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1.
Zhonghua Nan Ke Xue ; 27(2): 129-133, 2021 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-34914328

RESUMO

Objective: To evaluate the effect of real-time transrectal ultrasound-guided seminal vesiculoscopy (TRUS-SVS) in the treatment of azoospermia secondary to ejaculatory duct obstruction. METHODS: This retrospective study included 40 cases of azoospermia secondary to bilateral ejaculatory ducts obstruction treated by TRUS-SVS from June 2016 to June 2018 after failure to enter the vesiculoscope through the ejaculatory duct or prostatic utricle. We analyzed the success rate of surgery, operation time, postoperative complications, treatment results, and application value of TRUS-SVS. RESULTS: Real-time TRUS-SVS was successfully performed in 36 (90.0%) of the cases, 33 through bilateral and the other 3 through unilateral seminal vesicle, with a mean operation time of (32.8 ± 16.6) min. Thirty-seven of the cases were followed up for 6-15 (mean 9.3) months, of which sperm were found in 31 at 1-3 months and in 25 at 3-12 months, and pregnancies achieved in 9 cases within 12 months after surgery. No serious complications as retrograde ejaculation, urinary incontinence and rectal injury were observed postoperatively, except 2 cases of epididymitis and 2 cases of hematuria, which were all cured. CONCLUSIONS: For the patients who failed in seminal vesiculoscopy through the ejaculatory duct or prostatic utricle, real-time TRUS-SVS is a recommended procedure with the advantages of a high success rate, less damage to the prostate and rectum, and benefit to the improvement of semen quality.


Assuntos
Azoospermia , Ductos Ejaculatórios , Azoospermia/diagnóstico por imagem , Azoospermia/etiologia , Azoospermia/cirurgia , Ductos Ejaculatórios/diagnóstico por imagem , Ductos Ejaculatórios/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Análise do Sêmen , Ultrassonografia de Intervenção
2.
BMJ Case Rep ; 14(6)2021 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-34140330

RESUMO

Zinner syndrome (ZS) is a rare congenital malformation due to abnormal development of the urogenital tract. It is caused by a growth failure of the distal part of the Müllerian duct in early embryogenesis. It is characterised by the triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst and ipsilateral ejaculatory duct obstruction. Over the years, several cases have been reported in the literature since the initial report by Zinner in 1914. This syndrome is frequently misdiagnosed because it may present different patterns and the symptoms may be not specific. In this paper, we present two patients with two different patterns of presentation of Zinner syndrome.


Assuntos
Doenças dos Genitais Masculinos , Rim Único , Ductos Ejaculatórios , Humanos , Rim/diagnóstico por imagem , Masculino , Glândulas Seminais/diagnóstico por imagem , Glândulas Seminais/cirurgia
3.
J Proteomics ; 246: 104307, 2021 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-34174476

RESUMO

Peptides present in the seminal fluid of Drosophila melanogaster can function as antimicrobial agents, enzyme inhibitors and as pheromones that elicit physiological and behavioural responses in the post-mated female. Understanding the molecular interactions by which these peptides influence reproduction requires detailed knowledge of their molecular structures. However, this information is often lacking and cannot be gleaned from just gene sequences and standard proteomic data. We now report the native structures of four seminal fluid peptides (andropin, CG42782, Met75C and Acp54A1) from the ejaculatory duct of male D. melanogaster. The mature CG42782, Met75C and Acp54A1 peptides each have a cyclic structure formed by a disulfide bond, which will reduce conformational freedom and enhance metabolic stability. In addition, the presence of a penultimate Pro in CG42782 and Met75C will help prevent degradation by carboxypeptidases. Met75C has undergone more extensive post-translational modifications with the formation of an N-terminal pyroglutamyl residue and the attachment of a mucin-like O-glycan to the side chain of Thr4. Both of these modifications are expected to further enhance the stability of the secreted peptide. The glycan has a rare zwitterionic structure comprising an O-linked N-acetyl hexosamine, a hexose and, unusually, phosphoethanolamine. A survey of various genomes showed that andropin, CG42782, and Acp54A1 are relatively recent genes and are restricted to the melanogaster subgroup. Met75C, however, was also found in members of the obscura species groups and in Scaptodrosophila lebanonensis. Andropin is related to the cecropin gene family and probably arose by tandem gene duplication, whereas CG42782, Met75C and Acp54A1 possibly emerged de novo. We speculate that the post-translational modifications that we report for these gene products will be important not only for a biological function, but also for metabolic stability and might also facilitate transport across tissue barriers, such as the blood-brain barrier of the female insect. BIOLOGICAL SIGNIFICANCE: Seminal fluid peptides of D. melanogaster function as antimicrobials, enzyme inhibitors and as pheromones, eliciting physiological and behavioural responses in the post-mated female. A fuller understanding of how these peptides influence reproduction requires knowledge not only of their primary structure, but also of their post-translational modification. However, this information is often lacking and difficult to glean from standard proteomic data. The reported modifications, including the unusual glycosylation, adds much to our knowledge of this important class of peptides in this model organism, par excellence.


Assuntos
Drosophila melanogaster , Glicopeptídeos , Animais , Drosophila melanogaster/metabolismo , Ductos Ejaculatórios/metabolismo , Feminino , Glicosilação , Masculino , Peptídeos/metabolismo , Proteômica
5.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462046

RESUMO

Congenital malformations of the seminal vesicles (SVs) are rare and are associated with abnormalities of the ipsilateral urinary tracts as embryologically both the ureteral buds and SVs arise from the mesonephric ducts. The triad of SV cysts, ipsilateral renal agenesis and ejaculatory duct obstruction is known as the Zinner syndrome. We, herein, present three very rare presentations of Zinner syndrome. Case 1 presented with haematuria, and was found to have a large SV cyst with stones and underwent a robotic cyst excision. Case 2 presented with primary infertility, and was found to have a variant of Zinner syndrome. Case 3 was a known case of chronic kidney disease on maintenance haemodialysis who presented with fever and oliguria. He was found to have Zinner syndrome and underwent aspiration of SV abscess. To the best of our knowledge, such varying presentations of Zinner syndrome have been rarely reported thus far.


Assuntos
Anormalidades Congênitas/diagnóstico , Ductos Ejaculatórios/anormalidades , Nefropatias/congênito , Rim/anormalidades , Glândulas Seminais/anormalidades , Adulto , Humanos , Nefropatias/complicações , Nefropatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Síndrome , Adulto Jovem
6.
Curr Opin Urol ; 31(1): 43-48, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33165012

RESUMO

PURPOSE OF REVIEW: The aim of this review is to provide an overview of surgical treatment options for male infertility including varicocelectomy, treatment of ejaculatory duct obstruction, vasovasostomy, and sperm extraction, and to review recent advances in techniques and technologies that may improve operative outcomes. RECENT FINDINGS: Microscopic subinguinal varicocelectomy has been shown to have the highest success rates with lowest rates of complications, and may be facilitated by the use of Doppler, indocyanine green angiography, and the 4K3D operating video microscope. The standard treatment for ejaculatory duct obstruction by transurethral resection of the ejaculatory ducts has changed little over time, but vesiculoscopy may allow for temporary dilation of an obstruction to allow for natural conception, while also offering diagnostic capabilities. Use of the robotic platform has gained popularity for vasectomy reversals but controversy remains regarding the cost-effectiveness of this option. Recently, a reinforcing suture technique has been described for vasovasostomy to minimize anastomotic breakdown and reversal failure. Finally, gray-scale and color-enhanced ultrasound may improve ability to predict successful sperm retrieval during extraction procedures. SUMMARY: Though the fundamentals of surgical treatment options for male infertility have changed little with time, technological advancements have contributed to improved surgical outcomes over recent years.


Assuntos
Infertilidade Masculina , Vasovasostomia , Ductos Ejaculatórios/diagnóstico por imagem , Ductos Ejaculatórios/cirurgia , Humanos , Infertilidade Masculina/etiologia , Infertilidade Masculina/cirurgia , Masculino , Espermatozoides
8.
Zhonghua Nan Ke Xue ; 26(10): 911-916, 2020 Nov.
Artigo em Chinês | MEDLINE | ID: mdl-33382223

RESUMO

Objective: To explore the diagnosis, classification and treatment of ectopic seminal tract opening in enlarged prostatic utricle (EPU). METHODS: We retrospectively analyzed the clinical data on 22 cases of ectopic seminal tract opening in EPU confirmed by spermography, EPU open cannula angiography or intraoperative puncture of the vas deferens and treated by transurethral incision of EPU, cold-knife incision or electric incision of EPU, full drainage of the anteriorwal, and open or laparoscopic surgery from October 1985 to October 2017. RESULTS: Five of the patients were diagnosed with ectopic opening of the vas deferens and the other 17 with ectopic opening of the ejaculatory duct in EPU. During the 3-48 months of postoperative follow-up, symptoms disappeared in all the cases, semen quality was improved in those with infertility, and 2 of the infertile patients achieved pregnancy via ICSI. CONCLUSIONS: Ectopic seminal tract opening in EPU is rare clinically. Spermography is a reliable method for the diagnosis of the disease, and its treatment should be aimed at restoring the smooth flow of semen based on proper classification and typing of the disease.


Assuntos
Doenças Urogenitais Masculinas/cirurgia , Próstata/fisiopatologia , Análise do Sêmen , Glândulas Seminais , Ductos Ejaculatórios/patologia , Ductos Ejaculatórios/cirurgia , Humanos , Masculino , Próstata/cirurgia , Estudos Retrospectivos , Glândulas Seminais/cirurgia , Ducto Deferente/patologia , Ducto Deferente/cirurgia
9.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(4): 642-645, 2020 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-32773793

RESUMO

OBJECTIVE: To evaluate the utility of transurethral seminal vesiculoscopy with a slender ureteroscope in the treatment of severe oligoasthenozoospermia secondary incomplete ejaculatory duct obstruction (EDO). METHODS: From March 2018 to September 2018, the clinical data of 8 patients with severe oligoasthenozoospermia secondary incomplete EDO treated by the technique of transurethral seminal vesiculoscopy in the Peking University Third Hospital Reproductive Center were analyzed. Preoperative routine included semen analysis, hormone determination, transrectal ultrasonography, pelvic magne-tic resonance examination and other examinations. All the patients were diagnosed with severe oligoasthenozoospermia secondary to incomplete EDO. All the patients were operated by the same surgeon with multiple cases of experience in transurethral surgery, and 1 year follow-up was conducted to evaluate the surgical effect. RESULTS: The average age of the 8 patients was 29 years, and the average operation time was 32 min. Preoperative transrectal ultrasound indicated 6 cases of ejaculatory duct cyst or Mullerian cyst, 1 case of prostate calcification and bilateral seminal vesicle dilatation. The average maximum transverse diameter of the right seminal vesicle in pelvic MRI was 33.60 mm (24.63-42.28 mm), the average maximum transverse diameter of the left seminal vesicle was 32.85 mm (25.91-44.89 mm), the ave-rage maximum antero-posterior diameter was 27.99 mm (21.36-33.12 mm), the average maximum width of the seminal vesicle duct was 10.53 mm (5.93-19.39 mm). There were 5 cases of ejaculatory duct cyst, 2 cases of seminal vesicle hemorrhage, and 1 case of Mullerian cyst. The semen volume [(2.64±0.80) mL], the sperm concentration [(49.76±8.50)×106/mL], and the motility (grade a+b) [(25.76±6.48)%] in postoperation were significantly higher than those in preoperation [(1.46±0.50) mL, (28.78±5.17)×106/mL, and (2.88±0.93)%, P < 0.05]. Two patients conceived naturally during the follow-up of 6 months after surgery. There were no severe complications, such as retrograde ejaculation, urinary incontinence or rectal injury. CONCLUSION: The technique of transurethral seminal vesiculoscopy is safe and effective for treating severe oligoasthenozoospermia secondary to incomplete EDO. However, due to the small sample size of this study, short follow-up time, and the uncertainty in seminal vesicle surgery, it still needs to be further confirmed by long-term follow-up studies with large samples.


Assuntos
Ductos Ejaculatórios , Doenças dos Genitais Masculinos , Adulto , Humanos , Masculino , Análise do Sêmen , Glândulas Seminais , Ultrassonografia
10.
Micron ; 135: 102879, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32416441

RESUMO

Popillia japonica is an invasive scarab beetle native to Japan that in 1916 invaded New Jersey in USA. From that moment onwards, the insect has spread invading several US states, Canada, the Azores, Italy and, recently, Switzerland. It is a severe agricultural pest included in the EU priority pest list being able to feed on more than 300 plant species and having an important biotic potential. The general morphology of the reproductive apparatus shows paired testes, each of them having six testicular lobes grouped in threes. From the ventral part of each testicular lobe, each containing about 20 follicles, an efferent vessel originates that fuses with the other efferent vessels to form the deferent duct. A pair of long tubular accessory glands is present. The deferent ducts and accessory glands fuse together into an ejaculatory duct before entering the aedeagus. The sperm is a typical pterygote sperm, 110 µm long, composed of a head and a tail. In the head a three-layered acrosome of about 6 µm in length and a nucleus of about 18 µm long are present. During sperm maturation two C-shaped structures appear in the cytoplasm from the opposite sides of the nucleus that then disappear in late spermatids. In the tail a typical 9 + 9 + 2 flagellar axoneme and two mitochondrial derivatives are present. Moreover, in the head-tail transition region the centriolar adjunct forms a sheath from which three elongated accessory bodies originate. Two of these accessory bodies are placed alongside the axoneme, whilst the third one is placed beneath the mitochondrial derivatives. Mature sperm are grouped in cysts containing about 256 sperm cells. A morphological comparison with related species is provided.


Assuntos
Besouros/citologia , Microscopia Eletrônica de Transmissão/métodos , Espermatogênese , Espermatozoides/citologia , Espermatozoides/ultraestrutura , Acrossomo/ultraestrutura , Animais , Núcleo Celular/ultraestrutura , Besouros/ultraestrutura , Ductos Ejaculatórios/ultraestrutura , Masculino , Testículo/ultraestrutura
11.
BMC Urol ; 20(1): 34, 2020 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-32293392

RESUMO

BACKGROUND: Persistent or recurrent haemospermia often occurs in individuals with ejaculatory duct obstruction (EDO). This study aimed to evaluate the efficacy and safety of transurethral resection of the ejaculatory duct (TURED) combined with seminal vesiculoscopy in treating persistent or recurrent haemospermia in men with EDO. METHODS: From June 2014 to March 2018, 103 consecutive patients with EDO who underwent TURED combined with seminal vesiculoscopy for persistent or recurrent haemospermia at the Department of Urology of West China Hospital were enrolled into this retrospective study. The patients were evaluated mainly by detailed history-taking and performing semen analysis, transrectal ultrasonography, and magnetic resonance imaging. RESULTS: Among the 103 patients, 79 (76.70%) had cysts of the lower male genitourinary tract; 63 (61.17%) had blood clots; and 32 (31.07%) had calculi in the seminal vesicle and/or prostatic utricle. The duration of postoperative follow-up was 12 months, and the symptoms of haemospermia disappeared in 96 (93.20%) patients. There was no significant difference in the semen PH and sperm count before and after surgery; however, the ejaculate volume and sperm motility significantly improved postoperatively. Except for two cases of acute urinary retention and one case of watery ejaculate after surgery, no severe postoperative complications, including epididymitis, urethral stricture, urinary incontinence, retrograde ejaculation, or rectal injury, were observed. CONCLUSION: TURED combined with seminal vesiculoscopy is a suitable method for the diagnosis and treatment of persistent or recurrent haemospermia in men with EDO.


Assuntos
Ductos Ejaculatórios/cirurgia , Doenças dos Genitais Masculinos/cirurgia , Hemospermia/cirurgia , Glândulas Seminais/cirurgia , Adulto , Idoso , Endoscopia , Hemospermia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Uretra , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
13.
Clin Anat ; 33(8): 1164-1175, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31894887

RESUMO

The morphology of human ejaculatory ducts has not been well established. The objective of this study was to describe macroscopic and microscopic anatomy of ejaculatory ducts. We conducted a systematic review using MEDLINE, Scopus, PubMed, and Cochrane databases. Search terms were: "ejaculatory ducts," "seminal colliculus," "prostatic utricle," "anatomy," "histology," "radiology," and "embryology." We only included studies assessing adult (>18 years) humans published before November 1, 2019. We excluded studies describing pathological ducts and case reports. Independent authors extracted data using predefined criteria. Fourteen studies were included in the qualitative synthesis. Usually, the ejaculatory ducts entered the prostate by piercing the central part of its base. Most studies identified an anteromedial curve of the ducts at the outset within the prostate, their subsequent course being a straight path towards the seminal colliculus, their terminal parts diverging immediately before joining the prostatic urethra. However, the morphology of the terminal part of the ducts was inconsistent. The mean length of the ducts ranged from 1.4 to 2.2 cm. In conclusion, the luminal diameter gradually decreased as the ducts traveled towards the seminal colliculus. Ejaculatory ducts angulate anteromedially at their onset within the prostate and travel straight towards the seminal colliculus. Their terminal parts diverge immediately before joining the prostatic urethra. However, the reported dimensions of the ducts differ among studies.


Assuntos
Ductos Ejaculatórios/ultraestrutura , Variação Anatômica , Humanos , Masculino , Próstata/anatomia & histologia , Uretra/anatomia & histologia
14.
BJU Int ; 125(2): 314-321, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30924591

RESUMO

OBJECTIVE: To report our experience in the diagnosis, minimally invasive treatment, and composition of seminal vesicle calculi (SVC). PATIENTS AND METHODS: In the present study, we evaluated 20 patients who were admitted to our hospital from January 2013 to January 2018. All the patients were diagnosed with intractable haematospermia and SVC. The diagnosis was further confirmed by seminal vesiculoscopy. SVC were removed by basket extraction; with larger SVC fragmented by holmium laser before extraction. Scanning electron microscopy, X-ray diffraction, and infrared spectroscopy were used to determine the SVC composition. RESULTS: All operations were completed successfully without surgical complications. SVC were mostly composed of hydroxyapatite and protein, suggesting that they were produced by infections. CONCLUSIONS: Seminal vesiculoscopy is a simple, minimally invasive technique that can be used for diagnostic confirmation and treatment of seminal vesiculitis with SVC. This study improves our understanding of SVC and provides a theoretical basis for the prevention of postoperative recurrence of SVC.


Assuntos
Cálculos/cirurgia , Hemospermia/cirurgia , Litotripsia/métodos , Glândulas Seminais/cirurgia , Doenças Uretrais/cirurgia , Adulto , Pesquisa Biomédica , Cálculos/diagnóstico , Ductos Ejaculatórios/diagnóstico por imagem , Ductos Ejaculatórios/cirurgia , Endoscopia , Hemospermia/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Prevenção Secundária , Glândulas Seminais/fisiopatologia , Resultado do Tratamento , Doenças Uretrais/diagnóstico , Doenças Uretrais/fisiopatologia
16.
Asian J Androl ; 22(3): 287-291, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31274477

RESUMO

Ectopic seminal tract opening is a rare congenital malformation. Until recently, there has been a lack of comprehensive reporting on the condition. The purpose of this retrospective study is to summarize the experience of diagnosis and treatment of this condition based on 28 clinical practice cases throughout the past 30 years. We conducted auxiliary examinations on such patients including routine tests, imaging examinations, and endoscopy. Among these 28 cases, there were ectopic opening of vas deferens into enlarged prostatic utricles (6 cases); ejaculatory ducts into enlarged prostatic utricles, Müllerian ducts cysts, and urethras (18 cases, 2 cases, and 1 case, respectively); and ectopic opening of the unilateral vas deferens and the contralateral ejaculatory duct into enlarged prostatic utricle (1 case). The size of the enlarged prostatic utricle, the type of ectopic seminal tract opening, and the opening's location effectively assisted in the selection of clinical treatment methods, including transurethral fenestration of the utricle, transurethral cold-knife incision, open operation, laparoscopic operation, and conservative treatment. Satisfactory effect was achieved during follow-up. In conclusion, a definite diagnosis and personalized treatment are especially important for patients with ectopic seminal tract opening.


Assuntos
Ductos Ejaculatórios/anormalidades , Uretra , Anormalidades Urogenitais/diagnóstico por imagem , Ducto Deferente/anormalidades , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Cistos/diagnóstico por imagem , Cistos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Ductos Paramesonéfricos/anormalidades , Ductos Paramesonéfricos/diagnóstico por imagem , Ductos Paramesonéfricos/cirurgia , Próstata , Estudos Retrospectivos , Anormalidades Urogenitais/cirurgia , Procedimentos Cirúrgicos Urológicos , Adulto Jovem
17.
Andrology ; 8(3): 625-636, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31880400

RESUMO

BACKGROUND: Gene expression patterns along the epididymis are established by specific transcription factor networks that coordinate region-specific functions. In rodents, the epididymis can be divided in up to 19 segments. Based on gross anatomy, the human epididymis is divided into caput, corpus, and cauda segments together with efferent ducts that occupy the proximal part of this organ. OBJECTIVES: To determine to which extent gene expression pattern is segmented along the efferent ducts and the proximal region of the epididymis in men of reproductive age. MATERIALS AND METHODS: Epididymal transcriptome profiling was performed on eight distinct regions from three donors. Microarray analysis was performed on a gene-chip microarray. Differentially expressed genes (DEGs)>2-fold change (P < .05) were clustered in relation to their intensity profiles. Overrepresented biological functions from gene ontology were searched using DAVID 6.8. Expression profiles were validated by qRT-PCR quantification of selected genes. RESULTS: There were no DEGs among segments 1-3 of efferent ducts region neither among segments 4-6 of the caput epididymis. 1058 DEGs were identified between efferent ducts and the epididymis, whereas 444 and 846 DEGs distinguished the caput from the corpus (section 7) and cauda (section 8) epididymis, respectively. A total of 131 DEGs were detected between corpus (7) and cauda (8) transcriptomes. Up-regulated DEGs in the efferent ducts were predominantly related to cilium assembly/movement and cell differentiation. Fertilization, defense, and immune responses were associated with caput epididymis (4-6), while spermatogenesis and protein binding were found all along the epididymis (4-8). DISCUSSION: The proximal human epididymis is exclusively occupied by efferent ducts with a distinct DEG profile compared with the downstream epididymal segments. Moreover, gene expression profiling revealed two regions in the human epididymis: the caput and the distal corpus/cauda region. CONCLUSIONS: Human epididymal transcriptome reveals limited DEGs, and efferent ducts have a distinct DEGs profile.


Assuntos
Ductos Ejaculatórios , Epididimo , Transcriptoma , Humanos , Masculino
18.
Development ; 146(8)2019 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-30936178

RESUMO

GEMC1 and MCIDAS are geminin family proteins that transcriptionally activate E2F4/5-target genes during multiciliogenesis, including Foxj 1 and Ccno Male mice that lacked Gemc1, Mcidas or Ccno were found to be infertile, but the origin of this defect has remained unclear. Here, we show that all three genes are necessary for the generation of functional multiciliated cells in the efferent ducts that are required for spermatozoa to enter the epididymis. In mice that are mutant for Gemc1, Mcidas or Ccno, we observed a similar spectrum of phenotypes, including thinning of the seminiferous tubule epithelia, dilation of the rete testes, sperm agglutinations in the efferent ducts and lack of spermatozoa in the epididymis (azoospermia). These data suggest that defective efferent duct development is the dominant cause of male infertility in these mouse models, and this likely extends to individuals with the ciliopathy reduced generation of multiple motile cilia with mutations in MCIDAS and CCNO.


Assuntos
Proteínas de Ciclo Celular/deficiência , DNA Glicosilases/deficiência , Ductos Ejaculatórios/metabolismo , Ductos Ejaculatórios/patologia , Infertilidade Masculina/metabolismo , Infertilidade Masculina/patologia , Proteínas Nucleares/deficiência , Animais , Proteínas de Ciclo Celular/genética , Linhagem Celular , DNA Glicosilases/genética , Epididimo/metabolismo , Epididimo/patologia , Imunofluorescência , Humanos , Imuno-Histoquímica , Infertilidade Masculina/genética , Masculino , Camundongos , Camundongos Mutantes , Proteínas Nucleares/genética , Reação em Cadeia da Polimerase em Tempo Real , Testículo/metabolismo , Testículo/patologia
19.
Fertil Steril ; 111(3): 427-443, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30827517

RESUMO

Ejaculatory duct obstruction is an uncommon but surgically correctable cause of male infertility. With the advent and increased use of high-resolution transrectal ultrasonography, anomalies of the ejaculatory ducts related to infertility have been well documented. Although there are no pathognomonic findings associated with ejaculatory duct obstruction, the diagnosis should be suspected in an infertile male with oligospermia or azoospermia with low ejaculate volume, normal secondary sex characteristics, testes, and hormonal profile, and dilated seminal vesicles, midline cyst, or calcifications on transrectal ultrasound (TRUS). Although additional larger prospective and comparative studies are needed, it appears that TRUS with aspiration is the most effective method for diagnosis. While intrusive, it is less invasive than vasography. The most robust and published evidence for treatment involves transurethral resection of ejaculatory duct (TURED). More recent experience with antegrade endoscopic approaches are promising and may also be considered. An alternative to surgeries for reversal of obstruction is sperm retrieval for in vitro fertilization/intracytoplasmic sperm injection. A thorough discussion of all alternatives, including risks and benefits, should be held with couples facing this uncommon condition to allow them to make informed decisions regarding management.


Assuntos
Azoospermia/cirurgia , Ductos Ejaculatórios/cirurgia , Endoscopia , Infertilidade Masculina/cirurgia , Recuperação Espermática , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Azoospermia/complicações , Azoospermia/diagnóstico por imagem , Azoospermia/fisiopatologia , Ductos Ejaculatórios/diagnóstico por imagem , Ductos Ejaculatórios/fisiopatologia , Endoscopia/efeitos adversos , Fertilidade , Humanos , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/etiologia , Infertilidade Masculina/fisiopatologia , Masculino , Fatores de Risco , Injeções de Esperma Intracitoplásmicas , Recuperação Espermática/efeitos adversos , Resultado do Tratamento , Ultrassonografia de Intervenção , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
20.
Sci Rep ; 9(1): 5018, 2019 03 22.
Artigo em Inglês | MEDLINE | ID: mdl-30903016

RESUMO

To investigate the surgical outcomes of vesiculoscopy on refractory hematospermia and ejaculatory duct obstruction (EDO), the clinical data (including pelvic magnetic resonance imaging (MRI) examinations and the long-term effects of endoscopic treatment) from 305 patients were analyzed. Four main etiologic groups were found on MRI. We found that 62.0% (189/305) of patients showed abnormal signal intensity in MRI investigations in the seminal vesicle (SV) area. Cystic lesions were observed in 36.7% (112/305) of the patients. The third sign was dilatation or enlargement of unilateral or bilateral SV, which were observed in 32.1% (98/305) of the patients. The fourth sign was stone formation in SV or in an adjacent cyst, which was present in 8.5% (26/305) of the patients. The transurethral endoscopy or seminal vesiculoscopy and the related procedures, including fenestration in prostatic utricle (PU), irrigation, lithotripsy, stone removal, biopsy, electroexcision, fulguration, or transurethral resection/incision of the ejaculatory duct (TURED/TUIED), chosen according to the different situations of individual patients were successfully performed in 296 patients. Fenestrations in PU+ seminal vesiculoscopy were performed in 66.6% (197/296) of cases. Seminal vesiculoscopy via the pathological opening in PU was performed in 10.8% (32/296) of cases. TURED/TUIED + seminal vesiculoscopy was performed in 12.8% (38/296) of cases, and seminal vesiculoscopy by the natural orifices of the ejaculatory duct (ED) was performed in 2.4% (7/296) of cases. Electroexcision and fulguration to the abnormal blood vessels or cavernous hemangioma at posterior urethra were performed in 7.4% (22/296) of cases. Two hundred and seventy-one patients were followed up for 6-72 months. The hematospermia of all the patients disappeared within 2-6 weeks, and 93.0% of the patients showed no further hematospermia during follow-up. No obvious postoperative complications were observed. The transurethral seminal vesiculoscopy technique and related procedures are safe and effective approaches for refractory hematospermia and EDO.


Assuntos
Endoscopia/métodos , Hemospermia/terapia , Imageamento por Ressonância Magnética/métodos , Complicações Pós-Operatórias/terapia , Glândulas Seminais/patologia , Adulto , Idoso , Cálculos/terapia , Cistos/diagnóstico por imagem , Cistos/terapia , Ductos Ejaculatórios/diagnóstico por imagem , Ductos Ejaculatórios/patologia , Ductos Ejaculatórios/fisiopatologia , Hemangioma/diagnóstico por imagem , Hemangioma/terapia , Hemospermia/diagnóstico por imagem , Hemospermia/etiologia , Humanos , Infertilidade Masculina/diagnóstico por imagem , Infertilidade Masculina/terapia , Litotripsia/métodos , Imageamento por Ressonância Magnética/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Glândulas Seminais/diagnóstico por imagem , Glândulas Seminais/cirurgia , Resultado do Tratamento , Uretra/diagnóstico por imagem , Uretra/patologia , Adulto Jovem
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