Ultrasound in Male Infertility

  • Landon W. Trost
  • David D. Casalino
  • Robert E. Brannigan


Introduction: Ultrasonography is commonly utilized in the evaluation and diagnosis of male-factor infertility and functions as an adjunctive method for use with assisted reproductive techniques. In addition to the ability to visualize anatomic detail in real time, enhancements of Doppler, power Doppler, and duplex Doppler provide information on underlying physiologic and pathologic processes.

Methods: A PubMed literature review was performed of indexed articles relating to the use of ultrasonography in the evaluation and treatment of male-factor infertility. Treatment results and outcomes are reported where available.

Results: Scrotal and transrectal ultrasonographies assist in differentiating various etiologies for infertility including infectious, benign, and malignant processes of the epididymis, testicle, prostate, and seminal vesicles. Ultrasonography helps to differentiate between obstructive and nonobstructive oligo-/azoospermia and may identify conditions associated with infertility including renal anomalies and testicular malignancies. Although there is currently minimal data on the use of ultrasonography in sperm extraction procedures, limited reports have suggested potential utility to enhance outcomes at the time of sperm extraction.

Conclusions: Ultrasonography provides significant information for both the initial evaluation and diagnosis of male-factor infertility and may be used concomitantly at the time of surgery for the management of select obstructive etiologies. As ultrasound technology continues to improve, it may potentially play an increasingly central role in the management of the infertile male.


Infertile Male Transrectal Ultrasonography Testicular Volume Testicular Microlithiasis Sperm Density 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Congenital bilateral absence of the vas deferens


Ejaculatory duct obstruction


Male accessory gland infection


Seminal vesicle


Testicular sperm extraction


Transrectal ultrasonography


Transurethral resection of ejaculatory duct


  1. 1.
    Brugh 3rd VM, Matschke HM, Lipshultz LI. Male factor infertility. Endocrinol Metab Clin North Am. 2003;32:689.PubMedGoogle Scholar
  2. 2.
    Jaffe SB, Jewelewicz R. The basic infertility investigation. Fertil Steril. 1991;56:599.PubMedGoogle Scholar
  3. 3.
    Bablok L, Dziadecki W, Szymusik I, et al. Patterns of infertility in Poland – multicenter study. Neuro Endocrinol Lett. 2012;32:799.Google Scholar
  4. 4.
    Chiamchanya C, Su-angkawatin W. Study of the causes and the results of treatment in infertile couples at Thammasat Hospital between 1999–2004. J Med Assoc Thai. 2008;91:805.PubMedGoogle Scholar
  5. 5.
    Sundby J. Methodological considerations in the study of frequency, risk factors and outcome of reduced fertility. Scand J Soc Med. 1989;17:135.PubMedGoogle Scholar
  6. 6.
    Wilkes S, Chinn DJ, Murdoch A, et al. Epidemiology and management of infertility: a population-based study in UK primary care. Fam Pract. 2009;26:269.PubMedGoogle Scholar
  7. 7.
    Hull MG, Glazener CM, Kelly NJ, et al. Population study of causes, treatment, and outcome of infertility. BMJ. 1985;291:1693.PubMedGoogle Scholar
  8. 8.
    Milardi D, Grande G, Sacchini D, et al. Male fertility and reduction in semen parameters: a single tertiary-care center experience. Int J Endocrinol. 2012;2012:649149.PubMedCentralPubMedGoogle Scholar
  9. 9.
    Thonneau P, Marchand S, Tallec A, et al. Incidence and main causes of infertility in a resident population (1,850,000) of three French regions (1988–1989). Human Reprod. 1991;6:811.Google Scholar
  10. 10.
    Male Infertility Best Practice Policy Committee of the American Urological Association; Practice Committee of the American Society for Reproductive Medicine. Report on optimal evaluation of the infertile male. Fertil Steril. 2006;86(5 Suppl 1):S202–9.Google Scholar
  11. 11.
    Male Infertility Best Practice Policy Committee of the American Urological Association; Practice Committee of the American Society for Reproductive Medicine. Report on evaluation of the azoospermic male. Fertil Steril. 2006;86(5 Suppl 1):S210–5.Google Scholar
  12. 12.
    Practice Committee of the American Society for Reproductive Medicine. Report on management of obstructive azoospermia. Fertil Steril. 2006;86(5 Suppl 1):S259–63.Google Scholar
  13. 13.
    American Society for Reproductive Medicine. Report on varicocele and infertility. Fertil Steril. 2008;90:S247–249.Google Scholar
  14. 14.
    Dohle GR, Colpi GM, Hargreave TB, et al. EAU guidelines on male infertility. Eur Urol. 2005;48:703.PubMedGoogle Scholar
  15. 15.
    Pierik FH, Dohle GR, van Muiswinkel JM, et al. Is routine scrotal ultrasound advantageous in infertile men? J Urol. 1999;162:1618.PubMedGoogle Scholar
  16. 16.
    Sakamoto H, Saito K, Shichizyo T, et al. Color Doppler ultrasonography as a routine clinical examination in male infertility. Int J Urol. 2006;13:1073.PubMedGoogle Scholar
  17. 17.
    Qublan HS, Al-Okoor K, Al-Ghoweri AS, et al. Sonographic spectrum of scrotal abnormalities in infertile men. J Clin Ultrasound. 2007;35:437.PubMedGoogle Scholar
  18. 18.
    Grasso M, Blanco S, Raber M, et al. Elasto-sonography of the testis: preliminary experience. Arch Ital Urol Androl. 2010;82:160.PubMedGoogle Scholar
  19. 19.
    Nashan D, Behre HM, Grunert JH, et al. Diagnostic value of scrotal sonography in infertile men: report on 658 cases. Andrologia. 1990;22:387.PubMedGoogle Scholar
  20. 20.
    Wise GJ, Marella VK. Genitourinary manifestations of tuberculosis. Urol Clin North Am. 2003;30:111.PubMedGoogle Scholar
  21. 21.
    Everaert K, Mahmoud A, Depuydt C, et al. Chronic prostatitis and male accessory gland infection – is there an impact on male infertility (diagnosis and therapy)? Andrologia. 2003;35:325.PubMedGoogle Scholar
  22. 22.
    La Vignera S, Condorelli R, D’Agata R, et al. Semen alterations and flow-cytometry evaluation in patients with male accessory gland infections (MAGI). J Endocrinol Invest. 2012;35(2):219–23.PubMedGoogle Scholar
  23. 23.
    Lotti F, Corona G, Mancini M, et al. Ultrasonographic and clinical correlates of seminal plasma interleukin-8 levels in patients attending an andrology clinic for infertility. Int J Androl. 2011;34:600.PubMedGoogle Scholar
  24. 24.
    Weidner W, Krause W, Ludwig M. Relevance of male accessory gland infection for subsequent fertility with special focus on prostatitis. Hum Reprod Update. 1999;5:421.PubMedGoogle Scholar
  25. 25.
    Huwe P, Diemer T, Ludwig M, et al. Influence of different uropathogenic microorganisms on human sperm motility parameters in an in vitro experiment. Andrologia. 1998;30 Suppl 1:55.PubMedGoogle Scholar
  26. 26.
    Zahalsky MP, Berman AJ, Nagler HM. Evaluating the risk of epididymal injury during hydrocelectomy and spermatocelectomy. J Urol. 2004;171:2291.PubMedGoogle Scholar
  27. 27.
    Kauffman EC, Kim HH, Tanrikut C, et al. Microsurgical spermatocelectomy: technique and outcomes of a novel surgical approach. J Urol. 2011;185:238.PubMedGoogle Scholar
  28. 28.
    Wang ZQ, Li FH, Du J, et al. Ultrasonographic features of epididymides in obstructive azoospermia. Zhonghua Nan Ke Xue. 2010;16:984.PubMedGoogle Scholar
  29. 29.
    Cocuzza M, Athayde KS, Alvarenga C, et al. Grade 3 varicocele in fertile men: a different entity. J Urol. 2012;187(4):1363–8.PubMedGoogle Scholar
  30. 30.
    Vasilios S, Charalampos L, Elias P, et al. Ultrasound findings of an intratesticular varicocele. Report of a new case and review of the literature. Int Urol Nephrol. 2006;38:115.PubMedGoogle Scholar
  31. 31.
    Trum JW, Gubler FM, Laan R, et al. The value of palpation, varicoscreen contact thermography and colour Doppler ultrasound in the diagnosis of varicocele. Hum Reprod. 1996;11:1232.PubMedGoogle Scholar
  32. 32.
    Chiou RK, Anderson JC, Wobig RK, et al. Color Doppler ultrasound criteria to diagnose varicoceles: correlation of a new scoring system with physical examination. Urology. 1997;50:953.PubMedGoogle Scholar
  33. 33.
    MacLeod J. Seminal cytology in the presence of varicocele. Fertil Steril. 1965;16:735.PubMedGoogle Scholar
  34. 34.
    Al-Ali BM, Marszalek M, Shamloul R, et al. Clinical parameters and semen analysis in 716 Austrian patients with varicocele. Urology. 2010;75:1069.PubMedGoogle Scholar
  35. 35.
    Glazier DB, Marmar JL, Diamond SM, et al. A modified acrosome induction test. Arch Androl. 2000;44:59.PubMedGoogle Scholar
  36. 36.
    Dohle GR, Colpi GM, Hargreave TB, et al. EAU guidelines on male infertility. Eur Urol. 2005;48:703.PubMedGoogle Scholar
  37. 37.
    Zheng YQ, Gao X, Li ZJ, et al. Efficacy of bilateral and left varicocelectomy in infertile men with left clinical and right subclinical varicoceles: a comparative study. Urology. 2009;73:1236.PubMedGoogle Scholar
  38. 38.
    Marmar JL, Agarwal A, Prabakaran S, et al. Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis. Fertil Steril. 2007;88:639.PubMedGoogle Scholar
  39. 39.
    Agarwal A, Deepinder F, Cocuzza M, et al. Efficacy of varicocelectomy in improving semen parameters: new meta-analytical approach. Urology. 2007;70:532.PubMedGoogle Scholar
  40. 40.
    Zorba UO, Sanli OM, Tezer M, et al. Effect of infertility duration on postvaricocelectomy sperm counts and pregnancy rates. Urology. 2009;73:767.PubMedGoogle Scholar
  41. 41.
    Romeo C, Santoro G. Varicocele and infertility: why a prevention? J Endocrinol Invest. 2009;32:559.PubMedGoogle Scholar
  42. 42.
    Kondoh N, Meguro N, Matsumiya K, et al. Significance of subclinical varicocele detected by scrotal sonography in male infertility: a preliminary report. J Urol. 1993;150:1158.PubMedGoogle Scholar
  43. 43.
    Sakamoto H, Ogawa Y, Yoshida H. Relationship between testicular volume and varicocele in patients with infertility. Urology. 2008;71:104.PubMedGoogle Scholar
  44. 44.
    Donkol RH, Salem T. Paternity after varicocelectomy: preoperative sonographic parameters of success. J Ultrasound Med. 2007;26:593.PubMedGoogle Scholar
  45. 45.
    Hussein AF. The role of color Doppler ultrasound in prediction of the outcome of microsurgical subinguinal varicocelectomy. J Urol. 2006;176:2141.PubMedGoogle Scholar
  46. 46.
    El-Haggar S, Nassef S, Gadalla A, et al. Ultrasonographic parameters of the spermatic veins at the inguinal and scrotal levels in varicocele diagnosis and post-operative repair. Andrologia. 2012;44(3):210–3.PubMedGoogle Scholar
  47. 47.
    Jequier AM, Ansell ID, Bullimore NJ. Congenital absence of the vasa deferentia presenting with infertility. J Androl. 1985;6:15.PubMedGoogle Scholar
  48. 48.
    Bromage SJ, Falconer DA, Lieberman BA, et al. Sperm retrieval rates in subgroups of primary azoospermic males. Eur Urol. 2007;51:534.PubMedGoogle Scholar
  49. 49.
    Raviv G, Mor Y, Levron J, et al. Role of transrectal ultrasonography in the evaluation of azoospermic men with low-volume ejaculate. J Ultrasound Med. 2006;25:825.PubMedGoogle Scholar
  50. 50.
    Cornud F, Amar E, Hamida K, et al. Imaging in male hypofertility and impotence. BJU Int. 2000;86 Suppl 1:153.PubMedGoogle Scholar
  51. 51.
    Hall S, Oates RD. Unilateral absence of the scrotal vas deferens associated with contralateral mesonephric duct anomalies resulting in infertility: laboratory, physical and radiographic findings, and therapeutic alternatives. J Urol. 1993;150:1161.PubMedGoogle Scholar
  52. 52.
    Sakamoto H, Yajima T, Suzuki K, et al. Cystic fibrosis transmembrane conductance regulator (CFTR) gene mutation associated with a congenital bilateral absence of vas deferens. Int J Urol. 2008;15:270.PubMedGoogle Scholar
  53. 53.
    Cornud F, Belin X, Delafontaine D, et al. Imaging of obstructive azoospermia. Eur Radiol. 1997;7:1079.PubMedGoogle Scholar
  54. 54.
    Donohue RE, Fauver HE. Unilateral absence of the vas deferens. A useful clinical sign. JAMA. 1989;261:1180.PubMedGoogle Scholar
  55. 55.
    Augarten A, Yahav Y, Kerem BS, et al. Congenital bilateral absence of vas deferens in the absence of cystic fibrosis. Lancet. 1994;344:1473.PubMedGoogle Scholar
  56. 56.
    Sakamoto H, Saito K, Oohta M, et al. Testicular volume measurement: comparison of ultrasonography, orchidometry, and water displacement. Urology. 2007;69:152.PubMedGoogle Scholar
  57. 57.
    Sakamoto H, Saito K, Ogawa Y, et al. Testicular volume measurements using Prader orchidometer versus ultrasonography in patients with infertility. Urology. 2007;69:158.PubMedGoogle Scholar
  58. 58.
    Lenz S, Thomsen JK, Giwercman A, et al. Ultrasonic texture and volume of testicles in infertile men. Hum Reprod. 1994;9:878.PubMedGoogle Scholar
  59. 59.
    Bujan L, Mieusset R, Mansat A, et al. Testicular size in infertile men: relationship to semen characteristics and hormonal blood levels. Br J Urol. 1989;64:632.PubMedGoogle Scholar
  60. 60.
    Sakamoto H, Ogawa Y, Yoshida H. Relationship between testicular volume and testicular function: comparison of the Prader orchidometric and ultrasonographic measurements in patients with infertility. Asian J Androl. 2008;10:319.PubMedGoogle Scholar
  61. 61.
    Arai T, Kitahara S, Horiuchi S, et al. Relationship of testicular volume to semen profiles and serum hormone concentrations in infertile Japanese males. Int J Fertil Womens Med. 1998;43:40.PubMedGoogle Scholar
  62. 62.
    Sakamoto H, Yajima T, Nagata M, et al. Relationship between testicular size by ultrasonography and testicular function: measurement of testicular length, width, and depth in patients with infertility. Int J Urol. 2008;15:529.PubMedGoogle Scholar
  63. 63.
    Battaglia C, Pasini A, Mancini F, et al. Role of intratesticular ultrasonographic and Doppler flow analyses in evaluating gonadal status in male survivors of childhood malignancy. Fertil Steril. 2005;83:1867.PubMedGoogle Scholar
  64. 64.
    Tarhan S, Gumus B, Gunduz I, et al. Effect of varicocele on testicular artery blood flow in men – color Doppler investigation. Scand J Urol Nephrol. 2003;37:38.PubMedGoogle Scholar
  65. 65.
    Herwig R, Tosun K, Schuster A, et al. Tissue perfusion-controlled guided biopsies are essential for the outcome of testicular sperm extraction. Fertil Steril. 2007;87:1071.PubMedGoogle Scholar
  66. 66.
    Schurich M, Aigner F, Frauscher F, et al. The role of ultrasound in assessment of male fertility. Eur J Obstet Gynecol Reprod Biol. 2009;144 Suppl 1:S192.PubMedGoogle Scholar
  67. 67.
    Unsal A, Turgut AT, Taskin F, et al. Resistance and pulsatility index increase in capsular branches of testicular artery: indicator of impaired testicular microcirculation in varicocele? J Clin Ultrasound. 2007;35:191.PubMedGoogle Scholar
  68. 68.
    Moon MH, Kim SH, Cho JY, et al. Scrotal US for evaluation of infertile men with azoospermia. Radiology. 2006;239:168.PubMedGoogle Scholar
  69. 69.
    Foresta C, Garolla A, Bettella A, et al. Doppler ultrasound of the testis in azoospermic subjects as a parameter of testicular function. Hum Reprod. 1998;13:3090.PubMedGoogle Scholar
  70. 70.
    Toppari J, Kaleva M. Maldescendus testis. Horm Res. 1999;51:261.PubMedGoogle Scholar
  71. 71.
    Ritzen EM, Bergh A, Bjerknes R, et al. Nordic consensus on treatment of undescended testes. Acta Paediatr. 2007;96:638.PubMedGoogle Scholar
  72. 72.
    Lee PA. Fertility after cryptorchidism: epidemiology and other outcome studies. Urology. 2005;66:427.PubMedGoogle Scholar
  73. 73.
    Wiser A, Raviv G, Weissenberg R, et al. Does age at orchidopexy impact on the results of testicular sperm extraction? Reprod Biomed Online. 2009;19:778.PubMedGoogle Scholar
  74. 74.
    Tasian GE, Copp HL. Diagnostic performance of ultrasound in nonpalpable cryptorchidism: a systematic review and meta-analysis. Pediatrics. 2011;127:119.PubMedGoogle Scholar
  75. 75.
    Dieckmann KP, Pichlmeier U. Clinical epidemiology of testicular germ cell tumors. World J Urol. 2004;22:2.PubMedGoogle Scholar
  76. 76.
    Onur MR, Firdolas F, Onur R, et al. Scrotal ultrasonography: should it be used in routine evaluation of infertile men? Andrologia. 2008;40:58.PubMedGoogle Scholar
  77. 77.
    Phillips N, Jequier AM. Early testicular cancer: a problem in an infertility clinic. Reprod Biomed Online. 2007;15:520.PubMedGoogle Scholar
  78. 78.
    Kanto S, Takahashi K, Maehara I, et al. Incidental testicular cancers that subsequently developed in oligozoospermic and azoospermic patients: report of three cases. Fertil Steril. 2007;88:1374.PubMedGoogle Scholar
  79. 79.
    Older RA, Watson LR. Tubular ectasia of the rete testis: a benign condition with a sonographic appearance that may be misinterpreted as malignant. J Urol. 1994;152:477.PubMedGoogle Scholar
  80. 80.
    Colangelo SM, Fried K, Hyacinthe LM, et al. Tubular ectasia of the rete testis: an ultrasound diagnosis. Urology. 1995;45:532.PubMedGoogle Scholar
  81. 81.
    Jequier AM, Phillips N. Cystic dilatation of the rete testis: a hidden diagnosis among infertile men. Reprod Biomed Online. 2009;18:190.PubMedGoogle Scholar
  82. 82.
    Ross LS, Flom LS. Azoospermia: a complication of hydrocele repair in a fertile population. J Urol. 1991;146:852.PubMedGoogle Scholar
  83. 83.
    Zendejas B, Zarroug AE, Erben YM, et al. Impact of childhood inguinal hernia repair in adulthood: 50 years of follow-up. J Am Coll Surg. 2010;211:762.PubMedGoogle Scholar
  84. 84.
    Osegbe DN. Testicular function after unilateral bacterial epididymo-orchitis. Eur Urol. 1991;19:204.PubMedGoogle Scholar
  85. 85.
    Weidner W, Garbe C, Weissbach L, et al. Initial therapy of acute unilateral epididymitis using ofloxacin. II. Andrological findings. Urologe A. 1990;29:277.PubMedGoogle Scholar
  86. 86.
    Beard CM, Benson Jr RC, Kelalis PP, et al. The incidence and outcome of mumps orchitis in Rochester, Minnesota, 1935 to 1974. Mayo Clin Proc. 1977;52:3.PubMedGoogle Scholar
  87. 87.
    Mikuz G, Damjanov I. Inflammation of the testis, epididymis, peritesticular membranes, and scrotum. Pathol Annu. 1982;17(Pt 1):101.PubMedGoogle Scholar
  88. 88.
    Yeniyol CO, Sorguc S, Minareci S, et al. Role of interferon-alpha-2B in prevention of testicular atrophy with unilateral mumps orchitis. Urology. 2000;55:931.PubMedGoogle Scholar
  89. 89.
    Powell TM, Tarter TH. Management of nonpalpable incidental testicular masses. J Urol. 2006;176:96.PubMedGoogle Scholar
  90. 90.
    Raman JD, Nobert CF, Goldstein M. Increased incidence of testicular cancer in men presenting with infertility and abnormal semen analysis. J Urol. 2005;174:1819.PubMedGoogle Scholar
  91. 91.
    Carmignani L, Gadda F, Mancini M, et al. Detection of testicular ultrasonographic lesions in severe male infertility. J Urol. 2004;172:1045.PubMedGoogle Scholar
  92. 92.
    Eifler Jr JB, King P, Schlegel PN. Incidental testicular lesions found during infertility evaluation are usually benign and may be managed conservatively. J Urol. 2008;180:261.PubMedGoogle Scholar
  93. 93.
    Jacobsen R, Bostofte E, Engholm G, et al. Risk of testicular cancer in men with abnormal semen characteristics: cohort study. BMJ. 2000;321:789.PubMedGoogle Scholar
  94. 94.
    Carmignani L, Gadda F, Gazzano G, et al. High incidence of benign testicular neoplasms diagnosed by ultrasound. J Urol. 2003;170:1783.PubMedGoogle Scholar
  95. 95.
    Hopps CV, Goldstein M. Ultrasound guided needle localization and microsurgical exploration for incidental nonpalpable testicular tumors. J Urol. 2002;168:1084.PubMedGoogle Scholar
  96. 96.
    Leonhartsberger N, Ramoner R, Aigner F, et al. Increased incidence of Leydig cell tumours of the testis in the era of improved imaging techniques. BJU Int. 2011;108:1603.PubMedGoogle Scholar
  97. 97.
    Toren PJ, Roberts M, Lecker I, et al. Small incidentally discovered testicular masses in infertile men – is active surveillance the new standard of care? J Urol. 2010;183:1373.PubMedGoogle Scholar
  98. 98.
    Ron-El R, Strauss S, Friedler S, et al. Serial sonography and colour flow Doppler imaging following testicular and epididymal sperm extraction. Hum Reprod. 1998;13:3390.PubMedGoogle Scholar
  99. 99.
    Serter S, Gumus B, Unlu M, et al. Prevalence of testicular microlithiasis in an asymptomatic population. Scand J Urol Nephrol. 2006;40:212.PubMedGoogle Scholar
  100. 100.
    Yee WS, Kim YS, Kim SJ, et al. Testicular microlithiasis: prevalence and clinical significance in a population referred for scrotal ultrasonography. Korean J Urol. 2011;52:172.PubMedCentralPubMedGoogle Scholar
  101. 101.
    Aizenstein RI, DiDomenico D, Wilbur AC, et al. Testicular microlithiasis: association with male infertility. J Clin Ultrasound. 1998;26:195.PubMedGoogle Scholar
  102. 102.
    Cast JE, Nelson WM, Early AS, et al. Testicular microlithiasis: prevalence and tumor risk in a population referred for scrotal sonography. AJR Am J Roentgenol. 2000;175:1703.PubMedGoogle Scholar
  103. 103.
    Lam DL, Gerscovich EO, Kuo MC, et al. Testicular microlithiasis: our experience of 10 years. J Ultrasound Med. 2007;26:867.PubMedGoogle Scholar
  104. 104.
    Sakamoto H, Shichizyou T, Saito K, et al. Testicular microlithiasis identified ultrasonographically in Japanese adult patients: prevalence and associated conditions. Urology. 2006;68:636.PubMedGoogle Scholar
  105. 105.
    Meissner A, Mamoulakis C, de la Rosette JJ, et al. Clinical update on testicular microlithiasis. Curr Opin Urol. 2009;19:615.PubMedGoogle Scholar
  106. 106.
    Bhatt S, Dogra VS. Role of US in testicular and scrotal trauma. Radiographics. 2008;28:1617.PubMedGoogle Scholar
  107. 107.
    Vijayaraghavan SB. Sonographic differential diagnosis of acute scrotum: real-time whirlpool sign, a key sign of torsion. J Ultrasound Med. 2006;25:563.PubMedGoogle Scholar
  108. 108.
    Paltiel HJ, Kalish LA, Susaeta RA, et al. Pulse-inversion US imaging of testicular ischemia: quantitative and qualitative analyses in a rabbit model. Radiology. 2006;239:718.PubMedGoogle Scholar
  109. 109.
    Lin WW, Kim ED, Quesada ET, et al. Unilateral testicular injury from external trauma: evaluation of semen quality and endocrine parameters. J Urol. 1998;159:841.PubMedGoogle Scholar
  110. 110.
    Arap MA, Vicentini FC, Cocuzza M, et al. Late hormonal levels, semen parameters, and presence of antisperm antibodies in patients treated for testicular torsion. J Androl. 2007;28:528.PubMedGoogle Scholar
  111. 111.
    Romeo C, Impellizzeri P, Arrigo T, et al. Late hormonal function after testicular torsion. J Pediatr Surg. 2010;45:411.PubMedGoogle Scholar
  112. 112.
    Anderson MJ, Dunn JK, Lipshultz LI, et al. Semen quality and endocrine parameters after acute testicular torsion. J Urol. 1992;147:1545.PubMedGoogle Scholar
  113. 113.
    Taskinen S, Taskinen M, Rintala R. Testicular torsion: orchiectomy or orchiopexy? J Pediatr Urol. 2008;4:210.PubMedGoogle Scholar
  114. 114.
    Engin G, Kadioglu A, Orhan I, et al. Transrectal US and endorectal MR imaging in partial and complete obstruction of the seminal duct system. A comparative study. Acta Radiol. 2000;41:288.PubMedGoogle Scholar
  115. 115.
    Parsons RB, Fisher AM, Bar-Chama N, et al. MR imaging in male infertility. Radiographics. 1997;17:627.PubMedGoogle Scholar
  116. 116.
    Jarow JP. Transrectal ultrasonography of infertile men. Fertil Steril. 1993;60:1035.PubMedGoogle Scholar
  117. 117.
    Tuziak T, Spiess PE, Abrahams NA, et al. Multilocular cystadenoma and cystadenocarcinoma of the prostate. Urol Oncol. 2007;25:19.PubMedGoogle Scholar
  118. 118.
    Park JP, Cho NH, Oh YT, et al. Giant multilocular prostatic cystadenoma presenting with obstructive aspermia. Yonsei Med J. 2007;48:554.PubMedCentralPubMedGoogle Scholar
  119. 119.
    Goluboff ET, Stifelman MD, Fisch H. Ejaculatory duct obstruction in the infertile male. Urology. 1995;45:925.PubMedGoogle Scholar
  120. 120.
    Donkol RH. Imaging in male-factor obstructive infertility. World J Radiol. 2010;2:172.PubMedCentralPubMedGoogle Scholar
  121. 121.
    Philip J, Manikandan R, Lamb GH, et al. Ejaculatory-duct calculus causing secondary obstruction and infertility. Fertil Steril. 2007;88:706 e9.Google Scholar
  122. 122.
    Pryor JP, Hendry WF. Ejaculatory duct obstruction in subfertile males: analysis of 87 patients. Fertil Steril. 1991;56:725.PubMedGoogle Scholar
  123. 123.
    Nagler HM, Rotman M, Zoltan E, et al. The natural history of partial ejaculatory duct obstruction. J Urol. 2002;167:253.PubMedGoogle Scholar
  124. 124.
    Ruiz Rubio JL, Fernandez Gonzalez I, Quijano Barroso P, et al. The value of transrectal ultrasonography in the diagnosis and treatment of partial obstruction of the seminal duct system. J Urol. 1995;153:435.PubMedGoogle Scholar
  125. 125.
    Engin G, Celtik M, Sanli O, et al. Comparison of transrectal ultrasonography and transrectal ultrasonography-guided seminal vesicle aspiration in the diagnosis of the ejaculatory duct obstruction. Fertil Steril. 2009;92:964.PubMedGoogle Scholar
  126. 126.
    Orhan I, Onur R, Cayan S, et al. Seminal vesicle sperm aspiration in the diagnosis of ejaculatory duct obstruction. BJU Int. 1999;84:1050.PubMedGoogle Scholar
  127. 127.
    Jarow JP. Seminal vesicle aspiration of fertile men. J Urol. 1996;156:1005.PubMedGoogle Scholar
  128. 128.
    Purohit RS, Wu DS, Shinohara K, et al. A prospective comparison of 3 diagnostic methods to evaluate ejaculatory duct obstruction. J Urol. 2004;171:232.PubMedGoogle Scholar
  129. 129.
    Eisenberg ML, Walsh TJ, Garcia MM, et al. Ejaculatory duct manometry in normal men and in patients with ejaculatory duct obstruction. J Urol. 2008;180:255.PubMedGoogle Scholar
  130. 130.
    Stricker HJ, Kunin JR, Faerber GJ. Congenital prostatic cyst causing ejaculatory duct obstruction: management by transrectal cyst aspiration. J Urol. 1993;149:1141.PubMedGoogle Scholar
  131. 131.
    Heshmat S, Lo KC. Evaluation and treatment of ejaculatory duct obstruction in infertile men. Can J Urol. 2006;13 Suppl 1:18.PubMedGoogle Scholar
  132. 132.
    Schroeder-Printzen I, Ludwig M, Kohn F, et al. Surgical therapy in infertile men with ejaculatory duct obstruction: technique and outcome of a standardized surgical approach. Hum Reprod. 2000;15:1364.PubMedGoogle Scholar
  133. 133.
    Meacham RB, Hellerstein DK, Lipshultz LI. Evaluation and treatment of ejaculatory duct obstruction in the infertile male. Fertil Steril. 1993;59:393.PubMedGoogle Scholar
  134. 134.
    Kadioglu A, Cayan S, Tefekli A, et al. Does response to treatment of ejaculatory duct obstruction in infertile men vary with pathology? Fertil Steril. 2001;76:138.PubMedGoogle Scholar
  135. 135.
    Yurdakul T, Gokce G, Kilic O, et al. Transurethral resection of ejaculatory ducts in the treatment of complete ejaculatory duct obstruction. Int Urol Nephrol. 2008;40:369.PubMedGoogle Scholar
  136. 136.
    Xu B, Niu X, Wang Z, et al. Novel methods for the diagnosis and treatment of ejaculatory duct obstruction. BJU Int. 2011;108:263.PubMedGoogle Scholar
  137. 137.
    Zackrisson B, Hugosson J, Aus G. Transrectal ultrasound anatomy of the prostate and seminal vesicles in healthy men. Scand J Urol Nephrol. 2000;34:175.PubMedGoogle Scholar
  138. 138.
    Hernandez AD, Urry RL, Smith Jr JA. Ultrasonographic characteristics of the seminal vesicles after ejaculation. J Urol. 1990;144:1380.PubMedGoogle Scholar
  139. 139.
    Tanahashi Y, Watanabe H, Igari D, et al. Volume estimation of the seminal vesicles by means of transrectal ultrasonotomography: a preliminary report. Br J Urol. 1975;47:695.PubMedGoogle Scholar
  140. 140.
    Manno M, Marchesan E, Tomei F, et al. Polycystic kidney disease and infertility: case report and literature review. Arch Ital Urol Androl. 2005;77:25.PubMedGoogle Scholar
  141. 141.
    Pace G, Galatioto GP, Guala L, et al. Ejaculatory duct obstruction caused by a right giant seminal vesicle with an ipsilateral upper urinary tract agenesia: an embryologic malformation. Fertil Steril. 2008;89:390.PubMedGoogle Scholar
  142. 142.
    La Vignera S, Vicari E, Condorelli R, et al. Ultrasound characterization of the seminal vesicles in infertile patients with type 2 diabetes mellitus. Eur J Radiol. 2011;80:e64.PubMedGoogle Scholar
  143. 143.
    Andrade-Rocha FT. Unusual presentation of seminal vesiculitis in an infertile man. Can J Urol. 2007;14:3750.PubMedGoogle Scholar
  144. 144.
    Herwig R, Tosun K, Pinggera GM, et al. Tissue perfusion essential for spermatogenesis and outcome of testicular sperm extraction (TESE) for assisted reproduction. J Assist Reprod Genet. 2004;21:175.PubMedGoogle Scholar
  145. 145.
    Tunc L, Alkibay T, Kupeli B, et al. Power Doppler ultrasound mapping in nonobstructive azoospermic patients prior to testicular sperm extraction. Arch Androl. 2005;51:277.PubMedGoogle Scholar
  146. 146.
    Van Peperstraten A, Proctor M L, Johnson NP, et al. Techniques for surgical retrieval of sperm prior to intra-cytoplasmic sperm injection (ICSI) for azoospermia. Cochrane Database Syst Rev. 2008;(2):CD002807.Google Scholar
  147. 147.
    Ramkumar A, Lal A, Paduch DA, et al. Ultrasonically actuated silicon-microprobe-based testicular tubule metrology. Conf Proc IEEE Eng Med Biol Soc. 2010;2010:6469.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Landon W. Trost
    • 1
  • David D. Casalino
    • 2
  • Robert E. Brannigan
    • 3
  1. 1.Department of UrologyMayo ClinicRochesterUSA
  2. 2.Department of RadiologyNorthwestern University, Feinberg School of MedicineChicagoUSA
  3. 3.Department of UrologyNorthwestern University, Feinberg School of MedicineChicagoUSA

Personalised recommendations