[Unexplained male infertility and testicular microlithiasis]. / Infertilità maschile inspiegata e microlitiasi testicolare.

In this study we analyse the frequency of testicular microlithiasis in a group of otherwise infertile healthy men, visited at the Andrology Service of Prato Hospital. Here the ultrasound machine is located in the ambulatory and it is possible to use it during the first visit of the patient, as we have done in 250 consecutive infertile men. This examination, easy and not invasive, has been performed to evaluate the pampiniform plexus to find possible varicocele, epydidimis for obstructive signs and testes for the presence or absence of parenchymal calcifications or masses. We found 106 positive sonographic records (42.4%) for scrotal diseases. Between them, two cases of testicular microlithiasis (0.8% of 250 consecutive ultrasound examinations and 1.7% in the last twelve months). Our data, although with a lower incidence than literature, show the importance of ultrasound examination in absence of specific diagnostic questions too, in the study of male infertility. Clinical management of testicular microlithiasis is difficult, due to loss of treatment and to cancer risk. A long term follow up is request, with periodical (6-12 months) sonographic controls. A classification (here we propose) can be useful for a more precise monitoring.

Functional anatomy of cavernous helicine arterioles in potent subjects.

PURPOSE: We investigated the morphological and functional features of cavernous helicine arterioles in male potent subjects. MATERIALS AND METHODS: Ten young men reporting normal rigid erections which were confirmed by polysomnographic recording underwent power Doppler sonography of the cavernous helicine arterioles during flaccidity, after intracavernous injection of alprostadil, and after subsequent genital and audiovisual sexual stimulation. RESULTS: During flaccidity the helicine arterioles were never detected by power Doppler imaging while they became evident in all cases after alprostadil injection. They usually originated from the cavernous artery forming an acute angle and showed 3 orders of ramifications. Systolic and diastolic flow was present. After genital and audiovisual sexual stimulation, and achievement of maximum rigidity, the helicine arterioles were still evident but with only 1 or 2 orders of distal ramifications. Only systolic flow was present. During penile tumescence the helicine arterioles disappeared in all cases. CONCLUSIONS: Using power Doppler sonography it is possible to investigate the functional anatomy of the cavernous helicine arterioles during the various phases of the erectile cycle. Our preliminary study suggests that the helicine arterioles are functionally inactive during penile flaccidity while they are activated during penile tumescence and continue to supply blood to the corpora also during maximum penile rigidity.

[Echographic aspects of gynecomastia]. / Aspetti ecografici della ginecomastia.

Gynecomastia is a size increase of man's breast, due to non neoplastic ductal and glandular stroma proliferation. Prevalent ductal proliferation defines the "florid" type, while prevalent stroma increase defines the "quiescent" type. Pseudo-gynecomastia is a non glandular volume increase. Sonography is able to recognize the different parts of normal male breast and to diagnose gynecomastia. Moreover by sonography we can distinguish three echo-patterns linked to the anatomopathologic pattern which can lead therapy.

[Recent diagnostic and therapeutic aspects in male sexual impotence]. / Recenti aspetti diagnostici e terapeutici dell'impotenza sessuale maschile.

Male sexual impotence is the symptom of an alteration of central and peripheral mechanism neuropsychoendocrine, vascular and neurological. Nowadays it affects 8-10% of sexually active population. In some diseases, like diabetes and uremia, it can reach very high percentages of incidence. At our Andrology Center 35% of referrals are represented by sexual complaints. In the last years the diagnostic accuracy has increased, narrowing the percentage of unknown causes. Vasculopathy represents the most relevant pathological condition associated with impotence: it can affect both arterial and venous vessels. The new medical technologies and procedures permit an increase of the life span but often affecting the quality of life. Therefore, the iatrogenic causes of impotence, both pharmacological and surgical, are growing. A modern diagnostic approach starts with an accurate clinical history and physical examination, followed by an NPT (nocturnal penile tumescence) test and/or ICI (intracavernosal injection) with a standard dose of PGE1 and Doppler flowmetry of penile arteries. An endocrine evaluation (LH, testosterone and prolactin) is also performed. Further investigation of a vascular dysfunction is represented by more invasive procedures, like arteriography, cavernosography and cavernosometry. A suspect of neurological disease is confirmed by sacral evoked potentials. According to the findings of these examinations, a correct therapeutical approach can be applied in 100% of cases. An endocrine treatment is adequate only when a clear reduction of T plasma level or hyperprolactinemia are present. The treatment of other central disorders causing psychoneuroendocrine impotence is promising, but still under investigation. The intracavernosal injection of vasoactive drugs, apart from having revolutionized the diagnostic approach to the impotent patient, represents a clear standpoint in medical management of impotence, particularly in vascular and neurological diseases. The great advancement in the technology of penile prostheses has allowed the development of valuable and reliable tools to be used in selected cases.

[Defects in canalization of seminal pathways]. / I difetti di canalizzazione delle vie seminali.

We assessed the value of ultra sonography in diagnosis and grading the alterations in canalization of seminal pathways. After clinical examination and semen analysis, we studied 4100 patients by scrotal US with sector mechanical (7.5 MHz) probe with water bag and by transrectal US for prostatic vesicular region evaluation with 5-6.5 MHz linear probe (lately we used biplanar probe). In three cases, we performed us guided aspiration and contrast media injection of prostatic cavity. In 63 cases (1.53%) we found developmental malformations of seminal vesicles. The abnormality was bilaterally in 33% and it was associated with malformations of urinary tract in 17.46%. Other malformations were found in 0.12% cases. Ultrasonography was always able to establish obstruction level and type, and the possible associated abnormalities. US permitted to avoid or to restrict testis biopsy or vasoseminal vesiculogram. Ultrasonography is eventually able to guide second level diagnostic examination (aspiration biopsy and contrast media injection of prostatic cysts) and endourethral approach to drainage.