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Pitrone P, Silipigni S, Stagno A, Cinquegrani A, Cattafi A, Bottari A. Retrograde sclerotherapy of male varicocele with veno-venous shunts - incidence and management: a single-centre experience. Br J Radiol 2023; 96:20221061. [PMID: 36745115 PMCID: PMC10161912 DOI: 10.1259/bjr.20221061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The aim of our study is to compare the incidence of veno-venous shunts in male varicocele and evaluate the possibility to exclude them with manual compression or/and scrotal ligation in order to carry out the procedure of retrograde sclero-embolization. METHODS In our retrospective study, all patients undergone retrograde sclerotherapy for varicocele in our Interventional Radiology Unit in the last four years were evaluated. Collaterals toward other venous shunts were identified and how many and which patients would be able to complete the procedure safely were considered. RESULTS Of the 91 patients, as many as 22 (i.e., 24.17%) patients presented anatomical variants, consisting on shunting into left iliac vein (9 [9.89%]), lumbar left veins (3 [3.29%]), right iliac vein (1 [1.09%]), both iliac veins (1 [1.09%]), left femoral vein (1 [1.09%]) or a more proximal portion of the ISV itself without shunting (3 [3.29%]). Patients with duplication could benefit from a more distal injection in order to prevent back-flow; of the 19 left, nine successfully underwent sclerotherapy with manual compression or/and scrotal ligation, whereas in 10 flow through the collaterals could not be interrupted and patients were demanded for surgery. CONCLUSIONS Many patients with abnormal communications between the internal spermatic vein and the iliac veins (that is, shunts towards the iliac veins) may as well undergo retrograde sclerotherapy safely if compression/ligation is applied. ADVANCES IN KNOWLEDGE No large previous study highlighted the impact of veno-venous shunts in technical feasibility of retrograde sclerotherapy of varicocele.
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Affiliation(s)
- Pietro Pitrone
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, Section of Radiological Sciences, University of Messina, Messina, Italy
| | - Salvatore Silipigni
- Department of Imaging, Interventional Radiology Unit, University Hospital "G. Martino", Messina, Italy
| | - Alberto Stagno
- Department of Imaging, Interventional Radiology Unit, University Hospital "G. Martino", Messina, Italy
| | - Antonella Cinquegrani
- Department of Imaging, Interventional Radiology Unit, University Hospital "G. Martino", Messina, Italy
| | - Antonino Cattafi
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, Section of Radiological Sciences, University of Messina, Messina, Italy
| | - Antonino Bottari
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, Section of Radiological Sciences, University of Messina, Messina, Italy.,Department of Imaging, Interventional Radiology Unit, University Hospital "G. Martino", Messina, Italy
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Dolatkhah MA, Khezri S, Shokoohi M, Alihemmati A. The effect of Fumaria parviflora on the expression of sexual hormones along with their receptors in testicles of adult rats induced by varicocele. Andrologia 2022; 54:e14512. [PMID: 35753722 DOI: 10.1111/and.14512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/26/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022] Open
Abstract
Varicocele (VCL) is a pathological dilation of the venous pampiniform plexus of the spermatic cord and is also classified as male factor infertility. The current experiment aimed to examine the protective effect of Fumaria parviflora (FP), as a powerful antioxidant, against reproductive damage induced by VCL. In this experimental study, 32 male rats were randomly allocated into four groups, namely sham (simple laparotomy without additional intervention), FP (healthy rats administered 250 mg/kg FP), VCL + FP (underwent VCL and received 250 mg/kg FP), VCL (underwent VCL without receiving any treatment). The results showed that the number of Sertoli and germ cells were markedly reduced in the VCL group in comparison to the FP-treated and sham groups. The VCl + FP group had significantly higher serum levels of testosterone (T), FSH, and LH hormones than the VCL group. The quality and motility of spermatozoa were reduced in the VCL group compared with other groups (p ≤ 0.05). Moreover, our findings demonstrated that the administration of FP considerably enhanced the mRNA levels of CatSper-1 and -2, SF-1, 3β-HSD, 17β-HSD3, LHCGR, and FSHR (p ≤ 0.05). Based on the obtained results, treatment with FP is capable of preventing testicular dysfunction and elevating the concentration of hormones and some crucial genes, such as CatSper1 and 2, SF-1, 3β-HSD, 17β-HSD3, LHCGR, and FSHR that contribute to the spermatogenesis process.
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Affiliation(s)
- Mohammad Amin Dolatkhah
- Molecular Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Anatomical Sciences, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.,Valiasr Hospital, Department of Radiotherapy, Tabriz, Iran
| | - Shiva Khezri
- Department of Biology, Faculty of Science, Urmia, Iran
| | - Majid Shokoohi
- Department of Anatomical Sciences, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Alihemmati
- Molecular Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Anatomical Sciences, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Histology and Embryology, Faculty of Medicine, Tabriz, Iran
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3
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Agarwal A, Finelli R, Durairajanayagam D, Leisegang K, Henkel R, Salvio G, Aghamajidi A, Sengupta P, Crisóstomo L, Tsioulou PA, Roychoudhury S, Finocchi F, Darbandi M, Mottola F, Darbandi S, Iovine C, Santonastaso M, Zaker H, Kesari KK, Nomanzadeh A, Gugnani N, Rambhatla A, Duran MB, Ceyhan E, Kandil H, Arafa M, Saleh R, Shah R, Boitrelle F. Comprehensive Analysis of Global Research on Human Varicocele: A Scientometric Approach. World J Mens Health 2022; 40:636-652. [PMID: 35118839 PMCID: PMC9482861 DOI: 10.5534/wjmh.210202] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 12/05/2022] Open
Abstract
Purpose This study provides a comprehensive analysis of research trends on the etiology, mechanisms, potential risk factors, diagnosis, prognosis, surgical and non-surgical treatment of varicocele, and clinical outcomes before and after varicocele repair. Materials and Methods Varicocele studies published between 1988 and 2020 were retrieved from the Scopus database on April 5, 2021. Original studies on human varicocele were included, irrespective of language. Retrieved articles were manually screened for inclusion in various sub-categories. Bibliometric data was subjected to scientometric analysis using descriptive statistics. Network, heat and geographic mapping were generated using relevant software. Results In total, 1,943 original human studies on varicocele were published. These were predominantly from the northern hemisphere and developed countries, and published in journals from the United States and Germany. Network map analysis for countries showed several interconnected nodal points, with the USA being the largest, and Agarwal A. from Cleveland Clinic, USA, being a center point of worldwide varicocele research collaborations. Studies of adolescents were underrepresented compared with studies of adults. Studies on diagnostic and prognostic aspects of varicocele were more numerous than studies on varicocele prevalence, mechanistic studies and studies focusing on etiological and risk factors. Varicocele surgery was more investigated than non-surgical approaches. To evaluate the impact of varicocele and its treatment, researchers mainly analyzed basic semen parameters, although markers of seminal oxidative stress are being increasingly investigated in the last decade, while reproductive outcomes such as live birth rate were under-reported in the literature. Conclusions This study analyzes the publication trends in original research on human varicocele spanning over the last three decades. Our analysis emphasizes areas for further exploration to better understand varicocele’s impact on men’s health and male fertility.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Damayanthi Durairajanayagam
- Department of Physiology, Faculty of Medicine, Universiti Teknologi Mara, Sungai Buloh Campus, Selangor, Malaysia
| | - Kristian Leisegang
- Department of Physiology, School of Natural Medicine, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,LogixX Pharma Ltd., Theale, Berkshire, UK.,Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.,Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
| | - Gianmaria Salvio
- Department of Endocrinology and Metabolic Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Azin Aghamajidi
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Pallav Sengupta
- Department of Physiology, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Jenjarom, Selangor, Malaysia
| | - Luís Crisóstomo
- Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), Universidade do Porto, Porto, Portugal
| | - Petroula A Tsioulou
- Department of Physiology, Group of Physiology of Reproduction and Clinical Embryology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Federica Finocchi
- Department of Endocrinology and Metabolic Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Mahsa Darbandi
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran
| | - Filomena Mottola
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Sara Darbandi
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran
| | - Concetta Iovine
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta, Italy.,Gamma Analisi Cliniche S.r.l, Caserta, Italy
| | - Marianna Santonastaso
- Department of Women, Children and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Himasadat Zaker
- Histology and Mcroscopic Analysis Division, RASTA Specialized Research Institute (RSRI), West Azerbaijan Science and Technology Park (WASTP), Urmia, Iran
| | | | - Amir Nomanzadeh
- Histology and Mcroscopic Analysis Division, RASTA Specialized Research Institute (RSRI), West Azerbaijan Science and Technology Park (WASTP), Urmia, Iran
| | | | - Amarnath Rambhatla
- Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Mesut Berkan Duran
- Department of Urology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Erman Ceyhan
- Deparment of Urology, Baskent University Faculty of Medicine, Ankara, Turkey
| | | | - Mohamed Arafa
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Department of Andrology, Cairo University, Cairo, Egypt
| | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt.,Ajyal IVF Center, Ajyal Hopsital, Sohag, Egypt
| | - Rupin Shah
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Florence Boitrelle
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France.,Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
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4
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Characterization of varicocele-induced animal models: Potential role of inflammasome complex in the varicocele pathophysiology. J Reprod Immunol 2021; 149:103442. [PMID: 34773809 DOI: 10.1016/j.jri.2021.103442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/14/2021] [Accepted: 11/04/2021] [Indexed: 11/21/2022]
Abstract
Varicocele mechanisms and its impact in testicular dysfunction has been studied in order to understand the pathophysiology involved in this disease. However, study designs using testicular tissues from varicocele patients are restricted due to ethical limitations. Therefore, the use of animal models, mainly rats, that mimics varicocele and its effects is an option to develop new approaches. The surgical technique, that induces the varicocele in rats, is based on the partial obstruction of the left renal vein, leading to a dilation in the left spermatic vein and consequently to the pampiniform plexus, resulting in varicocele-induced condition. Thus, the study of the cellular and molecular mechanisms involved in varicocele development can be addressed in depth. Besides the animal model goal to uncover the exact varicocele pathophysiology, varicocele induced models are the best options to develop new non-surgical and less invasive therapies. Various animal model studies designed and investigated antioxidant and anti-inflammatory agents to face varicocele conditions. Minding this fact, we tried to discuss a newly uncovered complex in varicocele condition, known as inflammasome complex. Taking into consideration the possible inflammatory state present in varicocele, the inflammasome complex has been proposed to be involved in the pathophysiology of this disease.
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5
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Panner Selvam MK, Agarwal A. Sperm and Seminal Plasma Proteomics: Molecular Changes Associated with Varicocele-Mediated Male Infertility. World J Mens Health 2019; 38:472-483. [PMID: 31385477 PMCID: PMC7502311 DOI: 10.5534/wjmh.190018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/03/2019] [Accepted: 06/18/2019] [Indexed: 12/18/2022] Open
Abstract
Male infertility is a rising problem and the etiology at the molecular level is unclear. Use of omics has provided an insight into the underlying cellular changes in the spermatozoa of infertile men. Proteomics is one the promising omics techniques for biomarker screening that can provide complete information on molecular processes associated with male infertility. Varicocele is a pressing issue in the field of male infertility and the search for an appropriate diagnostic and therapeutic biomarker is still ongoing. In this review, we discuss the reports on proteomic profiles of sperm and seminal plasma in male infertility and provide an in-depth insight into varicocele studies associated with male infertility.
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Affiliation(s)
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
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6
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Freeman S, Bertolotto M, Richenberg J, Belfield J, Dogra V, Huang DY, Lotti F, Markiet K, Nikolic O, Ramanathan S, Ramchandani P, Rocher L, Secil M, Sidhu PS, Skrobisz K, Studniarek M, Tsili A, Tuncay Turgut A, Pavlica P, Derchi LE. Ultrasound evaluation of varicoceles: guidelines and recommendations of the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) for detection, classification, and grading. Eur Radiol 2019; 30:11-25. [DOI: 10.1007/s00330-019-06280-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/19/2019] [Accepted: 05/20/2019] [Indexed: 02/07/2023]
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7
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Tsili AC, Sofikitis N, Xiropotamou O, Astrakas LG, Ntorkou A, Argyropoulou MI. Diffusion tensor imaging as an adjunct tool for the diagnosis of varicocele. Andrologia 2018; 51:e13210. [DOI: 10.1111/and.13210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/15/2018] [Accepted: 11/02/2018] [Indexed: 01/30/2023] Open
Affiliation(s)
- Athina C. Tsili
- Department of Clinical Radiology, Medical School University of Ioannina Ioannina Greece
| | - Nikolaos Sofikitis
- Department of Urology, Medical School University of Ioannina Ioannina Greece
| | - Olga Xiropotamou
- Department of Clinical Radiology, Medical School University of Ioannina Ioannina Greece
| | - Loukas G. Astrakas
- Department of Medical Physics, Medical School University of Ioannina Ioannina Greece
| | - Alexandra Ntorkou
- Department of Clinical Radiology, Medical School University of Ioannina Ioannina Greece
| | - Maria I. Argyropoulou
- Department of Clinical Radiology, Medical School University of Ioannina Ioannina Greece
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8
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Zavattaro M, Ceruti C, Motta G, Allasia S, Marinelli L, Di Bisceglie C, Tagliabue MP, Sibona M, Rolle L, Lanfranco F. Treating varicocele in 2018: current knowledge and treatment options. J Endocrinol Invest 2018; 41:1365-1375. [PMID: 30284221 DOI: 10.1007/s40618-018-0952-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/11/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE Varicocele is defined as a state of varicosity and tortuosity of the pampiniform plexus around the testis caused by retrograde blood flow through the internal spermatic vein. The prevalence of clinically relevant varicocele ranges from 5 to 20% in the male population and is often associated with infertility and reduction of sperm quality. In this review, the pathophysiology and clinical aspects of varicocele are reviewed along with therapeutic options and treatment effects on sperm parameters and fertility both in adult and in pediatric/adolescent subjects. METHODS We conducted a Medline and a PubMed search from 1965 to 2018 to identify publications related to varicocele clinical aspects, treatment procedures and treatment outcomes. Keywords used for the search were: "varicocele", "varicocelectomy", "sclerotherapy", "male infertility", "subfertility", and "semen abnormalities". RESULTS Data from a large number of studies in adolescent and adult males indicate that varicocele correction improves semen parameters in the majority of patients, reducing oxidative stress and improving sperm nuclear DNA integrity either with surgical or percutaneous approach. CONCLUSIONS Varicocele repair seems to represent a cost-effective therapeutic option for all males (both adolescent and adults) with a clinical varicocele in the presence of testicular hypotrophy, worsening sperm alterations or infertility. On the other hand, some investigators questioned the role of varicocelectomy in the era of assisted reproduction. Thus, a better understanding of the pathophysiology of varicocele-associated male subfertility is of paramount importance to elucidating the deleterious effects of varicocele on spermatogenesis and possibly formulating new treatment strategies.
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Affiliation(s)
- M Zavattaro
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - C Ceruti
- Division of Urology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - G Motta
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - S Allasia
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - L Marinelli
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - C Di Bisceglie
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M P Tagliabue
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M Sibona
- Division of Urology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - L Rolle
- Division of Urology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - F Lanfranco
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
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Soni KK, Zhang LT, Choi BR, Karna KK, You JH, Shin YS, Lee SW, Kim CY, Zhao C, Chae HJ, Kim HK, Park JK. Protective effect of MOTILIPERM in varicocele-induced oxidative injury in rat testis by activating phosphorylated inositol requiring kinase 1α (p-IRE1α) and phosphorylated c-Jun N-terminal kinase (p-JNK) pathways. PHARMACEUTICAL BIOLOGY 2018; 56:94-103. [PMID: 29316840 PMCID: PMC6130442 DOI: 10.1080/13880209.2017.1421672] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
CONTEXT MOTILIPERM was prepared as a mixture of extracts of three medicinal herbs [roots of Morinda officinalis How (Rubiaceae), outer scales of Allium cepa L. (Liliaceae) and seeds of Cuscuta chinensis Lamark (Convolvulaceae)]. OBJECTIVE To investigate the role of reactive oxygen species (ROS)-based endoplasmic reticulum (ER) stress in a rat model of varicocele and the therapeutic efficacy of MOTILIPERM in this model. MATERIALS AND METHODS Sixty male rats were divided into five experimental groups: a normal control group (CTR + vehicle), a control group administered MOTILIPERM 200 mg/kg (CTR + M 200), a varicocele-induced control group (VC + vehicle) and two varicocele-induced groups administered MOTILIPERM 100 (VC + M 100) or 200 (VC + M 200) mg/kg for 4 weeks. Testis weights were recorded and serums were assayed for hormone concentrations. Tissues were subjected to semen analysis, histopathology, analyses of ER response protein expression levels and oxidative stress were assessed by measuring ROS, reactive nitrogen species (RNS), malondialdehyde (MDA) level and ratios of total glutathione (GSH)/oxidized GSH (GSSG). RESULTS MOTILIPERM treatment of varicocele-induced groups significantly increased left testis weight, testosterone level, sperm motility, count and spermatogenic cell density. ER-response protein expression levels were dose-dependently decreased in VC + M 200 group compared with VC + vehicle group. MOTILIPERM treatment also decreased MDA and ROS/RNS level but increased GSH/GSSG ratio. DISCUSSION AND CONCLUSIONS This study suggests that ROS-related ER stress may play a major role in varicocele-induced infertility and MOTILIPERM, a novel compound targeting ROS-based ER stress, may be therapeutically useful in treatment of varicocele, or as a supplement for the treatment of infertility.
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Affiliation(s)
- Kiran Kumar Soni
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
| | - Li Tao Zhang
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
| | - Bo Ram Choi
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
| | - Keshab Kumar Karna
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
| | - Jae Hyung You
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
| | - Yu Seob Shin
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
| | - Sung Won Lee
- Department of Urology, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chul Young Kim
- College of Pharmacy, Hanyang University, Ansan, Republic of Korea
| | - Chen Zhao
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, and Shanghai Institute of Andrology, Shanghai, China
| | - Han-Jung Chae
- Department of Pharmacology, Chonbuk University of Medical School, Jeonju, Republic of Korea
| | - Hye Kyung Kim
- College of Pharmacy, Kyungsung University, Busan, Republic of Korea
| | - Jong Kwan Park
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
- CONTACT Jong Kwan ParkDepartment of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju54909, Republic of Korea
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10
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Lundy SD, Sabanegh ES. Varicocele management for infertility and pain: A systematic review. Arab J Urol 2018; 16:157-170. [PMID: 29713547 PMCID: PMC5922006 DOI: 10.1016/j.aju.2017.11.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 12/18/2022] Open
Abstract
Despite being first described two thousand years ago, the varicocele remains a controversial multifaceted disease process with numerous biological consequences including infertility, hypogonadism, and chronic orchidalgia. The underlying mechanisms remain poorly understood and likely include hypoxia, oxidative stress, hyperthermia, anatomical aberrations, and genetics as primary components. Despite a high prevalence amongst asymptomatic fertile men, varicoceles paradoxically also represent the most common correctable cause for male infertility. In this systematic review we discuss the rich historical aspects of the varicocele and the contemporary data regarding its clinical manifestations. We performed a systematic literature review with the goal of comparing outcomes and complication rates of each of the major surgical approaches as they relate to infertility and pain. We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-compliant systematic literature review for manuscripts focused on varicocele and its biological consequences. We identified 112 studies suitable for qualitative analysis and included 56 of these for quantitative analysis, with an emphasis on infertility and chronic pain outcomes. Taken together, the clinical work to date suggests that the highest fertility rates and the lowest complication rates are associated with the microsurgical subinguinal surgical approach to varicocelectomy. In all, 26-40% of patients undergoing varicocelectomy will successfully achieve short-term spontaneous pregnancy, and up to 90% of all patients undergoing varicocelectomy for pain will have improvement and/or resolution of their symptoms. Taken together, the data support an ongoing role for varicocelectomy in both of these clinical arenas.
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Affiliation(s)
- Scott D. Lundy
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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11
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Pallotti F, Paoli D, Carlini T, Vestri AR, Martino G, Lenzi A, Lombardo F. Varicocele and semen quality: a retrospective case-control study of 4230 patients from a single centre. J Endocrinol Invest 2018. [PMID: 28647897 DOI: 10.1007/s40618-017-0713-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of the present study is to assess impairment of spermatogenesis induced by varicocele in, to our knowledge, the largest single-centre caseload available to date. MATERIALS AND METHODS We conducted a retrospective study on 4230 consecutive patients attending our Department for andrological outpatient assessment and preconception check-ups between 2011 and 2014. A total of 2113 patients had varicocele (Group V), while the remaining 2117 were selected as the control group (Group C). All patients were divided into age classes (<17, 18-28, 29-39 and ≥40 years), and Group V patients were classified as "low" (I-II) or "high" (III-IV) grade. RESULTS Varicocele patients had a higher mean height than controls, as well as lower BMI. There was also a statistically significant reduction in the concentration/mL and the total sperm number in Group V against Group C. When stratified by age, values for all semen parameters were significantly worse in the older than in the younger age classes in both Group V and Group C, except for concentration/mL and total sperm number in the 29-39 and ≥40 age classes in both groups. A multivariable logistic regression analysis showed that factors independently predicting the presence of varicocele were older age, higher BMI and smoking for more than 10 years. CONCLUSIONS Varicocele patients show worse semen parameters compared to controls, although their values were still within WHO reference limits. Semen quality is further worsened by increased age, grade and chronic smoking.
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Affiliation(s)
- F Pallotti
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - D Paoli
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - T Carlini
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - A R Vestri
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - G Martino
- Department of Surgical Sciences "R. Paolucci", "Sapienza" University of Rome, Rome, Italy
| | - A Lenzi
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - F Lombardo
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
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Clavijo RI, Carrasquillo R, Ramasamy R. Varicoceles: prevalence and pathogenesis in adult men. Fertil Steril 2017; 108:364-369. [PMID: 28865534 DOI: 10.1016/j.fertnstert.2017.06.036] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 06/29/2017] [Indexed: 11/28/2022]
Abstract
Varicocele, or dilation of the pampiniform venous plexus, affects up to 15% of men. However, few of these men encounter problems with fertility. This discrepancy between men with varicocele and the number of adversely affected men has led to abundant research to identify the mechanisms for formation of varicocele as well as the pathologic mechanisms by which varicoceles affect fertility potential. In this review, we discuss the prevalence of varicocele in adults, the anatomic features of varicocele, the leading theories as to how varicocele can negatively affect fertility potential, and finally, the current literature on the impact of varicocele on testosterone production.
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Affiliation(s)
- Raul I Clavijo
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Robert Carrasquillo
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida.
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13
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Varicocele embolization with glue and coils: A single center experience. Diagn Interv Imaging 2017; 98:529-534. [PMID: 28185841 DOI: 10.1016/j.diii.2017.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/10/2017] [Accepted: 01/11/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to compare metallic coils and glue (n-butyl-2 cyanoacrylate) for varicocele embolization, regarding immediate technical and clinical success, procedure time, complications and recurrence rates. MATERIALS AND METHODS A retrospective analysis of a consecutive series of varicocele embolization procedures performed between July 2012 and July 2015 was undertaken. A total of 129 procedures were performed, 26 using glue (20.2%; 26 men with a mean age of 32.6 years) and 103 using coils (79.8%; 103 men with a mean age of 32.3 years). Demographic data, indications, technique, procedure time, complications and outcomes were compared. RESULTS A total of 89 procedures (69%) were motivated by infertility (glue=20, coils=69) and 40 (31%) by testicular pain (glue=6, coils=34). The mean procedure time was 35.58±13.44 (SD) min for glue and 45.97±17.46 (SD) min for coils (P=0.0054). Immediate technical success rate was 100% using glue and 99% using coils (P=1.0000). A single minor complication was observed after coil embolization (0.97%). Both materials showed significant improvement of semen parameters, with similar clinical success rates. For patients referred for testicular pain, clinical success rate was 66.67% using glue and 88.24% using coils (P=0.2147). Recurrence rate was 11.54% with glue and 5.83% with coils (P=0.4000). Procedure time was significantly shorter with glue (P=0.0054). CONCLUSION Glue and coils are both safe and effective for varicocele embolization. However, the use of glue yields shorter procedure time.
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Varicocele Is Associated with Impaired Semen Quality and Reproductive Hormone Levels: A Study of 7035 Healthy Young Men from Six European Countries. Eur Urol 2016; 70:1019-1029. [DOI: 10.1016/j.eururo.2016.06.044] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/30/2016] [Indexed: 11/23/2022]
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16
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Esteves SC, Gosálvez J, López-Fernández C, Núñez-Calonge R, Caballero P, Agarwal A, Fernández JL. Diagnostic accuracy of sperm DNA degradation index (DDSi) as a potential noninvasive biomarker to identify men with varicocele-associated infertility. Int Urol Nephrol 2015; 47:1471-7. [PMID: 26228577 DOI: 10.1007/s11255-015-1053-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 06/30/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Varicocele is a frequent cause of impaired testicular function that has been associated with increased levels of sperm DNA fragmentation (SDF). Sperm with degraded DNA (DDS), as observed using the sperm chromatin dispersion (SCD) test, represent a subpopulation of spermatozoa with extensive DNA and nuclear protein damage. The aim of this work was to determine the usefulness of sperm DNA degradation index (DDSi) as a novel noninvasive biomarker to identify infertile men with varicocele. METHODS A total of 593 semen samples obtained from men attending infertility clinics were analyzed for SDF and DDS with the SCD test. These samples were classified as: (1) fertile donors; (2) infertile patients with least two failed assisted reproduction cycles; (3) leukocytospermia; (4) Chlamydia trachomatis infection; (5) testicular cancer, and (6) infertile men with varicocele. The DDSi was obtained by determining the proportion of DDS in the whole sperm population presenting with fragmented DNA. The diagnostic accuracy of DDSi was evaluated by correlation coefficient and receiver operating characteristics analyses. RESULTS A positive correlation (r ≥ 0.52) was observed between the SDF and the frequency of degraded sperm in all patient groups. The sperm DNA degradation index (DDSi) was at least twice as higher in infertile men with varicocele (mean: 0.54) compared with other clinical conditions and fertile donors (means ranging from 0.02 to 0.21; P < 0.0001). A DDSi ≥ 0.33 identified patients with varicocele with 94 % accuracy. CONCLUSION Although DDS is not pathognomonic of varicocele, the DDSi is a useful noninvasive biomaker to identify infertile individuals with varicocele when examining sperm DNA damage during a routine semen analysis. This finding may alert practitioners and laboratories performing semen analysis that in the presence of an abnormal DDSi it is likely that a given patient has varicocele. It is therefore strongly recommended that such patients be referred to urologists in order to undergo a full andrological examination and be properly counseled.
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Affiliation(s)
- Sandro C Esteves
- Androfert, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, Brazil,
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17
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Outcome of Varicocelectomy with Different Degrees of Clinical Varicocele in Infertile Male. ACTA ACUST UNITED AC 2015. [DOI: 10.1155/2015/432950] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim. To evaluate the prevalence and effect of varicocele repair on sperm motility, sperm concentration, testicular volume, and pregnancy rate in different degrees of clinical varicocele. Material and Methods. The case records were retrospectively evaluated for 482 infertile patients with varicocele who underwent varicocelectomy from December 2008 to December 2013. Semen analysis of patient at preoperative and 3-, 6-, and 12-month postoperative period was done. Varicocele was graded as per the World Health Organization grading (WHO 1993) system and included in the study. Testicular volume was noted by ultrasonography in pre- and postoperative period in one-year follow-up. Pregnancy rate was calculated at 3, 6, and 12 months of follow-up. Results. Significant differences were seen in sperm motility and concentration of patients with Grade 3 varicocele as compared with Grade 1 and Grade 2 varicocele. Significant increase in testicular volume was present after one year in Grade 3 varicocele in the postoperative period. There was significant correlation between the testicular volume and the sperm concentration. Percentage of spontaneous pregnancy in 1 year after varicocele treatment was 32 to 41% of cases. Conclusion. Varicocelectomy significantly improved sperm motility, concentration, and testicular volume. There were 32 to 41% of infertile patients who achieved pregnancy spontaneously.
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Gordhan CG, Sadeghi-Nejad H. Scrotal pain: evaluation and management. Korean J Urol 2015; 56:3-11. [PMID: 25598931 PMCID: PMC4294852 DOI: 10.4111/kju.2015.56.1.3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/04/2014] [Indexed: 11/18/2022] Open
Abstract
Scrotal pain is a common complaint in a urological practice. Its diagnosis can prove challenging in both acute and chronic forms and requires a thorough and complete history and physical examination. This article discusses the evaluation and management of several entities of scrotal pain, including testicular torsion, epididymitis, postvasectomy pain, varicocele, and chronic orchialgia.
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Affiliation(s)
- Chirag G Gordhan
- Division of Urology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Hossein Sadeghi-Nejad
- Division of Urology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
- Center for Male Reproductive Medicine & Microsurgery, Hackensack University Medical Center, Hackensack, NJ, USA
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Komiya A, Watanabe A, Kawauchi Y, Fuse H. Analysis of inter-examination differences in sperm nuclear vacuoles among male patients with infertility. Syst Biol Reprod Med 2014; 60:35-42. [PMID: 24423098 DOI: 10.3109/19396368.2013.855837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We analyzed the inter-examination differences in sperm nuclear vacuoles among male patients with infertility. We enrolled 56 male patients with infertility who underwent multiple semen analyses and high-magnification observation of the sperm head. A total of 162 ejaculates were evaluated. The average patient age was 34.5 years. Following the conventional semen analysis, the nuclear vacuoles in motile spermatozoa were evaluated at 3700-6150 × magnification on an inverted microscope equipped with differential interference contrast optics. A large sperm nuclear vacuole (LNV) was defined as one or more vacuoles with a maximum diameter exhibiting > 50% width of the sperm head. We compared the differences in the proportion of spermatozoa with LNVs between two consecutive semen samples before treatment. Treatment-related differences in the number of LNVs were also analyzed. Student's t-test was used to perform the statistical analyses. No differences were observed in any semen parameters between the first and second ejaculates. On high-magnification microscopy, the proportion of spermatozoa with LNVs was 23.5% and 29.4% (p = 0.0220) in the first and second ejaculates, respectively in 33 patients. Among the 18 patients who underwent varicocele repair using a microsurgical subinguinal approach, the proportion of spermatozoa with LNVs at baseline, three, and six months after surgery was 27.7%, 12.0% (p = 0.0132 versus baseline), and 10.3% (p = 0.0226 versus baseline), respectively. After three months of medical treatment for male infertility in 28 patients, the proportion of spermatozoa with LNVs slightly decreased from 33.3% to 28.6% (p = 0.1276); however, it was not statistically significant. In conclusion, when multiple ejaculates were obtained, in the subset of male patients with infertility, the proportion of spermatozoa with LNVs could be different. The number of LNVs decreased following varicocele repair.
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Affiliation(s)
- Akira Komiya
- Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama , Toyama-shi , Japan
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20
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Alan C, Ertung Y, Cakır DU, Topaloglu N, Ersay AR, Basturk G. Asymmetric dimethyl arginine levels in testicular tissue and blood of rats with induced experimental varicocele. Rev Int Androl 2014. [DOI: 10.1016/j.androl.2014.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ismail E, Orlando G, Pompa P, Gabrielli D, Di Donato L, Cardone D, Merla A. Time-domain analysis of scrotal thermoregulatory impairment in varicocele. Front Physiol 2014; 5:342. [PMID: 25278903 PMCID: PMC4165266 DOI: 10.3389/fphys.2014.00342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 08/21/2014] [Indexed: 11/25/2022] Open
Abstract
Varicocele is a common male disease defined as the pathological dilatation of the pampiniform plexus and scrotal veins with venous blood reflux. Varicocele usually impairs the scrotal thermoregulation via a hemodynamic alteration, thus inducing an increase in cutaneous temperature. The investigation of altered scrotal thermoregulation by means of thermal infrared imaging has been proved to be useful in the study of the functional thermal impairment. In this study, we use the Control System Theory to analyze the time-domain dynamics of the scrotal thermoregulation in response to a mild cold challenge. Four standard time-domain dynamic parameters of a prototype second order control system (Delay Time, Rise Time, closed poles locations, steady state error) and the static basal temperatures were directly estimated from thermal recovery curves. Thermal infrared imaging data from 31 healthy controls (HCS) and 95 varicocele patients were processed. True-positive predictions, by comparison with standard echo color Doppler findings, higher than 87% were achieved into the proper classification of the disease stage. The proposed approach could help to understand at which specific level the presence of the disease impacts the scrotal thermoregulation, which is also involved into normal spermatogenesis process.
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Affiliation(s)
- Enas Ismail
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti PescaraChieti-Pescara, Italy
- Institute for Advanced Biomedical Technologies (ITAB), G. d'Annunzio UniversityChieti-Pescara, Italy
- *Correspondence: Enas Ismail, Department of Neuroscience, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies (ITAB), G. d'Annunzio University, Campus Universitario, Via dei Vestini, 66013 Chieti Scalo, Italy e-mail:
| | | | - Paolo Pompa
- Department of Urology, Ospedale CivilePescara, Italy
| | - Daniela Gabrielli
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti PescaraChieti-Pescara, Italy
- Institute for Advanced Biomedical Technologies (ITAB), G. d'Annunzio UniversityChieti-Pescara, Italy
| | - Luigino Di Donato
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti PescaraChieti-Pescara, Italy
- Institute for Advanced Biomedical Technologies (ITAB), G. d'Annunzio UniversityChieti-Pescara, Italy
| | - Daniela Cardone
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti PescaraChieti-Pescara, Italy
- Institute for Advanced Biomedical Technologies (ITAB), G. d'Annunzio UniversityChieti-Pescara, Italy
| | - Arcangelo Merla
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti PescaraChieti-Pescara, Italy
- Institute for Advanced Biomedical Technologies (ITAB), G. d'Annunzio UniversityChieti-Pescara, Italy
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Muratorio C, Meunier M, Sonigo C, Massart P, Boitrelle F, Hugues JN. [Varicocele and infertility: where do we stand in 2013?]. ACTA ACUST UNITED AC 2013; 41:660-6. [PMID: 24183580 DOI: 10.1016/j.gyobfe.2013.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Indexed: 11/19/2022]
Abstract
While the incidence of clinical varicocele is common in infertile men (about 40%), the reasons why varicocele may affect sperm parameters is still unclear. In addition, the improvement of fertility after treatment of varicocele is also a subject of debate. The purpose of this review is to get new insight into the physiopathology of varicocele, its impact on sperm parameters and the effectiveness of varicocele treatment on fertility. Treatment is likely to be effective in infertile men with clinical varicocele and impaired spermatogenesis. Even if it does not systematically lead to an improvement in sperm parameters, it may prevent further sperm degradation. In case of non-obstructive azoospermia, few studies reported a slight improvement in the process of spermatogenesis. The critical role of an adequate methodology in order to establish clinical guidelines needs to be stressed. Indeed, the huge intra-individual variability in sperm production makes the usual analysis of sperm parameters inadequate to measure treatment effectiveness. Regarding the assessment of conception, it requires not only well designed and properly sized studies but also a multivariate analysis for weighing predictive factors of success. Thus, an active scientific research is needed to better identify pathogenic agents and appropriately assess the impact of varicocele treatment.
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Affiliation(s)
- C Muratorio
- Service de médecine de la reproduction, hôpital Jean-Verdier, Assistance publique-Hôpitaux de Paris, avenue du 14-juillet, 93143 Bondy cedex, France; Service de médecine de la reproduction, CHI de Poissy-Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78303 Poissy cedex, France.
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Iosa G, Lazzarini D. Hemodynamic classification of varicoceles in men: our experience. J Ultrasound 2013; 16:57-63. [PMID: 24294344 DOI: 10.1007/s40477-013-0016-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 02/01/2013] [Indexed: 12/15/2022] Open
Abstract
AIM The aim of this work is to propose a new hemodynamic classification of male varicoceles that can improve the accuracy of staging and the quality of the examination report. We retrospectively analyzed data on outpatients referred to our vascular ultrasonography service by general practitioners or urologists for work-up of "varicoceles." Quantification and characterization of venous reflux is essential for selecting patients who require treatment and for evaluating the latter's effectiveness, as demonstrated by our experience in a subgroup of 58 patients referred for imaging after surgery on endovascular procedures. MATERIALS AND METHODS We performed scrotal Doppler sonography on 278 males seen during the period 2009-2011 for doubts raised during clinical assessment of varicoceles or for postoperative evaluation of residual reflux. RESULTS The diagnosis of varicocele was confirmed on 193 subjects; in 32 patients who had undergone percutaneous or surgical treatment the examination demonstrated the presence of residual reflux, while in 85 cases the presence of pain or a scrotal mass was not associated with venous reflux. CONCLUSIONS Standardized instrumental criteria have been developed for the diagnosis of varicoceles but not for their staging. The classification system we propose provides a simple, hemodynamically accurate method for qualitatively evaluating venous reflux, and it can be a useful tool for verifying the success of surgical and endovascular procedures for correcting varicoceles.
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Affiliation(s)
- G Iosa
- Medicina Interna Ospedale "Marconi", Cesenatico, AUSL Cesena, Cesena, Italy
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Inci K, Gunay LM. The role of varicocele treatment in the management of non-obstructive azoospermia. Clinics (Sao Paulo) 2013; 68 Suppl 1:89-98. [PMID: 23503958 PMCID: PMC3583153 DOI: 10.6061/clinics/2013(sup01)10] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 03/19/2012] [Indexed: 02/06/2023] Open
Abstract
The literature on male reproductive medicine is continually expanding, especially regarding the diagnosis and treatment of infertility due to non-obstructive azoospermia. The advent of in vitro fertilization with intracytoplasmic sperm injection has dramatically improved the treatment of male infertility due to nonobstructive azoospermia. Assisted reproduction using testicular spermatozoa has become a treatment of hope for men previously thought to be incapable of fathering a child due to testicular failure. In addition, numerous studies on non-obstructive azoospermia have reported that varicocelectomy not only can induce spermatogenesis but can also increase the sperm retrieval rate; however, the value of varicocelectomy in patients with non-obstructive azoospermia still remains controversial. The purpose of this review is to present an overview of the current status of varicocele repair in men with non-obstructive azoospermia.
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Affiliation(s)
- Kubilay Inci
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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Soylemez H, Atar M, Ali Sancaktutar A, Bozkurt Y, Penbegul N. Varicocele among healthy young men in Turkey; prevalence and relationship with body mass index. Int Braz J Urol 2012; 38:116-21. [PMID: 22397773 DOI: 10.1590/s1677-55382012000100016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2011] [Indexed: 05/26/2023] Open
Abstract
AIM Varicocele is characterized by abnormal tortuosity and dilatation of the veins of the pampiniform plexus within the spermatic cord and is one of the causes related to male infertility. This study aimed to investigate the correlation between varicocele and somatometric parameters. We also aimed to determine prevalence and treatment ratio of this disorder among healthy young Turkish men. MATERIALS AND METHODS A total of 2061 young men aged from 19 to 34 years was enrolled and cross sectionally evaluated for status of varicocele. Body mass index was calculated. Patients were categorized as normal weight, overweight and obese using by National Institutes of Health criteria. Patients underwent physical examinations for the presence and grade of varicocele. If the varicocele was found and previously submitted to different treatment modalities, the age of treatment and outcomes were recorded. RESULTS Varicocele was present in 498 men (24.2%). The mean age of the participants was 22.7 ± 1.8 years, and the median BMI was 22.8 ± 2.0 kg/m². There were no significant differences in age, height, weight and BMI among the patients with different grades of varicocele (p > 0.05). Although no significant difference was found in varicocele prevalence between normal weight and over-weight participants (p > 0.05), obese participants had significantly lower varicocele prevalence compared with normal or over weight participants (p = 0.006). A total of 49 men had scrotal pain and the treatment ratio was only 2.8%. CONCLUSION Prevalence of varicocele was found in about 24% of healthy young Turkish population. Participants with varicocele had significantly lower BMI values compared with those without varicocele. Our findings supported the hypothesis that individuals with a greater BMI may have advantages in relieving the varicocele, but further studies are required to clarify this issue. Additionally treatment ratio was low among young men with varicocele.
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Affiliation(s)
- Haluk Soylemez
- Dicle University, Medical Faculty, Department of Urology, Turkey.
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Abdelrahman SS, Eassa BI. Outcome of Loupe-Assisted Sub-inguinal Varicocelectomy in Infertile Men. Nephrourol Mon 2012; 4:535-40. [PMID: 23573481 PMCID: PMC3614283 DOI: 10.5812/numonthly.1623] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 09/07/2011] [Accepted: 09/18/2011] [Indexed: 11/26/2022] Open
Abstract
Background Sub-inguinal varicocelectomy is widely used among surgeons. Objectives The aim of this study was to evaluate the outcome of varicocelectomy using a modified microsurgical method, specifically a loupe-assisted method, and its effects on sperm parameters in infertile men. Patients and Methods This study was performed in 40 patients who presented with varicocele. All patients had at least a 1-year history of infertility with abnormal semen parameters and varicocele proven by physical examination and confirmed with color Doppler ultrasound. Routine preoperative investigations were performed. Semen analysis and hormonal profiling were also performed and repeated postoperatively for follow-up. Half of the patients (20 patients) were treated by a sub-inguinal approach assisted by loupe magnification (Group A) and the other half was treated by the same approach but without magnification (Group B). To facilitate the procedure, an ×3.0 loupe was used during the spermatic cord dissection at the level of the external inguinal ring. During dissection, the dilated veins, including the vassal veins and external spermatic veins, were ligated and divided. Results In total, 40 patients were followed for more than 6 months. The age of the patients varied from 25 to 38 years (mean 32.5). No intra-operative complications occurred in both groups. Regarding post-operative complications, Group A contained only one patient (5%) who developed scrotal hematoma and two (10%) who developed wound infection, whereas in Group B, the complication rate was higher: two patients (10%) developed scrotal hematoma, two patients (10 %) developed wound infection, three patients (15%) developed hydrocele, two patients (10%) developed recurrence, and two patients (10%) developed scrotal edema. Regarding the seminal parameters, much improvement was observed in the sperm count and sperm motility, and a decrease in abnormal forms was observed after surgery with significant differences in Group A. In Group B, similar effects were observed, but without significant differences. Conclusions Loupe-assisted sub- inguinal varicocelectomy is a safe, simple, and effective method for the treatment of sub-fertile men, especially in medical facilities without microscopic equipment, and permits significant improvement in sperm parameters.
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Affiliation(s)
| | - Bayoumy I. Eassa
- Department of Dermatology, Venereology and Andrology, Al-Azhar University, Cairo, Egypt
- Corresponding author: Bayoumy Ibrahim Eassa, Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-hussein University Hospital, Al-Azhar University, Cairo, Egypt. Tel.: +20-24556558, Fax: +20-225104146, E-mail:
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Miyaoka R, Esteves SC. A critical appraisal on the role of varicocele in male infertility. Adv Urol 2011; 2012:597495. [PMID: 22162682 PMCID: PMC3228353 DOI: 10.1155/2012/597495] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 09/26/2011] [Indexed: 11/17/2022] Open
Abstract
Varicocele is a major cause of male infertility, as it may impair spermatogenesis through several distinct physiopathological mechanisms. With the recent advances in biomolecular techniques and the development of novel sperm functional tests, it has been possible to better understand the mechanisms involved in testicular damage provoked by varicocele and, therefore, propose optimized ways to prevent and/or reverse them. Up to now, there is still controversy involving the true benefit of varicocele repair in subfertile men as well as in certain specific situations such as concomitant contralateral subclinical varicocele or associated nonobstructive azoospermia. Also, with the continued development of assisted reproductive technology new issues and questions are emerging regarding the role of varicocelectomy in this context. This paper reviews the most recent data available on the pathogenesis, diagnosis, and management of varicocele with regard to male infertility.
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Affiliation(s)
- Ricardo Miyaoka
- ANDROFERT-Center for Male Reproduction, Av. Dr. Heitor Penteado 1464, Campinas 13075-460, São Paulo, Brazil
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Will MA, Swain J, Fode M, Sonksen J, Christman GM, Ohl D. The great debate: varicocele treatment and impact on fertility. Fertil Steril 2011; 95:841-52. [PMID: 21272869 PMCID: PMC3046876 DOI: 10.1016/j.fertnstert.2011.01.002] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 06/17/2010] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the current literature on the impact and potential mechanisms of varicocele repair on male fertility. DESIGN Pertinent articles were identified through computer PubMed search on varicocele repair and male factor infertility. References of selected articles were hand searched for additional citations. CONCLUSION(S) Varicocele repair has been shown to reverse a spectrum of effects contributing to men with impaired fertility. Clinical studies on the intervention have illustrated variable effects on postoperative sperm parameters and pregnancy rates (PR). Studies with conflicting results suffer from a significant number of confounding variables such as variable repair technique or lack of controls. Additional studies are warranted on the role of modern microsurgical varicocelectomy given the improvements in assisted reproductive technologies (ART).
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Affiliation(s)
- Matthew A Will
- Department of Obstetrics and Gynecology, University of Michigan Hospitals, Ann Arbor, Michigan 48109, USA.
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A histological study of ipsilateral testis after experimentally induced varicocele in albino rats and the role of L-carnitine supplementation. ACTA ACUST UNITED AC 2011. [DOI: 10.1097/01.ehx.0000395191.16543.ea] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cuda SP, Musser JE, Belnap CM, Thibault GP. Incidence and clinical significance of arterial injury in varicocele repair. BJU Int 2010; 107:1635-7. [PMID: 20950303 DOI: 10.1111/j.1464-410x.2010.09643.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE • This study was performed to histologically determine the rate of arterial injury in varicocele ligation surgery and to determine the clinical significance of these arterial injuries. MATERIALS AND METHODS • 41 men who underwent varicocele ligation surgery, and had segments of each ligated vessel examined histologically. • The patients were followed prospectively to determine the effect of arterial injury on surgical results and clinical complications. RESULTS • Arterial ligation was identified in 6 of 41 patients (12%), and in 7 of 132 specimens (5%), which is higher than previous reports. • Arterial injury was not associated with testicular atrophy and there was no apparent effect of arterial injury on surgical outcome. CONCLUSION • The rate of arterial injury during varicocele repair is higher than previously reported, but the clinical significance of these injuries appears to be limited.
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Affiliation(s)
- Scott P Cuda
- Tripler Army Medical Center, Urology Section, Honolulu, HI 96859-5000, USA
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Yoon CJ, Park HJ, Park NC. Reactive oxygen species in the internal spermatic and brachial veins of patients with varicocele-induced infertility. Korean J Urol 2010; 51:348-53. [PMID: 20495699 PMCID: PMC2873890 DOI: 10.4111/kju.2010.51.5.348] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Accepted: 04/14/2010] [Indexed: 11/29/2022] Open
Abstract
Purpose The aim of this study was to evaluate the relationship between the levels of reactive oxygen species (ROS) and the clinical characteristics of varicoceles among patients with varicocele-induced infertility. Materials and Methods Ninety-eight patients with infertile varicocele and 22 control subjects without varicocele were enrolled. Blood samples were drawn from the brachial vein (BV) and the dilated internal spermatic vein (ISV) on the side of the varicocele during surgery. ROS levels were determined by spectrophotometry, and comparisons between the varicocele and control groups were performed. In addition, the ROS levels were analyzed according to the characteristics of the varicocele, and ROS levels in the ISV and the BV were compared. Results The ROS levels measured in the ISV of men with varicocele were higher than in the control group regardless of the varicocele grade except for subclinical grade; however, in the BV, a difference was noted only for grade III. When the difference in testis volume between sides was greater than 3 ml, and the varicocele had been present for more than 3 years, ROS levels were higher in the ISV than in the BV. Sperm viability was significantly associated with ROS levels. Serum hormone levels were not correlated with ROS levels. Conclusions Serum ROS levels were higher in infertile men with a varicocele than in controls. They were correlated with varicocele grade, varicocele duration, the degree of testicular hypotrophy, and sperm viability. In addition, ROS levels and their associations with clinical characteristics were higher in the ISV than in the BV.
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Affiliation(s)
- Chang Jin Yoon
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
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Fuse H, Akashi T, Mizuno I, Nozaki T, Watanabe A. POSTOPERATIVE CHANGES OF SPERM CHROMATIN HETEROGENEITY, USING ACRIDINE ORANGE STAINING, IN VARICOCELE PATIENTS. ACTA ACUST UNITED AC 2009; 52:223-6. [PMID: 16574605 DOI: 10.1080/01485010500428397] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of this study was to evaluate postoperative changes in sperm chromatin heterogeneity in varicocele patients. In 15 infertile patients with varicocele, sperm parameters including concentration, motility, and morphology were evaluated before and after surgical correction of varicocele. Sperm motion analysis using computer-assisted semen analyzer (CASA) was also performed. To analyze the sperm nuclear proteins, the acridine orange staining method was used. On semen analysis, sperm concentration and motility significantly increased after surgery (p = 0.002, p = 0.003, respectively), although sperm morphology was unaltered postoperatively. CASA parameters, including velocity, linearity, amplitude of lateral head displacement and beat cross frequency were unaltered postoperatively. On the other hand, acridine orange staining significantly increased postoperatively (p = 0.002). Varicocele influences the sperm chromatin condition, as well as sperm concentration and motility.
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Affiliation(s)
- H Fuse
- Department of Urology, Faculty of Medicine, National University Corporation, University of Toyama, Toyama, Japan.
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The significance of age on success of surgery for patients with varicocele. Int Urol Nephrol 2009; 42:351-6. [DOI: 10.1007/s11255-009-9589-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Accepted: 05/07/2009] [Indexed: 10/20/2022]
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Acar H, Kilinc M, Guven S, Yurdakul T, Celik R. Comparison of semen profile and frequency of chromosome aneuploidies in sperm nuclei of patients with varicocele before and after varicocelectomy. Andrologia 2009; 41:157-62. [DOI: 10.1111/j.1439-0272.2008.00907.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
BACKGROUND A varicoceles is a meshwork of distended blood vessels in the scrotum, usually left-sided, due to dilatation of the spermatic vein. Although the concept that varicoceles causes, and varicocelectomy cures, male subfertility has been around for almost fifty years, the mechanisms by which varicoceles would affect fertility have not yet been satisfactorily explained, and neither have the mechanisms by which varicocelectomy would restore fertility. Furthermore, it has been questioned whether a causal relation exists at all between the distension of the pampiniform plexus and impairment of fertility. OBJECTIVES To evaluate the effect of varicoceles treatment on pregnancy rate in subfertile couples. SEARCH STRATEGY We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (12 Sept 2003 and October 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2004 and Issue 4, 2007), MEDLINE (January 1966 to October 2007), EMBASE (January 1985 to October 2007) and reference lists of articles. In addition, we handsearched specialist journals in the field from their first issue until 2007. We also checked cross-references, references from review articles and contacted researchers in the field. SELECTION CRITERIA Randomised controlled trials (RCTs) were included if they were relevant to the clinical question posed, if they reported pregnancy rates as an outcome measure, and if they reported data in treated (surgical ligation or radiological embolisation of the internal spermatic vein) and untreated groups. DATA COLLECTION AND ANALYSIS Nine studies met the inclusion criteria for the original review. One was an extension of a previously published study, which left eight studies for analysis. All eight only included men from couples with subfertility problems; one excluded men with sperm counts less than 5 million per mL and one men with sperm counts less than 2 million per mL, with or without progressive motility of less than 10%. Two trials involving clinical varicoceles included some men with normal semen analysis. Three studies specifically addressed only men with subclinical varicoceles. Two authors independently screened potentially relevant trials. Any differences of opinion were resolved by consensus (none occurred for this review). Studies were excluded from meta-analysis if they made comparisons other than those specified above. MAIN RESULTS The combined Peto odds ratio (OR) of the eight studies is 1.10 (95%CI 0.73 to 1.68), indicating no benefit of varicoceles treatment over expectant management in subfertile couples in whom varicoceles in the man is the only abnormal finding. AUTHORS' CONCLUSIONS There is no evidence that treatment of varicoceles in men from couples with otherwise unexplained subfertility improves the couple's chance of conception.
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Affiliation(s)
- Johannes Hans L H Evers
- Department of Obstetrics & Gynaecology, Academisch Ziekenhuis Maastricht, PO Box 5800, Maastricht, Netherlands, 6202 AZ.
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Abstract
BACKGROUND A varicoceles is a meshwork of distended blood vessels in the scrotum, usually left-sided, due to dilatation of the spermatic vein. Although the concept that varicoceles causes, and varicocelectomy cures, male subfertility has been around for almost fifty years, the mechanisms by which varicoceles would affect fertility have not yet been satisfactorily explained, and neither have the mechanisms by which varicocelectomy would restore fertility. Furthermore, it has been questioned whether a causal relation exists at all between the distension of the pampiniform plexus and impairment of fertility. OBJECTIVES To evaluate the effect of varicoceles treatment on pregnancy rate in subfertile couples. SEARCH STRATEGY We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (12 Sept 2003 and October 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2004 and Issue 4, 2007), MEDLINE (January 1966 to October 2007), EMBASE (January 1985 to October 2007) and reference lists of articles. In addition, we handsearched specialist journals in the field from their first issue until 2007. We also checked cross-references, references from review articles and contacted researchers in the field. SELECTION CRITERIA Randomised controlled trials (RCTs) were included if they were relevant to the clinical question posed, if they reported pregnancy rates as an outcome measure, and if they reported data in treated (surgical ligation or radiological embolisation of the internal spermatic vein) and untreated groups. DATA COLLECTION AND ANALYSIS Nine studies met the inclusion criteria for the original review. One was an extension of a previously published study, which left eight studies for analysis. All eight only included men from couples with subfertility problems; one excluded men with sperm counts less than 5 million per mL and one men with sperm counts less than 2 million per mL, with or without progressive motility of less than 10%. Two trials involving clinical varicoceles included some men with normal semen analysis. Three studies specifically addressed only men with subclinical varicoceles. Two authors independently screened potentially relevant trials. Any differences of opinion were resolved by consensus (none occurred for this review). Studies were excluded from meta-analysis if they made comparisons other than those specified above. MAIN RESULTS The combined Peto odds ratio (OR) of the eight studies is 1.10 (95%CI 0.73 to 1.68), indicating no benefit of varicoceles treatment over expectant management in subfertile couples in whom varicoceles in the man is the only abnormal finding. AUTHORS' CONCLUSIONS There is no evidence that treatment of varicoceles in men from couples with otherwise unexplained subfertility improves the couple's chance of conception.
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Affiliation(s)
- Johannes Hans L H Evers
- Department of Obstetrics & Gynaecology, Academisch Ziekenhuis Maastricht, PO Box 5800, Maastricht, Netherlands, 6202 AZ.
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Pini Prato A, MacKinlay GA. Is the laparoscopic Palomo procedure for pediatric varicocele safe and effective? Surg Endosc 2006; 20:660-4. [PMID: 16432660 DOI: 10.1007/s00464-004-2252-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2004] [Accepted: 06/13/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Varicocele is a rare disorder in children that can lead to testicular atrophy and infertility; therefore, radical treatment is frequently required. Whatever treatment is chosen, postoperative complications are fairly common (hydrocele, recurrence, persistence, and testicular atrophy). Laparoscopic varicocelectomy (the laparoscopic Palomo procedure) is one of the surgical options that has recently gained popularity. The aim of this study is to assess the safety and effectiveness of laparoscopic Palomo varicocelectomy by describing a series of patients operated on during a 9 year period at the Royal Hospital for Sick Children in Edinburgh. METHODS This is a retrospective unicentric study including patients operated on between June 1995 and June 2004. All patients preoperatively underwent ultrasound scan of the testicles (color Doppler) and the abdomen. Indications for surgery included symptoms, high-grade varicocele (grade II and III), and testicular atrophy. Pneumoperitoneum was created using carbon dioxide insufflation with intraabdominal pressure up to 12 mmHg. Three 5 mm ports were inserted. The first port was inserted just below the umbilicus (telescope) under direct vision, and the others were inserted at the left flank and in the suprapubic region. All the enlarged spermatic and vas vessels were ligated or clipped. Outcomes and possible intraoperative, postoperative, or long-term complications are described. RESULTS Forty-one patients were included in the study. Ninety percent of symptomatic patients improved significantly postoperatively, and 62% of patients with preoperative testicular atrophy showed postoperative catch-up growth of the involved testis. Nevertheless, hydrocele represents the most frequent postoperative complication in this series of patients. Approximately 15% of the patients required some sort of further surgical intervention (12% because of postoperative hydrocele occurrence). CONCLUSIONS The laparoscopic Palomo procedure is a safe and effective surgical option for the treatment of pediatric varicocele, although it carries a fairly high risk of postoperative hydrocele. Postoperative hydrocele seems to be related to some sort of lymphatic obstruction, therefore lymphatic sparing procedures that can be accomplished laparoscopically should be reconsidered. Nevertheless, their feasibility and effectiveness need to be more carefully assessed.
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Affiliation(s)
- A Pini Prato
- Department of Pediatric Surgery, Giannina Gaslini Institute, Genova, Italy.
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Canales BK, Zapzalka DM, Ercole CJ, Carey P, Haus E, Aeppli D, Pryor JL. Prevalence and effect of varicoceles in an elderly population. Urology 2005; 66:627-31. [PMID: 16140091 DOI: 10.1016/j.urology.2005.03.062] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2004] [Revised: 03/02/2005] [Accepted: 03/24/2005] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The prevalence of a varicocele in the adolescent and young adult populations is approximately 15%. Because other varicose veins increase in prevalence with advanced age, we hypothesized that the incidence of varicoceles in the elderly population would be greater and might affect testicular size, consistency, and function. METHODS As part of a prostate cancer screening program, we prospectively evaluated 354 men (mean age 60.7 years) by physical examination for the presence of a varicocele, testicular size, and consistency, and measured the serum testosterone level. RESULTS A varicocele was present bilaterally in 19.8% (70 of 354), left sided only in 22.0% (78 of 354), and right sided only in 1.1% (4 of 354) of patients. Decreased testosterone levels correlated with older age (P = 0.001) and the presence of bilaterally soft testes (P = 0.02) but not the presence of a varicocele. Testes in men with bilateral varicoceles were significantly smaller (P = 0.001) and softer (P = 0.001) than in men without varicoceles. Higher grade varicoceles were more likely to be associated with soft testes (P = 0.001) than were lower grade varicoceles. CONCLUSIONS The 42% prevalence of varicoceles in our elderly population was greater than that for historic control younger populations, suggesting either an increase with age or examiner sensitivity bias. Varicoceles in the elderly, especially when bilateral, significantly affect testicular consistency (softer) and testicular size (smaller), but do not directly decrease serum testosterone levels. The presence of bilaterally soft testes in elderly men indicates bilateral gonadal dysfunction and may be a physical examination finding associated with decreased serum testosterone.
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Affiliation(s)
- Benjamin K Canales
- Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Siegel Y, Gat Y, Bacher GN, Gornish M. A Proposed Anatomic Typing of the Right Internal Spermatic Vein: Importance for Percutaneous Sclerotherapy of Varicocele. Cardiovasc Intervent Radiol 2005; 29:192-7. [PMID: 16328687 DOI: 10.1007/s00270-005-0037-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To classify the anatomic types of the right internal spermatic vein (ISV). METHODS We evaluated venograms obtained in 150 consecutive patients with idiopathic varicocele referred for transfemoral sclerotherapy. RESULTS Six anatomic types of the right internal spermatic vein (ISV) were recognized. These were classified by the location of their orifices and the tributary venous patterns. In roughly half the patients (53%), the ISV appeared as a simple vein with no remarkable retroperitoneal interconnections. In the remainder, complex retroperitoneal anastomoses were encountered. CONCLUSION By understanding these anatomic variations, the angiographer can approach treatment of right-sided varicocele with foreknowledge of the nature of these types and the presence of valves and collaterals.
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Affiliation(s)
- Yoel Siegel
- Department of Radiology, Rabin Medical Center Beilinson Campus (the Sackler Medical School Tel Aviv University), Petach Tikva, 49100, Israel.
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Gat Y, Bachar GN, Everaert K, Levinger U, Gornish M. Induction of spermatogenesis in azoospermic men after internal spermatic vein embolization for the treatment of varicocele. Hum Reprod 2004; 20:1013-7. [PMID: 15618245 DOI: 10.1093/humrep/deh706] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To evaluate the improvement in semen quality and pregnancy rate after internal spermatic vein (ISV) embolization in men with nonobstructive azoospermia virtual azoospermia, or extremely severe oligoteratoasthenoazoospermia (OTA). METHODS A prospective cohort of 101 azoospermic or severe oligoteratoasthenospermic men of mean (+/-SD) age 34.1+/-7.7 years who underwent ISV between September 1998 and June 2003 were evaluated for semen characteristics, endocrinology profile, and conception rate. RESULTS Significant improvement was noted in mean sperm concentration, motility, and morphology in 83 men (82%). Mean sperm concentration increased from 0.22+/-0.30 x 10(6)/ml total sperm in the ejaculate to 9.28+/-1.2 x 10(6)/ml after embolization (P < 0.001); mean sperm motility rose from 8.78+/-1.59 to 29.56+/-2.0% (P < 0.001), and mean sperm morphology rose from 3.79+/-0.74 to 13.72+/-1.37% (P < 0.005). Pregnancy was achieved in 34 cases (34%), 20 (20%) unassisted and 14 (14%) assisted. CONCLUSIONS Based on our findings, the following statements can be made: (i) Varicocele may cause any variation of severity in OTA, including azoospermia. (ii) Since male fertility is preserved with only one testis, OTA, azoospermia or virtual azoospermia represent bilateral testicular dysfunction. (iii) Treatment of bilateral varicocele may reverse testicular dysfunction and improve spermatognesis and testosterone production in men with extremely severe OTA and induce sperm production in men with azoospermia and virtual azoospermia. (iv) If azoospermia is not too long-standing, the treatment of varicocele may significantly improve spermatogenesis and renew sperm production. (v) Adequate treatment may spare in > 50% of azoospermic patients the need for testicular sperm extraction as preparation for ICSI. (vi) Since achievement of pregnancy in IVF units is higher when spermatogenesis is better, the treatment of varicocele (bilateral) is an effective medical adjunct for the IVF units prior to the treatment. We recommend that infertile men with azoospermia or virtual azoospermia or extremely severe OTA be evaluated for varicocele, with special attention to its bilateral nature.
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Affiliation(s)
- Yigal Gat
- Andrology Unit, Department of Obstetrics & Gynecology, Rabin Medical Center, Beilinson Campus, Petah Tiqva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Gat Y, Gornish M, Belenky A, Bachar GN. Elevation of serum testosterone and free testosterone after embolization of the internal spermatic vein for the treatment of varicocele in infertile men. Hum Reprod 2004; 19:2303-6. [PMID: 15298976 DOI: 10.1093/humrep/deh443] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To evaluate the effect of internal spermatic vein (ISV) embolization on levels of serum testosterone and free testosterone and on spermatogenesis. METHODS The files of 83 infertile men treated for varicocele were reviewed for changes in serum testosterone, free testosterone and spermatogenesis after ISV embolization. RESULTS Mean serum testosterone concentration rose after embolization by 43%, from 12.07 +/- 6.07 nmol/l to 17.22 +/- 8.43 nmol/l (P<0.001). Mean serum free testosterone concentration rose by 72%, from 5.93 +/- 2.44 nmol/l to 10.21 +/- 7.69 nmol/l (P<0.001). Mean sperm concentration increased from 7.49 +/- 1.73 x 10(6)/ml to 18.14 +/- 2.36 x 10(6)/ml (P<0.001); mean sperm motility increased from 21.74 +/- 2.47 to 34.47 +/- 2.27% (P<0.001); and mean sperm morphology increased from 6.63 +/- 1.07 to 13.08 +/- 1.44% (P<0.001). CONCLUSIONS ISV embolization apparently induces an increase in both serum testosterone and free testosterone concentrations and in sperm parameters in infertile patient with varicocele, regardless of the size of the varicocele.
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Affiliation(s)
- Yigal Gat
- Andrology Unit, Department of Obstetrics & Gynecology, Rabin Medical Center, Beilinson Campus, Petah Tiqva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Grober ED, Chan PTK, Zini A, Goldstein M. Microsurgical treatment of persistent or recurrent varicocele. Fertil Steril 2004; 82:718-22. [PMID: 15374720 DOI: 10.1016/j.fertnstert.2004.03.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2003] [Revised: 03/23/2004] [Accepted: 03/23/2004] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the effectiveness of subinguinal microsurgical varicocelectomy in the treatment of persistent or recurrent varicocele. DESIGN Retrospective chart review. SETTING Urban, tertiary care, academic teaching hospital. PATIENT(S) Fifty-four men who presented for treatment of persistent or recurrent varicocele. INTERVENTION(S) A single surgeon using an artery and lymphatic sparing subinguinal microsurgical technique with delivery of the testis repaired all varicocele. MAIN OUTCOME MEASURE(S) Preoperative to postoperative changes in semen parameters (volume of ejaculate, sperm concentration, percent motility, percent morphologically normal sperm, total motile sperm concentration), serum hormone levels, and testicular volume. Pregnancy rates and surgical complications were documented. RESULT(S) Postoperative mean serum T and mean testicular volume increased significantly from prevaricocelectomy levels. Median sperm concentration, percent motility, and total motile sperm per ejaculate improved significantly following recurrent varicocelectomy. Among patients with follow-up over 24 weeks (65%, 35 out of 54), the overall pregnancy rate was 40% (14 out of 35), including 23% (8 out of 35) of pregnancies achieved through natural intercourse, 9% (3 out of 35) with IVF/intracytoplasmic sperm injection, and 9% (3 out of 35) with IUI. Complications such as hydrocele, hematoma, wound infection, and testicular atrophy were not observed during the follow-up period. CONCLUSION(S) Treatment of persistent or recurrent varicocele using an artery and lymphatic sparing subinguinal microsurgical technique with delivery of the testis improves semen parameters, serum T levels, and testicular volume from preoperative levels without a significant risk of postoperative complications.
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Affiliation(s)
- Ethan D Grober
- Department of Surgery, Division of Urology, Mt. Sinai Hospital, University of Toronto, 155 Rosewell Avenue, Toronto, Ontario, Canada.
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Adelman WP, Joffe A. Controversies in male adolescent health: varicocele, circumcision, and testicular self-examination. Curr Opin Pediatr 2004; 16:363-7. [PMID: 15273494 DOI: 10.1097/01.mop.0000131451.41322.43] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The authors review three common clinical controversies encountered by primary care providers of adolescent males: management of varicoceles, the role of circumcision in the acquisition and transmission of sexually transmitted infections, and the value of teaching testicular self-examination. RECENT FINDINGS Recent findings in adolescent varicoceles have advanced knowledge regarding the cause of varicoceles, the mechanism by which they may lead to infertility, new screening methods, and optimal surgical management. Accumulating evidence shows circumcision to be protective against acquisition and transmission of sexually transmitted infections, and preliminary work also indicates the potential for protection against the spread of AIDS in Africa. Testicular self-examination remains an unproven screening modality that is suboptimally performed by at-risk patients. SUMMARY This review updates the provider on these topics and clarifies issues involved in these controversies
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Affiliation(s)
- William P Adelman
- Department of Adolescent Medicine, National Naval Medical Center, Bethesda, Maryland 20889, USA.
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Abstract
BACKGROUND Varicocele repair is a widely used treatment for subfertility. Our aim was to identify and combine the results from randomised controlled trials published to ascertain whether the pregnancy rates after varicocele repair are higher than those with no treatment. METHODS We did a systematic review of seven studies identified by searching Medline and a register of controlled trials. We also searched the contents of specialist journals and the annual meeting programmes of relevant societies by hand. Inclusion criteria were treatment of varicocele in subfertile couples, random allocation to treatment and control groups, and pregnancy or livebirth rates as an outcome measure. We pooled data by use of fixed and random effects models. FINDINGS None of seven eligible studies published between 1979 and 2002 described a strategy for concealment of the allocation sequence. There were 61 pregnancies among 281 treated couples and 50 pregnancies among 259 controls. The overall relative benefit of treatment was 1.01 (95% CI 0.73-1.40) by the fixed effects model and 1.04 (0.62-1.75) by the random effects model. The overall risk difference was 0.2% (-7 to 7) and 3% (-7 to 14), respectively. In subgroup analyses, varicocele treatment was not effective in trials restricted to male subfertility with clinical varicocele, or in those that included men with subclinical varicocele or normal semen analysis. However, this systematic review, done with a meta-analytical method, might have had insufficient power to detect small effects because of the small number of patients in some subgroups. INTERPRETATION Varicocele repair does not seem to be an effective treatment for male or unexplained subfertility.
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46
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Younes AKH. Improvement of sexual activity, pregnancy rate, and low plasma testosterone after bilateral varicocelectomy in impotence and male infertility patients. ARCHIVES OF ANDROLOGY 2003; 49:219-28. [PMID: 12746101 DOI: 10.1080/01485010390196706] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To evaluate the effects of bilateral varicocelectomy on sexual activity, testicular volumes, semen quality, and serum hormone levels in impotence and male infertility patients, 48 patients were studied from an outpatient clinic from May 1998 to March 2001. The mean age was 37+/-5.9; 16 patients were complaining of erectile dysfunction and 32 patients were complaining of male infertility. The mean duration of impotence was 3.3+/-2.4 years and for male infertility was 3.8+/-3.2 years. Sexual and reproductive history was taken for erectile dysfunction and male infertility patients. General, local examination, and laboratory investigations were done for all patients. Preoperative and postoperative testicular volumes; semen parameters, including semen volume, sperm count, and motility; and morphology and hormonal parameters, including LH and FSH, and testosterone levels were measured. All patients were followed up for 3-36 months after varicocele repair. Left and right testicular volume was improved in impotence and male infertility patients and fertility groups, but this improvement was not statistically significant (p>.25). The semen volume was significantly increased in male infertility patients and fertility group (p<.05), but there was no statistical significant difference in impotent patients (p>.25). The sperm count was improved in male infertility patients and fertility group, but this improvement was not statistically significant (p>.25), and in impotent patients there was no significant difference (p>.40). The sperm motility was very significantly increased in male infertility patients and the fertility group (p<.0005), and highly significantly increased in impotent patients (p<.005). The abnormal forms were not statistically significant in impotence and male infertility patients (p>.40), but significantly decreased in the fertility group (p<.05). Serum testosterone was very significantly increased in impotence and male infertility patients (p<.0005) and was highly significantly increased in fertility groups (p<.005). Serum FSH was improved in impotence and male infertility patients, but this improvement was not statistically significant (p>.10), and in fertility groups of male infertility patients, the results showed a statistically significant increase (p<.05). Serum LH was not statistically significant in impotence and male infertility patients (p>.10), and was significantly increased in fertility groups (p<.05). The improvement of sexual activity was 50-75%, the pregnancy rate for their partners was 37% and increased plasma testosterone levels over a period of 3 years of follow-up after varicocele repair.
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47
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Fuse H, Iwasaki M, Mizuno I, Ikehara-Kawauchi Y. Evaluation of acrosome reactivity using the Acrobeads test in varicocele patients: findings before and after treatment. ARCHIVES OF ANDROLOGY 2003; 49:1-6. [PMID: 12647773 DOI: 10.1080/01485010390129124] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The Acrobeads test was performed on semen samples from 43 patients with varicocele before and after varicocelectomy. Sperm motility significantly increased after surgery (p <.05), while sperm concentration and motile sperm concentration did not alter postoperatively. Sperm motion analysis using CellSoft 3000 did not demonstrate a significant change after treatment. Acrobeads score significantly increased after the procedure (p<.005). Pregnancy was achieved in 10 patients (28%). Acrobeads score in cases that achieved pregnancy was increased postoperatively (p<.005). The percentage of patients with a postoperative increase in Acrobeads score in the group that achieved pregnancy was significantly higher than that observed in the unsuccessful group (p <.05). Sperm parameters other than the Acrobeads score did not show a significant difference between the successful and unsuccessful patients. The Acrobeads test assessed postoperatively can be useful in precisely evaluating fertility potential after varicocele repair.
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Affiliation(s)
- H Fuse
- Department of Urology, Faculty of Medicine, Toyama Medical and Pharmaceutical University, Sugitani, Toyama, Japan.
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48
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Köksal T, Erdoğru T, Toptaş B, Gülkesen KH, Usta M, Baykal A, Baykara M. Effect of experimental varicocele in rats on testicular oxidative stress status. Andrologia 2002; 34:242-7. [PMID: 12220232 DOI: 10.1046/j.1439-0272.2002.00500.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The present experiments were undertaken to determine the levels of MDA, SOD and catalase in the testis of adolescent rats with experimental left varicoceles. Male Wistar rats, 7 weeks old and weighing 160-170 g, were randomly allocated into three groups. The first group of rats underwent partial ligation of the left renal vein (n = 15). The second group of rats underwent a sham operation (n = 7) and the third group acted as controls (n = 7). Animals were sacrificed 6 weeks after surgery and dilatation of the internal spermatic veins was observed. Levels of MDA, SOD and catalase activity were measured in testis. The experimental left varicocele group showed severe testicular changes compared to other groups. The mean MDA (SEM) levels in right and left testicular tissues of varicocele bearing rats, sham-operated rats, and control rats were 0.48 +/- 0.24 and 0.31 +/- 0.11, 0.22 +/- 0.02 and 0.35 +/- 0.12, 0.62 +/- 0.29 and 0.13 +/- 0.05, respectively (P > 0.05). The mean SOD (SEM) levels in right and left testicular tissues of varicocele bearing rats, sham-operated rats, and control rats were 7,790 +/- 606 and 6,974 +/- 574, 7,475 +/- 1,517 and 7020 +/- 1,106, 8,727 +/- 1,188 and 9,019 +/- 1,129, respectively (P > 0.05). The mean catalase (SEM) levels in right and left testicular tissues of varicocele bearing rats,sham-operated rats, and control rats were 75.77 +/- 11.5 and 53.82 +/- 10.1, 91.94 +/- 14 and 94.90 +/- 32, 65.40 +/- 5.7 and 90.93 +/- 16.4, respectively (P > 0.05). Our results suggest that oxidative status, which reflects a relative balance between reactive oxygen species (ROS) generated and ROS scavenged, may not be responsible for the testicular dysfunction associated with experimentally induced varicocele during adolescence in rats.
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Affiliation(s)
- T Köksal
- Department of Urology, Akdeniz University Faculty of Medicine, Antalya, Turkey.
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49
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Joshi NV, Medina H, Osuna JA. Ultrastructural pathology of varicocele spermatozoa by using atomic force microscopy (AFM). ARCHIVES OF ANDROLOGY 2001; 47:143-52. [PMID: 11554686 DOI: 10.1080/014850101316901352] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Ultrastructural investigation of pathological spermatozoa of patients having varicocele (grades I and III) in its natural environment (without fixation, dehydration, embedding, sectioning, etc.) was carried out by using Atomic Force Microscope (AFM) in tapping mode. This is a unique technique to examine the topographical structure with precision and to obtain 3-D images. It revealed structural alterations caused by the presence of varicocele. Not only neckpieces and flagella were defective, but also the head; particularly, dimensions and heights are altered.
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Affiliation(s)
- N V Joshi
- Laboratorio de Fisiologia de la Conducta, Facultad de Medicina, Universidad de Los Andes, Merida, Venezuela.
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50
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Cayan S, Kadioglu TC, Tefekli A, Kadioglu A, Tellaloglu S. Comparison of results and complications of high ligation surgery and microsurgical high inguinal varicocelectomy in the treatment of varicocele. Urology 2000; 55:750-4. [PMID: 10792094 DOI: 10.1016/s0090-4295(99)00603-2] [Citation(s) in RCA: 133] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To prospectively compare sperm parameters, pregnancy and recurrence rates, and complications after randomized high ligation surgery versus microsurgical high inguinal varicocelectomy (MHIV). METHODS Varicocele was diagnosed by physical examination and color Doppler ultrasound in 468 patients who underwent one of two procedures: high ligation surgery (n = 232) or MHIV (n = 236). The high ligation surgery was left unilateral in 142 and bilateral in 90. The MHIV was left unilateral in 128 and bilateral in 108. The patients were postoperatively evaluated by spermiograms and physical examination. The pregnancy rate was monitored for 2 years. RESULTS One year after surgery, 34.05% in the high ligation group and 46.61% in the MHIV group had a more than 50% increase in their total motile sperm count (P = 0.000). The increase in sperm count was not statistically different between the two groups (P = 0.1), but the difference in the increase in sperm motility in the MHIV group was statistically significant (P = 0.000). Pregnancy rates at the end of 2 years reached 33.57% in the high ligation group and 42.85% in the MHIV group, not a statistically significant difference (P = 0.0571). The postoperative recurrence as detected by physical examination was markedly different between the two techniques. The recurrence rate was 15.51% in the high ligation group and 2.11% in the MHIV group (P = 0.000). Also, the incidence of postoperative hydrocele was significantly different between the two groups (9.09% in the high ligation group and 0.69% in the MHIV group; P = 0.000). CONCLUSIONS MHIV has lower recurrence and hydrocele rates, a higher increase in sperm motility, and results in higher pregnancy rates. Therefore, it should be the preferred technique for varicocelectomy.
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Affiliation(s)
- S Cayan
- Department of Urology, Mersin University Faculty of Medicine, Mersin, Turkey
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