Poster électronique

Malformations et obstacles des voies génitales profondes chez l'homme infertile : apport de l'IRM
L. Rocher (1), S. Hammoud (2), V. Izard (2), G. Cluzel (2), G. Serra-Tosio (1), J. Ifergan (1), B. El Mahmoud (2), MF. Bellin (1) - (1) Le Kremlin-Bicêtre - France, (2) Paris - France
Congrès 2009
Résumé
Objectifs
Evaluer l'IRM pelvienne pour l'analyse morphologique des voies génitales profondes chez l'homme infertile suspect de malformation ou d'occlusion génitale.
Matériels et méthodes
Depuis 3 ans sur 3000 patients adressés pour exploration échographique d'une hypofertilité, 35 patients ont bénéficié d'une IRM pelvienne pour suspicion de malformation des voies génitales ou obstacle sur les voies séminales. Protocole d'examen : antenne de surface (phase–array cardiaque), T 2 dans les 3 plans, T1 axial.
Résultats
On retrouve des agénésies ou atrésies déférentielles ou vésiculaires chez 8 patients, une dilatation des confluents vésiculo-déférentiels ou des vésicules séminales chez 14 patients, des abouchements ectopiques urétéraux chez 3 patients, des urétérocèles chez 2 patients, des kystes compressifs chez 4 patients, un adénocarcinome de l'utricule chez 1 patient. Une stagnation spermatique au sein des voies génitales apparaît hypersignal T1 est retrouvée chez 6 patients. Certaines de ces malformations entrent dans le cadre de pathologies connues : syndrome de Noonan, syndrome de Kalman de Morsier, syndrome de Prune Belly, imperforation anale. Les anomalies de signal de la zone périphérique prostatique, à type de plages en hyposignal T2 ou d'hyposignal diffus concernent 33 patients sur 35, dont la moitié ne montrait pas d'anomalie échographique, et l'autre moitié présentait des plages hyperéchogènes.
Conclusion
L'IRM permet une meilleure analyse objective des voies génitales profondes et complète l'échographie transrectale. Les anomalies de signal prostatique dans ces pathologies sont peu décrites et étant donné leur fréquence dans cette série, elles pourraient faire l'objet d'une étude prospective plus large : les remaniements infectieux ou inflammatoires ou l'environnement biochimique de la prostate peuvent-ils être à l'origine d'hypofertilité masculine ?
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2017-09-01 00.08 :
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2017-04-11 18.31 :
Michael Law

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