Obstruction Of Seminal Ducts Research Articles

Zinner's syndrome: clinical case of a rare pathology

Zinner’s syndrome is a rare congenital urogenital anomaly characterised by the triad of seminal vesicle cyst, ipsilateral renal aplasia, and seminal duct obstruction. According to the published data, the incidence of seminal vesicle cysts with ipsilateral renal agenesis is 0.0046%, but the true incidence appears to be higher. The article presents a rare clinical case of patient K, 17 years old, followed since birth with a solitary right kidney. The patient was repeatedly examined (ultrasound, cystography, urography, abdominal MRI, pelvic CT). The boy was admitted to our clinic with the diagnosis of "Solitary right kidney" and pelvic cystic formation detected according to the last CT scan. MRI examination of the small pelvis, cystoscopy, diagnostic laparoscopy, puncture of the cystic mass were performed. The diagnosis of "Zinner's syndrome" was made. The size of the cyst did not change during follow-up.

Синдром Циннера у детей

In this article, we report three cases of Zinner syndrome (renal agenesis or renal dysplasia, ipsilateral seminal vesicle cyst, and seminal duct obstruction) in children of different age and describe their diagnosis and treatment. All patients have undergone kidney and bladder ultrasonography, renal scintigraphy, and cystoscopy. Two children have also undergone contrast-enhanced computed tomography; one child has undergone magnetic resonance imaging. A 6-month-old patient with a large cyst and clinical manifestations of infravesical obstruction and chronic constipation was operated on. He has undergone diagnostic laparoscopy and cyst removal; seminal duct atresia was confirmed intraoperatively. Key words: Zinner syndrome, renal agenesis, seminal vesicle cyst

Clinical application of cross microsurgical vasovasostomy in scrotum for atypical obstructive azoospermia.

Seminal duct obstruction may result in obstructive azoospermia (OA) and severe oligoasthenoteratozoospermia (OAT) (<0.5 million/mL) (Nordhoff et al., 2015). Cases of partial OA and OAT can be treated effectively by microsurgical anastomosis (Goldstein and Kim, 2013) to obtain successful surgical reversal. However, microsurgical vasovasostomy (VV) (Dickey et al., 2015) and vasoepididymostomy (VE) (Peng et al., 2017) are not suitable for patients with atypical OA and poor epididymis conditions or unpredictable obstruction of the distal vas deferens. For those patients, cross anastomosis may be applied instead of routine VE or VV. A single-center, retrospective, comparison study was conducted, which assessed the usefulness of the cross VV (CVV) in the scrotum for indication and efficacy. A total of 77 cases with OA or OAT were included, and 20 cases implemented cross anastomosis, including unilateral CVV (UCVV) in 4 cases, unilateral VE plus CVV (UVE+CVV) in 11 cases, and unilateral VV-based CVV (UVV+CVV) in 5 cases. The other 57 cases received no cross-matching anastomosis. The patency and natural pregnancy rates in one year were 75.0% and 50.0%, respectively, in the UCVV group; 54.5% and 27.3%, respectively, in the UVE+CVV group; and 60.0% and 40.0%, respectively, in the UVV+CVV group. The CVV in the scrotum in the selected patients with OA and severe OAT could yield good results. We regard the CVV in the scrotum as an efficacious operation with a lower risk of injury in cases of atypical OA.

ANDROLOGY EXAMINATION OF PATIENTS WITH PANCREATIC-SUFFICIENT AND PANCREATIC-INSUFFICIENT CYSTIC FIBROSIS

Introduction. Cystic fibrosis (CF) is common monogenic disease resulted from CFTR gene mutations. A most of CF male patients are infertile due to the obstructive azoospermia, however, the mechanisms of the reduced fertility in male patients without the obstruction of seminal ducts, also as the influence of CFTR genotype on their development is understudied.Objectiveis to assess an influence the effect of CFTR genotype, clinical form of CF and age on men reproductive system organs, fertility, and testosterone level and semen parameters in male patients with CF. Materials and methods. We examined 71 Russian men (17–39 years old, mean 24.9 ± 5.3) with CF (pancreatic-sufficient, n = 34, and pancreatic-insufficient, n = 37). Clinical, andrology, laboratory and instrumental examination, including scrotal ultrasonography, biochemical semen, and hormonal analyses were performed.Results. Testicular hypoplasia was reveled in 40,5 % CF patients. Diffuse alterations of epididymis, of epididymal and/or testicular cysts were detected in 62 % patients; 10 % of the patients presented symptoms of hypogonadism. As many as 88 % patients showed spermiological signs of bilateral obstruction of seminal ducts at the level of the vas deferens and epididymis, aplasia of the seminal vesicles (azoospermia, oligospermia, low pH and fructose level of the ejaculate). Pancreatic-insufficient CF is an unfavorable prognostic sign for the obstruction of vas deferens, morphological changes in the scrotum. Patients until 25 years (23 %) as 3849+10kb C&gt;T mutation’s carriers (72 %) significantly more frequently presented preserved vas deferens.Conclusion. Pancreatic-sufficient CF, young age and 3849+10kbС&gt;T mutation are favorable factors presented preserved vas deferens and the possible fertility in men with CF.

Comprehensive semen examination in patients with cystic fibrosis

Introduction. Cystic fibrosis (CF) is a common genetic disorder associated with male infertility. Almost all men with CF are infertile due to obstructive azoospermia. The objective is to evaluate semen parameters, excretion of seminal fluid, and spermatogenesis in CF patients. Materials and methods . We examined 44 male CF patients with pancreatic sufficiency (n = 20) and pancreatic insufficiency (n = 24). Standard semen analysis, quantitative karyological analysis of immature germ cells from ejaculate sediment, biochemical semen analysis (fructose, α-glucosidase, citric acid) were performed. Results. Semen analysis diagnosed azoospermia in 77.3 % patients, severe oligozoospermia (< 1 million/ml) and other diagnoses (oligozoospermia, asthenozoospermia, normozoospermia) in 13.6 % and 9.1 % patients, respectively. The signs of obstruction of the vas deferens and aplasia of seminal vesicles were observed in 91 % patients. Azoospermia, oligospermia, pH <7.0 and low content of fructose in the semen samples result from bilateral obstruction of the vas deferens and aplasia of the seminal vesicles. Conclusion . Cryptozoospermia and immature germ cells, detected in ejaculate sediment in all azoospermic patients with CF, indicated aplasia, but not congenital absence of the vas deferens. The majority of CF patients presented signs of seminal ducts obstruction and impaired spermatogenesis and seminal fluid secretion. In contrast to pancreatic-sufficient CF male patients, pancreatic-insufficient CF patients can be fertile and have no obstruction of seminal ducts and severe pathozoospermia.

Flexible Vesiculovasoscopy Using a Microoptical System in a Human Cadaver Model: An Experimental Approach for Atraumatic Endoscopy of the Seminal Tract.

The most common pathologies of the seminal tract are persistent hematospermia, seminal vesicle stones, and seminal duct obstruction. Endoscopic diagnostic work-up of the seminal tract is impeded by complex anatomy and lack of technical equipment. To date, there is no standardized endoscopic approach. The purpose of this study was to investigate the applicability and feasibility of a flexible microoptical device for atraumatic endoscopy of the seminal tract in a male human cadaver. The transurethral endoscopic examination was performed on a male cadaver. No premortal interventions or diseases of the genitourinary tract had been reported. The seminal orifice was identified via cystoscopy and accessed by the Seldinger technique using a hydrophilic guidewire and ureteral catheter. Retrograde endoscopic inspection of the distal seminal tract was performed using a miniaturized flexible endoscope. An antegrade endoscopic inspection of the seminal tract was carried out via high scrotal access to the vas deferens. Structures of the seminal tract, such as the ejaculatory duct, seminal vesicles, and distal portion of the ductus deferentes, were visualized using the miniaturized endoscope. Image quality allowed identification of anatomical structures and characterization of tissue properties. The technical limitations we observed involved the system's maneuverability. Initial results of this novel endoscopic approach to the seminal tract using a flexible microoptical system are encouraging. However, considerable anatomical limitations of the targeted organs necessitate further refinements of the technical equipment. This approach might improve diagnostics and treatment of genitourinary diseases. Future surgical techniques may include intraseminal laser therapy or endoocclusion to monitor fertility in men.

Flexible Vesiculo-Vasoscopy Using a Micro-Optical System in a Human Cadaver Model: An Experimental Approach for Atraumatic Endoscopy of the Seminal Tract

Objectives: The most common pathologies of the seminal tract are persistent hematospermia, seminal vesicle stones, and seminal duct obstruction. Endoscopic diagnostic work-up of the seminal tract is impeded by complex anatomy and lack of technical equipment. To date, there is no standardized endoscopic approach. Purpose of this study was to investigate the applicability and feasibility of a flexible micro-optical device for atraumatic endoscopy of the seminal tract in a human male cadaver. Materials and Methods: The transurethral endoscopic examination was performed on a male cadaver. No premortal interventions or diseases of the genitourinary tract had been reported. The seminal orifice was identified through cystoscopy and accessed by Seldinger technique using a hydrophilic guidewire and ureteral catheter. Retrograde endoscopic inspection of the distal seminal tract was performed using a miniaturized flexible endoscope. An antegrade endoscopical inspection of the seminal tract was carried out through high scrotal access to the vas deferens. Results: Structures of the seminal tract such as the ejaculatory duct, seminal vesicles, and distal portion of the ductus deferentes were observed using the miniaturized endoscope. Image quality allowed identification of anatomical structures and characterization of tissue properties. The technical limitations we observed involved the system's maneuverability. Conclusions: Initial results of this novel endoscopic approach to the seminal tract using a flexible micro-optical system are encouraging. However, considerable anatomical limitations of the targeted organs necessitate further refinements of the technical equipment. This approach might improve diagnostics and treatment of genitourinary diseases. Future surgical techniques may include intraseminal laser therapy or endo-occlusion to monitor fertility in men. Acknowledgment: We would like to thank Schoelly Fiberoptics GmbH, Denzlingen, Germany, for providing the instruments and technical support for this study. The cadaver (body donor) was provided by the Institute for Anatomy, Medical Faculty, Justus-Liebig-University, Giessen. Institutional funding (Medical Faculty of the University of Freiburg) and nonfinancial industrial funding (providing the instruments and technical support for the study) were by Schoelly Fiberoptic GmbH, Denzlingen, Germany. D.S., M.M., S.H., F.A., and W.W. have no conflicts of interest or financial ties to disclose. M.S. consultant contract with Schoelly Fiberoptics GmbH, Denzlingen, Germany, and NeoTract, Inc., Pleasanton, USA. T.D. Lilly Deutschland GmbH (stocks/stock options, employee: through family member), Pfizer (speaker honorarium), Takeda Pharma GmbH (speaker honorarium), AMS Deutschland (speaker honorarium), Jenapharm GmbH (speaker honorarium), Glenwood (speaker honorarium), Cheplapharm Arzneimittel GmbH (consultant), Marpinion GmbH (Advisory Board member, consultant), Advance Medical S.A., Barcelona (ESP) (Consultatnt, Reviewer). A.M. consultant contract with Schoelly Fiberoptics GmbH, Denzlingen, Germany. Runtime of video: 6 mins 10 secs

Multiple advanced surgical techniques to treat acquired seminal duct obstruction.

The aim of this study was to evaluate the outcomes of multiple advanced surgical treatments (i.e. microsurgery, laparoscopic surgery and endoscopic surgery) for acquired obstructive azoospermia. We analyzed the surgical outcomes of 51 patients with suspected acquired obstructive azoospermia consecutively who enrolled at our center between January 2009 and May 2013. Modified vasoepididymostomy, laparoscopically assisted vasovasostomy and transurethral incision of the ejaculatory duct with holmium laser were chosen and performed based on the different obstruction sites. The mean postoperative follow-up time was 22 months (range: 9 months to 52 months). Semen analyses were initiated at four postoperative weeks, followed by trimonthly (months 3, 6, 9 and 12) semen analyses, until no sperm was found at 12 months or until pregnancy was achieved. Patency was defined as >10,000 sperm ml−1 of semen. The obstruction sites, postoperative patency and natural pregnancy rate were recorded. Of 51 patients, 47 underwent bilateral or unilateral surgical reconstruction; the other four patients were unable to be treated with surgical reconstruction because of pelvic vas or intratesticular tubules obstruction. The reconstruction rate was 92.2% (47/51), and the patency rate and natural pregnancy rate were 89.4% (42/47) and 38.1% (16/42), respectively. No severe complications were observed. Using multiple advanced surgical techniques, more extensive range of seminal duct obstruction was accessible and correctable; thus, a favorable patency and pregnancy rate can be achieved.

Rôle de l'urologue dans la prise en charge de l'homme infertile à l'heure de l'injection intracytoplasmique de spermatozoı̈des

Although intracytoplasmic sperm injection (ICSI) revolutionized treatment and prognosis of male infertility, check-up (case history, clinical and paraclinical examinations) practised by urologist in infertile man keeps all its place. Varicocele, congenital or acquired seminal duct obstruction, urogenital tract infection, or ejaculation disorder must be sought, because these affections remain accessible to treatment.