超声在梗阻性无精子症病因诊断中的价值

目的评价高频超声（HFUS）和经直肠超声（TRUS）在梗阻性无精子症病因诊断中的价值。方法 189例梗阻性无精子症患者,经过一系列临床与实验室检查包括体检、精液分析、精浆生化、血清性激素检测后,均进行了阴囊HFUS和TRUS检查。结果 189例梗阻性无精子症患者病变类型多样,梗阻水平分近段梗阻和远段梗阻,梗阻因素有先天发育异常,与胚胎发育相关的残留囊肿、射精管梗阻及附属性腺的炎性病变。结论 HFUS和TRUS检查是临床诊断梗阻性无精子症的安全可靠的首选检查手段。     

经直肠超声在射精管梗阻性无精症所致男性不育症的诊断和治疗中的临床价值

目的探讨经直肠超声在射精管梗阻所致男性不育症的诊断及临床治疗观察中的应用价值。方法回顾性分析26例射精管梗阻性无精症所致男性不育症的经直肠超声检查声像图表现,并与精浆生化因子检测结果相结合对照。结果 26例患者中经直肠超声表现为射精管囊肿13例,苗勒管囊肿6例,射精管扩张7例,其中射精管扩张中细菌感染所致4例,结核性所致1例,射精管结石2例。结论经直肠超声能有效诊断射精管梗阻性无精症,是临床治疗男性不育症的首选检查手段。     

经直肠超声对男性不育症与精囊及射精管病变关系的探讨，

目的：探讨男性不育症与精囊及射精管病变之间的关系。方法：应用经直肠彩色多普勒超声对152例男性不育症患者进行精囊及射精管检查。结果：①152例男性不育症患者中，14．47％（22例）的患者精囊及射精管未发现明显病变，54．61％（83例）的患者有明显的精囊疾病，30．92％（47例）的患者有射精管病变；②与正常对照者比较，精囊囊肿（P〈0．01）和急性精囊炎（P〈0．05）患者的精囊短径明显大于正常对照者，而慢性精囊炎（P〈0．05）、精囊萎缩（P〈0．05）和精囊发育不全（P〈0．01）患者的精囊短径明显低于对照者；③精囊及射精管疾病与精液常规之间有着十分密切的关系。结论：精囊及射精管病变与男性不育症之间有着十分密切的关系，精囊及射精管病变可引起男性不育。对于各种精囊及射精管疾病，经直肠超声检查是一种有价值的检测手段。     

射精管-精囊区梗阻所致无精子症的MRI诊断

【摘要】目的：探讨射精管-精囊区梗阻所致无精子症的MRI表现，提高对该区域病变的认识。方法：回顾性分析本院2010年1月－2018年12月在我院诊断为射精管-精囊区梗阻所致无精子症的54例患者的临床及影像资料，其中先天性病变30例、继发性病变24例。所有患者行盆腔MR平扫及增强扫描。结果：射精管-精囊区各种来源的囊肿MR信号基本相仿：在T1WI上呈低~等信号，T2WI上呈高信号，囊内可有出血，增强扫描囊内容物无明显强化。鉴别主要依靠定位、形态及相关表现。先天性病变：①精囊发育不全或不发育（12例），表现为双侧精囊缺如，双侧精囊体积缩小，单侧精囊体积缩小而对侧精囊缺如；②前列腺苗勒管囊肿（6例），表现为位于前列腺后正中部、双侧精囊之间的精阜区、矢状面或冠状面图像上呈倒置的水滴状的的囊性病灶，边缘光整；③Zinner综合征（5例），为一侧肾脏缺如合并同侧精囊囊肿；④常染色体显性遗传性多囊肾（ADPKD）合并双侧精囊囊肿（7例），表现为双侧多囊肾（1例合并多囊肝）伴有双侧精囊囊肿。继发性病变：①精囊炎（14例），可合并或不合并精囊囊肿，表现为单侧或双侧精囊扩张、形态大小不一，扩张的精囊囊壁增厚；②射精管囊肿（10例），为前列腺部后部的精阜区偏一侧且长轴方向与射精管走行一致的、边缘光整、边界清晰的囊性病灶。结论：射精管-精囊区病变所致的梗阻性无精子症的病种多样、复杂，通过其特征性的MRI表现和合适的检查方法，有助于正确诊断该区域的病变。     

男性不育症的经直肠US所见及其价值

作者对276例男性不育的病人作了经直肠US(TRUS)研究。年龄24～52岁,均为射精量少(<1.5ml)及无精子。病人左侧卧位,用7.5～9.0MHz高频直肠内换能器,行横断面和矢状面检查输精管末端、精囊、射精管和前列腺,并记录测定结果,仔细注意内部回声及输精管和精囊的结构。所有病人均作了肾US以发现潜在的肾异常。 结果显示,除70例(25.4％)TRUS未发现解剖学异常外,其余病人均有异常,包括先天性双侧输精管缺如或发育不良94例(34.1％),双僻输精管闭     

超声和MRI测量前列腺大小的比较

作者采用与手术标本相对照的方法,分析了15例患者用磁共振成像(MRI)和超声(US)测量前列腺大小的相对准确性。其中良性前列腺增生10例,前列腺癌5例。结果表明经腹超声能准确测量前列腺的前后径和宽径,长径的测量不准确;经直肠超声测定前列腺的长径和前后径较准确,经尿道超声可准确测量前列腺的前后径和宽径。经腹和直肠矢状面超声相结合,可提高超声诊断的准确性,使测量的平均误差从14%±12(SD)降到8%±7(SD)。MRI能清楚显示前列腺,而且测量准确,平均误差为6%±6(SD)。但与经腹和直肠相结合的超声相比,两种方法无显著性差异。实时超声可观察膀胱的排空功能,MRI不能。两者都不能鉴别前列腺病变组织的良恶性。作者认为MRI与超声相比具有多平面直接成像、软组织分辨率高、视野广、对恶性病变分期较准确等优点,但     

经直肠超声检查男性不育症射精管梗阻的临床价值

近年来,直肠超声在检查男性不育症射精管梗阻的应用也越来越广泛[1～4].本文收集2009年6月～2012年6月因男性不育症来我院检查的检查者28例临床资料,探讨经直肠超声在男性不育症射精管梗阻中的应用价值. 1材料与方法 本组28例患者,年龄23～45岁,平均年龄(35.4±2.3)岁,婚龄2～12年,平均婚龄(4.3±1.7)年,均有正常的性生活,未采取避孕措施.     

直肠腔内超声对前列腺及精囊疾患的诊断价值

目的：探讨直肠腔内超声对前列腺及精囊疾患的诊断价值。方法：使用频率为７ＭＨｚ的手执式直肠探头，通过Ａｃｕｓｏｎ１２８型彩色电脑声像仪，对５２例有尿频、遗尿、排尿不畅、夜尿次数增多及血精等症状男性患者，行经直肠腔内超声检查。结果：全部病例均获取满意的前列腺及精囊声像图。所检出的８例前列腺囊肿及２０例前列腺结石经腹Ｂ超均未能发现，对前列腺增生及精囊的显示，其清晰度为经腹部Ｂ超所不及。结论：本检查法可获取更为清楚的前列腺及精囊声像图，提高超声诊断的准确性     

显微镜纵行二针法输精管、附睾管吻合7例报告

据世界卫生组织(WHO)统计,全球约有10%～15%育龄夫妇因种种因素影响不能正常生育,其中男性因素占到一半,10%～20%的男性病因是由无精子症所致,附睾梗阻是梗阻性无精症最多见的一种。采用显微外科技术行输精管、附睾管吻合是近年来迅速发展的新术式,疗效良好。     

前列腺及其周围的超声解剖及临床研究

前列腺位于耻骨连合后方,膀胱颈部与尿生殖隔之间。其底在膀胱下面,其尖部位于尿生殖隔上。立体观呈前后比较薄的倒三角锤状结构,其后下方为直肠、肛门。正常前列腺横径约4cm,下上径约3cm,前后径约2cm。20～50岁几乎无变化。作者对98例前列腺作了US研究。其中正常50例,前列腺肥大37例及前列腺癌11例。正常前列腺经腹壁横断扫描,前部呈低回声,稍后部呈高回声。正确诊断率为94%。经会阴矢状扫描前列腺呈类圆形低回声,对前部区域诊断困难。正常精囊经腹壁横断扫描呈哑铃形低回声,左右对称,形态大致相等,正确诊断率为100%,而经会阴矢状扫描正确诊断率为18%。输精管呈长约5cm低回声管状结     

Role of transrectal ultrasonography in evaluating the cause of azoospermia.

OBJECTIVE: To assess the role of transrectal ultrasonography in the investigation of azoospermia, a significant cause of infertility. METHODS: Over a 2-year period, 35 patients with azoospermia underwent an infertility workup, which included transrectal ultrasonography. RESULTS: Sonograms of 10 of the 35 patients were normal; 8 patients had enlarged seminal vesicles containing cysts, 6 had ejaculatory duct dilation, 5 had seminal vesicle calcification, 3 had seminal vesicle atrophy-hypoplasia and 3 patients had midline prostatic cysts. CONCLUSION: Transrectal sonography is a useful modality to evaluate seminal duct abnormalities, some of which may cause azoospermia.     

Transrectal US and endorectal MR imaging in partial and complete obstruction of the seminal duct system. A comparative study

PURPOSE: To evaluate transrectal ultrasonography (US) and MR imaging findings of infertile patients with suspected complete or partial obstruction of the seminal duct system. MATERIAL AND METHODS: Two hundred and eighteen infertile patients with low ejaculate volume were evaluated by transrectal US. Endorectal MR imaging was performed on 62/218 patients. Prostatic cysts, ejaculatory duct (ED) dilatation (>2 mm in width), ED calculi or calcifications, seminal vesicle (SV) dilatation (a.p. diameter >15 mm), SV hypo/agenesis (a.p. diameter <7 mm), SV cysts (>5 mm), vasal agenesis and chronic prostatitis (coarse calcifications, heterogeneity in prostate) were considered significant findings for obstruction of the seminal duct system. RESULTS: Pathologic findings were detected in 75% and 61% of patients with azoospermia on transrectal US and MR imaging, respectively. Transrectal US and MR imaging did not reveal any pathologies in 64.7% and 59.1% of patients with nonazoospermia, respectively. The incidences of hypoplastic/atrophic SV (12/48 vs. 5/170), SV agenesis (6/48 vs. 1/170), vasal agenesis (5/48 vs. 1/170) were significantly higher in the azoospermic subgroup (p<0.002). CONCLUSION: US is a good method for initial evaluation of these patients especially in complete obstruction. Endorectal MR imaging should be reserved for selected patients in whom results of transrectal US are not conclusive.     

经直肠超声对输尿管中下段结石的诊断价值

目的：探讨经直肠超声在输尿管中下段结石诊断中的应用价值。方法：对150例疑似输尿管中下段结石患者,均行经直肠超声检查,并与经腹部超声对比。结果：经直肠超声对输尿管中下段结石检出率及其快闪伪像显示率均显著高于经腹部超声,且结石周边组织显示清晰。结论：经直肠超声对输尿管中下段结石有重要临床诊断价值,值得推广。     

经直肠超声诊断输尿管中下段结石

目的 :评价经直肠超声在诊断输尿管中下段结石中的价值。材料和方法 :运用经直肠超声对 2 2例输尿管中下段结石的患者进行了研究 ,并与体表超声进行比较。结果 :经直肠超声输尿管中下段结石显示率明显高于体表超声。结论 :运用经直肠超声进行扫查 ,有利于提高病灶显示率 ,是诊断输尿管中下段结石的方法之一 ,具有较高的临床应用价值 ,值得推广。     

Transrectal ultrasound in the investigation of haemospermia.

The transrectal ultrasound findings in 52 patients with haemospermia were reviewed. Scan abnormalities were demonstrated in 43 patients (83%). These included benign prostatic hyperplasia (24 patients), seminal vesicle abnormalities (10 patients), prostatic calcification (32 patients) and two patients with prostatitis. No patient was proven to have prostatic malignancy. Transrectal ultrasonography can suggest a cause of haemospermia in the majority of patients without resort to invasive investigations, and can exclude underlying prostatic malignancy. It is recommended as the first radiological investigation in patients presenting with haemospermia.     

Real-time US versus CT determination of pubic arch interference for brachytherapy

PURPOSE: Part 1, to determine whether transrectal ultrasonography (US) enables accurate determination of pubic arch interference (PAI) for prostate brachytherapy (PBT); part 2, to compare the accuracy of transrectal US with that of computed tomography (CT) for PAI determination; and part 3, to determine the cost savings of PAI determination with transrectal US versus that with CT. MATERIALS AND METHODS: Part 1: The pubic arch was identified intraoperatively with transrectal US and compared with attempted needle passage (14 patients). Part 2: Planning CT with the patient supine was compared with planning transrectal US with patients in the dorsal lithotomy position (nine patients). Part 3: Cost savings were calculated for PAI determination with transrectal US versus that with CT (32 patients per group). RESULTS: Part 1: Transrectal US accurately showed the pubic arch relative to the prostate. Part 2: CT resulted in PAI overestimation by 11.8 mm. Part 3: Cost savings with transrectal US were $1,465 per patient. CONCLUSION: Transrectal US PAI determination is easily performed, intraoperatively useful, and accurate. CT can result in PAI overestimation. Reducing direct CT costs and the indirect costs of unnecessary hormonal therapy for false-positive PAI will reduce expense and improve patient care. Transrectal US should replace CT for PAI determination.     

Imaging in male-factor obstructive infertility

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.     

Transrectal US of the seminal vesicles and ejaculatory ducts: clinical correlation

Transrectal ultrasonography (US) provides excellent anatomic detail of pathologic changes in the seminal vesicles and ejaculatory ducts. Fifty-two patients with US findings of seminal vesicle dilatation or cysts, ejaculatory duct cysts, or seminal vesicle or ejaculatory duct calculi were given questionnaires concerning a broad spectrum of genito-urinary symptoms. Compared with age-matched controls with normal US findings, patients with calculi in the seminal vesicles or ejaculatory ducts had a significantly increased prevalence of hematospermia and ejaculatory pain (P less than .01), and patients with cystic dilatation of the seminal vesicles were more likely to have perineal pain. Large midline cysts containing calculi or debris were symptomatic and probably represent müllerian duct remnants. Small cysts of the ejaculatory ducts were asymptomatic. Transrectal US may provide clinical insight into the causes of significant genitourinary symptoms that may previously have been ascribed to chronic nonbacterial prostatitis or have been considered to be idiopathic.