ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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УЖМБС 2020, 5(3): 222–227
https://doi.org/10.26693/jmbs05.03.222
Clinical Medicine

Ultrasound Screening for Unilateral Obstruction of the Vas Deferens in Men with Reduced Ejaculate Fertility

Panasovskiy N. L.
Abstract

It is officially recognized today that 40-50% of all cases of infertile marriages are associated with a man, more precisely, with diseases of the male genital area. In another 23% of couples, both spouses have problems. Data on the structure of infertility in men are very contradictory. Among the diseases that reduce fertility and require surgical treatment, one of the leading places is the obstruction of the vas deferens, the so-called obstructive infertility. Obstruction of the vas deferens takes 3-7.4% in the structure of male infertility, including 20-31% among all men with azoospermia. In this case, obstruction can be localized in any area from the efferent ducts of the testis to the ejaculatory ducts. The purpose of the research was to study the possibilities of ultrasound screening in the diagnosis of unilateral obstruction of the vas deferens in men with reduced sperm parameters. Material and methods. The data of ultrasound examination of 54 men with reduced spermogram parameters were collected and analyzed, in which congenital, endocrine, infectious-toxic and any other negative causal factors were excluded (group I). Comparisons were made with similar ultrasound data from patients with diagnosed acquired obstructive azoospermia in 47 men (group II) and 33 healthy men who comprised the control group. Results and discussion. The pre-ejaculatory ultrasound sizes of the seminal vesicles had individual variability in healthy men, as well as in patients with obstruction of the vas deferens. But on average these sizes did not have significant differences, although there was a slight tendency to increase in the latter case. In the control group the average length of seminal vesicles according to ultrasound screening data was 32.5±0.8 mm and 31.7±0.8 mm on the left and right, respectively. In patients with obstruction of the vas deferens (group II) the results were 35.7±0.9 and 35.5±0.8 mm (p> 0.05); in group I the results were 32.4±0.9 and 33.1±0.9 mm, respectively (p> 0.05). Average width (anteroposterior size) was 12.2±0.5 and 11.9±0.5 mm versus 13.3±0.6 and 13.4±0.6 mm; 11.8±0.5 and 12.2±0.5 mm, respectively (p> 0.05). The comparison of the sizes of seminal vesicles before and after ejaculation turned out to be more informative. So, in healthy men, after ejaculation, a significant (p <0.05) bilateral decrease (primarily) of the width of the seminal vesicles by more than 50% of the initial size was observed on average, 2.4±0.5 times. Moreover, post-ejaculatory indicators of length changed less significantly within 10-20% of the initial parameter. Unlike healthy individuals, in patients with obstruction of the vas deferens (group II), pre- and post-ejaculatory sizes of seminal vesicles did not undergo significant changes (p> 0.05), on the contrary, there was an unreliable trend to increase them. Average values were the following: length – 37.3±0.8 mm and 36.8±0.8 mm; width – 13.9±0.7 mm and 14.1±0.7 mm left and right, respectively. As for patients from group I, ultrasound scans performed in the pre- and post-ejaculatory periods revealed signs in the 14 (25.9%) cases of the absence of emptying of the seminal vesicles (as in group II), but having a one-sided asymmetric character (8 – on the left; 6 – on the right), which testified in favor of the obstruction of one of the vas deferens and probably caused a decrease in the quality of the ejaculate. Conclusion. Thus, an ultrasound examination of the size of the seminal vesicles before and after ejaculation can have some screening information in patients with reduced sperm quality, in some cases, reveal signs of unilateral obstruction of the vas deferens, which is important for determining a further diagnostic and therapeutic approach.

Keywords: obstruction of the vas deferens, obstructive infertility, ultrasound screening

Full text: PDF (Rus) 453K

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