sodium-pertechnetate-tc-99m and Infertility--Male

The purpose of our study was to assess the value of a radionuclide scrotal blood-pool index (SBPI) in diagnosing and grading clinical and subclinical varicocele.. Scrotal scans were performed on 1360 infertile patients. Thirty fertile patients with a normal scrotum on palpation served as controls. The patients' red blood cells were labeled in vivo by administration of stannous ions of pyrophosphate followed by the intravenous administration of 99Tc-pertechnetate. The scans initially were inspected visually and, when bilateral varicocele was excluded, a computerized analysis of the ratio of the blood-pool activity in each hemiscrotum (SBPI) permitted accurate grading of the varicocele. A subgroup of 224 patients was selected randomly and had gonadal venography. The results of physical examination, scrotal scan, gonadal venography and semen analysis were compared.. Normal values of SBPI (0.9-1.1) were derived from the control group. There was a 93.5% correlation between palpation and SBPI grade in diagnosing palpable varicocele. When compared to gonadal venography, subclinical varicocele was demonstrated by scrotal scan in 54.8% of infertile male patients with abnormal semen analysis, normal female partners and no other cause of infertility. Of these patients, 32.6% had, unexpectedly, Grade 2 or 3 varicocele. Right and bilateral varicocele were demonstrated three times as often by scrotal scan than by palpation. SBPI was accurate in diagnosing recurrent varicocele but there was a low correlation (61.1%) between SBPI and gonadal venography grade. There was a high correlation between SBPI grade and sperm analysis grade.. SBPI grading of varicocele was validated as an accurate, quantitative and noninvasive method of grading varicocele, equivalent to the grading system by palpation in a large group of infertile patients. The main contribution of SBPI was in detecting and grading subclinical varicocele in infertile patients with no other cause of infertility. SBPI also was accurate in diagnosing but not in grading recurrent varicocele.

Topics: Adolescent; Adult; Erythrocytes; Humans; Infertility, Male; Male; Middle Aged; Palpation; Phlebography; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Random Allocation; Scrotum; Sodium Pertechnetate Tc 99m; Testis; Varicocele

Forty-three men underwent varicocele scintigraphy to exclude underlying varicocele as a possible cause of decreased semen quality. The total acquisition time for each study amounted to as little as 200 seconds. In four cases retrograde blood flow was seen in the left internal spermatic vein, with subsequent clear visualization of the pampiniform plexus. In three of four of these patients, pregnancy ensued after therapeutic intervention. Seven patients showed only increased scrotal activity locally, in the absence of retrograde blood flow. The remaining 32 patients showed a normal blood flow pattern. The existence of spermatic vein reflux in varicocele-related infertility is thought to be a major factor in proper patient selection for therapeutic ligation or embolization of the internal spermatic vein. It is suggested that this simplified scintigraphic method may be useful in the detection of retrograde blood flow in patients with varicocele, especially in small or subclinical varicocele.

Topics: Adult; Analysis of Variance; Embolization, Therapeutic; Female; Humans; Infertility, Male; Ligation; Male; Patient Selection; Pregnancy; Radionuclide Imaging; Radiopharmaceuticals; Regional Blood Flow; Scrotum; Semen; Sodium Pertechnetate Tc 99m; Spermatic Cord; Time Factors; Varicocele; Veins

Testicular circulatory isolation (TCI) holds promise as a method to avoid drug-induced infertility in male patients about to receive cancer chemotherapy. Complete exclusion of blood flow to the testicle is essential to the success of this technique. We have compared the hand-held Doppler probe and radionuclide angiography (technetium-99m pertechnetate) as monitors of testicular blood flow in 10 patients subjected to unilateral TCI. When Doppler evaluation indicated that testicular circulation had been interrupted, the radionuclide angiogram uniformly confirmed and quantified this conclusion. These results validate the hand-held Doppler as an appropriate tool for assessing testicular blood flow in patients undergoing TCI.

Topics: Aged; Antineoplastic Agents; Humans; Infertility, Male; Male; Observer Variation; Radionuclide Angiography; Regional Blood Flow; Rheology; Sodium Pertechnetate Tc 99m; Testis

A clinical study was done of 19 patients in our male infertility clinic, who were diagnosed as having a varicocele and showed atypical radionuclide accumulation in the dynamic image of scrotal scintigraphy. The semen quality was good in 26 percent and poor in 42 percent. Patients with severe congestion in the varicocele tended to be small in number. The dynamic images of the varicoceles were classified into two groups: one group with no radionuclide accumulation, and one group with patchy radionuclide accumulations. Surgical treatment was performed in patients with poor semen quality or with a long infertility period. Neither improvement in the semen quality nor impregnation was achieved postoperatively in patients who had shown no accumulation of the radionuclide in the dynamic imaging. In patients who had shown patchy radionuclide accumulations, the postoperative results were good. We concluded that preoperative dynamic imaging of scrotal scintigraphy is a good means of estimating the postoperative prognosis of fertility.

Topics: Adult; Constriction, Pathologic; Humans; Infertility, Male; Male; Phlebography; Radionuclide Imaging; Regional Blood Flow; Renal Veins; Scrotum; Sodium Pertechnetate Tc 99m; Sperm Count; Sperm Motility; Varicocele

Gamma-camera and radioimmunological study of hormones of hypophyseal-gonadal axis were carried out on 34 patients with hypogonadism and infertility after successfully performed orchidopexy. The results from this study showed that gamma-camera scintigraphy was exact and noninvasive method for determining the structure and function of testes after operative intervention. The results of the established hormonal deviations in the secretion of hormones of hypophyseal-gonadal axis are sure and early criterium for diagnosis of infertility in these patients. They could indicate the therapeutic management in these patients.

Topics: Adult; Gonadal Steroid Hormones; Humans; Hypogonadism; Infertility, Male; Male; Pituitary Hormones; Postoperative Period; Radioimmunoassay; Radionuclide Imaging; Scintillation Counting; Sodium Pertechnetate Tc 99m; Testis

Topics: Adolescent; Adult; Child; Child, Preschool; Cryptorchidism; Gonadal Steroid Hormones; Humans; Infertility, Male; Male; Pituitary Hormones; Radioimmunoassay; Radionuclide Imaging; Scintillation Counting; Sodium Pertechnetate Tc 99m; Testis

The clinically obvious varicocele is perhaps the most common identifiable and correctable cause of male infertility. However, less is known about the subclinical (not palpable) varicocele and its relationship to infertility. We undertook this study to compare the ability of high-resolution sonography and radionuclide scrotal scanning to detect subclinical varicocele. Fifty patients who were referred to our department with a diagnosis of infertility, an abnormal semen analysis, and a normal physical examination of the scrotum underwent both sonography and nuclear scanning. The final study group included 20 men who agreed to surgical ligation of the spermatic vein(s) after a positive sonographic and/or radionuclide study. Sonography was considered positive for subclinical varicocele in 95% of patients, while nuclear scanning was considered positive in only 55%. Postoperatively, all patients showed improvement in their semen and 40% (eight patients) became fertile. Subclinical varicocele seems to be an important causal factor in infertility and, in our experience, high-resolution sonography is superior to radionuclide scanning in its diagnosis.

Topics: Humans; Infertility, Male; Male; Radionuclide Imaging; Scrotum; Semen; Sodium Pertechnetate Tc 99m; Sperm Count; Ultrasonography; Varicocele