Donkol Ragab H
Ragab H Donkol, Department of Radiology, Aseer Central Hospital, PO Box 34, 31911, Abha, Saudi Arabia; Department of Radiology, Faculty of Medicine, Cairo University, Kasr Al-Ainy, 1 Al-Saray Street, Al-Manial, 11559, Cairo, Egypt.
World J Radiol. 2010 May 28;2(5):172-9. doi: 10.4329/wjr.v2.i5.172.
The main purpose of imaging evaluation in male infertility is to identify and treat correctable causes of infertility, such as obstruction of the seminal tract. Various imaging modalities are available to evaluate men with obstructive infertility including scrotal ultrasonography, transrectal ultrasound (TRUS), vasography, magnetic resonance imaging, seminal vesicle aspiration, seminal tract washout, and seminal vesiculography. To date the most reliable and accurate diagnostic technique for obstructive infertility is unclear. In this review article, we report the role of these modalities in diagnosis of obstructive infertility. Scrotal sonography is the initial modality, and if patient results indicate non obstructive azoospermia as varicocele or testicular pathology they will be treated according to standard protocols for management of these pathologies. If the patient findings indicate proximal obstructive azoospermia, they can be managed by vasoepididymostomy. If the scrotal ultrasound is normal, TRUS is the second imaging modality. Accordingly, they are classified into patients with criteria of obstructive infertility without urogenital cysts where TRUS-guided aspiration and seminal vesiculography can be performed and transurethral resection of the ejaculatory ducts (TURED) will be the management of choice. In patients with urogenital cyst, TRUS-guided cyst aspiration and opacification are performed. If the cyst is communicating with the seminal tract, management will be transurethral incision of the cyst. If the cyst is not in communication, the obstruction may be relieved after cyst aspiration. If the obstruction is not relieved, TURED will be the management of choice. Sperm harvested during aspiration may be stored and used in assisted reproduction techniques. If the results of TRUS are inconclusive or doubtful, endorectal magnetic resonance imaging should be performed to serve as a "detailed map" for guiding corrective operative interventions.
男性不育症影像学评估的主要目的是识别和治疗可纠正的不育原因，如精道梗阻。有多种影像学检查方法可用于评估梗阻性不育的男性，包括阴囊超声检查、经直肠超声（TRUS）、输精管造影、磁共振成像、精囊抽吸、精道冲洗和精囊造影。迄今为止，梗阻性不育最可靠、准确的诊断技术尚不清楚。在这篇综述文章中，我们报告了这些检查方法在梗阻性不育诊断中的作用。阴囊超声检查是初步检查方法，如果患者的检查结果显示为非梗阻性无精子症，如精索静脉曲张或睾丸病变，则将根据这些病变的标准治疗方案进行治疗。如果患者的检查结果显示为近端梗阻性无精子症，则可通过输精管附睾吻合术进行治疗。如果阴囊超声检查结果正常，TRUS是第二种影像学检查方法。因此，他们被分为符合梗阻性不育标准但无泌尿生殖系统囊肿的患者，在这些患者中可进行TRUS引导下的抽吸和精囊造影，经尿道射精管切除术（TURED）将是首选的治疗方法。对于有泌尿生殖系统囊肿的患者，进行TRUS引导下的囊肿抽吸和显影。如果囊肿与精道相通，则治疗方法将是经尿道囊肿切开术。如果囊肿不相通，囊肿抽吸后梗阻可能会缓解。如果梗阻未缓解，TURED将是首选的治疗方法。抽吸过程中采集的精子可储存起来并用于辅助生殖技术。如果TRUS的结果不确定或有疑问，应进行直肠内磁共振成像，以作为指导纠正性手术干预的“详细地图”。
