Imagerie des voies seminales

Abstract

During the past decade, various imaging method have been developed which can be used to study the male reproductive tract. Ultrasonography, especially using high frequencies (7.5 or 10 MHz) and transrectal probes, provides very good visualization of the prostatic and testicular parenchyma. This has allowed the diagnosis of two types of tissue: cysts, in the case of congenital disease or post-infection dilation: and calcification, as a sequela of post-infection disease. Although this approach permits an accurate assessment when there is a small mass, it is less precise for large masses, which require a conventional radiological approach. Cystic puncture provides fluid samples for analysis. The diagnosis of varicocoeles is greatly facilitated, but for localization of an ectopic testis ultrasonography is only accurate in the superficial inguinal region. Vasography remains the best method for evaluation of the vas deferens, but it does require a surgical approach with the attendant risk of vasal occlusion. It is essential that a complex congenital pathology be evaluated fully before contemplating surgery. Computer-assisted tomography (CAT scan) and magnetic resonance imaging (MRI) are only useful for ectopic testes, although MRI is the preferred method for investigating a complex congenital pathology dues to its multiplanar sections and good contrast between different tissues.

Resume

Les méthodes d’imagerie médicale pour l’exploration des voies séminales se sont multipliées ces dernières années. L’examen échographique, surtout grâce au développement des sondes de haute fréquence et endocavitaires, permet une approche morphologique trés précise des parenchymes, mais il n’explore pas les structures canalaires dont l’analyse est encore du domaine de la radiologie convention-nelle. Les méthodes d’imagerie dites “lourdes”, tomodensitométrie et imagerie par résonance magnétique, ont des indications plus limitées. Dans tous les cas, les résultats de l’imagerie doivent être confrontés à ceux de l’examen clinique et des résultats biologiques.