UNASSIGNED: Epididymal cysts (ECs) are uncommon in the pediatric population. The objective of this study was to evaluate the frequency, clinical characteristics, and management strategies of ECs in children.
UNASSIGNED: We performed a retrospective review of pediatric scrotal ultrasounds between January 2014 and August 2022 to identify children with ECs.
UNASSIGNED: One hundred and forty-three children boys were found to have ECs, with 95 being pre-pubertal and 48 post-pubertal. The age of the patients ranged from 1 day to 18 years, with a mean age of 10.64 ± 4.55 years. The size of the cysts varied from 2 mm to 35 mm. The most common comorbidities observed were hydrocele, testicular microlithiasis and varicocele. The majority of ECs were detected through routine physical examination. Conservative management was employed for all patients, except for one who required surgical excision. Resolution of ECs occurred in 12 patients, while a reduction in cyst size was observed in 6 cases. Conversely, 2 patients experienced an increase in cyst size, and 6 patients exhibited an increase in cyst number during the follow-up period.
UNASSIGNED: Conservative management is the preferred approach for the majority of cases, with surgical intervention reserved for specific instances.

暂无摘要。

Tubular ectasia of the rete testis (TERT) presents as multiple cystic structures within the rete testis, often incidentally detected on ultrasound as echo-free intratesticular cystic lesions. Despite its benign nature, assessing testicular cystic lesions can sometimes be challenging. The primary importance of identifying this uncommon condition lies in its distinction from cystic testicular malignancies and thus avoiding further radical procedures. We report an instance of TERT within the right testis discovered incidentally in a patient with a medical background of epididymitis, presenting for management of left testis cryptorchidism, and bilateral inguinal hernia.

Contrast-enhanced ultrasound (CEUS) has emerged as a promising imaging modality for the characterization of hepatic and renal lesions. However, there is a paucity of data describing the use of CEUS for the evaluation of intra-scrotal pathology. In the following review, we describe the clinical utility of CEUS for the characterization and differentiation of common and uncommon intra-scrotal conditions, including testicular torsion, infection, trauma, and benign and malignant intratesticular and extratesticular neoplasms. In addition, we outline key principles of CEUS and provide case examples from our institution.

OBJECTIVE: To update the 2010 CNGOF clinical practice guidelines for the first-line management of infertile couples.
METHODS: Five major themes (first-line assessment of the infertile woman, first-line assessment of the infertile man, prevention of exposure to environmental factors, initial management using ovulation induction regimens, first-line reproductive surgery) were identified, enabling 28 questions to be formulated using the Patients, Intervention, Comparison, Outcome (PICO) format. Each question was addressed by a working group that had carried out a systematic review of the literature since 2010, and followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) methodology to assess the quality of the scientific data on which the recommendations were based. These recommendations were then validated during a national review by 40 national experts.
RESULTS: The fertility work-up is recommended to be prescribed according to the woman\'s age: after one year of infertility before the age of 35 and after 6months after the age of 35. A couple\'s initial infertility work-up includes a single 3D ultrasound scan with antral follicle count, assessment of tubal permeability by hysterography or HyFOSy, anti-Mullerian hormone assay prior to assisted reproduction, and vaginal swabbing for vaginosis. If the 3D ultrasound is normal, hysterosonography and diagnostic hysteroscopy are not recommended as first-line procedures. Chlamydia trachomatis serology does not have the necessary performance to predict tubal patency. Post-coital testing is no longer recommended. In men, spermogram, spermocytogram and spermoculture are recommended as first-line tests. If the spermogram is normal, it is not recommended to check the spermogram. If the spermogram is abnormal, an examination by an andrologist, an ultrasound scan of the testicles and hormonal test are recommended. Based on the data in the literature, we are unable to recommend a BMI threshold for women that would contraindicate medical management of infertility. A well-balanced Mediterranean-style diet, physical activity and the cessation of smoking and cannabis are recommended for infertile couples. For fertility concern, it is recommended to limit alcohol consumption to less than 5 glasses a week. If the infertility work-up reveals no abnormalities, ovulation induction is not recommended for normo-ovulatory women. If intrauterine insemination is indicated based on an abnormal infertility work-up, gonadotropin stimulation and ovulation monitoring are recommended to avoid multiple pregnancies. If the infertility work-up reveals no abnormality, laparoscopy is probably recommended before the age of 30 to increase natural pregnancy rates. In the case of hydrosalpinx, surgical management is recommended prior to ART, with either salpingotomy or salpingectomy depending on the tubal score. It is recommended to operate on polyps>10mm, myomas 0, 1, 2 and synechiae prior to ART. The data in the literature do not allow us to systematically recommend asymptomatic uterine septa and isthmoceles as first-line surgery.
CONCLUSIONS: Based on strong agreement between experts, we have been able to formulate updated recommendations in 28 areas concerning the initial management of infertile couples.

The role of partial epididymal obstruction as contributing to the development of oligozoospermia has been neglected for decades. In the early 1970s, however, Robert Schoysman, a gynecological surgeon devoted to the surgical and medical management of male factor infertility, dedicated many efforts to study such a pathology and its possible effects on male fertility. Following the studies of this pioneer in the field, we concentrated our attention to the patterns of partial and complete epididymal obstruction during surgical scrotal exploration, once made possible even in oligozoospermic men by diagnostic and therapeutic interventions, such as vasovesciculography or seminal tract washout test, at present considered obsolete and no longer feasible in light of the current guidelines. Interestingly, we found signs of partial epididymal obstruction in about 30% of oligozoospermic men with normal testicular volume and serum FSH level as well as normal spermatogenesis at testis biopsy. We, then, compared the findings of scrotal ultrasound with those of scrotal exploration and found that the ultrasound abnormalities of the epididymis were highly predictive of anatomic alteration of the gland. In the present study, we report our experience, together with a historical review of the literature, on this topic.

Scrotal swellings in neonates are very common. A 25-day-old male child had right-sided firm, nontender scrotal swelling. Ultrasound scan (USS) diagnosed as meconium periorchitis (MPO). At 70 days of age, repeat USS and plain abdominoscrotal radiograph confirmed MPO, and surgery was avoided. Radiological diagnosis and management of MPO are discussed.

Background and Objectives: The relationship between male infertility (MI) and testicular cancer (TC) is bilateral. On one hand, it is well-established that patients diagnosed with TC have a high risk of pre- and post-treatment infertility. On the other hand, the risk of developing TC in male infertile patients is not clearly defined. The objective of this review is to analyze the histopathological, etiological, and epidemiological associations between MI and the risk of developing testicular cancer. This review aims to provide further insights and offer a guide for assessing the risk factors for TC in infertile men. Materials and Methods: A comprehensive literature search was conducted to identify relevant studies discussing the relationship between MI and the risk of developing TC. Results: The incidence rates of germ cell neoplasia in situ (GCNIS) appear to be high in infertile men, particularly in those with low sperm counts. Most epidemiological studies have found a statistically significant risk of developing TC among infertile men compared to the general or fertile male populations. The concept of Testicular Dysgenesis Syndrome provides an explanatory model for the common etiology of MI, TC, cryptorchidism, and hypospadias. Clinical findings such as a history of cryptorchidism could increase the risk of developing TC in infertile men. Scrotal ultrasound evaluation for testis lesions and microlithiasis is important in infertile men. Sperm analysis parameters can be useful in assessing the risk of TC among infertile men. In the future, sperm and serum microRNAs (miRNAs) may be utilized for the non-invasive early diagnosis of TC and GCNIS in infertile men. Conclusions: MI is indeed a risk factor for developing testicular cancer, as demonstrated by various studies. All infertile men should undergo a risk assessment using clinical examination, ultrasound, and semen parameters to evaluate their risk of TC.

BACKGROUND: Scrotal ultrasonography is a useful, sensitive, readily available and safe imaging modality in the investigation of scrotal pathologies, including those possibly contributory to male infertility. The aim of this study was to review the scrotal ultrasound scans (SUSS) done in the University of Uyo Teaching Hospital over a period of 18 months from July 2018 to December 2019.
METHODS: This was a retrospective study of all the SUSS performed in the Department of Radiology of University of Uyo Teaching Hospital (UUTH) within an 18-month period. All subjects who presented for scrotal ultrasound with adequately filled request forms which included the biodata and clinical information were included in the study.
RESULTS: A total of 79 scans were reviewed during the period. The age range of study patients was 4 - 78 years, with a mean of 41.2 ±15 years. The modal age group was 30-39 years, made up of 20 cases (25.6%). Primary and secondary infertility were the major indications for referrals, in 17 cases (21.8%) and 13 cases (16.7%) respectively. Following SUSS, the findings were normal in 11 patients (14.1%), while hydrocele, and varicocele accounted for 19 cases (24.3%) and 9 cases (11.5%) respectively. Microlitiasis was seen in 7 cases (9%) while a diagnosis of testicular tumor was made in 5 (6.4%) of cases. Three (3) of the 5 testicular tumors, were confirmed histologically.
CONCLUSIONS: Infertility was the main indication for SUSS and hydrocele the commonest finding. Ultrasound is recommended as first line imaging modality in the investigation of scrotal lesions.
BACKGROUND: L’échographie scrotale est une modalité d’imagerie utile, sensible, facilement accessible et sûre pour l’examen des pathologies scrotales, y compris celles qui peuvent contribuer à l’infertilité masculine. L’objectif de cette étude était d’examiner les échographies scrotales (SUSS) effectuées à l’hôpital universitaire de l’Université d’Uyo sur une période de 18 mois, de juillet 2018 à décembre 2019.
UNASSIGNED: Il s’agissait d’une étude rétrospective de toutes les SUSS réalisées dans le département de radiologie de l’hôpital universitaire d’Uyo (UUTH) au cours d’une période de 18 mois. Tous les sujets qui se sont présentés pour une échographie scrotaleavec des formulaires de demande adéquatement remplis qui comprenaient des données biologiques et des informations cliniques ont été inclus dans l’étude.
UNASSIGNED: Au total, 79 échographies ont été examinées au cours de la période. L’âge des patients étudiés était compris entre 4 et 78 ans, avec une moyenne de 41,2 ±15 ans. La tranche d’âge modale était de 30 à 39 ans, soit 20 cas (25,6 %). L’infertilité primaire et secondaire était la principale indication de consultation, dans 17 cas (21,8 %) et 13 cas (16,7 %) respectivement. Après le SUSS, les résultats étaient normaux chez 11 patients (14,1 %), tandis que l’hydrocèle et la varicocèle représentaient 19 cas (24,3 %) et 9 cas (11,5 %) respectivement. La microlitiasis a été observée dans 7 cas (9 %) tandis qu’un diagnostic de tumeur testiculaire a été posé dans 5 cas (6,4 %). Trois (3) des 5 tumeurs testiculaires ont été confirmées histologiquement.
CONCLUSIONS: L’infertilité était la principale indication de SUSS et l’hydrocèle la constatation la plus fréquente. la plus fréquente. L’échographie est recommandée comme modalité d’imagerie de première ligne dans l’investigation des lésions scrotales.
UNASSIGNED: Échographie scrotale, infertilité masculine, hydrocèle, varicocèle.

The use of scrotal ultrasonography (SUS) has increased the detection rate of indeterminate testicular masses. Defining radiological characteristics that identify malignancy may reduce the number of men undergoing unnecessary radical orchidectomy.
To define which SUS or scrotal magnetic resonance imaging (MRI) characteristics can predict benign or malignant disease in pre- or post-pubertal males with indeterminate testicular masses.
This systematic review was conducted in accordance with Cochrane Collaboration guidance. Medline, Embase, Cochrane controlled trials and systematic reviews databases were searched from (1970 to 26 March 2021). Benign and malignant masses were classified using the reported reference test: i.e., histopathology, or 12 months progression-free radiological surveillance. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool (QUADAS-2).
A total of 32 studies were identified, including 1692 masses of which 28 studies and 1550 masses reported SUS features, four studies and 142 masses reported MRI features. Meta-analysis of different SUS (B-mode) values in post-pubertal men demonstrated that a size of ≤0.5 cm had a significantly lower odds ratio (OR) of malignancy compared to masses of >0.5 cm (P < 0.001). Comparison of masses of 0.6-1.0 cm and masses of >1.5 cm also demonstrated a significantly lower OR of malignancy (P = 0.04). There was no significant difference between masses of 0.6-1.0 and 1.1-1.5 cm. SUS in post-pubertal men also had a statistically significantly lower OR of malignancy for heterogenous masses vs homogenous masses (P = 0.04), hyperechogenic vs hypoechogenic masses (P < 0.01), normal vs increased enhancement (P < 0.01), and peripheral vs central vascularity (P < 0.01), respectively. There were limited data on pre-pubertal SUS, pre-pubertal MRI and post-pubertal MRI.
This meta-analysis identifies radiological characteristics that have a lower OR of malignancy and may be of value in the management of the indeterminate testis mass.