinence, and visual troubles. Physical examination revealed signs of hypogonadism and increased bilateral testicular volume. Magnetic resonance imaging (MRI) showed a large lesion in the sellar-suprasellar area, with mass effect. Hormone testing showed high levels of FSH (517 mIU/mL) and low levels of both luteinizing hormone (LH) (2.2 mIU/mL) and testosterone (1.3 ng/mL). A partial resection of an immunopositive FSH adenoma was performed; FSH declined after surgery, but the patient died...

The influence of antisperm antibodies, intratesticular haemodynamics and the surgical approach to varicocelectomy on seminal variables

ObjectiveTo evaluate the effect of antisperm antibodies (ASAs), hormonal levels, intratesticular haemodynamics and the surgical approach on the outcomes of varicocelectomy in infertile men, as assessed by seminal variables. Patients and methodsIn a prospective case-series study, 82 infertile men with varicocele (35 left and 47 bilateral) were evaluated. The preoperative assessment included a physical examination, semen analysis, assessment of ASAs in seminal plasma, hormonal levels (follicle-stimulating hormone (FSH), luteinising hormone and testosterone), and scrotal colour Doppler ultrasonography (CDUS) to measure the peak systolic velocity (PSV), end diastolic velocity (EDV), resistive index (RI) and pulsatility index. Patients were scheduled for varicocelectomy, with high ligation (Palomo) used in 40 patients (18, 45%, with left and 22, 55%, with bilateral varicocele), or an inguinal approach (Ivanissivich) with loupe magnification used in 42 (17, 40%, with left and 25, 60%, with bilateral varicocele). The men were reassessed at ⩾3months after surgery and according to the improvement in seminal variables (expressed as a ⩾50% increase in total motile sperm count, TMSC), patients were further categorised into ‘improved’ or ‘unimproved’. Binary logistic regression analysis was used to investigate the predictors of improvement. ResultsBefore surgery the ASAs were positive in 17 men (21%). There was no significant difference between the right and left sides in intratesticular haemodynamics. The TMSC was improved in 52 (63%) patients who had a significant improvement in the haemodynamic variables. Intratesticular haemodynamics, serum FSH and testosterone levels differed significantly between the improved and unimproved patients. Positivity for ASAs, the surgical approach and laterality of the varicocele were not significantly different, although the ASA-positive cases were characterised by a significant decrease in motility. Logistic regression analysis showed that the EDV, PSV, FSH, testosterone level and bilateral testicular volume (BTV) were significant predictors of improvement. ConclusionPositivity for ASAs is not a predictor of the outcome after varicocelectomy but affects only the motile fraction in positive cases, despite the improvement in other seminal variables and testicular haemodynamics, and regardless of the surgical approach. The EDV, PSV, FSH, testosterone and BTV were significant predictors of a successful outcome.

Ultrasonographic caput epididymis diameter is reduced in non-obstructive azoospermia compared with normozoospermia but is not predictive for successful sperm retrieval after TESE.

Is the ultrasonographic determination of the caput epididymis diameter predictive for sperm retrieval after testicular sperm extraction (TESE) in non-obstructive azoospermia (NOA)? Ultrasonographic determination of the caput epididymis diameter did not give any relevant clinical information in NOA and was not predictive for positive sperm retrieval after TESE. The diameter of the caput epididymis in ultrasonography (US) has a diagnostic relevance in azoospermic men to correctly identify obstructive azoospermia; however, its clinical value in NOA is not yet determined. We performed a retrospective study of 100 azoospermic and 160 normozoospermic men attending a university infertility clinic. Participants were submitted to scrotal US to determine the mean value of bilateral testicular volumes (ml), the bilateral longitudinal caput diameter (mm) and the antero-posterior diameter of the corpus (mm) epididymis. The number of spermatozoa retrieved after TESE and the testicular histology of azoospermic men was obtained and the percentage of seminiferous tubules with elongated spermatids (%T) was used to classify cases with normal spermatogenesis (obstructive azoospermia) (OA) (n = 20; %T ≥ 80) or with NOA (n = 80; %T < 70). The US testes volumes and caput diameters were reduced (P < 0.05) in NOA compared with OA and with normozoospermia, but the corpus values were not different. The caput diameter in the side submitted to biopsy was significantly reduced when germinal epithelium was absent (Sertoli cell only) (P < 0.05) and the lowest value of caput diameter was observed when the seminiferous epithelium and tubule lumen were absent (testicular hyalinosis). On the contrary, a total arrest of spermatogenesis at the first meiosis level, or a defect of spermiogenesis resulting in scattered elongated spermatids in each tubule, did not show a reduced diameter of caput epididymis compared with normozoospermia. The caput diameter did not show any difference between NOA patients with or without successful sperm retrieval at TESE. On the contrary testicular volume was significantly reduced in NOA patients with no sperm retrieval (P = 0.0037). The caput diameter was not correlated with the number of retrieved sperm, the serum level of follicle stimulating hormone, or with the percentage of tubules with elongated spermatids at histological analysis. The aetiology of NOA was not included in the statistical analysis due to the low rate of cases with a specific aetiology for a testicular failure. Larger studies should exclude the possibility that besides testicular histology, aetiology of NOA might influence the diameter of caput epididymis. Moreover, whether a reduced diameter of caput epididymis is only a result of a testicular pathologic phenotype or whether it may underscore a primitive dysfunction influencing the number of ejaculated spermatozoa is not yet determined. We reported that US diameter of the caput epididymis is reduced in cases of NOA but, in contrast with the testicular volume, it is independent of the completion of spermatogenesis and subsequent presence of spermatozoa in the epididymis. Therefore ultrasonographic determination of caput epididymis diameter is not predictive for positive sperm retrieval after TESE in cases of a primitive testicular failure. Our novel findings may help to define which reproducible parameters of scrotal US should be assessed in the work-up of male infertility. This work was supported by the Ministero dell'Università e Ricerca (I) PRIN 2009. The authors declare no competing interest.

Evaluation of testicular artery blood flow by Doppler ultrasonography as a predictor of spermatogenesis in the dog

The present study examines the relationship between reproductive and seminal characteristic with blood flow supply of the testis in male dogs by means of Doppler ultrasonography. Five male dogs were subject to a clinical examination, blood sampling, B-Mode and Doppler ultrasonography of the testis, semen evaluation at collections and after storage at 4°C for 24, 48 and 72h in three replicates 30days apart. Peak Systolic Velocity was positively correlated with testicular volume and negatively with live sperm at collections and after 24h. A negative correlation existed between Resistive Index and Pulsatility Index with total and progressive motility at collections and also after 24, 48 and 72h. Resistive Index and Pulsatility Index were also negatively correlated with the percentage of membrane intact sperms with curled tails at collections while the latter was positively correlated with End Diastolic Velocity. Moreover, positive linear correlations of weight with bilateral testicular volume and total sperm concentration and also between age and abnormal sperm at collections and after 24h were established. The results suggest that the Resistive Index and Pulsatility Index seem to be potential markers of seminal quality in dogs.

2294 CLINICAL CHARACTERIZATION AND REPRODUCTIVE OUTCOMES IN MEN WITH COMPLETE AZFC DELETIONS: A 17-YEAR EXPERIENCE

You have accessJournal of UrologyInfertility: Evaluation1 Apr 20132294 CLINICAL CHARACTERIZATION AND REPRODUCTIVE OUTCOMES IN MEN WITH COMPLETE AZFC DELETIONS: A 17-YEAR EXPERIENCE Akanksha Mehta, Ali Dabaja, Peggy King, Anna Mielnik, Darius Paduch, and Peter Schlegel Akanksha MehtaAkanksha Mehta New York, NY More articles by this author , Ali DabajaAli Dabaja New York, NY More articles by this author , Peggy KingPeggy King New York, NY More articles by this author , Anna MielnikAnna Mielnik New York, NY More articles by this author , Darius PaduchDarius Paduch New York, NY More articles by this author , and Peter SchlegelPeter Schlegel New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2235AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Deletions of the AZFc region of the Y-chromosome are the most common genetic cause of spermatogenic failure. Unlike complete AZFa and AZFb deletions, paternity is possible in the setting of complete AZFc deletions. This study investigated the clinical characteristics, surgical sperm retrieval rates, and pregnancy outcomes in a large cohort of patients with complete AZFc deletions screened at a specialized academic center. METHODS Medical records of consecutive male infertility patients undergoing Y-chromosome microdeletion (YCMD) testing between 1995 and 2012 were reviewed. Only patients with a complete AZFc deletion were included. All available data on serum hormone levels, sperm concentration, karyotype analysis, testicular size and histology, sperm retrieval rates (SRR), and pregnancy outcomes was collected. Student's t-test and Fisher's exact test were used to compare baseline characteristics with respect to SRR and pregnancy outcomes. A p-value <0.05 was considered statistically significant. RESULTS Of 2780 men screened for YCMD, 118 patients with complete AZFc deletions were identified. Mean age was 34 yrs. Mean concentrations of serum testosterone, FSH, LH, and estradiol were 400 ng/mL, 15.9 mIU/mL, 6.6 mIU/mL, and 32.9 pg/mL, respectively. Bilateral testicular volumes averaged 12.4 mL. Of 100 men for whom semen analysis data was available, 59 were azoospermic, 33 had sperm concentration ¡Ü1 million/ml, and two had concentrations of 5 and 21 million/ml, respectively. The majority (96%) had a normal 46,XY karyotype. The overall SRR, using microsurgical testicular sperm extraction (TESE) for azoospermic men, was 73% (41/56). Clinical pregnancy occurred in 59% (33/56) of treatment cycles. Four spontaneous miscarriages were reported. There was no difference maternal or paternal age, FSH levels, or testicular size between cycles where sperm were and were not retrieved. However, the chance of finding sperm with TESE was affected by the predominant histologic pattern on random testis biopsy (58 vs. 76 vs. 100% for Sertoli-only vs. maturation arrest vs. hypospermatogenesis, p<0.001). CONCLUSIONS While the majority of patients with AZFc deletions have sperm concentrations <1 million/mL, higher concentrations are possible in a small fraction of men. Surgical sperm retrieval using TESE is successful in 73% of patients with AZFc deletion, with pregnancy rates of approximately 50% at our center. As with other patients, focal areas of hypospermatogenesis on testicular histology may predict a higher chance of sperm retrieval in AZFc-deleted men. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e940 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akanksha Mehta New York, NY More articles by this author Ali Dabaja New York, NY More articles by this author Peggy King New York, NY More articles by this author Anna Mielnik New York, NY More articles by this author Darius Paduch New York, NY More articles by this author Peter Schlegel New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...