Incidentally detection of non-palpable testicular nodules at scrotal ultrasound: What is new?

The increased use of ultrasound in patients with urological and andrological symptoms has given an higher detection of intra-testicular nodules. Most of these lesions are hypoechoic and their interpretation is often equivocal. Recently, new ultrasound techniques have been developed alongside of B-mode and color-Doppler ultrasound. Although not completely standardized, contrast-enhanced ultrasound (CEUS) and tissue elastography (TE), added to traditional ultrasonography, can provide useful information about the correct interpretation of incidentally detected non-palpable testicular nodules. The purpose of this review article is to illustrate these new techniques in the patient management

Comparison of 1.0 M gadobutrol and 0.5 M gadopentate dimeglumine-enhanced MRI in 471 patients with known or suspected renal lesions: Results of a multicenter, single-blind, interindividual, randomized clinical phase III trial

The purpose of this phase III clinical trial was to compare two different extracellular contrast agents, 1.0 M gadobutrol and 0.5 M gadopentate dimeglumine, for magnetic resonance imaging (MRI) in patients with known or suspected focal renal lesions. Using a multicenter, single-blind, interindividual, randomized study design, both contrast agents were compared in a total of 471 patients regarding their diagnostic accuracy, sensitivity, and specificity to correctly classify focal lesions of the kidney. To test for noninferiority the diagnostic accuracy rates for both contrast agents were compared with CT results based on a blinded reading. The average diagnostic accuracy across the three blinded readers ('average reader') was 83.7% for gadobutrol and 87.3% for gadopentate dimeglumine. The increase in accuracy from precontrast to combined precontrast and postcontrast MRI was 8.0% for gadobutrol and 6.9% for gadopentate dimeglumine. Sensitivity of the average reader was 85.2% for gadobutrol and 88.7% for gadopentate dimeglumine. Specificity of the average reader was 82.1% for gadobutrol and 86.1% for gadopentate dimeglumine. In conclusion, this study documents evidence for the noninferiority of a single i.v. bolus injection of 1.0 M gadobutrol compared with 0.5 M gadopentate dimeglumine in the diagnostic assessment of renal lesions with CE-MRI

Children and adults varicocele: diagnostic issues and therapeutical strategies

Varicocele is defined as abnormally dilated scrotal veins. It is present in 15\ua0% of normal males and in 40\ua0% of males with infertility. This disorder is a challenge for the physicians involved in the diagnosis and treatment, as the pathophysiology of varicocele is not yet completely understood. For this reason, accurate diagnostic criteria and clear indications for treatment in asymptomatic adolescents or adults with clinical or subclinical varicocele are still not defined. Ultrasonography (US) is considered the best method for calculating the volume of the testicles, measuring vein diameter and monitoring the growth of the testis in adolescent patients. Color-Doppler US is the method of choice for detecting spermatic vein reflux and for classifying the grade of varicocele. Various classification systems have been published with recommendations on how to perform US imaging of the scrotum. Currently, color-Doppler US and spectral analysis are the most effective, non-invasive diagnostic procedures as they allow detection of subclinical varicocele associated with infertility. Various techniques are used in the treatment of varicocele including open surgery, laparoscopic procedures and interventional radiology. However, there is no consensus among physicians on which technique is the most effective in terms of outcome and complication rates. This review shows that color-Doppler US is currently the most widely employed diagnostic method for detection and classification of varicocele caused by venous reflux, as it is reliable and easily performed. The review also highlights the role of varicocelectomy in the management of adult male infertility

Neoplasms of the Urethra

Urethral cancer is a rare disease which may occur at any age but is observed more often during the seventh decade. It is usually considered more common in females, but a recent study shows in the United States an annual age-adjusted incidence rate of 4.3 per million men and 1.5 per million women. The incidence is higher in African Americans. Different histologic patterns of urethral tumors are recognized. The most common type of urethral malignancy is squamous cell carcinoma which accounts for about 80 % of cases in men and 60 % of cases in women. Transitional cell carcinoma is the second most common urethral malignancy in both sexes. In males, this lesion accounts for 15 % of total cases, in females for 20 % of patients. Other primary malignant tumors of the urethra are rare. Only sporadic cases of lymphoma, melanoma, and neuroendocrine tumors have been reported in the literatur

Benign Prostate Hyperplasia and Prostatic Tumor

Rising life expectancy has swollen the ranks of men of middle age and beyond. These individuals have a 43 % risk of symptoms of benign prostatic hyperplasia (BPH) and a 9 % chance of being diagnosed with prostate cancer. Although not always life-threatening, prostate diseases are often associated with a significant reduction in quality of life not only for the sufferer but also for his partner. Men beyond middle age are increasingly reluctant to accept restrictions on their day-to-day activities as they grow older. As a consequence, prostate diseases are now acknowledged as an important determinant of men\u2019s health and therefore worthy of proper scrutiny, treatment, and enhanced research. In this chapter, the role of imaging modalities in evaluation of prostate disorders in elderly is illustrated, with emphasis both on current clinical practice and on the evolving imaging modalities that will affect treatment in the futur

Neoplasms of the Penis and Scrotum

Neoplasms of the penis represent a significant health problem in developing countries. Primary malignant neoplasms of the penis include squamous cell carcinomas, sarcomas, melanoma, basal cell carcinoma, and lymphoma. Hemangioma, neurilemmoma, leiomyoma, neurofibroma, and schwannoma constitute benign neoplasms of the penis. Tumors of the tunicae and scrotal wall are rare. Malignant mesothelioma of the tunica vaginalis testis, scrotal hemangioma, and granulosa cell tumor of the tunica albuginea may arise from tunica and scrotal wal