[Testicular Microlithiasis: Update on diagnosis and management.] / Actualidades sobre microlitiasis testicular.

Testicular microlithiasis (TM) is an uncommonurologic condition incidentally diagnosed byscrotal ultrasound. It has been associated with differentdiseases, such as Klinefelter`s syndrome, testicular atrophy,cryptorchidism, testicular torsion, and infertility.However, it can also present in healthy males that haveno associated risk factors. Currently, TM is most oftendetected thanks to the superior resolution of today's ultrasoundequipment, compared with former models. In the1990s, TM was considered a benign condition with noimportant clinical relevance, but later reports associatedit with the development of testicular neoplasias andinfertility. Thus, many authors recommended periodic surveillance with tumor markers and ultrasound imaging,with some even promoting the use of testicular biopsy.The aim of this article is to clearly and specifically presentcurrent information about testicular microlithiasis, toestablish both diagnostic and follow-up indications.

La microlitiasis testicular (MT) es un padecimiento urológico poco frecuente que se diagnostica de forma incidental mediante ltrasonografía escrotal. Ha sido asociado a diversas enfermedades como síndrome de Klinefelter, atrofia testicular, criptorquidia, torsión testicular e infertilidad. Sin embargo, también se puede encontrar en varones sanos sin factores de riesgo asociados. La microlitiasis testicular es detectada con mayor frecuencia en la actualidad, debido a la resolución superior de los equipos de ultrasonido actuales en comparación a los anteriores.  En la década de los  noventa la MT fue considerada una condición benigna sin gran relevancia clínica. Sin embargo, reportes posteriores asociaron este padecimiento al desarrollo de neoplasias testiculares e infertilidad. Por tal motivo muchos autores recomendaban la vigilancia periódica con marcadores tumorales y ultrasonido, e incluso algunos preconizaban el uso de la biopsia testicular. El objetivo del presente articulo de revisión es exponer de manera clara y especifica la evidencia actual de la microlitiasis testicular para así establecer las pautas tanto diagnósticas como de seguimiento.

[Irregular secretion of prolactin in infertile women with normoprolactinemic galactorrhea]. / Secreción irregular de prolactina en mujeres infértiles con galactorrea normoprolactinémica.

BACKGROUND: Abnormal frequency and pulse amplitud of prolactin secretion in micro and macroprolactinomas has been atributed to a dysfunctional tumoral lactotrope. Previous evidence suggests that non tumoral hyperprolactinemia is caused by a hypothalamic dysfunction. The regularity of prolactin secretion has not been studied with cuantitative methods in patients with normoprolactinemic galactorrhea (NPG) which could be considered an entity that precedes non tumoral and tumoral hyperprolactinemia. OBJECTIVE: To analyze the 24-hour prolactin secretion pattern and its secretion regularity in a group of infertile women with normoprolactinemic galatorea. PATIENTS AND METHODS: A transversal-comparative study was carried out in 6 infertile women with normoprolactinemic galactorrhea and 4 healthy women as controls. The 24 hour prolactin profile, the ratio night time mean concentration/daytime mean concentrattion (NM/DM ratio) and apparent entropy (Ap En, Ap En ratio) were compared in the two groups. RESULTS: Blunting of the nyctohemeral rythm and nocturn hyperprolactinaemia occurred in patients with normoprolactinemic galactorrhea (NPG). NM/DM ratio was lower in patients with NPG than in controls (1.28 +/- 0.25 vs. 1.75 +/- 0.05; p= 0.01). Higher irregularity of prolactin secretion was found in patients with NPG (ApEn: 0.853 +/- 0.158 vs 0.608 +/- 0.171, p=0.04; Ap En ratio: 0.839 +/- 0.11 vs 0.661 +/- 0.14; p=0.04). CONCLUSIONS: The irregularity of prolactin secretion in patients with NPG is not dependant on the presence of a pituitary tumour which suggests that a hypothalamic dysfunction underlies this condition. An irregular secretion and a higher daily mass production of prolactin in patients with NPG could explain both galactorrhea and infertility.

[Change of pulsatile release and luteinizing hormone response to naloxone related to testicle damage]. / Cambio en la secreción pulsátil y en la respuesta de la hormona luteinizante a la naloxona en relación con el daño testicular.

OBJECTIVE: To compare the pulsatile release of LH, the tone of endogenous opioids and the mass of LH secreted after a naloxone infusion in healthy subjects and patients with normogonadotropic oligospermia (NO) in a model of progressive testicular damage. PATIENTS AND METHODS: Pulsatile secretion of LH was analyzed in a period of 8 hours in a group of healthy subjects (group 3, n=5), in patients with NO and FSH/LH ratio <1.6 (group 1, n=5) and in patients with NO and FSH/LH ratio >1.6 (group 2, n=5). The area under the curve of LH response after naloxone infusion was also calculated. RESULTS: Free serum testosterone concentration was lower (p < 0.01) and estradiol concentration higher in patients with NO than control subjects (1 vs. 3: p = 0.01; 2 vs. 3: p = 0.001). Frequency of pulses in group 1 was 3.33 +/- 0.57/8 h, in group 2: 4 +/- 1/8 h; and in group 3: 2.66 - 0.57/8 h (2 vs. 3 p < 0.01; 2 vs. 1 p = 0.05). The area under the curve after naloxone infusion was 19,300.44 +/- 11,403.31 in group 1, 5696.09 +/- 1753.44 in group 2; and 3080.97 +/- 1159.78 in group 3 (1 vs. 3 Anova p = 0.01). CONCLUSIONS: The data indicate that patients with NO have a subclinical pantesticular failure and that the opioid tone is increased at the initial phase of testicular dysfunction, but it decreases at more advanced stages of testicular damage.

[Seminal quality and hormones in patients with diabetes mellitus type 2]. / Calidad seminal y hormonas en pacientes con diabetes mellitus tipo 2.

INTRODUCTION: The role of the series of metabolic derangements associated to diabetes mellitus type 2 on the function of the hypothalamic-pituitary-testicular axis and on semen quality is still controversial due in part to the lack of information about the selection criteria of subjects included in previously published studies. This is important due to the high prevalence of occult pathology of the seminal tract. OBJECTIVE: To determine if diabetes mellitus type 2 is related to hormonal or seminal disorders. PATIENTS AND METHODS: In this retrospective study serum concentration of the hormones that regulate the hypothalamic-pituitary-testicular axis and semen quality were analyzed comparatively in patients with diabetes mellitus type 2 and normoglycemic subjects. In both groups occult seminal disorders and conditions associated to the hypothalamic-pituitary-testicular axis dysfunction were discarded. RESULTS: Serum concentration of FSH was higher in patients with diabetes mellitus type 2 than in controls (6.06 +/- 2.28 vs. 4.74 +/- 1.92, p = 0.04). Serum concentration of prolactin was lower in diabetics than in controls (6.71 +/- 1.28 vs. 8 +/- 1.97, p = 0.002). The only seminal abnormality found in patients with diabetes mellitus type 2 was a lower progressive mobility (46.52 +/- 17.77 vs. 58.88 +/- 16.81, p = 0.003). CONCLUSION: This suggests that the patients with diabetes mellitus type 2 have subclinical tubular dysfunction manifested by a low sperm progressive mobility and that this might be associated to subfertility.

[Aspirated sperm activation from deferens in an ionic media similar to seminal plasma]. / Activación de espermatozoides aspirados del deferente con un medio iónico similar al plasma seminal.

OBJECTIVE: To compare motility on sperm obtained from the vas deferens and incubated in seminal plasma (PS), a ionic medium similar to seminal plasma (MA) and HTF-HEPES culture medium. MATERIAL AND METHOD: Aspirates from de proximal vas deferens were obtained in eight healthy men during vasectomy and separated in three aliquots (5-6 millions sperm/mL). Aliquots were incubated on PS, MA and HTF-HEPES. Quantitative and qualitative motility were assessed at one hour intervals. RESULTS: Sperm motility decreased 30% in the 1st hour but at the 3rd hour it increased 70% in aliquots incubated in PS and MA. Straight line velocity (VSL) also increased significatively at the 1st and 3rd hour only in aliquots incubated in PS and MA compared to aliquots incubated in HTF-HEPES (1st hour: p < 0.01; 3rd hour: p < 0.001). Curvilinear velocity (VCL) decreased at 3 hours in aliquots incubated in PS and MA compared to HTF-HEPES (P < 0.001). VCL was lower on aliquots incubated in PS compared to MA (p < 0.01). CONCLUSIONS: Sperm activation occurred in PS and MA at 3 hours. Incubation in HTF-HEPES culture medium resulted in a progressive decrease of sperm motility. This suggests that ionic/osmolar composition of PS is important for sperm activation of sperm obtained from the vas deferens.

Actualidades sobre microlitiasis testicular / No disponible

La microlitiasis testicular (MT) es un padecimiento urológico poco frecuente que se diagnostica de forma incidental mediante ltrasonografía escrotal. Ha sido asociado a diversas enfermedades como síndrome de Klinefelter, atrofia testicular, criptorquidia, torsión testicular e infertilidad. Sin embargo, también se puede encontrar en varones sanos sin factores de riesgo asociados. La microlitiasis testicular es detectada con mayor frecuencia en la actualidad, debido a la resolución superior de los equipos de ultrasonido actuales en comparación a los anteriores. En la década de los noventa la MT fue considerada una condición benigna sin gran relevancia clínica. Sin embargo, reportes posteriores asociaron este padecimiento al desarrollo de neoplasias testiculares e infertilidad. Por tal motivo muchos autores recomendaban la vigilancia periódica con marcadores tumorales y ultrasonido, e incluso algunos preconizaban el uso de la biopsia testicular. El objetivo del presente articulo de revisión es exponer de manera clara y especifica la evidencia actual de la microlitiasis testicular para así establecer las pautas tanto diagnósticas como de seguimiento

Testicular microlithiasis (TM) is an uncommon urologic condition incidentally diagnosed by scrotal ultrasound. It has been associated with different diseases, such as Klinefelter's syndrome, testicular atrophy, cryptorchidism, testicular torsion, and infertility. However, it can also present in healthy males that have no associated risk factors. Currently, TM is most often detected thanks to the superior resolution of today’s ultrasound equipment, compared with former models. In the 1990s, TM was considered a benign condition with no important clinical relevance, but later reports associated it with the development of testicular neoplasias and infertility. Thus, many authors recommended periodic surveillance with tumor markers and ultrasound imaging, with some even promoting the use of testicular biopsy. The aim of this article is to clearly and specifically present current information about testicular microlithiasis, toestablish both diagnostic and follow-up indications