Color Doppler ultrasonography as a routine clinical examination in male infertility

AIM: We assessed the value of scrotal color Doppler ultrasonography as a routine examination in infertile men. METHODS: Color Doppler ultrasonography was performed in 545 infertile men with a mean age of 35.8 years to detect intrascrotal abnormalities. Findings were compared with those of physical examination. RESULTS: Intrascrotal abnormalities were detected by ultrasonography in 65.3% of patients. Of 374 abnormalities, 58.3% were undetected by physical examination. Left varicocele was found in 313 patients (57.4%); testicular microlithiasis in 30 (5.5%); epididymal cyst in 21 (3.9%); right varicocele in 4 (0.8%); and testicular cysts in 3 (0.6%). One occurrence each (0.2%) was found for testicular tumor, intrascrotal hemangioma, and hydrocele of the spermatic cord. Compared to ultrasonography, sensitivity in detecting left varicocele by physical examination was 58.4%; specificity, 79.3%; accuracy, 67.3%; and positive predictive value, 79.3%. Venous diameters in the pampiniform plexus were 3 mm or more in 61.5% of 130 subclinical left varicoceles. Of 30 patients with testicular microlithiasis, 14 had varicocele, 2 had epididymal cyst,s 3 had a history of mumps orchitis, 1 had retractile testis, and 1 had a history of orchiectomy for contralateral testicular tumor. CONCLUSIONS: The routine Color Doppler ultrasonography is valuable for diagnosing scrotal abnormalities in infertile men, frequently detecting non-palpable lesions.     

Intravenous urography in evaluation of acute retention

The intravenous urograms of 894 patients with acute retention were assessed. The total number of lesions demonstrated was less than 1 per cent; consequently the value of routine intravenous urograms in patients with acute urinary retention is questioned.     

Intravenous excretory urography using Optiray in office urology

Experiences with the nonionic contrast medium Optiray^® 300 were analyzed in 120 consecutive patients who underwent intravenous urography. Allergic diathesis was recorded prior to the examination in 12.5% of the patients, pretreatment was given in only 3 cases. The clinical safety of Optiray was outstanding, no adverse reactions were noted. Diagnostic quality of the radiographs was excellent in 78% and good in 22% of the cases. Optiray is considered to be a safe and effective contrast agent for use in intravenous excretory urography.     

Intravenous urography in evaluation of asymptomatic microscopic hematuria

BACKGROUND AND PURPOSE: In 2001, the American Urologic Association Best Practice Policy Panel recommended CT or intravenous urography (IVU) over ultrasonography as the initial imaging modality in patients with asymptomatic microhematuria. We here present results of a study initiated many years ago and completed prior to 2001 that provides information pertinent to the use of IVU as the initial imaging modality for such patients. PATIENTS AND METHODS: This study compared the results of IVU and ultrasonography in patients 40+ years of age who were referred to a single urology department for evaluation of microscopic hematuria between 1994 and 2000. There were 290 patients who agreed to participate by undergoing ultrasonography in addition to IVU; 247 completed both tests. There were 81 men and 166 women with a mean age of 56.4 years (range 40-86 years). Thirty patients (12%) were smokers. RESULTS: A renal lesion or mass suggestive of tumor was found in 8 patients (3.2%); 3 patients had this finding on the IVU examination and 5 on ultrasonography. None of the patients had such a lesion/mass on both examinations. Two patients with suspect lesions were ultimately found to have renal-cell carcinoma. Both of the patients with renal cancer had a suspect lesion on the ultrasound examination but not on the contemporaneous IVU. CONCLUSION: Intravenous urography may miss lesions/masses that lead to a diagnosis of upper-tract neoplasia.     

Importance of routine vascular nephrotomography in excretory urography

The rapid intravenous injection of a large bolus of contrast medium produces a vascular as well as a tubular nephrogram. They are additive but the vascular phase is early, intense, and brief whereas the tubular phase is less intense but more prolonged. The addition of tomography during either phase improves visualization of the renal parenchyma and its outline. A comparison study of tomography during the vascular phase (vascular nephrotomography) with that at five minutes demonstrated the superiority of the former. Our technique, data, and illustrative case abstracts are presented.     

Intravenous urography after acute urinary retention.

The results of a 12-month prospective study of 113 patients show that intravenous urography has no place in the management of men with acute urinary retention without haematuria.     

The value of routine intravenous urography in acute epididymitis

The urographies of 106 patients with acute epididymitis are reviewed. In 71 cases the urography was completely normal, while in the remaining 35 patients abnormalities were found. In 25 patients the findings were consistent with hypertrophy of the prostate. More than half of the patients had known urological diseases and had undergone cystoscopy and/or catheterization prior to the onset of acute epididymitis. All 35 patients had demonstrated symptoms that would otherwise have resulted in intravenous urography independent of the epididymitis. No cases of urogenital tuberculosis were found. The authors conclude that routine urography under the age of 50 is not recommended. Over the age of 50 concomitant urological diseases are so common that urography is often indicated, but acute epididymitis in itself is only a relative indication.     

静脉尿路造影辅助CT仿真内窥镜诊断膀胱肿瘤

目的　探讨IVU造影辅助CT仿真内窥镜 (CTVC)诊断膀胱肿瘤的临床价值。　方法　经IVU、CT仿真内窥镜检查 2 2例膀胱肿瘤病人 ,获得的图像信息与膀胱镜所见及手术结果比较分析。　结果　 2 2例病人经CTVC发现浅表乳头状瘤 18个 ,结节、团块乳头状瘤 11个 ,浸润性肿瘤1个。肿瘤直径最小 3.0mm。与膀胱镜检查及手术结果完全符合。根据CTVC图像结合断层CT扫描分析参照膀胱镜分型将膀胱肿瘤分为 3型 :(1)浅表乳头状瘤 ,(2 )结节、团块状乳头状瘤 ,(3)浸润性肿瘤。　结论　CTVC是一种新的无创检查方法 ,可以显示直径 >3.0mm突入膀胱的肿瘤和肿瘤表面特征、肿瘤与输尿管口及膀胱颈的关系、膀胱粘膜情况 ,对膀胱肿瘤诊断有较高的实用价值     

Intravenous urography with a nonionic low osmolality contrast medium (iopamidol) in elderly patients

Intravenous urography was carried out with a nonionic low osmolality contrast medium, iopamidol (Iopamiron 300) in 30 elderly patients (aged 65 to 86; with the mean age of 75 +/- 6), and the safety for the aged and radiopacity were evaluated. Although no purgative was given and water was not restricted in consideration of dehydration and bad influence on renal function, the total urinary system was well visualized. Side-effect was observed in none of 30 patients. This method seems to be useful for patients with a risk of dehydration and elderly patients.