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Girod BJ, Nguyen NC. Prostatic Utricle Cysts as a Potential Pitfall in PSMA PET/CT Interpretation. Clin Nucl Med 2024; 49:e470-e472. [PMID: 38914051 DOI: 10.1097/rlu.0000000000005340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
ABSTRACT A 60-year-old man with T2aN0M0 prostate cancer underwent intensity-modulated radiotherapy targeting the prostate and seminal vesicles. Experiencing biochemical recurrence after 6 years, 68 Ga-PSMA-11 PET/CT revealed focal radioactivity in the posterior midline of the prostate, identified as a prostatic utricle cyst on subsequent MRI. Similar findings appeared in a previous 18 F-piflufolastat PET/CT, with negative biopsy results. The patient then received intensity-modulated radiotherapy directed to 2 PSMA-avid pelvic nodes and leuprolide acetate, achieving an undetectable PSA in 4 months. This case highlights a potential pitfall in PSMA PET interpretation associated with prostatic utricle cysts.
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Affiliation(s)
- Bradley J Girod
- From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
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2
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Giannakodimos I, Ziogou A, Giannakodimos A, Mitakidi E, Tzelepis K, Fragkiadis E, Charalampakis N. Primary Paraganglioma of the Prostate: A Systematic Review of the Literature for A Rare Entity. Rev Recent Clin Trials 2024; 19:189-195. [PMID: 38549519 DOI: 10.2174/0115748871293735240209052044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Paragangliomas of the urinary tract are exceptionally uncommon, and sporadic case reports of primary paraganglioma of the prostate have been reported in the literature. METHODS Systematic research in PubMed/Medline and Scopus databases concerning primary prostatic paraganglioma was performed by two independent investigators. RESULTS This analysis included 25 adult males, with a mean age of 49.8 ± 22.4 years. 32% of included patients had a history of hypertension. Problems during urination (52%), blood loss (44%), either as hematuria or hemospermia, and catecholamine-related symptoms (36%) comprised the most frequently reported clinical manifestations. Digital rectal examination found a palpable nodule in 36% of patients, while prostatic specific antigen (PSA) was normal in all tested patients. Abdominal ultrasound (44%), computed tomography (44%) and magnetic resonance imaging (28%) helped to identify the primary lesion. 24-hour urine epinephrine, norepinephrine and vanillylmandelic acid (VMA) levels were elevated in 90%, 80% and 90% of included patients. Open surgical excision of the mass was performed in 40%, transurethral resection in 8%, open radical prostatectomy in 24%, transurethral resection of the prostate in 16% and robot-assisted radical prostatectomy in 4% of included patients. CONCLUSION Due to atypical clinical manifestation and scarcity of prostatic paraganglioma, urologists should be aware of this extremely rare entity.
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Affiliation(s)
- Ilias Giannakodimos
- Department of Urology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Afroditi Ziogou
- Department of Medical Oncology, Metaxa Cancer Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexios Giannakodimos
- Department of Medical Oncology, Metaxa Cancer Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Mitakidi
- Department of Urology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tzelepis
- Department of Urology, Geniko Kratiko Nikaias General Hospital, Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Fragkiadis
- Department of Urology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Charalampakis
- Department of Medical Oncology, Metaxa Cancer Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Kose SI. Imaging in Male Infertility. Curr Probl Diagn Radiol 2023; 52:439-447. [PMID: 37270300 DOI: 10.1067/j.cpradiol.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 04/04/2023] [Accepted: 05/08/2023] [Indexed: 06/05/2023]
Abstract
Infertility is defined as inability to conceive despite regular unprotected sexual intercourse for greater than 1 year. Conditions involving the male partner accounts for the infertility in approximately 50% of cases. The goals of imaging in male infertility are to detect treatable/ reversible causes, imaging for sperm retrieval from testis or epididymis for assisted reproductive techniques like in vitro fertilization or intracytoplasmic sperm injection and to provide appropriate genetic counselling for prevention of occurrence of disease in future offspring. The purpose of this article is to describe imaging features in various causes of male infertility to acquaint radiologists with various imaging appearances of causes of male infertility to avoid missing these pathologies.
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Affiliation(s)
- Snehal Ishwar Kose
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India.
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Elsorougy A, Farg H, Abdelhamid A, Zakaria M, El-Ghar MA. Should asymptomatic small anteriorly located midline prostatic cyst in young adults be treated surgically or conservatively? A case report and review of the literature. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00780-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Prostatic cysts are uncommon, typically asymptomatic and discovered by chance during imaging. Prostatic cysts in the midline are less prevalent and primarily seen in the posterior aspect of the prostate.
Case presentation
We describe a case of a 32-year-old man with a complaint of left loin pain and a little sensation of pelvic discomfort. Ultrasound was done revealing small pelvic cystic structure related to urinary bladder base and neck with possibility to be prostatic in origin. Transrectal ultrasound and pelvic magnetic resonance imaging were done and showed an anteriorly located midline prostatic cyst protruding into the bladder lumen, with no communication with the urethra on conventional ascending urethrogram.
Conclusion
The rare relationship between the cyst, bladder neck, and prostate make this case to some extent unique and further interesting. To our best knowledge, this is the eighth documented case in the literature to describe an anteriorly located midline intraprostatic cyst projecting at the bladder neck and base with illustration of different plans of treatment.
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Kerr DM, Middleton WD. Ultrasound of the Normal and Abnormal Vas Deferens. Ultrasound Q 2022; 38:224-236. [PMID: 35129151 DOI: 10.1097/ruq.0000000000000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The extrapelvic portion of the vas deferens is readily visible with ultrasound but often overlooked. Several publications have described the scanning technique and the normal anatomy of the vas deferens. Sonographic evaluation of the vas deferens provides critical information in the workup of male infertility. Obstruction, inflammatory conditions, and neoplasms of the vas deferens can also be diagnosed with ultrasound. Knowledge of the normal and abnormal appearance of the vas deferens improves scans of the scrotum and expands the conditions that can be recognized and accurately diagnosed with ultrasound.
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Müllerian duct cyst: Case report with updates in cellular origin, corresponding immunohistochemistry, and contrast to prostatic utricle cyst. Pathol Res Pract 2021; 228:153657. [PMID: 34700015 DOI: 10.1016/j.prp.2021.153657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 11/21/2022]
Abstract
A 20-year-old male presented to the emergency department with lower abdominal pain, urinary retention, and constipation. Computed tomography (CT) revealed a large cyst on the posterior aspect of the prostate gland; he was ultimately diagnosed with a Müllerian duct cyst (MDC). Although much has been written on the radiologic diagnosis of such cysts, there is a paucity of recent literature concerning the pathological diagnosis. While older studies debated the Müllerian origin of a midline cyst abutting the poster prostate, we believe that with the advent of monoclonal PAX8 (which was positive in this lesion) and monoclonal PAX2 (which was negative), we have strong evidence that the present cyst is indeed of Müllerian origin. Further, there is debate in the literature as to whether MDC is synonymous or distinct from prostatic utricle cyst. We present an interdisciplinary analysis as to the merits and weaknesses of both sides of the debate and how data gathered from the current case could be used in a future, larger study to arrive at a more definitive conclusion.
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Cai W, Min X, Chen D, Fan C, Feng Z, Li B, Zhang P, You H, Xie J, Liu J, Wang L. Noninvasive Differentiation of Obstructive Azoospermia and Nonobstructive Azoospermia Using Multimodel Diffusion Weighted Imaging. Acad Radiol 2021; 28:1375-1382. [PMID: 32622745 DOI: 10.1016/j.acra.2020.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/13/2020] [Accepted: 05/30/2020] [Indexed: 10/23/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the diagnostic performance of parameters derived from multimodel diffusion weighted imaging (monoexponential, stretched-exponential diffusion weighted imaging and diffusion kurtosis imaging [DKI]) from noninvasive magnetic resonance imaging in distinguishing obstructive azoospermia (OA) from nonobstructive azoospermia (NOA). MATERIALS AND METHODS Forty-six patients with azoospermia were prospectively enrolled and classified into two groups (21 OA patients and 25 NOA patients). The multimodel parameters of diffusion-weighted imaging (DWI; apparent diffusion coefficient [ADC], distributed diffusion coefficient [DDC], diffusion heterogeneity [α], diffusion kurtosis diffusivity [Dapp], and diffusion kurtosis coefficient [Kapp]) were derived. The diagnostic performance of these parameters for the differentiation of OA and NOA patients were evaluated using receiver operating characteristic analysis. The area under the curve (AUC) was calculated to evaluate the diagnostic accuracy of each parameter. RESULTS All the parameters (ADC, α, DDC, Dapp, and Kapp) values were significantly different between OA and NOA (P < 0.001 for all). For the differentiation of OA from NOA, Kapp showed the highest AUC value (0.965), followed by DDC (0.946), Dapp (0.933), ADC (0.922), and α (0.887). Kapp had a significantly higher AUC than the conventional ADC (P < 0.05). CONCLUSION Parameters derived from multimodels of DWI have the potential for the noninvasive differentiation of OA and NOA. The Kapp value derived from the DKI model might serve as a useful imaging marker for the differentiation of azoospermia.
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Abstract
Obstructive azoospermia (OA) is caused by excurrent duct obstruction, which can occur anywhere along the course of the male reproductive tract and is classically characterized by normal spermatogenesis. To be familiar with the imaging anatomy of normal and abnormal male genital ducts is essential to the diagnosis of OA. In some circumstances, OA can also be related to some specific syndromes; thus, making an accurate diagnosis may require an integral view of the whole abdomen and pelvis. MR is a great complementary imaging modality either for the detection of obstructive factors, especially for characterization of those indeterminate features on ultrasound, or for the identification of specific syndromes related to OA. In this article, a series of patients with OA caused by different kinds of lesions in and out of the pelvic cavity (abdomen) shown on MR imaging were included, and some cases of specific syndromes related to OA were also reviewed.
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Prostatic Utricle Cyst as the Most Likely Cause in a Case of Recurrent Episodes of Hematospermia. Case Rep Urol 2018; 2017:7502878. [PMID: 29430319 PMCID: PMC5752985 DOI: 10.1155/2017/7502878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/16/2017] [Accepted: 12/06/2017] [Indexed: 12/02/2022] Open
Abstract
Hematospermia is a clinical symptom that raises anxiety in patients and has various causes, benign and malignant. We report a case of hematospermia for which appropriate multidisciplinary expertise favored a conservative management of a benign prostatic cyst, namely, a prostatic utricle cyst. A cystic lesion found by transrectal ultrasound in the context of hematospermia related to masturbation in a young virgin male patient was investigated with a high-field magnetic resonance imaging (MRI) and an endorectal coil. The association of high-field MRI and endorectal coil leads to high quality images.
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Mittal PK, Little B, Harri PA, Miller FH, Alexander LF, Kalb B, Camacho JC, Master V, Hartman M, Moreno CC. Role of Imaging in the Evaluation of Male Infertility. Radiographics 2017; 37:837-854. [DOI: 10.1148/rg.2017160125] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Pardeep K. Mittal
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Brent Little
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Peter A. Harri
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Frank H. Miller
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Lauren F. Alexander
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Bobby Kalb
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Juan C. Camacho
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Viraj Master
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Matthew Hartman
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Courtney C. Moreno
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
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Mittal PK, Camacho JC, Sahani DV, Kalb B, Harri PA, Master V, Kokabi N, Hartman M, Kitajima HD, Moreno CC. Hematospermia Evaluation at MR Imaging. Radiographics 2016; 36:1373-89. [PMID: 27517360 DOI: 10.1148/rg.2016150195] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Hematospermia is a challenging and anxiety-provoking condition that can manifest as a single episode or recur over the course of weeks to months. It is usually a benign self-limiting condition in younger sexually active males without a history of risk factors such as cancer, urogenital malformations, bleeding disorders, and their associated symptoms. However, patients with recurrent, refractory and painful hematospermia with associated symptoms, such as fever, pain, or weight loss, require evaluation through clinical assessment and noninvasive investigations to rule out underlying pathologic conditions such as ejaculatory obstruction, infectious and inflammatory causes, malignancy, vascular malformations, and systemic disorders that increase the risk of bleeding, especially when presenting in older men. If these investigations are negative, the patient should be reassured and treated accordingly. In the recent past, magnetic resonance (MR) imaging has assumed a major role in the investigation of hematospermia due to its excellent soft-tissue contrast and multiplanar capabilities. In this review, we will discuss the potential causes of hematospermia and its diagnostic workup, including pathophysiology, anatomic considerations, the imaging appearance of associated pathologic conditions, and management. (©)RSNA, 2016.
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Affiliation(s)
- Pardeep K Mittal
- From the Department of Radiology and Imaging Sciences (P.K.M., J.C.C., P.A.H., N.K., H.D.K., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Massachusetts General Hospital, Boston, Mass (D.V.S.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Juan C Camacho
- From the Department of Radiology and Imaging Sciences (P.K.M., J.C.C., P.A.H., N.K., H.D.K., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Massachusetts General Hospital, Boston, Mass (D.V.S.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Dushyant V Sahani
- From the Department of Radiology and Imaging Sciences (P.K.M., J.C.C., P.A.H., N.K., H.D.K., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Massachusetts General Hospital, Boston, Mass (D.V.S.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Bobby Kalb
- From the Department of Radiology and Imaging Sciences (P.K.M., J.C.C., P.A.H., N.K., H.D.K., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Massachusetts General Hospital, Boston, Mass (D.V.S.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Peter A Harri
- From the Department of Radiology and Imaging Sciences (P.K.M., J.C.C., P.A.H., N.K., H.D.K., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Massachusetts General Hospital, Boston, Mass (D.V.S.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Viraj Master
- From the Department of Radiology and Imaging Sciences (P.K.M., J.C.C., P.A.H., N.K., H.D.K., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Massachusetts General Hospital, Boston, Mass (D.V.S.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Nima Kokabi
- From the Department of Radiology and Imaging Sciences (P.K.M., J.C.C., P.A.H., N.K., H.D.K., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Massachusetts General Hospital, Boston, Mass (D.V.S.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Matthew Hartman
- From the Department of Radiology and Imaging Sciences (P.K.M., J.C.C., P.A.H., N.K., H.D.K., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Massachusetts General Hospital, Boston, Mass (D.V.S.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Hiroumi D Kitajima
- From the Department of Radiology and Imaging Sciences (P.K.M., J.C.C., P.A.H., N.K., H.D.K., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Massachusetts General Hospital, Boston, Mass (D.V.S.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Courtney C Moreno
- From the Department of Radiology and Imaging Sciences (P.K.M., J.C.C., P.A.H., N.K., H.D.K., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Massachusetts General Hospital, Boston, Mass (D.V.S.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
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12
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Abstract
This article discusses MR imaging of the normal prostate and of disease conditions of the prostate including prostatitis, cystic lesions, amyloidosis, calculi, hematospermia, benign prostatic hyperplasia, and malignancy.
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Affiliation(s)
- Ekta Gupta
- Department of Radiology, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA
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13
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Shebel HM, Farg HM, Kolokythas O, El-Diasty T. Cysts of the lower male genitourinary tract: embryologic and anatomic considerations and differential diagnosis. Radiographics 2014; 33:1125-43. [PMID: 23842975 DOI: 10.1148/rg.334125129] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cysts of the lower male genitourinary tract are uncommon and usually benign. These cysts have different anatomic origins and may be associated with a variety of genitourinary abnormalities and symptoms. Various complications may be associated with these cysts, such as urinary tract infection, pain, postvoiding incontinence, recurrent epididymitis, prostatitis, and hematospermia, and they may cause infertility. Understanding the embryologic development and normal anatomy of the lower male genitourinary tract can be helpful in evaluating these cysts and in tailoring an approach for developing a differential diagnosis. There are two main groups of cysts of the lower male genitourinary tract: intraprostatic cysts and extraprostatic cysts. Intraprostatic cysts can be further classified into median cysts (prostatic utricle cysts, müllerian duct cysts), paramedian cysts (ejaculatory duct cysts), and lateral cysts (prostatic retention cysts, cystic degeneration of benign prostatic hypertrophy, cysts associated with tumors, prostatic abscess). Extraprostatic cysts include cysts of the seminal vesicle, vas deferens, and Cowper duct. A variety of pathologic conditions can mimic these types of cysts, including ureterocele, defect resulting from transurethral resection of the prostate gland, bladder diverticulum, and hydroureter and ectopic insertion of ureter. Accurate diagnosis depends mainly on the anatomic location of the cyst. Magnetic resonance imaging and transrectal ultrasonography (US) are excellent for detecting and characterizing the nature and exact anatomic origin of these cysts. In addition, transrectal US can play an important therapeutic role in the management of cyst drainage and aspiration, as in cases of prostatic abscess.
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Affiliation(s)
- Haytham M Shebel
- Department of Radiology, Urology and Nephrology Center, Mansoura University, El-Gomheria St, Mansoura 35516, Egypt.
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14
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Prostatic stromal neoplasms: differential diagnosis of cystic and solid prostatic and periprostatic masses. AJR Am J Roentgenol 2013; 200:W571-80. [PMID: 23701087 DOI: 10.2214/ajr.12.9741] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objectives of this article are to illustrate the radiologic-pathologic correlation of prostate stromal neoplasms and to review the imaging appearances of cystic and solid prostatic and periprostatic masses that may mimic prostatic stromal neoplasms. CONCLUSION The differential diagnosis for cystic and solid masses in the prostate is broad, and masses arising from periprostatic structures may mimic the appearance of primary prostatic diseases. Attention to clinical and imaging features is helpful in narrowing the differential diagnosis.
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Ammar T, Sidhu PS, Wilkins CJ. Male infertility: the role of imaging in diagnosis and management. Br J Radiol 2012; 85 Spec No 1:S59-68. [PMID: 22763036 DOI: 10.1259/bjr/31818161] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The investigation of male infertility is assuming greater importance, with male factors implicated as a causal factor in up to half of infertile couples. Following routine history, examination and blood tests, imaging is frequently utilised in order to assess the scrotal contents for testicular volume and morphology. Additionally, this may give indirect evidence of the presence of possible reversible pathology in the form of obstructive azoospermia. Further imaging in the form of transrectal ultrasound and MRI is then often able to categorise the level of obstruction and facilitate treatment planning without resort to more invasive imaging such as vasography. Ultrasound guidance of therapy such as sperm or cyst aspiration and vasal cannulation may also be performed. This article reviews the imaging modalities used in the investigation of male infertility, and illustrates normal and abnormal findings that may be demonstrated.
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Affiliation(s)
- T Ammar
- Department of Radiology, King's College Hospital, Denmark Hill, London, UK
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Gómez Herrera JJ, Zabía Galíndez E, Carrera Terrón R, Borruel Nacenta S. [Complete unilateral dilation of the vas deferens as a cause of an inguinal mass]. RADIOLOGIA 2011; 55:533-6. [PMID: 21733536 DOI: 10.1016/j.rx.2010.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 12/10/2010] [Accepted: 12/14/2010] [Indexed: 11/28/2022]
Abstract
The complete unilateral dilation of the vas deferens is an extremely rare radiologic finding. Most cystic structures adjacent to the prostate can be grouped into cysts and diverticula. The finding of an inguinal mass makes it necessary to rule out intestinal hernias and other entities. We present the case of a patient who developed an inguinal mass secondary to unilateral dilation of the vas deferens.
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Affiliation(s)
- J J Gómez Herrera
- Servicio de Radiodiagnóstico, Departamento de Diagnóstico por Imagen, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, España.
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Robin G, Boitrelle F, Leroy X, Peers MC, Marcelli F, Rigot JM, Mitchell V. [Assessment of azoospermia and histological evaluation of spermatogenesis]. Ann Pathol 2010; 30:182-95. [PMID: 20621595 DOI: 10.1016/j.annpat.2010.03.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Accepted: 03/28/2010] [Indexed: 01/19/2023]
Abstract
Azoospermia may be obstructive (blockage of the genital ducts) or non-obstructive (a lack of testicular production). The distinction is based on an ensemble of clinical, spermiological, hormonal, ultrasound, genetic and histological data. Azoospermia is the main indication for testicular biopsy for therapeutic and diagnostic purposes. Testicular spermatozoids are processed in the reproductive biology laboratory (simultaneously with oocyte retrieval or not) for in vitro fertilization with intra-cytoplasmic sperm injection. The histological study of spermatogenesis is usually performed on a testicular biopsy sample taken at the same time and provides additional diagnostic information on infertility. Histological alterations in the testicular tissues are frequently observed in azoospermic men. In non-obstructive azoospermia, three histological situations prevail: hypospermatogenesis, Sertoli-cell-only syndrome and germ cell arrest. One can distinguish between pure forms (in which all the seminiferous tubules have the same appearance) and mixed forms (in which the tubules' aspects are heterogeneous). Hypospermatogenesis is highly prevalent in azoospermia and is characterized by a low, basal level of spermatozoid production. The prevalence of Sertoli-cell-only syndrome varies from 27 to 68% and the mean spermatozoid recovery rate is between 16 and 33%. Germ cell arrests are rare phenotypes and have a poor prognosis for spermatozoid recovery. Overall, histological examination (still the only way to fully describe spermatogenesis) must be qualitative and quantitative, with the adoption of a standardized, universally understood terminology. It is essential to compare the histological data with (i) recovery of testicular spermatozoids, (ii) clinical, ultrasound, hormonal and genetic data and (iii) the outcome of IVF/ICSI procedures.
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18
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Donkol RH. Imaging in male-factor obstructive infertility. World J Radiol 2010; 2:172-9. [PMID: 21161032 PMCID: PMC2999021 DOI: 10.4329/wjr.v2.i5.172] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 04/24/2010] [Accepted: 05/01/2010] [Indexed: 02/06/2023] Open
Abstract
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.
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Abstract
OBJECTIVE This article will review the workup of infertility in a male. The imaging of common conditions associated with infertility, including varicocele, ejaculatory duct obstruction, seminal vesicle agenesis, and undescended testis, will be shown, as well as other conditions that can be incidentally seen. CONCLUSION The analysis of infertility in males has become more common in recent years. The practicing radiologist should be familiar with the evaluation of the infertile man and the common radiologic findings and disease processes associated with infertility.
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Middleton WD, Dahiya N, Naughton CK, Teefey SA, Siegel CA. High-resolution sonography of the normal extrapelvic vas deferens. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:839-846. [PMID: 19546325 DOI: 10.7863/jum.2009.28.7.839] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the reliability of sonographic visualization of the normal extrapelvic vas deferens and to analyze its appearance and dimensions. METHODS Scans of the scrotum and spermatic cords were obtained in 25 fertile volunteers. Identification of the vas deferens was attempted bilaterally in the scrotal, suprascrotal, and prepubic segments in all volunteers. When possible, the total thickness and the diameter of the lumen were measured. Visualization and dimensions were correlated with the body mass index (BMI) and abstinence interval. RESULTS All segments of the vas deferens were identified bilaterally in all volunteers. In all cases, it appeared as an anechoic or very hypoechoic tubular structure that was noncompressible and contained no detectable blood flow. It was convoluted inferiorly and became straight as it progressed from the scrotum to the suprascrotal and prepubic segments. The lumen was seen in the suprascrotal segment in all of the volunteers except the one with the highest BMI. The total thickness of the vas ranged from 1.5 to 2.7 mm (mean, 1.89 mm). The lumen of the vas ranged from 0.2 to 0.7 mm (mean, 0.43 mm). There was no correlation between the luminal diameter and the abstinence interval. CONCLUSIONS The extrapelvic portion of the vas deferens is reliably visualized sonographically. Its appearance is characteristic and reproducible. The lumen can be measured in almost all cases.
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Affiliation(s)
- William D Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri 63110, USA
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21
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22
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Robin G, Marcelli F, Mitchell V, Marchetti C, Lemaitre L, Dewailly D, Leroy-Billiard M, Rigot JM. [Why and how to assess hypospermia?]. ACTA ACUST UNITED AC 2008; 36:1035-42. [PMID: 18801689 DOI: 10.1016/j.gyobfe.2008.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Accepted: 04/15/2008] [Indexed: 11/28/2022]
Abstract
Hypospermia is a semen volume lower than 2 mL on at least two semen analyses. The etiologies of hypospermia are many and may be divided into two pathophysiologic sub-groups: disturbances of ejaculation reflex leading to partial retrograde ejaculation and seminal glands and ducts anatomic and functional anomalies. In this last pathologic mechanism, the mutations of CFTR gene, involved in many different forms of cystic fibrosis, represent a possible cause of hypospermia. The molecular anomaly of CFTR gene's screening is very important for the potential descendents and for the patient himself. It must be considered any time clinic and/or paraclinic context is evocative.
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Affiliation(s)
- G Robin
- Service d'andrologie, hôpital Albert-Calmette, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
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23
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Curran S, Akin O, Agildere AM, Zhang J, Hricak H, Rademaker J. Endorectal MRI of Prostatic and Periprostatic Cystic Lesions and Their Mimics. AJR Am J Roentgenol 2007; 188:1373-9. [PMID: 17449785 DOI: 10.2214/ajr.06.0759] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Sean Curran
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, USA
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25
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Langer JE, Cornud F. Inflammatory disorders of the prostate and the distal genital tract. Radiol Clin North Am 2006; 44:665-77, vii. [PMID: 17030219 DOI: 10.1016/j.rcl.2006.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Inflammatory disease of the prostate and distal genital tract is emerging as a major health problem because it is estimated that up to 15% of adult men may be affected at some point in their lives. Clinically, the diagnosis of "prostatitis" refers to multiple disorders that cause pelvic pain and discomfort, ranging from acute bacterial infection to complex conditions that may not necessarily be caused by prostatic inflammation. Because the traditional etiology-based classification system did not always correlate with symptoms and therapeutic efficacy, a new classification of prostatitis has been suggested by the National Institutes of Health. New imaging techniques such as high-resolution transrectal ultrasonography (TRUS) and MR imaging provide exquisite anatomic detail and often play a crucial role in the evaluation of these patients.
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Affiliation(s)
- Jill E Langer
- Department of Radiology, Hospital of the University of Pennsylvania, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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26
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Raviv G, Mor Y, Levron J, Shefi S, Zilberman D, Ramon J, Madgar I. Role of transrectal ultrasonography in the evaluation of azoospermic men with low-volume ejaculate. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:825-9. [PMID: 16798892 DOI: 10.7863/jum.2006.25.7.825] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The purpose of this prospective study was to evaluate the incidence of distal ejaculatory system defects with transrectal ultrasonography (TRUS) among patients evaluated for azoospermia. METHODS Forty-two patients with low-volume ejaculate and azoospermia were evaluated by physical examination, serum follicle-stimulating hormone and luteinizing hormone level determination, karyotyping, selective screening for cystic fibrosis mutations, and TRUS. RESULTS On physical examination, in 29 patients (69%), either 1 (12 patients) or both (17 patients) of the vasa deferentia could not be palpated. In the group of 17 patients with bilateral involvement of the vasa deferentia, the ultrasonographic imaging universally showed bilateral absence or hypoplasia of the seminal vesicles with bilateral agenesis of the vasa deferentia and nonvisualization of both ejaculatory ducts. In the patients with a unilateral abnormality on physical examination, the ultrasonographic imaging showed absence of the ipsilateral seminal vesicle in 7 patients and the hypoplastic seminal vesicle in 5. In the group of 13 patients with normal physical examination findings, a variety of obstructive causes were diagnosed by TRUS examination. CONCLUSIONS According to this study, TRUS appears to be a sensitive method for evaluating the anatomy of the distal ejaculatory system. Its safety and low costs make it a good alternative to the other invasive and expensive methods.
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Affiliation(s)
- Gil Raviv
- Male Infertility Unit, Division of Urology, The Chaim Sheba Medical Center, Tel Hashomer and Sackler School of Medicine, Tel-Aviv University, Ramat-Gan 52621, Israel.
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27
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MALE INFERTILITY DUE TO A BENIGN PROSTATIC POLYP. J Urol 2000. [DOI: 10.1097/00005392-200011000-00055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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TA SONY, KLAUSNER ADAMP, SAVAGE STEPHENJ, UNGER PAMELA, BAR-CHAMA NATAN. MALE INFERTILITY DUE TO A BENIGN PROSTATIC POLYP. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67060-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- SONY TA
- From the Departments of Urology and Pathology, Mount Sinai School of Medicine, New York, New York
| | - ADAM P. KLAUSNER
- From the Departments of Urology and Pathology, Mount Sinai School of Medicine, New York, New York
| | - STEPHEN J. SAVAGE
- From the Departments of Urology and Pathology, Mount Sinai School of Medicine, New York, New York
| | - PAMELA UNGER
- From the Departments of Urology and Pathology, Mount Sinai School of Medicine, New York, New York
| | - NATAN BAR-CHAMA
- From the Departments of Urology and Pathology, Mount Sinai School of Medicine, New York, New York
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30
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Affiliation(s)
- E S Siegelman
- Department of Radiology, University of Pennsylvania Medical Center, Philadelphia 19104-4283, USA
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31
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Killi RM, Pourbagher A, Semerci B. Transrectal ultrasonography-guided echo-enhanced seminal vesiculography. BJU Int 1999; 84:521-3. [PMID: 10468773 DOI: 10.1046/j.1464-410x.1999.00255.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- R M Killi
- Department of Radiology, Ege University, Bornova, Izmir, Turkey
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Dahms SE, Hohenfellner M, Linn JF, Eggersmann C, Haupt G, Thüroff JW. Retrovesical mass in men: pitfalls of differential diagnosis. J Urol 1999; 161:1244-8. [PMID: 10081878 DOI: 10.1016/s0022-5347(01)61647-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE We review the differential diagnosis and treatment of retrovesical masses in men. MATERIALS AND METHODS During the last 8 years 21 male patients 3 to 79 years old (mean age 47.1) presented with symptoms or signs of a retrovesical mass. Clinical features and diagnostic findings were reviewed, and related to surgical and histopathological findings. RESULTS The retrovesical masses included prostatic utricle cyst in 3 cases, prostatic abscess in 1, seminal vesicle hydrops in 6, seminal vesicle cyst in 2, seminal vesicle empyema in 3, large ectopic ureterocele in 1, myxoid liposarcoma in 1, malignant fibrous histiocytoma in 1, fibrous fossa obturatoria cyst in 1, hemangiopericytoma in 1 and leiomyosarcoma in 1. In 17 patients various symptoms were seen and in 4 the mass was incidentally detected. A mass was palpable on digital rectal examination in 16 cases and visible on sonography in 20. For a cystic mass medial location relative to the bladder neck was suggestive of prostatic abscess or utricle cyst, while lateral location was suggestive of seminal vesicle cyst/hydrops or empyema, ectopic ureter or ureterocele. In 6 patients diagnosis was established only by exploratory laparotomy and histopathological examination. CONCLUSIONS Digital rectal examination and sonography reliably detect a retrovesical mass. Nevertheless, clinical signs and median or lateral location relative to the bladder neck on ultrasound are diagnostic only for cystic lesions. Computerized tomography and magnetic resonance imaging are useful for staging malignant tumors. However, needle or open biopsy is required in most cases to establish a histopathological diagnosis. Exploratory laparotomy and histopathological examination are the procedures of choice when other findings are equivocal.
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Affiliation(s)
- S E Dahms
- Department of Urology, Johannes Gutenberg University, School of Medicine, Mainz, Germany
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