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TRANS RECTAL ULTRASOUND IN THE EVALUATION OF MALE INFERTILITY

TRANS RECTAL ULTRASOUND IN THE EVALUATION OF MALE INFERTILITY. DR. Joseph SHMUELI RABIN MEDICAL CENTER. TRUS-MALE INFERTILITY. AZOOSPERMIA - FRUCTOSE POSITIVE Idiopathic Cryptorchidism Chromosomal abnormalities Systemic disease Orchitis Neurological disease. TRUS-MALE INFERTILITY.

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TRANS RECTAL ULTRASOUND IN THE EVALUATION OF MALE INFERTILITY

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  1. TRANS RECTAL ULTRASOUND IN THE EVALUATION OF MALE INFERTILITY DR. Joseph SHMUELIRABIN MEDICAL CENTER

  2. TRUS-MALE INFERTILITY AZOOSPERMIA - FRUCTOSE POSITIVE • Idiopathic • Cryptorchidism • Chromosomal abnormalities • Systemic disease • Orchitis • Neurological disease

  3. TRUS-MALE INFERTILITY AZOOSPERMIA - FRUCTOSE NEGATIVE • Congenital - urogenital sinus - midline retrovesical CAVD • Acquired - infection - gonorrhea , prostatitis epididymitis • Trauma - prolonged catheterization

  4. TRUS-MALE INFERTILITY GENITAL TRACT OBSTRUCTION • 7% of infertile patients • Any level of ductal system • From efferent ductules to ejaculatory duct

  5. TRUS-MALE INFERTILITY • Therapy depends on the level of obstruction. (best results, no infection) • Fructose Negative- probably secondary to agenesis or obstruction of ejaculatory ducts and vas rather than absence of seminal vesicles.

  6. TRUS-MALE INFERTILITY TRANSRECTAL ULTRASOUND (TRUS) • HIGH frequency • High resolution rectal probe • Non invasive • Risk free procedure • Not expensive • Clear picture of the male ductal system

  7. TRUS-MALE INFERTILITY SHEBA STUDY • 42 patients - mean age of 29±5.6 years (range 25-40). • The mean testicular volume was 24.5±2.5 cc (range from 22 – 30 cc). • Abnormal physical examination- 29 (69%) • 17-bilateral • 12-unilateral

  8. TRUS-MALE INFERTILITY • 17 patients bilateral involvement of the vas deferens • bilateral absence or hypopalsia of the seminal vesicles with bilateral agenesis of the vas deferens with non-visualization of both ejaculatory ducts.

  9. NO SV NO VAS

  10. TRUS-MALE INFERTILITY 12 pts.– unilateral abnormality on physical examination • 7 patients -absence of the seminal vesicle • 5 patients and hypoplastic SV.

  11. TRUS-MALE INFERTILITY 5 - contra lateral SV cyst. 3 - calcification of SV

  12. TRUS-MALE INFERTILITY NORMAL PHYSICAL EXAMINATION 13 patients • 4 patients - midline cyst in the periurethral location. • 4 - bilateral cyst of SV,

  13. 3 - cystic dilation of the ED with calcification • 2 - bilateral cystic dilation of SV and ED

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