Jain Bharath, Gaddi Mahalakshmi, Nallathambi Naveenkumar, Palande Amisha, A Prashanth, S Gajalakshmi, A Prashannalakshmi, Holebasu B, Prasad Roshan, Mittal Gaurav
Radiology, S. S. Institute of Medical Sciences and Research Centre, Davanagere, IND.
Obstetrics and Gynaecology, SDM College of Medical Sciences and Hospital, Dharwad, IND.
Cureus. 2024 Jun 21;16(6):e62848. doi: 10.7759/cureus.62848. eCollection 2024 Jun.
Background Infertility affects many couples, with male factors being responsible for over half of the cases. Male infertility can arise from various testicular illnesses, such as varicocele and cryptorchidism, as well as posttesticular disorders, like ejaculation abnormalities. Infertility is defined as the inability to conceive after 12 months of unprotected sexual activity or after six months for women over 35. Diagnostic techniques such as semen analysis and scrotal ultrasonography are done to evaluate conditions like varicocele and epididymo-orchitis. This study aims to assess the diagnostic utility of ultrasonography for male infertility and compare its findings with those from surgery and clinical care. Methodology All patients were referred to the Department of Radiology, Tertiary Care Hospital, South India, for transrectal and scrotal ultrasonography, using a high-frequency transducer with a frequency of 7.5 MHz and a color Doppler when necessary. The study included all male patients with infertility and abnormal semen analysis, as well as those with infertility accompanied by scrotal abnormalities detected during clinical examination. Patients were placed in the left lateral decubitus position for the transrectal ultrasonography examination. The testes and epididymis were thoroughly examined on both sides and compared regarding symmetry, size, texture, and vascularity. Results Varicocele was the most frequent anomaly detected by both clinical examination and ultrasonography. Ultrasound detected 30 cases of varicocele, whereas clinical examination diagnosed 15 cases. Hydrocele was identified in eight cases through clinical examination and in 15 cases through ultrasound. Epididymal cysts were found in five cases via clinical examination, while both clinical examination and ultrasonography discovered epididymitis in 10 cases. Overall, the number of anomalies detected by ultrasound was significantly higher than those found by physical examination, with a statistically significant p value of 0.001. Conclusion Transrectal ultrasound provides high-resolution imaging of the prostate, seminal vesicles, and distal vas deferens, which aids in diagnosing obstructive azoospermia. Imaging is a valuable supplement to clinical examination and laboratory studies for accurately identifying anatomy and abnormalities. Both transrectal and scrotal ultrasonography offer crucial information in diagnosing male infertility. Ultrasonography is more effective in identifying pathological abnormalities than clinical palpation.
背景 不孕症影响着许多夫妇，其中男性因素导致的病例占半数以上。男性不育可由各种睾丸疾病引起，如精索静脉曲张和隐睾症，以及睾丸后疾病，如射精异常。不孕症的定义是在无保护性行为12个月后仍无法受孕，35岁以上女性为6个月后仍无法受孕。通过精液分析和阴囊超声检查等诊断技术来评估精索静脉曲张和附睾炎等病症。本研究旨在评估超声检查对男性不育症的诊断效用，并将其结果与手术和临床护理的结果进行比较。
方法 所有患者均被转诊至印度南部三级护理医院的放射科，使用频率为7.5MHz的高频探头进行经直肠和阴囊超声检查，必要时使用彩色多普勒。该研究纳入了所有精液分析异常的男性不育患者，以及临床检查发现伴有阴囊异常的不育患者。经直肠超声检查时，患者采取左侧卧位。对双侧睾丸和附睾进行全面检查，并比较其对称性、大小、质地和血管分布情况。
结果 精索静脉曲张是临床检查和超声检查中最常发现的异常情况。超声检查发现30例精索静脉曲张，而临床检查诊断出15例。临床检查发现8例鞘膜积液，超声检查发现15例。临床检查发现5例附睾囊肿，临床检查和超声检查均发现10例附睾炎。总体而言，超声检查发现的异常数量明显高于体格检查，p值具有统计学意义，为0.001。
结论 经直肠超声能够对前列腺、精囊和远端输精管进行高分辨率成像，有助于诊断梗阻性无精子症。影像学检查是临床检查和实验室研究的重要补充，有助于准确识别解剖结构和异常情况。经直肠和阴囊超声检查在男性不育症的诊断中均提供了关键信息。超声检查在识别病理异常方面比临床触诊更有效。
