Intratesticular Arteries Research Articles

The intratesticular artery resistive index as a predictor of spermatogenesis: A prospective study.

With the objective to assess the correlation between the resistive index of intratesticular artery as predictor of spermatogenesis this case control study was conducted. A Prospective study conducted during period April 2021 to March 2023. Total 50 patients, with oligoasthenozoospermia taken as cases and other 50 men with normal sperm count taken as controls. History taken & clinical examination, Semen analysis, hormonal evaluation & Color Doppler ultrasonography of scrotum done. Resistive Index of testicular arteries was obtained. Cases and controls were compared. The age of the study group ranged between 21 and 40 years. Among the cases maximum patients 23 out of 50 and among controls with maximum number 21 out of 50 patients were belonged to age group 26-30 years.The mean semen volume for the cases & controls was 2.76 ± 0.44 ml and 3.32 ± 0.54 ml respectively. The Mean sperm concentration in the cases & controls was 14.33 million/ml & 84.8 million/ml. Mean Type A sperm motility was 20.82% ± 7.86 in cases and 54.96% ± 5.41 in controls. The mean testicular volume in cases was 18.36 ± 0.75 & in controls was 18.39 ± 0.62 ml. Hormonal evaluation done in both cases and controls and mean value of FSH in cases and controls was 7.57 ± 2.34 and 6.27 ± 3.55 respectively (p-value = 0.036). Mean value of Resistive Index (PSV - EDV)/PSV) in cases and controls were found 0.63 ± 0.32 and 0.53 ± 0.37 respectively (p-value = 0.001). The intratesticular artery resistive index can be utilized as valuable predictive marker to indicate spermatogenesis.

Study of alteration in testicular perfusion after Lichtenstein hernia repair

Background: Inguinal hernia affects both men and women but is much more common in men who comprise over 90% of the operated patients. Considering both the operated and the non-operated inguinal hernias, the lifetime prevalence rate is 47% for men upto and including the age of 75. Repair of an inguinal hernia is one of the most common operations among adults in the western world today. Aims and objectives were to compare the alteration in testicular perfusion following Lichtenstein hernia repair. Methods: Thirty patients diagnosed with inguinal hernia admitted in our hospital with study period of 12 months were included in the study. Color Doppler ultrasound evaluation of testicular blood flow was done for all cases. Comparisons of results between groups were done using independent t test and Pearson correlation test. Results: The mean age of patients in the study was 46.10±17.27 years. Twenty three percent of patients had COPD as comorbidity. Mean peak systolic volume (PSV) of testicular artery in preop, at 24 hours, 1 week and 3 months are 18.36±2.21, 20.27±3.25, 19.21±2.31 and 18.98±2.06 respectively with a p=0.001. On further observations, no significant difference was found in the PSV of Capsular and intratesticular artery and EDV and RI of testicular, capsular and intratesticular artery. Conclusions: Testicular perfusion following hernioplasty can be easily monitored and evaluated with Duplex ultrasonography; the flow in the spermatic artery and testicular artery and its branches is of low resistance, with a relatively broad systolic part and holodiastolic flow. There is no evidence for a significant impairment of cord structures after open hernia repair using tension free techniques. It is clear that fine surgical dissection

Color Doppler Ultrasound of the Testis in Young Men with a Serum Testosterone Level below the Average Values of the Standard for a Prolonged Period

Introduction: This study aimed to correlate the testicular volume, ultrasound imaging, and blood flow parameters, determined using color Doppler ultrasonography in young men with a testosterone level below the average values of the standard for a prolonged period. Material and Methods: From January 2013 and December 2019, we examined 73 men aged 37 to 45 years with a testosterone level below the average values of the standard for a prolonged period and а 20 age-matched men with a testosterone level above the average values of the standard. We use color Doppler ultrasound as a method to evaluate the volume, ultrasound imaging and Doppler parameters of the testicular blood flow. Results: We obtained significantly lower but still within the reference range values for total testosterone (p<0.001), compared to those of the control group. We found no differences in the ultrasound characteristics of the testicular parenchyma and significant differences between testicular volumes in patients with a testosterone level below the average values of the standard for a prolonged period and those in the control group. In the color Doppler ultrasound we recorded fluctuations only in the blood flow of a aa.intratesticularis, expressed in a slight increase in the resistance index. Conclusions: Ultrasonography of young men with a serum T level below the average values of the standard for a prolonged period found no reduction in testicular volume and no change in the ultrasound characteristic of the parenchyma, which suggests to us that this is not a congenital condition, but cannot answer the question of whether it will lead to structural changes in the testicles in the future and if so what. The non-significant increase in RI in the intratesticular arteries in all examined men is a non-specific indicator that directs the specialist’s attention to additional testing of total testosterone in patients with complaints from the male reproductive system.

INFLUENCE OF EXPLANTATION ON THE HEMOCIRCULATION OF THE TESTICLE IN MEN OF FERTILITY AGE: LONG-TERM RESULTS, PRELIMINARY FINDINGS

Abstract. The introduction of explantation techniques into clinical practice allowed to reduce the percentage of recurrence of inguinal hernias to the level of less than 1%. But there are data indicating a negative effect on the reproductive function of men. On the other hand, a number of researchers deny the negative consequences of explantation.
 The purpose of this study is to evaluate the effect of a polypropylene prosthesis on testicular hemocirculation in men of childbearing age.
 Materials and methods. The peak systolic velocity, end-diastolic velocity and resistive index (RI) in the testicular, capsular, and intratesticular arteries were studied using the Doppler ultrasound method in 30 men aged 20-45 who underwent surgical intervention — herniotomy, Lichtenstein hernioplasty for a unilateral inguinal hernia. The obtained results were compared according to the data of the contralateral side. The study was conducted 6 and 12 months after surgery.
 Results and discussion. None of the applied parameters of testicular hemocirculation in the arteries that were studied during the observation period was statistically significantly different from the control.
 Conclusions. Within 6-12 months after hernioplasty, the synthetic explant does not have a negative effect on the state of testicular hemodynamics.

Перфузия яичек в оценке аутопластики пахового канала перемещенным апоневротическим лоскутом

BACKGROUND: Numerous methods of eliminating abdominal wall defects developed in the world today do not allow us to talk about solving the problem of hernias. In particular, the causes of chronic postoperative pain associated with the effect of scarring on the spermatic cord have not been fully studied. Testicular flow studies after hernia repair mostly showed different outcomes. AIM: Comparative assessment of blood flow parameters of the testicular, capsular and intratesticular arteries, as well as the diameter of the testicular artery after autoplasty with a displaced aponeurotic flap and Lichtenstein hernioplasty using ultrasound. MATERIALS AND METHODS: A new method of autoplasty was used in 35 patients (Group I). The comparison group (Group II) amounted to 35 patients with Lichtenstein hernioplasty surgery using partially absorbable mesh endoprosthesis (UltraPro). The dynamics of changes in blood flow in the arteries was assessed using color Doppler before surgery, in the early and late postoperative periods. RESULTS: The Wilcoxon paired test showed a significant difference between preoperative and immediately postoperative measurements in both groups. Statistically significant differences between the groups were found in the end-diastolic velocity and resistance index in the testicular, capsular and intratesticular arteries 6 months and 1 year after surgery. The difference in peak systolic velocity was significant in the testicular artery also in the late stages after hernioplasty. The diameter of the testicular artery tended to increase in dynamics, but there was no any statistically significant difference between the groups. CONCLUSIONS: The method of autoplasty in the inguinal canal with a displaced aponeurotic flap does not significantly affect testicular perfusion. In Group II, arterial blood flow indicators 6 months and 1 year after surgery were lower than basal values and had statistically significant differences compared to Group I.

Сонографія яєчок у контексті лапароскопічного лікування лівобічного варикоцеле

Purpose - to determine significant sonographic pathogenetic markers of infertility formation in left-sided varicocele of II-III grades and their dynamics after laparoscopic varicocelectomy in the context of fertility restoration. Materials and methods. In the study, 214 patients with left-sided varicocele II-III grades and 25 practically healthy men aged 19 to 33 years were examined. All patients underwent laparoscopic varicocelectomy. The testes volume, the resistance index in the intratesticular arteries, and the diameter of the varicose veins of the left spermatic cord at rest in a horizontal position on the back with the head raised by 15° and during the Valsalva maneuver in a vertical position. During Valsalva maneuver also determined the duration and rate of venous blood reflux in the testes. Results. Ultrasound in patients with left varicocele II-III grades confirmed deterioration of hemodynamics in the spermatic cord and testis. According to the results of sonography in patients with left varicocele II-III grades identified significant prognostic markers of testicular lesions: RI>0.66, VD>2.4 mm, VDvm>3 mm, VRFvm>2 cm/s, and DVR>1.1 s. The negative dynamics of these indicators are an indication for the correction of varicocele, and their normalization in the postoperative period indicates the effectiveness of treatment. Conclusions. Testicular ultrasound is more informative than palpation. In patients of reproductive age with left-sided varicocele II-III grades sonography diagnoses testicular tissue damage in the early stages of the disease. It should be used as a non-invasive screening method for a comprehensive examination to determine testicular lesions and for monitoring in the context of fertility prognosis after varicocelectomy. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: varicocele, laparoscopic varicocelectomy, ultrasound examination, testicles.

Ultrasound evaluation of long-term outcome in boys operated on due to testicular torsion.

We aimed at verifying the usefulness of spectral Doppler ultrasonography in determining development of the testis after torsion in boys.The study involved 28 patients and 30 control cases divided into 3 developmental groups: pre-pubertal, early pubertal, and pubertal. It presented surgical management in testicular torsion (TT), volume, and echogenicity of testes, as well as peak-systolic velocity (PSV), end-diastolic velocity (EDV), and vascular resistance index (RI) in the capsular and intra-testicular arteries, regarding developmental groups, detorsed testes, uninvolved ones, and testes in the control group.Orchiectomy was performed in 13 boys with complete TT, in 11 lasting for over 24 hours, and in 2 lasting for 9 and 10 hours, respectively. Orchiectomy mainly involved patients aged up to 6 years, who at the time of the follow-up ultrasound belonged to the pre-pubertal group.There is no clear correlation between the type of testicular torsion, its duration, and the echogenicity of the testis. Testicular torsion has a negative effect on the volume of detorsed testis with compensatory hypertrophy of the uninvolved testis. The study represents a new approach to the issue of long-term gonadal blood supply abnormalities after treatment of testicular torsion in childhood.

Differential Diagnosis of Acute Scrotum in Childhood andAdolescence with High-Resolution Duplex Sonography.

Acute testicular pain in childhood can be caused by testicular torsion, torsion of the appendix testis, or epididymo-orchitis. Quick and reliable diagnosis is essential for determining the further course of action (surgery or conservative approach). The diagnostic tool of choice is high-resolution sonography with a linear transducer (> 10 MHz) combined with color and spectral Doppler sonography. The Doppler device settings should include a low pulse repetition frequency (< 4 cm/s), a low wall filter (< 100 Hz), and adequate gain. Comparison with the unaffected healthy testis is essential. The most important of the three diseases is torsion of the spermatic cord because it requires immediate surgical intervention and detorsion. The affected testis is enlarged and has an inhomogeneous echotexture with hypoechoic and hyperechoic areas as well as an associated hydrocele. In testicular torsion, color Doppler shows reduced or absent intratesticular vessels in comparison with the healthy contralateral testis. Spectral Doppler shows decreased flow velocities especially during diastole in intratesticular arteries and an increased resistance index. The investigation should always include imaging of the spermatic cord from the outer inguinal ring to the upper pole of the testis. In contrast to a normal finding, the vessels and the ductus deferens are not displayed as linear tubular structures but in form of a spiral twist. Ultrasound shows a target-like structure with multiple concentric rings. Color Doppler sonography shows the typical whirlpool sign. In torsion of the appendix testis, the appendix testis is enlarged in the groove between the testis and epididymis. The longitudinal diameter of the appendix testis can be greater than 5 mm. The echogenicity of the torsed appendage can vary between hypoechoic (acute torsion) and hyperechoic (prior torsion). An associated hydrocele of varying size is usually seen. Color Doppler sonography reveals a lack of perfusion of the enlarged appendix testis and increased vascularity of the testis and primarily the epididymis. Epididymo-orchitis is characterized by an enlarged epididymis and/or testis with inhomogeneous echogenicity (hypoechoic - hyperechoic). Color Doppler sonography shows increased vascularity in comparison with the unaffected testis. Spectral Doppler reveals increased diastolic flow velocities and a decreased resistance index. Idiopathic scrotal edema and an incarcerated inguinal hernia must be ruled out in the differential diagnosis.

Role of total motile sperm count in the evaluation of young men with bilateral subclinical varicocele and asthenospermia.

In comparison to its clinical analogue, the subclinical varicocele represents a questionable entity and specific guidelines for the optimal management are lacking. In our previous study of patients with subclinical varicocele, we showed that bilateral condition is associated with risk of dyspermia. In the present study, we evaluated the risk of deterioration of semen quality in men with bilateral disease and impaired motility according to WHO criteria. Men with bilateral subclinical varicocele, not desiring fatherhood at the time of presentation, were included in study. During initial evaluation, the number of Total Motile Sperm Count (TMSC) was calculated and the patients' age, total testicular volume (TTV), maximum venous size and mean resistive index (RI) of the intratesticular arteries were recorded. We classified the participants in five classes according to the TMSC reading: class A-: TMSC < 5 x 106, class A: TMSC between 5-10 x 106, class B: TMSC between 10-15 x 106, class C: TMSC between 15-20 x 106, and class D: TMSC > 20 x 106 per ejaculate. The participants were seen after 6 months for a repeat spermiogram and physical examination. If clinical varicocele was diagnosed or a new abnormality in the spermiogram was noted, the participants were excluded from the study. The remaining patients were allocated to two groups according to the repeat TMSC reading: patients sub-classified into a lower class (group 1), and patients remaining at the same class (group 2). A comparative analysis was performed between two groups. Nineteen men were included. Nine patients were subclassified (group 1). Three patients moved to A- class (< 5 x 106). Ten patients remained in the same class having no deterioration (group 2). Comparing the two groups, no statistically significant difference was recognized for age, TTV, maximum venous size on both sides, and mean RI (p > 0.05). However, the initial reading for TMSC was 14.57 x 106 in group 1, and 22.84 x 106 in group 2, respectively. This difference was statistically significant (p < 0.05). Additionally, in a paired analysis there was a significant difference in TMSC after 6 months (p < 0.05), too. Summary Conclusions: Young men with bilateral varicocele and asthenospermia seem to be at risk of deterioration in their semen quality after a follow-up of 6 months. The measurement of TMSC can unmask patients at risk, whereas men with the lowest readings seem to be at highest risk for deterioration. The possibility of a worsening sperm quality should be considered in the appropriate clinical context.

Role of the scrotal color Doppler ultrasound findings in management of severe orchitis to do orchiectomy

Background: Introduction: Determination of the type of treatment and prognosis of epididymoorchitis is a challenge for clinicians. Objectives: The current study aimed at investigating the relationship between the indexes of vascular resistance index (RI) (%) of the intra-testicular artery by color Doppler ultrasonography (CDUS), and its relationship with the treatment and prognosis in patients with epididymo-orchitis. Patients and Methods: The current prospective observational study was conducted on the collected data of 30 patients with epididymo-orchitis. Initial and secondary CDUS (24 hours after admission) were conducted on all patients and RI was calculated from the mean of two intratesticular arteries for all patients. Patients were divided into four groups based on RI through, RI; 70-80%, RI; 80- 90%, RI &gt;90%, and absent of flow. Results: The mean and standard deviation (SD) of the patients’ age was 47.70 ± 15.56 years (ranged 30-79 years). Among 30 patients, 15 (50%) had left epididymo-orchitis, 13 (43.5%) right, and in two subjects (6.71%), it was bilateral. The mean ± SD of RI in the initial and secondary CDUS were 0.8516 ± 0.1022% and 0.7845 ± 0.1235%, respectively (P=0.031). The ROC under area of RI diagnosis power for the types of epididymo-orchitis treatment were 0.904 [95% confidence interval (CI): 0.774-1.000] and 0.990 (95%CI: 0.958-1.000) in the initial and second day of CDUS, respectively. Additionally, the mean ± SD of RI in initial CDUS were 0.7633 ± 0.03786%, 0.84400 ± 0.02944%, and 0.7600 ± 0.03162% in patients with a decreased prognosis, atrophy, and parenchymal heterogeneity, which were significantly different (P= 0.011). Accordingly, in the CDUS of 24 hours after admission, the mean ± SD of RI in patients with low prognosis was 0.6600 ± 0.0100%, in patients with atrophy was 0.0170 ± 0.7575%, and in patients with parenchymal heterogeneity was 0.7100 ± 0.04729%. Conclusion: RI of intratesticular artery in CDUS is a useful index to determine and predict the type of treatment and prognosis of patients with epididymo-orchitis.

Diagnostic accuracy of resistive index of capsular and intratesticular branches of testicular arteries in infertile men with oligoasthenospermia: A case-control study.

IntroductionMale infertility accounts for nearly 50% of couples' infertility. Only a few studies evaluate the diagnostic accuracy of resistive index (RI) of testicular arteries using color Doppler imaging to identify male infertility. The aim of this study was to investigate the diagnostic accuracy of RI of the capsular and intratesticular branches of testicular arteries in infertile men with oligoasthenospermia and its comparison with normal men.Material and methodsIn a case-control study, 30 patients with oligoasthenospermia (case group) and 30 healthy controls who meet the inclusion criteria, were selected. For all patients, RI was measured using color Doppler ultrasonography in upper and lower testicular poles. Also, testicular volumes were measured for all participants.ResultsMean RI of the intratesticular artery (0.624 ± 0.051 versus 0.509 ± 0.054; P < 0.001) and capsular artery (0.663 ± 0.057 versus 0.557 ± 0.055; P < 0.001) were significantly higher in the case group compared to control group. The frequency of abnormal RI of intratesticular artery in the control (13.3%) and case (66.7%) groups were significantly different (OR: 13.0; 95% CI: 3.44-47.59; P < 0.001). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy (OA) of intratesticular artery RI were 66.67%, 86.67%, 83.33%, 72.22%, and 76.67%, respectively. The frequency of abnormal RI of capsular artery was 23.3% in the control group and 90.0% in the case group (OR: 29.57; 95% CI: 6.85-127.63; P < 0.001). The sensitivity, specificity, PPV, NPV and OA of capsular artery RI were 90.0%, 76.67%, 79.41%, 88.46% and 83.33%, respectively.ConclusionThe results of this study indicated that assessing testicular Doppler RI of capsular and intratesticular branches of the testicular arteries, as a bio-imaging biomarker, may be a valuable non-invasive and simple complementary diagnostic modality with a high diagnostic value in identifying infertile men with oligoasthenospermia.

Pulse-wave Doppler pulsatility and resistive indexes of the testicular artery increase in canine testis with abnormal spermatogenesis

Pulse-wave Doppler (PWD) ultrasonography of the testicular artery was recently used to compare parameters in fertile and infertile males, or males with normal and abnormal semen quality, while no studies verified the concomitant histological feature of the testis. The experimental hypothesis of the present study was that the blood flow parameters measured by PWD at different levels of the testicular artery reflect sperm attributes evaluated on spermatozoa collected from the tail of the epididymis and testicular histological characteristics. Pulse-wave Doppler parameters were recorded on both testes from 16 dogs of unknown fertility. After routine castration, epididymal spermatozoa were collected and evaluated for sperm total and progressive motility, membrane integrity, and sperm morphology. Testes were submitted to histological and immunohistochemical evaluations to quantify microscopic attributes and connective tissue and vascular area extent, respectively. The findings showed that the increased PWD indexes were suggestive of testicular histological alteration since negative correlations were found between pulsatility index and resistive index, measured in the marginal testicular artery, and histological attributes such as the seminiferous epithelial thickness (R = −0.528, P = 0.016 and R = −0.554, P = 0.005, respectively) and the tubular area/total area ratio (R = −0.494, P = 0.024 and R = −0.563, P = 0.004, respectively). Some histological characteristics, such as tubular diameter, seminiferous epithelium thickness, and the tubular area/total area ratio of the testis are correlated with the percentage of primary abnormalities (R = −0.874, P = 0.001, and R = −0.847, P = 0.001, and R = - 0.865, P = 0.001, respectively). In testes with increased sperm primary abnormalities, higher pulsatility index was found compared with testes with normal spermatogenesis in supratesticular artery (1.07 ± 0.06 vs 0.82 ± 0.23, P < 0.05), marginal artery (0.73 ± 0.04 vs 0.61 ± 0.07, P < 0.05), and intratesticular artery (0.67 ± 0.03 vs 0.43 ± 0.1, P < 0.05). Similarly, the resistive index was found significantly higher in the same vessel tracts in testes with abnormal and normal spermatogenesis (0.62 ± 0.02, 0.53 ± 0.02, and 0.46 ± 0.02 vs 0.51 ± 0.06, 0.44 ± 0.04, and 0.32 ± 0.06, respectively; P < 0.05). Our data demonstrated for the first time the relationship between PWD indexes and the contextual testicular architecture, suggesting that the pulsatility and resistive indexes could be an effective tool in andrology. In light of different histological alterations in the testis, caution is warranted in the definition of thresholds for normal and abnormal testicular blood flow indexes.

Semen collection, sperm characteristics and ultrasonographic features of reproductive tissues in crab-eating fox (Cerdocyon thous)

Our objective was to condition adult male crab-eating fox (Cerdocyon thous) to allow semen collection by digital manipulation of the penis, assess sperm characteristics, and use ultrasonography to assess and measure testes and prostate and determine echotexture, as well as hemodynamics of testicular and spermatic cord arteries. Five captive C. thous (2–5 y, ∼7 kg) were used. After conditioning for digital sperm collection, 13 ejaculates were obtained from two males. Ejaculate characteristics (mean ± SD) were volume (393.2 ± 178.0 μL), concentration (463.7 ± 594.4 × 106 sperm/mL), total sperm number (217.4 ± 304.0 × 106 sperm), total motility (68.0 ± 6.1%), progressive motility (48.8 ± 5.1%) and rapid sperm (57.2 ± 6.8%). The most prevalent sperm morphological defects were abnormal acrosome, small abnormal head, and diadem defect. Under chemical restraint, testes and prostate were evaluated with B-mode and spectral Doppler ultrasonography. Based on ultrasonography, testicular volumes were (2.2 ± 0.7 and 2.1 ± 0.7 cm3 for left and right testes, respectively), whereas prostate dimensions were 2.3 ± 0.4 cm long and 1.5 ± 0.3 cm thick. Lastly, using triplex Doppler, peak systolic velocity (PSV) was higher in testicular versus intratesticular arteries. In conclusion, adult male C. thous were conditioned to allow sperm collection by digital manipulation without urine contamination, enabling evaluation of sperm characteristics. Furthermore, B-mode ultrasound facilitated evaluation of testes and prostate morphometry and echotexture, whereas Doppler was used to characterize testicular blood flow. This was proof of concept for semen collection and baseline data for future male reproductive soundness examinations and development of assisted reproductive techniques in this species.

Three-dimensional simulation analysis of microdissection testicular sperm extraction for patients with non-obstructive azoospermia.

BackgroundMicrodissection testicular sperm extraction (microTESE) is considered the gold standard method of sperm retrieval from patients with non‐obstructive azoospermia (NOA). For careful and thorough examination of seminiferous tubules during microTESE, maximizing surface area of the testicles which we are able to search is essential.ObjectivesTo develop a systematic procedure for microTESE to maximize surface area and to achieve high sperm retrieval rate (SRR) in microTESE.Materials and methodsWe simulated microTESE using three‐dimensional (3D) simulation model and analyzed mathematically the sum of the surface area in various methods. The best method obtained from this simulation model was applied to 102 patients with NOA from 2014 to 2018. These new clinical results were compared with those of 56 patients who underwent a previous method of microTESE from 2011 to 2014.ResultsThe mathematical 3D simulation model of microTESE indicated that a longitudinal incision on the tunica albuginea and following transverse slicing incisions of testicular parenchyma maximized the surface area coverage. Forty‐six (45%) out of 102 patients who underwent microTESE with the new method had successful retrieval of testicular spermatozoa compared with 16 (29%) of 56 patients with the previous method of microTESE (P = .04).DiscussionTransverse resections of parenchyma in our method run parallel to the courses of intratesticular arteries and do not interfere with the blood supply. The small amount of extracted seminiferous tubules was equivalent to that of the previous method, and no patients exhibited post‐operative symptoms of androgen deficiency in our study. As for post‐operative pain, our new method was comparable with the previous method. Although our study needs a longer follow‐up, there will be limited effects on testicular functions.ConclusionLongitudinal incision on the tunica albuginea and following transverse slicing incisions in the testicular parenchyma maximized the surface area and improved the SRR of microTESE.

Does laparoscopic hernia repair affect the vascularity of testis?

Context:Laparoscopic hernia repair, despite its safety and effectivity is related to some drawbacks. Testicular complications are uncommon but serious among them. Testicular atrophy occurs in 0% to 2% of patients after hernioplasty.Aim:In this study, we tried to evaluate the effects of laparoscopic total extraperitoneal (TEP) repair on testicular blood flow in Indian population by comparing the testicular perfusion in preoperative and postoperative status.Settings and Design:A prospective study.Subjects and Methods:A prospective study was conducted among adult male patients having an uncomplicated inguinal hernia. Preoperative and postoperative CDUS evaluation of testicular blood flow was done for each patient.Statistical Analysis Used:Data were analyzed using the SPSS (SPSS, Chicago, IL, USA) software program.Results:The resistive indexes of testicular, capsular, and intratesticular arteries of the operated and nonoperated side were similar preoperatively and did not differ ominously postoperatively.Conclusion:Laparoscopic hernia surgery does not have any significant effect on testicular blood supply and can be advocated safely without any added risk of testicular atrophy.

Bilateral disease and intratesticular haemodynamics as markers of dyspermia in patients with subclinical varicocele: A prospective study

ABSTRACTObjective: To study scrotal ultrasonographic characteristics in patients with subclinical varicocele (SV) and investigate their relationship with semen parameters.Patients and methods: In all, 56 men with SV were recruited and divided into two groups, according to their semen characteristics. Group A, comprised 34 men with normal semen analysis; and Group B, comprised 22 men who carried at least one abnormality, regarding sperm concentration, motility and morphology. Between the two groups we compared: age; body mass index (BMI); semen pH and semen volume; total testicular volume (TTV); maximal vein diameter (MVD) and degree of reflux; mean values of peak-systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) of the intratesticular arteries; whether bilateral SV; and serum testosterone and follicle-stimulating hormone (FSH) levels.Results: Asthenospermia was present in all patients in Group B; 10 patients had asthenospermia only, six patients were astheno-oligospermic and six patients had astheno-oligo-teratospermia. Age, BMI, semen pH and volume, TTV, MVD and degree of reflux did not differ significantly between the two groups (P > 0.05). However, EDV, PSV and RI were significantly different (P < 0.05). Bilateral SV was significantly more frequent in patients in Group B (P < 0.05). Finally, FSH was elevated in Group B (P < 0.05), whereas testosterone was normal in both groups, albeit significantly lower in men with abnormal semen analyses (P < 0.05).Conclusion: Classic ultrasonographic characteristics in men with SV, such as venous size or degree of reflux, were insufficient to distinguish patients with abnormal semen analysis. However, bilateral disease and intratesticular haemodynamics differed significantly in patients with SV and abnormal semen analysis.Abbreviations: BMI: body mass index; CDU: colour Doppler ultrasonography; EDV: end-diastolic velocity; MVD: maximal vein diameter; PSV: peak-systolic velocity; RI: resistive index; SV: subclinical varicocele; TTV: total testicular volume; US: ultrasonography

Pulse Doppler ultrasound as a tool for the diagnosis of chronic testicular dysfunction in stallions.

Testicular function is particularly susceptible to vascular insult, resulting in a negative impact on sperm production and quality of the ejaculate. A prompt diagnosis of testicular dysfunction enables implementation of appropriate treatment, hence improving fertility forecasts for stallions. The present research aims to: (1) assess if Doppler ultrasonography is a good tool to diagnose stallions with testicular dysfunction; (2) to study the relationship between Doppler parameters of the testicular artery and those of sperm quality assessed by flow cytometry and (3) to establish cut off values to differentiate fertile stallions from those with pathologies causing testicular dysfunction. A total of 10 stallions (n: 7 healthy stallions and n: 3 sub-fertile stallions) were used in this study. Two ejaculates per stallion were collected and preserved at 5°C in a commercial extender. The semen was evaluated at T0, T24 and T48h by flow cytometry. Integrity and viability of sperm (YoPro®-1/EthD-1), mitochondrial activity (MitoTracker® Deep Red FM) and the DNA fragmentation index (Sperm Chromatin Structure Assay) were assessed. Doppler parameters were measured at three different locations on the testicular artery (Supratesticular artery (SA); Capsular artery (CA) and Intratesticular artery (IA)). The Doppler parameters calculated were: Resistive Index (RI), Pulsatility Index (PI), Peak Systolic Velocity (PSV), End Diastolic Velocity (EDV), Time Average Maximum Velocity (TAMV), Total Arterial Blood Flow (TABF) and TABF rate. The capsular artery was the most reliable location to carry out spectral Doppler assessment, since blood flow parameters of this artery were most closely correlated with sperm quality parameters. Significant differences in all the Doppler parameters studied were observed between fertile and subfertile stallions (p ≤ 0.05). The principal components analysis assay determined that fertile stallions are characterized by high EDV, TAMV, TABF and TABF rate values (high vascular perfusion). In contrast, subfertile stallions tend to present high values of PI and RI (high vascular resistance). The ROC curves revealed that the best Doppler parameters to predict sperm quality in stallions were: Doppler velocities (PSV, EDV and TAMV), the diameter of the capsular artery and TABF parameters (tissue perfusion parameters). Cut off values were established using a Youden´s Index to identify fertile stallions from stallions with testicular dysfunction. Spectral Doppler ultrasound is a good predictive tool for sperm quality since correlations were determined among Doppler parameters and markers of sperm quality. Doppler ultrasonography could be a valuable diagnostic tool for use by clinical practitioners for the diagnosis of stallions with testicular dysfunction and could be a viable alternative to invasive procedures traditionally used for diagnosis of sub-fertility disorders.

Color Doppler ultrasound characteristics after subinguinal microscopic varicocelectomy.

The present study evaluated the effect of differences in the peak systolic velocity (PSV) and resistive index (RI) inthe testicular artery (TA), capsular artery (CA), and intratesticular artery (ITA) after microscopic subinguinal varicocelectomy(MSV) on postoperative pain and semen parameters. Scrotal color Doppler ultrasound (CDUS) measurementswere made in 33 patients (age 18-31 years) prior to MSV and 3 and 6 months after MSV. Pain was recorded using avisual analog scale and sperm concentration was determined to analyze the predictive value of the CDUS parameters regardingsurgical outcome. A significant decrease in pain scores was observed in most patients at both follow-ups. The firstpostoperative CDUS revealed a significant increase in the TA-PSV (p<0.001) and a decrease in the TA-RI (p=0.002) and CARI(p=0.006). The second postoperative CDUS also revealed a significant increase in the TA-PSV and a decrease in the TA-RI,and the PSV in the ITA and CA and RI in the ITA and CA were significantly different from the values obtained pre-operativelyand at the first follow-up. A negative correlation was found between the pain level and TA-PSV (r=-0.433, p=0.012), whereassperm concentration positively correlated with both the TA-PSV and CA-PSV (r=0.534, p=0.001 and r=0.455, p=0.008, respectively). The PSV and RI are useful parameters for detecting changes in testicular microhemodynamics afterMSV. In addition, the TA-PSV and CA-PSV can be used to predict improvements in pain and sperm concentration.

Laparoscopic TEP repair of inguinal hernia does not alter testicular perfusion

The effect of laparoscopic TEP repair on testicular perfusion is unclear. The procedure entails dissection of testicular blood vessels off the hernial sac and incorporation of a prosthetic mesh. This carries at minimum, a theoretical risk of compromise in testicular blood supply, which in turn may affect fertility. Our study aims to establish if any alteration in testicular perfusion occurs in very early (24h), early (1week) or late postoperative period (3months) after laparoscopic TEP repair in the Indian population. In our prospective trial, 20 patients underwent unilateral and 8 underwent bilateral laparoscopic TEP hernia repairs using standard technique by experienced surgeons. Flow parameters of testicular, capsular and intratesticular artery were noted using color Doppler ultrasound preoperatively and postoperatively and the postoperative resistive indexes of operated side (n=36) were compared with preoperative values. Additionally, for unilateral repairs, flow parameters on operated side were compared with the non-operated side. No statistically significant difference was noticed in the resistive index of the arteries upon comparing these postoperative with preoperative values. For unilateral repairs, the flow parameters of the operated side were comparable with that of non-operated side (i.e. p>0.05). Laparoscopic TEP performed by experienced surgeons does not alter testicular flow dynamics in early or late postoperative period.

Morphological variations of intra-testicular arterial vasculature in bovine testis--a corrosion casting study.

BackgroundProper blood supply is necessary for the physiological function of every internal organ. The article offers the first classification of the bovine intra-testicular arteries. A corrosive study focused on the intra-testicular arterial vasculature was performed on 40 bovine testes. The vessels were analyzed accurately using MultiScanBase v.18.02 software.MethodsA corrosive study focused on the intra-testicular arteries was performed on 40 bovine testes. The vessels were analyzed accurately using MultiScanBase v.18.02 software.ResultIn bulls, the centripetal arteries tended to run straight to the mediastinal region, where they form knot-like vascular structures. Those structures are the origin for centrifugal recurrent branches, running peripherally. However, three basic types of intra-testicular arterial vasculature were noted. Type I had centrifugal, recurrent branches, running peripherally towards the surface of the testis but did not reach the tunica albuginea. Type II exhibited centrifugal, recurrent branches running more horizontally than type I. Type III is the most heterogeneous type, composed of other variform types of arteries not classified as type I or type II. Type II was most commonly observed as a vascular conglomerate of intra-testicular arteries within the arterial network of the mediastinum testis. In type III, artery diameter was significantly smaller than observed in types I and II (p < 0.01). Types I and II did not differ between each other regarding artery diameter (p > 0.05).ConclusionVariations of the intra-testicular arterial vasculature in bovine testis may suggest that particular types of vessels play different physiological roles. The most common type of intra-testicular artery comprising the arterial network of the mediastinum testis was type II.