Varicocele grading.

 

Clinical and ultrasonography grading of varicocele

Varicocele grading is done to provide a standardization in the diagnosis, treatment and follow-up of the disease.

Varicocele staging (grade) is done in two main ways:

1.     Grading system made clinically, namely by examination.

2.     Grading with scrotal color Doppler ultrasonography.

Clinical Grading of varicocele

Grade	Description
Grade 0	Seen on ultrasound, but not physically detectable (also called “subclinical varicocele”)
Grade I	Palpable (felt on exam) when the patient is performing the valsalva maneuver (“bearing down”)
Grade II	Palpable even without valsalva
Grade III	Varicocele causing visible deformity of the scrotum.

- Sperm Motility grading.

Sperm Motility grading.

(Human sperm stained for semen quality testing in the clinical laboratory.)

• Grade 1: sperm are immotile meaning that they fail to move at all.
• Grade 2: sperm are labeled as non-progressive motility because they do not move forward despite the fact that they move their tails.
• Grade 3: sperm (non-linear motility) also move forward but tend to travel in a curved or crooked motion.
• Grade 4: sperm are known to have progressive motility meaning they are the strongest and swim fast in a straight line.

Ideal sperm quality dictates that a man should have grade 3 or 4 sperm in order to fertilize an egg.

 Dr Ibrahim
Return to list of medical grades (click here) 

- Hutchinson’s Triad.

Hutchinson's triad

It is a common pattern of presentation for congenital syphilis.
It consists of :-

1. Interstitial keratitis
2. Hutchinson incisors
3. Eighth nerve deafness.

Dr Ibrahim

Return to other triads here.

-Mechanical causes of Impotence.

Mechanical causes of Impotence
"Hope"

Huge bilateral hydrocele or inguinal hernia.
Morbid Obesity.
Penile carcinoma.
Peyrone's disease(fibrotic scar of tunica alibuginea surrounding corpora cavernosa resulting in curvature of penis in erection)
Elephantiasis of penis or scrotum.

Dr Ibrahim

- Metabolic cuases of Impotence.

Metabolic cuases of Impotence (erectile dysfunction).

"Rash"

Renal Failure.
Alcoholism.
Sickle cell disease
Hoemochromatosis.
Hepatic failure.
Hyperglycemia (D.M).

Dr Ibrahim

- Kallmann syndrome.

 Kallmann syndrome

- Def :- It is a rare X-linked recessive genetic disease which characterized by delayed or absent puberty and an impaired sense of smell, also referred as olfactogenital dysplasia.

- Kallmann syndrome is a form of secondary hypogonadism, reflecting that the primary cause of the defect in sex-hormone production lies within the pituitary and hypothalamus rather than a physical defect of the testes or ovaries.

- Kallmann syndrome was described in 1944 by Franz Josef Kallmann, a German-American geneticist.(1)(2)

- Incidence:-

It affects primarily males at an incidence of 1 out of 10,000 in a study of French conscripts.(3)
The male-to-female ratio ranges from 4:1 to 5:1.

- Cause:-

Mutations in the KAL1, FGFR1, PROKR2, and PROK2 genes cause Kallmann syndrome.
These genes play a role in the development of certain areas of the brain before birth. Although some of their specific functions are unclear, these genes appear to be involved in the formation and movement (migration) of a group of nerve cells that are specialized to process smells (olfactory neurons).(4)

- Synonyms:-

• de Morsier’s syndrome II.
• Morsier-Gauthier syndrome.
• Kallmann-de Morsier syndrome.
• Maestre-Kallmann-de Morsier syndrome.
• Maestre de San Juan-Kallmann syndrome.
• Maestre de San Juan-Kallmann-de Morsier syndrome.
• anosmic hypogonadism.
• anosmic idiopathic hypogonadotropic hypogonadism.
• hypogonadotropic hypogonadism and anosmia.
• hypogonadotropic hypogonadism-anosmia syndrome.
  
  

- Sertoli-cell-only syndrome (germinal cell aplasia).

Sertoli-cell-only syndrome (SCO)

-Def:- It is a condition in which only Sertoli cells line the seminiferous tubules of the testes and characterized by male sterility (due to azoospermia) without sexual abnormality.

- Synonyms:-

• Del Castillo syndrome.
• Germ cell aplasia.

-The etiology (1):-

• Most causes of SCO syndrome are idiopathic. A congenital absence of germ cells due to failure of migration of gonocytes is theoretically possible.
• Massive deletions in the azoospermia factor (AZF) region of the Y chromosome. found.
• Exposure to chemicals and toxins may cause SCO; however, direct cause-and-effect relationships in humans have been difficult to document.
• Klinefelter syndrome, 47 XXY, results in a characteristic biopsy appearance of SCO and Leydig cell hyperplasia.