Multiparametric ultrasound for the assessment of testicular lesions with negative tumoral markers

The purpose of this study was to evaluate the diagnostic performance of multiparametric ultrasound(mpUS;grayscale US,color Doppler US,strain elastography,and contrast-enhanced US)in the assessment of testicular lesions with negative tumoral markers.MpUS imaging data,patient age,serum tumor markers,scrotal pain,cryptorchidism,and related clinical information were retrospectively collected for patients who underwent mpUS examination between January 2013 and December 2019.Histologic results or follow-up examinations were used as the reference standard.In total,83 lesions from 79 patients were included in the analysis.Fifty-six patients were finally diagnosed with benign tumors,and 23 patients were ultimately diagnosed with malignant tumors.Chi-square tests or Fisher's exact tests were used to assess the difference between the two groups.Stepwise multivariate logistic regression analysis showed that lesion diameter(odds ratio[OR]=1.072,P=0.005),vascularization on color Doppler US(OR=4.066,P=0.001),and hyperenhancement during the early phase(OR=6.465,P=0.047)were significant independent risk factors for malignancy;however,when compared with neoplastic lesions,pain(OR=0.136,P<0.001),absence of vascularization on color Doppler US(OR=1.680,P=0.042),and nonenhancement during the late phase(OR=3.461,P=0.031)were strongly associated with nonneoplastic lesions.MpUS features are useful for differentiating testicular lesions with negative tumoral markers and improving the preoperative diagnosis,which may avoid inappropriate radical orchiectomy.

Testicular ultrasound inhomogeneity is an informative parameter for fertility evaluation

Testicular volume(TV)is proposed to be a positive predictor of male fertility status,because of the relation known between the TV and the seminiferous tubule content.Independently of the measurement methodology,the role of TV and testicular ultrasound(US)assessments is still debated in andrological clinical practice.In this retrospective cohort study,we evaluated TV and testis US role in the diagnostic workup of andrological patients.All consecutive outpatients undergoing single-operator testis US(Modena,Italy)from March 2012 to March 2018 were enrolled,matching sonographic,hormonal,and seminal data.A total of 302 men were referred and evaluated for gynecomastia,suspected hypogonadism,couple infertility(Cl),or sexual dysfunction.In the hypogonadal group,TV was lower compared to that in other groups(P<0.001),and a significant,direct correlation between TV and testosterone level was observed in nonandrogen-treated patients(R=0.911,P<0.001),suggesting that testicular size could be related to the testosterone-secreting compartment.In the Cl group,normozoospermic patients showed higher TV compared to men with impaired semen quality(P=0.003)and azoospermia(P=0.003).However,TV was not able to discriminate between patients presenting normal and altered semen quality.On the contrary,testis US inhomogeneity was more frequent in patients with impaired sperm quality(55.0%;P=0.007)and azoospermia(40.0%;P=0.012),compared to patients with normozoospermia(5%),identifying thereby the sonographic pattern as an informative parameter of the fertility status.Therefore,in the Cl workup,US evaluation seems to be more informative than the TV assessment alone.

Sperm banking before gonadotoxic treatment:is it worth the effort?

We aimed to compare the sperm quality in different cancer types and benign diseases before gonadotoxic treatment,and assess the usage rate of cryopreserved sperm for assisted reproductive treatment(ART).This retrospective study was conducted at two university clinics between January 2008 and July 2018.A total of 545 patients suffering from cancer or benign diseases were included in the study.The pretreatment sperm analyses were based on the World Health Organization(WHO)guidelines.Patients with testicular malignancy(TM)showed a significantly lower sperm count(median[interquartile range]:18.7×10^(6)[5.3×10^(6)-43.0×10^(6)]ml^(-1);P=0.03)as well as total sperm count(42.4×10^(6)[13.3×10^(6)-108.5×10^(6)]per ejaculate;P=0.007)compared to other malignant and benign diseases.In addition,patients with nonseminomatous TM showed the lowest sperm count(14.3×10^(6)[6.0×10^(6)-29.9×10^(6)]ml^(-1),vs seminomas:16.5 x 106[4.6×10^(6)-20.3×10^(6)]ml^(-1);P=0.001).With reference to the WHO 2010 guidelines,approximately 48.0%of the patients with TM and 23.0%with hematological malignancies(HM)had oligozoospermia.During the observation period,only 29 patients(5.3%)used their frozen sperms for 48 ART cycles,resulting in 15 clinical pregnancies and 10 live births.The sperm quality varies with the type of underlying disease,with TM and HM patients showing the lowest sperm counts.Due to the observed low usage rate of cryopreserved sperm,further patient interviews and sperm analyses should be included in the routine oncologic protocols to avoid unnecessary storage expenses.However,sperm banking is worth the effort as it provides hope for men who cannot reproduce naturally after gonadotoxic treatment.