الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
Ultrasonography is a recent, rapid, harmless, cheap, painless and
non-invasive method to visualise intrascrotal contents. It has been
proved very valuable for diagnosis in many fields of medicine. It has
so far stood the test of time. We tried in this work to evaluate the
role of grey scale ultrasound in the diagnosis of the conditions of
the testes in cases of male infertility.
One hundred infertile males, who were going to be operated upon
for testicular biopsy, were the target of this study. In addition to
routine examinations and investigations for each of them, ultrasonic
examination for the testes, with a 5 MHz transducer and a grey-scale
apparatus, was done. We compared the results of the various investigations,
and the testicular biopsies with the results gained by ultrasonic
examination of their testes. Ten normal control fertile male-subjects
were taken as controls.
OUr study has revealed the following data:
The mean age of the one hundred patients was 32.66 ~ 7.5686
years. Their ages ranged from 19 to 55 years.
Of the one hundred infertile patients, 94 complained of primary
infertility and six of secondary infertility.
The mean duration of their mariages till presenting was 6.99 ~
5.764 years. This reflects late presentation of the male partner
of the infertile couple.
Ninety four patients were azoospermic, while six were oligozoospermic
with mean counts below 10 millions/mi.
Testicular biopsies for the one hundred patients revealed that
(34%) showed normal spermatogenesis, (20%) 5ertoli-cell only
syndrome, (20%) spermatogenic arrest (at different stages),
(18%) Klinefelter’s syndrome picture, (3%) progressive tubular
hyal inization, (3%) mixed 5ertol i cell, (1%) prepubertal testis
and (1%) multiple mixed lesions.
In all patients subjected to bilateral testicular biopsy, there
were no difference in histological appearance between the
right and left testes.
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- Measuring the testicular dimensions accurately by the ultrasound
apparatus. we calculated the testicular volume. The mean
testicular volume of the infertile group was generally smaller
than that of the fertile controls. We showed that testicular
volume alone is not significant and should be combined with
other parameters to be of value.
We measured electronically the transverse cross-sectional area
of each testis. We studied the possibility of using it instead
of testicular volume as an objective measure. There is a
perfect positive linear correlation between testicular volume
and testicular transverse cross-sectional area (for the right
side r = 0.885 and P <: 0.001. for the left side r = 0.98 and
P -c 0.001).
Hormonal assays including serum FSH. LH. Prolactin and testosterone
were obtained for twenty five of our patients. Their
results and their meaning were discussed. FSH level is of basic
importance in the management of azoospermic men as it shows
an inverse correlation with the gross impairment of spermatogenesis.
Our ultrasonic examination of the testes revealed that:
* The internal testicular echoes of the glandular elements showed
a granular texture of medium echogeni£ity.
* The same picture was revealed by patients whose biopsies showed
normal spermatogenesis (34%).
* The normal epididymis. vas deferens. appendix epididymis.
appendix testis and rete testis were not resolved in our study.
* Ultrasonic examination of testes of patients whose biopsies
showed Klinefelter’s syndrome. Sertoli-cell only syndrome
and spermatogenic arrest at spermatogonia showed a very characteristic
uniform pattern with hyperechoic very coarse granular
internal testicular shadows. They collectively constitute
(43%) of our series. They were of small testicular
volumes (and also of small transverse testicular cross-sectional
areas). Those patients can be selected by their characterstic
ultrasonic pattern.
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* Other testicular histopathological groups studied represented
(23%) of our series. Each of these groups has given a hyperechoic
pattern. These patterns were of variable degrees of
coarsity of the internal testicular shadows. However, their
differentiation may be confusing. Further experience is needed
to differentiate between them. Till then, testicular
biopsy will be needed for those patients (23%).
* Ultrasound has revealed other pathological conditions, e.g.:
spermatoceles, mild hydroceles and pathological enlargement
of the epididymis especially when associated with a moderate
or big hydrocele.
This work has shown that gray scale ultrasound is valid for the
study of the condition of the testes in cases of male infertility.
However, for the evaluation of its sensitivity and specificity, more
research, with different design is needed.