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Warli SM, Nabil RA, Kadar DD, Prapiska FF, Siregar GP. A comparison between the efficacy and complication of laparoscopic and microsurgical varicocelectomy: Systematic review and meta-analysis. Urol Ann 2024; 16:113-119. [PMID: 38818427 PMCID: PMC11135350 DOI: 10.4103/ua.ua_3_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 08/30/2023] [Indexed: 06/01/2024] Open
Abstract
Varicocele is the dilatation of the scrotal veins and may affect sperm count and infertility. It is caused by congenital vein insufficiency or absence of venous valve. The main treatment is by surgery, and currently, there are two minimally invasive choices: laparoscopic and microsurgical varicocelectomy. This systematic review aimed to record randomized clinical trials from various sources using all qualified studies up to June 2022. The assessed outcomes were operation time, hydrocele, hospital stay, change in semen parameter, recurrence rate, and pregnancy rate. The essential data extracted were Jadad score, publication year, age, and sample size. This systematic review consisted of 509 and 512 patients in the laparoscopic and microsurgery group, respectively, taken from 12 out of 281 studies. The result of this systematic review was significant difference in operation time between patients from two groups (weighted mean difference [WMD] -21.40, 95% confidence interval [CI]: -28.90--13.89); length of hospitalization (WMD: 0.38, 95% CI: 0.02-0.74); laparoscopic could significantly increase the risk of hydrocele by 3.30-fold (risk ratio [RR]: 3.30, 95% CI: 1.07-10.12); laparoscopic could significantly increase the recurrence rate by 6.98-fold (RR: 6.98, 95% CI: 3.46-14.08); no significant difference in spontaneous pregnancy between patients in both groups (RR: 0.81, 95% CI: 0.57-1.16); and laparoscopic surgery decreased the occurrence of sperm parameter changes by 40% (RR = 0.40, 95% CI: 0.25-0.62).
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Affiliation(s)
- Syah Mirsya Warli
- Department of Surgery, Division of Urology, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia
- Department of Urology, Universitas Sumatera Utara, Universitas Sumatera Utara Hospital, Medan, Indonesia
| | - Rizky An Nabil
- Department of Urology, Faculty of Medicine, Universitas Indonesia – Haji Adam Malik General Hospital, Medan, Indonesia
| | - Dhirajaya Dharma Kadar
- Department of Surgery, Division of Urology, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia
| | - Fauriski Febrian Prapiska
- Department of Surgery, Division of Urology, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia
| | - Ginanda Putra Siregar
- Department of Surgery, Division of Urology, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia
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Lira Neto FT, Roque M, Esteves SC. Effect of varicocele and varicocelectomy on sperm deoxyribonucleic acid fragmentation rates in infertile men with clinical varicocele. Minerva Obstet Gynecol 2024; 76:49-69. [PMID: 36222786 DOI: 10.23736/s2724-606x.22.05169-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Varicocele is the leading cause of male infertility. It can affect sperm quantity and quality through various non-mutually exclusive pathophysiological mechanisms, mainly oxidative stress. Excessive production of reactive oxygen species may overwhelm the sperm's defenses against oxidative stress and harm the sperm's DNA. Excessive sperm DNA breaks, so-called sperm DNA fragmentation, result from the oxidative stress cascade and are commonly found in the ejaculates of men with varicocele and fertility-related issues. Measuring sperm DNA fragmentation can provide valuable information on the extent of harm and might help select candidates for surgical treatment. Varicocelectomy is beneficial for alleviating oxidative stress-associated infertility and improving sperm DNA integrity. However, reproductive outcomes of infertile men with elevated sperm DNA fragmentation rates and surgically treated varicoceles remain poorly studied, and there is a need for well-designed trials to determine the impact of sperm DNA fragmentation reduction on natural and medically assisted reproduction.
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Affiliation(s)
- Filipe T Lira Neto
- AndrosRecife, Andrology Clinic, Recife, Brazil
- Department of Urology, Prof. Fernando Figueira Institute of Integrative Medicine, Recife, Brazil
| | - Matheus Roque
- Department of Reproductive Medicine, Mater Prime, São Paulo, Brazil
| | - Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, Brazil -
- Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, Brazil
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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Aksakalli T, Utlu A, Demirdogen SO, Cinislioglu AE, Karabulut I. Effects of smoking on varicocelectomy outcomes: a retrospective cohort study. Int Urol Nephrol 2024; 56:415-421. [PMID: 37812377 DOI: 10.1007/s11255-023-03816-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 09/16/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE To evaluate the effects of smoking on semen parameters and spontaneous pregnancy development by comparing smoker and non-smoker varicocelectomy patients. METHODS This study included 63 male patients with primary infertility for at least one year, and underwent microscopic subinguinal varicocelectomy at the Erzurum City Hospital urology clinic between 2020 and 2023. Patient files were retrospectively evaluated, and 27 patients were assigned to smoker group, whereas 36 patients were assigned to non-smoker group. Demographic data, semen parameters, spontaneous pregnancy development and timing were compared between two groups. RESULTS No statistically significant differences were observed in age, partner's age, BMI, clinical presentation, varicocele grade, side of varicocele, testicular volume, or testicular vein diameters (p > 0.05). The mean age of the study group was determined to be 30.7 ± 4.9 years. In the non-smoker group, 27 patients (75%) had only subfertility complaints, while 9 patients (25%) also experienced scrotal pain. Progressive motility was significantly higher in the non-smoker group at the 3rd month (28.11 ± 5.78 vs. 24.51 ± 4.24, p < 0.05) and 6th month (29.61 ± 5.16 vs. 26.22 ± 4.14, p < 0.05) evaluations. When comparing the rates of pregnancy development, the non-smoker group was determined to have a higher rate (53%), but this comparison was not statistically significant. (p < 0.05) Regarding the timing of pregnancy, the non-smoker group was associated with earlier spontaneous pregnancy. (5.84 ± 2.26 vs. 9.20 ± 2.30, p < 0.05). CONCLUSION Smoking negatively affects the outcomes of varicocelectomy in terms of semen parameters, spontaneous pregnancy development and timing. Prospective, randomized, and larger sample-sized studies are required on this subject. TRIAL REGISTRATION This study was approved by the Ataturk University Local Ethics Committee (approval number: B.30.2.ATA.0.01.00/234).
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Affiliation(s)
- Tugay Aksakalli
- Department of Urology, University of Health Sciences, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
| | - Adem Utlu
- Department of Urology, University of Health Sciences, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | | | - Ahmet Emre Cinislioglu
- Department of Urology, University of Health Sciences, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Ibrahim Karabulut
- Department of Urology, University of Health Sciences, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
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Maimaitiming A, Muhemaiti A, Mulati Y, Li X. Nomograms for Predicting Postoperative Sperm Improvements in Varicocele Patients. EUR UROL SUPPL 2024; 59:40-48. [PMID: 38264086 PMCID: PMC10804247 DOI: 10.1016/j.euros.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 01/25/2024] Open
Abstract
Background Varicocele is a condition that seriously affects male fertility. It can cause pathological changes in the testicles and affect their spermatogenesis and endocrine function. Objective To formulate nomograms to predict sperm improvements after microscopic varicocelectomy. Design setting and participants A retrospective analysis was conducted on varicocele patients who met the research criteria and were enrolled from March 2020 to June 2022. They were divided into a development and a validation cohort in a 2:1 ratio. Outcome measurements and statistical analysis Data on preoperative testicular atrophy index, bilateral testicular elastic modulus, testosterone, pre- and postoperative 6-mo total sperm count, sperm concentration, and sperm vitality were collected. An increase of ≥25% is considered a postoperative improvement in sperm parameters. Predictive nomograms were constructed through forward stepwise LR regression, based on independent risk factors filtered by univariate and multivariate logistic regression analyses. Receiver operating characteristic curve analysis, calibration curve, and decision curve analysis were employed to assess the performance of the models. Results and limitations The areas under the curve of nomograms for predicting the postoperative improvement of total sperm count, sperm concentration, and sperm vitality were 0.915, 0.986, and 0.924 respectively. The nomogram models demonstrated good predictive performance. The single-center sample size was a limitation of this study. Conclusions In this study, we developed effective predictive nomogram models for anticipating postoperative improvements in sperm quality among varicocele patients. These models offer a significant value in providing accurate predictions of surgical outcomes. However, it is crucial to conduct further external validation. Patient summary In this study, a predictive nomogram model was constructed for assessing the improvement of sperm quality in varicocele patients after surgery. The model offered satisfactory results.
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Affiliation(s)
- Abulaiti Maimaitiming
- Urology Department, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Clinical Research Center for Genitourinary System, Urumqi, China
| | - Aidibai Muhemaiti
- Ultrasound Department, Medical Imaging Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yelisudan Mulati
- Urology Department, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Clinical Research Center for Genitourinary System, Urumqi, China
| | - Xiaodong Li
- Urology Department, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Clinical Research Center for Genitourinary System, Urumqi, China
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Galea M, Brincat MR, Calleja-Agius J. A review of the pathophysiology and evidence-based management of varicoceles and pelvic congestion syndrome. HUM FERTIL 2023; 26:1597-1608. [PMID: 37190955 DOI: 10.1080/14647273.2023.2212846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 04/25/2023] [Indexed: 05/17/2023]
Abstract
Pelvic congestion syndrome (PCS) in females and varicoceles in males may be regarded as closely related conditions since the main pathophysiological cause for both processes is pelvic venous insufficiency. Varicoceles are more prevalent amongst sub-fertile males, with an approximate incidence of 15% in the general male population. PCS is commonly diagnosed amongst premenopausal multiparous women, representing one of the leading causes of chronic pelvic pain. Both conditions appear to be predominantly left-sided and are associated with oxidative stress and pro-inflammatory cascades with subsequent effects on fertility. Clinical examination and pelvic ultrasonography play an essential role in the assessment of varicoceles, PCS and chronic pelvic pain. Venography is generally considered as a gold-standard procedure for both conditions. There is still much debate on how these conditions should be managed. This review article provides a comparative analysis of the underlying pathophysiological mechanisms of both PCS and varicoceles, their impact on fertility, as well as their clinical management.
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Affiliation(s)
- Matteo Galea
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Mark R Brincat
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
- Department of Obstetrics and Gynaecology, Mater Dei Hospital, Msida, Malta
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Loffroy R, Chevallier O, Mazit A, Malakhia A, Midulla M. Amplatzer ™ Vascular Plugs for Embolisation: A 10-Year Single-Centre Retrospective Study. J Clin Med 2023; 12:6790. [PMID: 37959254 PMCID: PMC10647837 DOI: 10.3390/jcm12216790] [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: 09/05/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Our objective was to investigate the indications, effectiveness, and safety of Amplatzer™ Vascular Plugs (AVPs) in clinical practice. To retrospectively identify patients managed with AVPs at the Dijon University Hospital between January 2011 and April 2021, we searched materials vigilance registries and procedure reports. The 110 identified patients underwent 111 procedures with delivery of 202 AVPs into 118 vessels; 84% of the procedures were performed by radiologists with over 10 years' experience and 67% were scheduled. Varicocele, haemostasis, pelvic varicose veins, and arterio-venous dialysis fistulas accounted for 69% of procedures. The technical and clinical success rates were 99% and 97%, respectively. The single major complication was AVP migration in a high-flow internal iliac vein, with no residual abnormalities after successful device retrieval. Several AVPs and/or concomitant injection of coils or liquid agents were used in 80% of cases. The use of AVPs alone occurred chiefly for splenic artery embolisation in trauma patients and for collateral vein occlusion in dysfunctional arterio-venous dialysis fistulas. No cases of recanalisation occurred during the 19 ± 29 month follow-ups. Based on their good safety and effectiveness profile, AVPs deserve to be part of the therapeutic armamentarium of every interventional radiologist.
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Affiliation(s)
- Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (O.C.); (A.M.); (A.M.); (M.M.)
- ICMUB Laboratory, UMR CNRS 6302, 9 Avenue Alain Savary, 21000 Dijon, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (O.C.); (A.M.); (A.M.); (M.M.)
- ICMUB Laboratory, UMR CNRS 6302, 9 Avenue Alain Savary, 21000 Dijon, France
| | - Amin Mazit
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (O.C.); (A.M.); (A.M.); (M.M.)
| | - Alexandre Malakhia
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (O.C.); (A.M.); (A.M.); (M.M.)
| | - Marco Midulla
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (O.C.); (A.M.); (A.M.); (M.M.)
- ICMUB Laboratory, UMR CNRS 6302, 9 Avenue Alain Savary, 21000 Dijon, France
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Megahed A, Schlachter T, Cornman-Homonoff J. Large left varicocele in a patient with portal hypertension treated via transjugular intrahepatic portosystemic shunt placement and both variceal and varicocele embolization. BMC Urol 2023; 23:94. [PMID: 37189067 PMCID: PMC10184390 DOI: 10.1186/s12894-023-01268-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/04/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Scrotal swelling from varicocele is a common complaint in adult men. Varicocele due to portosystemic collaterals is a rare presentation of portal hypertension. Imaging workup and intervention for varicocele in this case is more complex than varicocele due to absent or incompetent valves in the testicular veins and pampiniform plexus. CASE PRESENTATION We present the case of a 53-year-old man with alcohol-related cirrhosis presented with persistent left scrotal heaviness, pain, and swelling found to have a large left varicocele. Given his history of cirrhosis, a contrast-enhanced CT of the abdomen and pelvis was obtained showing that the varices were supplied by a vessel arising from the splenic vein and draining into the left renal vein as well as gastric varices. Varicocele embolization alone is not sufficient in this case, and we treated with transjugular intrahepatic portosystemic shunt, variceal and varicocele embolization. CONCLUSION In patients presenting with a varicocele with a history of cirrhosis/portal hypertension, cross sectional imaging of the abdomen and pelvis should be obtained prior to treatment to evaluate for the presence of varices which may be pressured by varicocele embolization. If present, consideration should be given to referral to an interventional radiologist for possible concurrent variceal embolization and TIPS placement.
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Affiliation(s)
- Ayah Megahed
- Department of Radiology, Yale New Haven Health, Bridgeport Hospital, Bridgeport, USA
| | - Todd Schlachter
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, SP2-213, 20 York Street, New Haven, CT, 06510, USA
| | - Joshua Cornman-Homonoff
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, SP2-213, 20 York Street, New Haven, CT, 06510, USA.
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Errico A, Vinco S, Ambrosini G, Dalla Pozza E, Marroncelli N, Zampieri N, Dando I. Mitochondrial Dynamics as Potential Modulators of Hormonal Therapy Effectiveness in Males. BIOLOGY 2023; 12:biology12040547. [PMID: 37106748 PMCID: PMC10135745 DOI: 10.3390/biology12040547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/21/2023] [Accepted: 04/01/2023] [Indexed: 04/29/2023]
Abstract
Worldwide the incidence of andrological diseases is rising every year and, together with it, also the interest in them is increasing due to their strict association with disorders of the reproductive system, including impairment of male fertility, alterations of male hormones production, and/or sexual function. Prevention and early diagnosis of andrological dysfunctions have long been neglected, with the consequent increase in the incidence and prevalence of diseases otherwise easy to prevent and treat if diagnosed early. In this review, we report the latest evidence of the effect of andrological alterations on fertility potential in both young and adult patients, with a focus on the link between gonadotropins' mechanism of action and mitochondria. Indeed, mitochondria are highly dynamic cellular organelles that undergo rapid morphological adaptations, conditioning a multitude of aspects, including their size, shape, number, transport, cellular distribution, and, consequently, their function. Since the first step of steroidogenesis takes place in these organelles, we consider that mitochondria dynamics might have a possible role in a plethora of signaling cascades, including testosterone production. In addition, we also hypothesize a central role of mitochondria fission boost on the decreased response to the commonly administrated hormonal therapy used to treat urological disease in pediatric and adolescent patients as well as infertile adults.
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Affiliation(s)
- Andrea Errico
- Department of Neurosciences, Biomedicine and Movement Sciences, Biochemistry Section, University of Verona, 37100 Verona, Italy
| | - Sara Vinco
- Department of Neurosciences, Biomedicine and Movement Sciences, Biochemistry Section, University of Verona, 37100 Verona, Italy
| | - Giulia Ambrosini
- Department of Neurosciences, Biomedicine and Movement Sciences, Biochemistry Section, University of Verona, 37100 Verona, Italy
| | - Elisa Dalla Pozza
- Department of Neurosciences, Biomedicine and Movement Sciences, Biochemistry Section, University of Verona, 37100 Verona, Italy
| | - Nunzio Marroncelli
- Department of Neurosciences, Biomedicine and Movement Sciences, Biochemistry Section, University of Verona, 37100 Verona, Italy
| | - Nicola Zampieri
- Department of Engineering and Innovation Medicine, Paediatric Fertility Lab, Woman and Child Hospital, Division of Pediatric Surgery, University of Verona, 37100 Verona, Italy
| | - Ilaria Dando
- Department of Neurosciences, Biomedicine and Movement Sciences, Biochemistry Section, University of Verona, 37100 Verona, Italy
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Belkovsky M, Sarmento EO, Novaes LFC, Passerotti CC, Pontes Junior J, Maximiano LF, Otoch JP, DA-Cruz JAS. Bilateral inguinal transabdominal pre-peritoneal laparoscopic hernioplasty associated to bilateral laparoscopic varicocelectomy in the same intervention: a feasibility study. Rev Col Bras Cir 2023; 50:e20233468. [PMID: 36995836 PMCID: PMC10519696 DOI: 10.1590/0100-6991e-20233468-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/28/2022] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Inguinal hernia and varicocele are common conditions in male population. Laparoscopy brings the opportunity to treat them simultaneously, through the same incision. However, there are different opinions about the risks for testicular perfusion of multiple procedures in the inguinal region. In this study, we assessed the feasibility of simultaneous laparoscopic procedures by studying clinical and surgical outcomes of patients undergoing bilateral inguinal hernioplasty using the transabdominal preperitoneal (TAPP) technique with and without concomitant bilateral laparoscopic varicocelectomy (VLB). METHODS a sample of 20 patients from the University Hospital of USP-SP with indirect inguinal hernia and varicocele with indication for surgical correction was selected. Patients were randomized into two groups, 10 undergoing TAPP (Group I) and 10 undergoing simultaneous TAPP and VLB (Group II). Data regarding total operative time, complications and postoperative pain was gathered and analyzed. RESULTS there was no statistical difference between groups regarding total operative time and postoperative pain. Only one complication (spermatic cord hematoma) was observed in Group I and no complications were observed in Group II. CONCLUSIONS simultaneous TAPP and VLB in was shown to be effective and safe, which provides a basis for conducting studies on larger scales.
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Affiliation(s)
- Mikhael Belkovsky
- - Faculdade de Medicina da USP, Técnica Cirúrgica e Cirurgia Experimental - Sâo Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Centro de Cirurgia Robótica - São Paulo - SP - Brasil
| | | | | | | | - José Pontes Junior
- - Faculdade de Medicina da USP, Técnica Cirúrgica e Cirurgia Experimental - Sâo Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Centro de Cirurgia Robótica - São Paulo - SP - Brasil
| | - Linda Ferreira Maximiano
- - Faculdade de Medicina da USP, Técnica Cirúrgica e Cirurgia Experimental - Sâo Paulo - SP - Brasil
| | - José Pinhata Otoch
- - Faculdade de Medicina da USP, Técnica Cirúrgica e Cirurgia Experimental - Sâo Paulo - SP - Brasil
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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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BELKOVSKY MIKHAEL, SARMENTO EDGAROLIVEIRA, NOVAES LUISFELIPECOUTO, PASSEROTTI CARLOCAMARGO, PONTES JUNIOR JOSÉ, MAXIMIANO LINDAFERREIRA, OTOCH JOSÉPINHATA, DA-CRUZ JOSEARNALDOSHIOMI. Hernioplastia inguinal pré-peritoneal transabdominal bilateral e varicocelectomia laparoscópica bilateral na mesma intervenção: um estudo de viabilidade. Rev Col Bras Cir 2023. [DOI: 10.1590/0100-6991e-20233468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
RESUMO Introdução: hérnia inguinal e varicocele são doenças comuns na população masculina. O advento da laparoscopia traz a oportunidade de tratá-las simultaneamente, pelo mesmo acesso. Entretanto, existem divergências sobre os riscos para a perfusão testicular de múltiplos procedimentos na região inguinal. Neste estudo, avaliamos a viabilidade de procedimentos laparoscópicos simultâneos estudando resultados clínicos e cirúrgicos de pacientes submetidos à hernioplastia inguinal bilateral pela técnica transabdominal préperitoneal (TAPP) com e sem varicocelectomia laparoscópica bilateral (VLB) concomitante. Métodos: uma amostra de 20 pacientes do Hospital Universitário da USP-SP com hérnia inguinal indireta e varicocele com indicação de correção cirúrgica foi selecionada. Os pacientes foram randomizados em dois grupos, sendo 10 submetidos à TAPP (Grupo I) e 10 submetidos à TAPP e VLB simultâneas (Grupo II). O tempo operatório total, complicações e dor pós-operatória foram coletados e analisados. Resultados: não houve diferença estatística entre os grupos com relação ao tempo operatório total e à dor pós-operatória. Apenas uma complicação (hematoma do cordão espermático) foi observada no Grupo I e não foram observadas complicações no Grupo II. Conclusões: no mesmo procedimento, submeter pacientes à TAPP e à VLB no mesmo procedimento se mostrou eficaz e seguro, o que fornece embasamento para a realização de estudos em maiores escalas.
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CIRSE Standards of Practice on Varicocele Embolisation. Cardiovasc Intervent Radiol 2023; 46:19-34. [PMID: 36380154 DOI: 10.1007/s00270-022-03293-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Percutaneous embolisation is an effective, minimally invasive means of treating a variety of benign and malignant lesions and has been successfully used to treat varicoceles since the late 1970s, with refined and expanded techniques and tools currently offering excellent outcomes for varicocele embolisation. PURPOSE This document will presume that the indication for treatment is clear and approved by the multidisciplinary team (MDT) and will define the standards required for the performance of each modality, as well as their advantages and limitations. CIRSE Standards of Practice documents are not intended to impose a standard of clinical patient care, but recommend a reasonable approach to, and best practices for, the performance of percutaneous varicocele embolisation. METHODS The writing group was established by the CIRSE Standards of Practice Committee and consisted of five clinicians with internationally recognised expertise in embolisation of male varicoceles. The writing group reviewed the existing literature on varicocele embolisation, performing a pragmatic evidence search using PubMed to search for publications in English and relating to human subjects published from 2006 to 2021. The final recommendations were formulated through consensus. CONCLUSION Embolisation has an established role in the successful management of male varicoceles. This Standards of Practice document provides up-to-date recommendations for the safe performance of varicocele embolisation.
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Soetandar A, Noegroho BS, Siregar S, Adriansjah R, Mustafa A. Microsurgical varicocelectomy effects on sperm DNA fragmentation and sperm parameters in infertile male patients: A systematic review and meta-analysis of more recent evidence. Arch Ital Urol Androl 2022; 94:360-365. [DOI: 10.4081/aiua.2022.3.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Varicocele is known to have impacts in infertility cases and sperm quality. This review aimed to evaluate the effects of microsurgical varicocelectomy on sperm DNA fragmentation index (DFI) and sperm parameters. Methods: Open full English text articles from January 2017 to October 2021 were searched from online database including PubMed, EMBASE, Scopus, Cochrane Library and Google Scholar. Results: Systematic search resulted in 277 potential papers. After throughout paper analysis, 5 studies were included in this review. From all five analyzed studies, microsurgical varicocelectomy was statistically proven to reduce DNA fragmentation index by 5.46% (mean difference -5.46; 95% CI: -4.79, -6.13; p < 0.00001). Moreover, the procedure also significantly improved other sperm parameters (sperm concentration +8.23%, sperm motility +7.17%, sperm progressive motility +2.77%, sperm morphology +0.64%). Conclusion: Microsurgical varicocelectomy significantly improves spermatogenesis as reflected by biomarkers of infertile men including semen parameters and sperm DNA fragmentation (SDF).
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Lu X, Han H, Zhang ZB, Chen H, Huang X, Zhang R. The Application Effect of Jiawei Sanyu Shengjing Decoction Combined with High Ligation of the Spermatic Vein in Varicocele Male Infertility Patients. Appl Bionics Biomech 2022; 2022:2629140. [PMID: 36032045 PMCID: PMC9410973 DOI: 10.1155/2022/2629140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 07/31/2022] [Accepted: 08/04/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To analyze the application effect of Jiawei Sanyu Shengjing decoction combined with high ligation of the internal spermatic vein in male infertility patients with varicocele (VC). Methods 106 male infertility patients with VC treated in our hospital from December 2018 to March 2019 were selected as examples. According to the length of stay, they were divided into the control group and observation group, with 53 cases in each group. High ligation of the internal spermatic vein was performed in both groups. On this basis, the observation group was treated with modified Sanyu Shengjing decoction, and the therapeutic effects of the two groups were compared. Results The effective rate of 94.34% in the observation group was higher than 79.25% in the control group (P < 0.05). After treatment, the serum index level and sperm deformity rate in the observation group were lower than those in the control group, and the semen density and sperm activity were higher than those in the control group (P < 0.05). Conclusion The treatment of VC male infertility with modified Sanyu Shengjing decoction combined with high ligation of the internal spermatic vein can effectively improve the number of sperm and reduce the density of semen.
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Affiliation(s)
- Xiangpeng Lu
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, China
| | - Hao Han
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, China
| | - Zhi Biao Zhang
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, China
| | - Hao Chen
- Heilongjiang Traditional Chinese Medicine Hospital, China
| | - Xingru Huang
- Heilongjiang Traditional Chinese Medicine Hospital, China
| | - Rui Zhang
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, China
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15
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Feng R, Jiang J, Cheng D, Lu K. Clinical efficacy comparison of sclerosing embolization with 3% polidocanol and the microsurgical subinguinal varicocelectomy in primary varicocele patients. Andrologia 2022; 54:e14530. [PMID: 35801615 DOI: 10.1111/and.14530] [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: 01/13/2022] [Revised: 04/19/2022] [Accepted: 06/26/2022] [Indexed: 11/29/2022] Open
Abstract
Varicocele is a more common male genitourinary system disease with sperm quality dysfunction or discomfort. This study was aimed to compare the clinical efficacy of sclerosing embolization with 3% polidocanol and the microsurgical subinguinal varicocelectomy in treating primary varicocele. Total of 59 patients with primary varicocele receiving a 3-month postoperative follow-up were included to analyse their biochemical parameters and clinical outcomes, including the operative time, hospitalization time, postoperative recurrence rates, and complication rate. Nineteen patients were treated with sclerosing embolization with 3% polidocanol (SE group), while 40 patients were treated with microsurgical subinguinal varicocelectomy (MSV group). For the SE group, 17 patients were treated on the left side, and two patients have treated on both without recurrences and complications during the follow-up period. For the MSV group, three patients were treated bilaterally, and 36 patients were treated separately on the left side with a total 5% recurrence rate and 10% complication rate. The duration of surgery and the hospitalization time of the SE group (46.2 ± 9.79 min and 2.53 ± 0.90 days, respectively) are significantly lower than MSV group (100.5 ± 13.76 min and 3.6 ± 1.58 days, respectively), p < 0.05. The total sperm count at 3 months was significantly higher in the SE group than in the MSV group (p < 0.05). In summary, sclerosing embolization is more effective for varicocele in improving sperm quality, shortening recovery time, and reducing recurrence rates and complications.
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Affiliation(s)
- Rui Feng
- Interventional Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
| | - Jingsong Jiang
- Vascular Surgery Department, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
| | - Dexin Cheng
- Interventional Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
| | - Kaiping Lu
- Vascular Surgery Department, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
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Fabiani A, Pavia MP, Stramucci S, Antezza A, De Stefano V, Castellani D. Do sclero-embolization procedures have advantages over surgical ligature in treating varicocele in children, adolescents and adults? Results from a systematic review and meta-analysis. Andrologia 2022; 54:e14510. [PMID: 35750057 DOI: 10.1111/and.14510] [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: 05/10/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022] Open
Abstract
We aimed to systematically review complications, and recurrence rate of varicocele treatment by comparing the surgical ligature versus sclero-embolization techniques in children, adolescents and adults. The secondary outcomes were the evaluation of semen parameters and spontaneous pregnancy rate in adults. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Continuous variables were pooled using the inverse variance of the mean difference (MD) with a fixed effect, and 95% confidence interval (CI). The incidences of complications were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as Odds Ratio (OR), and 95% CI. Statistical significance was set two-tail p-value < 0.05. Twenty studies were included. Incidence of postoperative hydrocele was significantly higher in the surgical ligation group (OR 3.06 95% CI 1.06-8.88, p = 0.04). Incidence of postoperative orchiepidydimitys was significantly higher in sclero-embolization group (OR 0.26 95% CI 0.08-0.85, p = 0.02). Presence of normal spermatozoa was significantly higher sclero-embolization group compared with the surgical ligature group (MD 2.54% 95% CI 0.43-4.65, p = 0.02). No difference was found in overall complications, wound infection, testis pain, surgical site hematoma, total sperm count, sperm motility, pregnancy and recurrence rate. This review confirms that current data does still not support the superiority of one type of treatment over other ones.
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Affiliation(s)
| | | | - Silvia Stramucci
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University of the Marche Region, Ancona, Italy
| | - Angelo Antezza
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University of the Marche Region, Ancona, Italy
| | - Virgilio De Stefano
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University of the Marche Region, Ancona, Italy
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University of the Marche Region, Ancona, Italy
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Chakraborty S, Roychoudhury S. Pathological Roles of Reactive Oxygen Species in Male Reproduction. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1358:41-62. [PMID: 35641865 DOI: 10.1007/978-3-030-89340-8_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Reactive oxygen species (ROS) are free radicals that have at least one unpaired electron and play specific roles in the human body. An imbalance of ROS and antioxidant levels gives rise to a condition called oxidative stress. High levels of ROS in the male reproductive tract can interfere with its normal functioning and can even pose as toxic to the sperm, inhibiting sperm functioning (including motility) and metabolism. Oxidative stress resulting from ROS and lipid peroxidation is one of the major causes of male infertility including infertility in varicocele patients. These may cause DNA and peroxidative damage and apoptosis. Production of ROS in excess also leads to erectile dysfunction (ED). In recent years, studies have also linked oxidative stress with the development, progress, and therapy response of prostate cancer patients. The present study summarizes the pathological roles of ROS in male reproductive problems such as infertility, ED, and prostate cancer and also provide an insight into the probable mechanism through which ROS exert their pathological impact.
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18
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Zhang S, Li H, Du J, Xv L, Li F, Jiang L. Is it important to measure the internal spermatic vein diameter after varicocelectomy? A self‐controlled trial. Andrologia 2022; 54:e14484. [PMID: 35624551 DOI: 10.1111/and.14484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/24/2022] [Accepted: 05/06/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Shijun Zhang
- Department of Ultrasound, Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Hongli Li
- Department of Ultrasound, Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Jing Du
- Department of Ultrasound, Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Li Xv
- Department of Ultrasound, Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Fenghua Li
- Department of Ultrasound, Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Lixin Jiang
- Department of Ultrasound, Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
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Napolitano L, Pandolfo SD, Aveta A, Cirigliano L, Martino R, Mattiello G, Celentano G, Barone B, Rosati C, La Rocca R, Spena G, Spirito L. The Management of Clinical Varicocele: Robotic Surgery Approach. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:791330. [PMID: 36303643 PMCID: PMC9580646 DOI: 10.3389/frph.2022.791330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/07/2022] [Indexed: 12/04/2022] Open
Abstract
Varicocele is a pathologic dilation of the testicular veins within the spermatic cord. Varicocele is considered the most common problem in reproductive medicine practice. It is identified in 15% of healthy men and up to 35% of men with primary infertility. The exact pathophysiology of varicoceles is not very well understood, and several theories have been proposed to explain it. Varicocele can impair sperm quality and fertility via various mechanisms: reflux of adrenal metabolites, increased testicular hypoxia, oxidative stress, and increased testicular temperature have been proposed. Several studies have reported the significant benefits on semen parameters with the surgical treatment of varicocele: reducing oxidatively induced sperm DNA damage and potentially improving fertility. Varicocele repair should be offered as a part of treatment option for male partners of infertile couples presenting with palpable varicoceles. Nowadays, there are several surgical approaches available for the treatment of varicocele, such as the retroperitoneal approach, inguinal approach, and the subinguinal approach. The subinguinal microscopic approach offers the best outcomes, such as shorter hospital stays, preservation of the testicular arteries and lymphatics, least number of postoperative complications, recurrence, and a higher number of pregnancies. Currently robotic-assisted laparoscopic surgery is widely adopted in urology and surgeons began to explore the potential applications of the robotic platform to male infertility microsurgical operations. Robotic approach offers many advantages: elimination of tremor, retraction with third arm, high quality, 3-dimensional visualization and surgeon ergonomics, all contributing to the precision of surgery.
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Affiliation(s)
- Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Savio Domenico Pandolfo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Achille Aveta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Lorenzo Cirigliano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Raffaele Martino
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Gennaro Mattiello
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Giuseppe Celentano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Biagio Barone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Claudia Rosati
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Roberto La Rocca
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Gianluca Spena
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Lorenzo Spirito
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
- *Correspondence: Lorenzo Spirito
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Oh KT, Kim SW, Kang SK, Kim SH, Lee CN, Han SW, Lee YS. An Analysis of Major Causes of Surgical Failure Using Bähren System in Intraoperative Venography During Varicocelectomy. Yonsei Med J 2021; 62:928-935. [PMID: 34558872 PMCID: PMC8470570 DOI: 10.3349/ymj.2021.62.10.928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/14/2021] [Accepted: 07/19/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE In young patients with varicocele, preservation of the internal spermatic artery may be advantageous for catch-up growth, but it may also increase the likelihood of treatment failure. Intraoperative venography reduces the likelihood that unsealed veins will remain after varicocelectomy. We analyzed the characteristics of remnant veins visualized through intraoperative venography to investigate the cause of surgical failure in artery-sparing varicocelectomy (ASV). MATERIALS AND METHODS We retrospectively analyzed clinical characteristics and outcomes of patients aged 18 years or younger who underwent varicocelectomy with intraoperative venography from January 2005 to December 2017. During varicocelectomy, intraoperative venography was performed to distinguish veins from other structures. Any unsealed veins that were discovered were ligated and classified using the Bahren system. RESULTS One hundred and sixty-two patients underwent intraoperative venography: 153 cases (94.4%) were for primary varicocelectomy, and 9 cases (5.6%) were for repeat varicocelectomy. Open varicocelectomy was performed in 105 cases (64.8%), and laparoscopic varicocelectomy was performed in 57 cases (35.2%). Venography revealed remnant veins after the first ligation in 51 cases (31.2%), 46 (90.2%) and 5 (9.8%) of which were Bähren types 3 and 4, respectively. Five patients (3.1%) experienced varicocele recurrence, classified as persistence in 1 patient (0.6%) and relapse in 4 patients (2.5%). CONCLUSION Remnant collateral veins of the internal spermatic vein (ISV) (Bahren type 3) are the most common cause of failure in ASV. In a few patients, an external spermatic vein merges with the ISV at a higher level (Bahren type 4) and is unidentifiable without venography.
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Affiliation(s)
- Kyung Tak Oh
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Woon Kim
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Ku Kang
- Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sung Hoon Kim
- Department of Pediatric Urology, Severance Children's Hospital, Seoul, Korea
| | - Cho Nyeong Lee
- Department of Pediatric Urology, Severance Children's Hospital, Seoul, Korea
| | - Sang Won Han
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Seung Lee
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
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Talebi-Yazdabadi Z, Jahanbakhsh N, Dormiani K, Forouzanfar M, Lachinani L, Zohrabi D, Tavalaee M, Nasr-Esfahani MH. Assessment of MUSASHI 1 and MUSASHI 2 expression in spermatozoa and testicular tissue. Andrologia 2021; 53:e14187. [PMID: 34309875 DOI: 10.1111/and.14187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/25/2021] [Accepted: 06/24/2021] [Indexed: 01/13/2023] Open
Abstract
MUSASHI (MSI) family plays the main role in the spermatogenesis process. The purpose of this study was the assessment of sperm MSI1 and MSI2, and sperm functional tests in infertile men (n = 30) with varicocele and fertile men (n = 30). Furthermore, MSI1 and MSI2 proteins were assessed in testicular tissue of azoospermic men (n = 9) as well as epididymal spermatozoa and testis of mice. Expression of MSI1 and MSI2 was assessed at RNA and protein levels in human spermatozoa. Sperm concentration and motility were significantly lower, while abnormal sperm morphology, lipid peroxidation, DNA fragmentation and protamine deficiency were significantly higher in men with varicocele compared to fertile individuals. Any significant difference was not observed in the expression of MSI1 and MSI2 mRNA between the two groups. Unlike MSI1 protein that was not detectable in humans, the relative expression of MSI2 protein was similar in varicocele and fertile individuals. The expression level of both Msi1 and Msi2 proteins was also observable in mouse spermatozoa. No significant relationship was observed between sperm functional parameters with expression of these genes. The data of this study demonstrated that although MSI1 and MSI2 play important roles during spermatogenesis, their relative expression in spermatozoa was not affected by varicocele.
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Affiliation(s)
- Zohreh Talebi-Yazdabadi
- Department of Animal Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran.,ACECR Institute of Higher Education, Isfahan, Iran
| | - Neda Jahanbakhsh
- Department of Animal Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran.,Department of Biology, Faculty of Science, NourDanesh Institute of Higher Education, Isfahan, Iran
| | - Kianoush Dormiani
- Department of Animal Biotechnology, Cell Science Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Mahboobeh Forouzanfar
- Department of Animal Biotechnology, Cell Science Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Liana Lachinani
- Department of Animal Biotechnology, Cell Science Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Dina Zohrabi
- ACECR Institute of Higher Education, Isfahan, Iran
| | - Marziyeh Tavalaee
- Department of Animal Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Mohammad Hossein Nasr-Esfahani
- Department of Animal Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran.,Isfahan Fertility and Infertility Center, Isfahan, Iran
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Seiler F, Kneissl P, Hamann C, Jünemann KP, Osmonov D. Laparoscopic varicocelectomy in male infertility : Improvement of seminal parameters and effects on spermatogenesis. Wien Klin Wochenschr 2021; 134:51-55. [PMID: 34181069 PMCID: PMC8813831 DOI: 10.1007/s00508-021-01897-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 05/21/2021] [Indexed: 12/01/2022]
Abstract
Background The suitability of laparoscopic varicocelectomy for assisted reproductive technology depends on the improvement of semen parameters. The present study analyzed the improvement of semen parameters following laparoscopic varicocele ligation. Material and methods A retrospective study of the laparoscopic varicocele clippings at the Department of Urology of University Hospital of Kiel between the years 2007 and 2019 was conducted. The semen analyses according to WHO standards (sperm count, density, motility and morphology) were conducted before and 12 months after surgery. Screening for surgical complications took place at the time of the follow-up seminal analysis. Included were patients with oligozoospermia, asthenozoospermia and/or teratozoospermia (group 1, OAT) or with nonobstructive azoospermia (group 2, NOA). Results This study included data of 27 patients and 22 patients presented preoperative OAT (81%, group 1). Another 5 patients showed NOA (19%, group 2). Data of group 1 showed that semen parameters normalized in 32% of the patients after surgery. Significant improvement in total sperm count (p < 0.005), sperm density (p < 0.005) and total motile sperm count (p < 0.005) was observed. No deterioration of semen parameters was observed. In group 2 we detected spermatozoa in 1 case in the postoperative ejaculate. None of the patients showed complications according to the Clavien-Dindo classification, postoperative hydrocele formation or recurrence of varicocele at the time of control spermiogram. Conclusion Laparoscopic varicocelectomy is a valid therapeutic approach to improve semen parameters for further assisted reproductive techniques. Spermatogenesis may be induced for patients with NOA. Normalization of semen parameters can be achieved for patients with OAT.
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Affiliation(s)
- Felix Seiler
- Department of Urology, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
| | - Philipp Kneissl
- Department of Urology, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Claudius Hamann
- Department of Urology, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Klaus-Peter Jünemann
- Department of Urology, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Daniar Osmonov
- Department of Urology, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
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Abstract
PURPOSE OF REVIEW The aim of this review is to provide an overview of surgical treatment options for male infertility including varicocelectomy, treatment of ejaculatory duct obstruction, vasovasostomy, and sperm extraction, and to review recent advances in techniques and technologies that may improve operative outcomes. RECENT FINDINGS Microscopic subinguinal varicocelectomy has been shown to have the highest success rates with lowest rates of complications, and may be facilitated by the use of Doppler, indocyanine green angiography, and the 4K3D operating video microscope. The standard treatment for ejaculatory duct obstruction by transurethral resection of the ejaculatory ducts has changed little over time, but vesiculoscopy may allow for temporary dilation of an obstruction to allow for natural conception, while also offering diagnostic capabilities. Use of the robotic platform has gained popularity for vasectomy reversals but controversy remains regarding the cost-effectiveness of this option. Recently, a reinforcing suture technique has been described for vasovasostomy to minimize anastomotic breakdown and reversal failure. Finally, gray-scale and color-enhanced ultrasound may improve ability to predict successful sperm retrieval during extraction procedures. SUMMARY Though the fundamentals of surgical treatment options for male infertility have changed little with time, technological advancements have contributed to improved surgical outcomes over recent years.
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Morini D, Spaggiari G, Daolio J, Melli B, Nicoli A, De Feo G, Valli B, Viola D, Garganigo S, Magnani E, Pilia A, Polese A, Colla R, Simoni M, Aguzzoli L, Villani MT, Santi D. Improvement of sperm morphology after surgical varicocele repair. Andrology 2021; 9:1176-1184. [PMID: 33825345 PMCID: PMC8360177 DOI: 10.1111/andr.13012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/11/2021] [Accepted: 03/31/2021] [Indexed: 12/14/2022]
Abstract
Background A causative relationship between varicocele and impairment of semen quality has been largely investigated in the context of male infertility, although its clinical benefit remains controversial. Objective To investigate the effect of varicocele correction on detailed morphologic microscopic semen parameters in a large homogeneous cohort of patients and to evaluate which factors could predict semen improvement after the surgical treatment. Materials and methods An observational, retrospective cohort study was carried out including all patients undergoing surgical treatment for varicocele from September 2011 to March 2020 in the same clinical centre. Enrolled males performed at least one semen analysis before and one after surgical varicocele correction. Primary outcome was the detailed morphologic microscopic sperm evaluation. Secondary outcomes were conventional semen analyses. Results A total of 121 males (mean age 24.6 ± 6.1 years) were enrolled. Using detailed morphologic microscopic sperm evaluation, a significant morphological improvement was recorded, with a reduction in head and tail abnormalities. Moreover, a significant increase in sperm concentration (p = 0.015) and percentage of progressive and total motility (p = 0.022 and p = 0.039) were observed after surgery. The multivariate logistic analysis identified the ultrasonography varicocele degree before surgery as a main predictor of the sperm concentration improvement (p = 0.016), with the highest improvement for varicocele of I and II degree. Discussion For the first time, the detailed morphologic microscopic sperm evaluation highlights a relevant reduction in sperm abnormalities after varicocele surgery, showing its potential application in clinical practice.
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Affiliation(s)
- Daria Morini
- Department of Obstetrics and Gynaecology, Fertility Centre, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giorgia Spaggiari
- Unit of Endocrinology, Department of Medical Specialties, Ospedale Civile of Baggiovara, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Jessica Daolio
- Department of Obstetrics and Gynaecology, Fertility Centre, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Beatrice Melli
- Department of Obstetrics and Gynaecology, Fertility Centre, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,International PhD School in Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, Modena, Italy
| | - Alessia Nicoli
- Department of Obstetrics and Gynaecology, Fertility Centre, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gaetano De Feo
- Department of Obstetrics and Gynaecology, Fertility Centre, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Barbara Valli
- Department of Obstetrics and Gynaecology, Fertility Centre, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Domenico Viola
- Department of Urology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Simona Garganigo
- Chemical-Clinical and Endocrinology Analysis Laboratory Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Elena Magnani
- Chemical-Clinical and Endocrinology Analysis Laboratory Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Annalisa Pilia
- Chemical-Clinical and Endocrinology Analysis Laboratory Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Alessandra Polese
- Chemical-Clinical and Endocrinology Analysis Laboratory Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Rossana Colla
- Chemical-Clinical and Endocrinology Analysis Laboratory Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Manuela Simoni
- Unit of Endocrinology, Department of Medical Specialties, Ospedale Civile of Baggiovara, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Aguzzoli
- Department of Obstetrics and Gynaecology, Fertility Centre, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria Teresa Villani
- Department of Obstetrics and Gynaecology, Fertility Centre, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Daniele Santi
- Unit of Endocrinology, Department of Medical Specialties, Ospedale Civile of Baggiovara, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Persad E, O'Loughlin CA, Kaur S, Wagner G, Matyas N, Hassler-Di Fratta MR, Nussbaumer-Streit B. Surgical or radiological treatment for varicoceles in subfertile men. Cochrane Database Syst Rev 2021; 4:CD000479. [PMID: 33890288 PMCID: PMC8408310 DOI: 10.1002/14651858.cd000479.pub6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Varicoceles are associated with male subfertility; however, the mechanisms by which varicoceles affect fertility have yet to be satisfactorily explained. Several treatment options exist, including surgical or radiological treatment, however the safest and most efficient treatment remains unclear. OBJECTIVES: To evaluate the effectiveness and safety of surgical and radiological treatment of varicoceles on live birth rate, adverse events, pregnancy rate, varicocele recurrence, and quality of life amongst couples where the adult male has a varicocele, and the female partner of childbearing age has no fertility problems. SEARCH METHODS We searched the following databases on 4 April 2020: the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL. We also searched the trial registries and reference lists of articles. SELECTION CRITERIA We included randomised controlled trials (RCTs) if they were relevant to the clinical question posed and compared different forms of surgical ligation, different forms of radiological treatments, surgical treatment compared to radiological treatment, or one of these aforementioned treatment forms compared to non-surgical methods, delayed treatment, or no treatment. We extracted data if the studies reported on live birth, adverse events, pregnancy, varicocele recurrence, and quality of life. DATA COLLECTION AND ANALYSIS Screening of abstracts and full-text publications, alongside data extraction and 'Risk of bias' assessment, were done dually using the Covidence software. When we had sufficient data, we calculated random-effects (Mantel-Haenszel) meta-analyses; otherwise, we reported results narratively. We used the I2 statistic to analyse statistical heterogeneity. We planned to use funnel plots to assess publication bias in meta-analyses with at least 10 included studies. We dually rated the risk of bias of studies using the Cochrane 'Risk of bias' tool, and the certainty of evidence for each outcome using the GRADE approach. MAIN RESULTS We identified 1897 citations after de-duplicating the search results. We excluded 1773 during title and abstract screening. From the 113 new full texts assessed in addition to the 10 studies (11 references) included in the previous version of this review, we included 38 new studies, resulting in a total of 48 studies (59 references) in the review providing data for 5384 participants. Two studies (three references) are ongoing studies and two studies are awaiting classification. Treatment versus non-surgical, non-radiological, delayed, or no treatment Two studies comparing surgical or radiological treatment versus no treatment reported on live birth with differing directions of effect. As a result, we are uncertain whether surgical or radiological treatment improves live birth rates when compared to no treatment (risk ratio (RR) 2.27, 95% confidence interval (CI) 0.19 to 26.93; 2 RCTs, N = 204; I2 = 74%, very low-certainty evidence). Treatment may improve pregnancy rates compared to delayed or no treatment (RR 1.55, 95% CI 1.06 to 2.26; 13 RCTs, N = 1193; I2 = 65%, low-certainty evidence). This suggests that couples with no or delayed treatment have a 21% chance of pregnancy, whilst the pregnancy rate after surgical or radiological treatment is between 22% and 48%. We identified no evidence on adverse events, varicocele recurrence, or quality of life for this comparison. Surgical versus radiological treatment We are uncertain about the effect of surgical versus radiological treatment on live birth and on the following adverse events: hydrocele formation, pain, epididymitis, haematoma, and suture granuloma. We are uncertain about the effect of surgical versus radiological treatment on pregnancy rate (RR 1.13, 95% CI 0.75 to 1.70; 5 RCTs, N = 456, low-certainty evidence) and varicocele recurrence (RR 1.31, 95% CI 0.82 to 2.08; 3 RCTs, N = 380, low-certainty evidence). We identified no evidence on quality of life for this comparison. Surgery versus other surgical treatment We identified 19 studies comparing microscopic subinguinal surgical treatment to any other surgical treatment. Microscopic subinguinal surgical treatment probably improves pregnancy rates slightly compared to other surgical treatments (RR 1.18, 95% CI 1.02 to 1.36; 12 RCTs, N = 1473, moderate-certainty evidence). This suggests that couples with microscopic subinguinal surgical treatment have a 10% to 14% chance of pregnancy after treatment, whilst the pregnancy rate in couples after other surgical treatments is 10%. This procedure also probably reduces the risk of varicocele recurrence (RR 0.48, 95% CI 0.29, 0.79; 14 RCTs, N = 1565, moderate-certainty evidence). This suggests that 0.4% to 1.1% of men undergoing microscopic subinguinal surgical treatment experience recurrent varicocele, whilst 1.4% of men undergoing other surgical treatments do. Results for the following adverse events were inconclusive: hydrocele formation, haematoma, abdominal distension, testicular atrophy, wound infection, scrotal pain, and oedema. We identified no evidence on live birth or quality of life for this comparison. Nine studies compared open inguinal surgical treatment to retroperitoneal surgical treatment. Due to small sample sizes and methodological limitations, we identified neither treatment type as superior or inferior to the other regarding adverse events, pregnancy rates, or varicocele recurrence. We identified no evidence on live birth or quality of life for this comparison. Radiological versus other radiological treatment One study compared two types of radiological treatment (sclerotherapy versus embolisation) and reported 13% varicocele recurrence in both groups. Due to the broad confidence interval, no valid conclusion could be drawn (RR 1.00, 95% CI 0.16 to 6.20; 1 RCT, N = 30, very low-certainty evidence). We identified no evidence on live birth, adverse events, pregnancy, or quality of life for this comparison. AUTHORS' CONCLUSIONS Based on the limited evidence, it remains uncertain whether any treatment (surgical or radiological) compared to no treatment in subfertile men may be of benefit on live birth rates; however, treatment may improve the chances for pregnancy. The evidence was also insufficient to determine whether surgical treatment was superior to radiological treatment. However, microscopic subinguinal surgical treatment probably improves pregnancy rates and reduces the risk of varicocele recurrence compared to other surgical treatments. High-quality, head-to-head comparative RCTs focusing on live birth rate and also assessing adverse events and quality of life are warranted.
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Affiliation(s)
- Emma Persad
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
- Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Clare Aa O'Loughlin
- Department of Obstetrics and Gynaecology, Wellington Hospital, Capital & Coast District Health Board, Wellington, New Zealand
| | - Simi Kaur
- The University of Auckland, Auckland, New Zealand
| | - Gernot Wagner
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Nina Matyas
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | | | - Barbara Nussbaumer-Streit
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
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26
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Zhao J, Ma W, Zhong Y, Deng H, Zhou B, Wu Y, Yang M, Li H. Transcriptional Inhibition of lncRNA gadd7 by CRISPR/dCas9-KRAB Protects Spermatocyte Viability. Front Mol Biosci 2021; 8:652392. [PMID: 33778010 PMCID: PMC7991575 DOI: 10.3389/fmolb.2021.652392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/29/2021] [Indexed: 12/18/2022] Open
Abstract
Our previous study found that lncRNA gadd7 was up-regulated in the semen of varicocele patients, and could promote the apoptosis of mouse spermatocytes and inhibit their proliferation. Therefore, we further explored whether down-regulation of Gadd seven expression could protect the viability of spermatocytes. Here we designed specific sgRNAs targeting the ORF region of gadd7, and constructed a CRISPR-dCas9-KRAB system that effectively inhibits gadd7 at the transcriptional level. The CRISPRi system can effectively prevent the apoptosis of spermatocytes and enhance their proliferation, which is expected to provide a potentially effective molecular intervention method for the treatment of male infertility caused by varicocele.
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Affiliation(s)
- Jun Zhao
- Assisted Reproductive Technology Center, Foshan Maternal and Child Health Care Hospital, Foshan, China
| | - Wenmin Ma
- Assisted Reproductive Technology Center, Foshan Maternal and Child Health Care Hospital, Foshan, China
| | - Yucheng Zhong
- Assisted Reproductive Technology Center, Foshan Maternal and Child Health Care Hospital, Foshan, China
| | - Hao Deng
- Assisted Reproductive Technology Center, Foshan Maternal and Child Health Care Hospital, Foshan, China
| | - Bingyu Zhou
- Assisted Reproductive Technology Center, Foshan Maternal and Child Health Care Hospital, Foshan, China
| | - Yaqin Wu
- Assisted Reproductive Technology Center, Foshan Maternal and Child Health Care Hospital, Foshan, China
| | - Meiqiong Yang
- Assisted Reproductive Technology Center, Foshan Maternal and Child Health Care Hospital, Foshan, China
| | - Huan Li
- Assisted Reproductive Technology Center, Foshan Maternal and Child Health Care Hospital, Foshan, China
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27
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Fathi A, Mohamed O, Mahmoud O, Alsagheer GA, Reyad AM, Abolyosr A, Abdel-Kader MS, Saber-Khalaf M. The impact of varicocelectomy on sperm DNA fragmentation and pregnancy rate in subfertile men with normal semen parameters: A pilot study. Arab J Urol 2021; 19:186-190. [PMID: 34104495 PMCID: PMC8158247 DOI: 10.1080/2090598x.2021.1889746] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: To evaluate the outcome of microscopic subinguinal varicocelectomy on sperm DNA fragmentation (SDF) and pregnancy rate in men with normal semen parameters. Patients and methods: A pilot study that included male patients with a minimum of a 1-year history of male subfertility, normal semen parameters, a high percentage of SDF, and clinically palpable varicoceles. Microscopic subinguinal varicocelectomy was carried out for 45 patients (study group), while 40 patients had no intervention (control group). Semen analysis and SDF were measured before and at 6 months after the varicocelectomy. The pregnancy rate was assessed at the 6- and 12-month follow-ups. Results: Between July 2014 and January 2019, 85 subfertile men were included in the study and completed 12 months of follow-up. The two groups were comparable in terms of their age, body mass index, infertility duration, infertility type, varicoceles laterality, and varicoceles grade (P values = 0.84, 0.34. 0.35, 1, 0.39, and 0.46, respectively). At 6 months after varicocelectomy, the mean SDF was reduced in both groups, and this reduction was statistically higher in the varicocelectomy group (P < 0.001). After 1-year, spontaneous pregnancy was achieved in 62% of the patients in the varicocelectomy group compared to 30% in the control group (P = 0.009). Conclusion: Varicocelectomy has a positive impact on SDF and spontaneous pregnancy in infertile men with clinically palpable varicoceles and normal semen parameters. Abbreviations: BMI: body mass index; DFI: DNA fragmentation Index; SDF: sperm DNA fragmentation
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Affiliation(s)
- Atef Fathi
- Department of Urology, Qena Faculty of Medicine, South Valley University, Qina, Egypt
| | - Omar Mohamed
- Department of Urology, Qena Faculty of Medicine, South Valley University, Qina, Egypt
| | - Osama Mahmoud
- Department of Urology, Qena Faculty of Medicine, South Valley University, Qina, Egypt
| | - Gamal A Alsagheer
- Department of Urology, Qena Faculty of Medicine, South Valley University, Qina, Egypt
| | - A M Reyad
- Department of Urology, Sohag University Hospital, Sohag University, Sohag, Egypt
| | - Ahmed Abolyosr
- Department of Urology, Qena Faculty of Medicine, South Valley University, Qina, Egypt
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28
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Agarwal A, Panner Selvam MK, Baskaran S, Finelli R, Leisegang K, Barbăroșie C, Pushparaj PN, Robert KA, Ambar R, Iovine C, Durairajanayagam D, Henkel R. A scientometric analysis of research publications on male infertility and assisted reproductive technology. Andrologia 2020; 53:e13842. [PMID: 33236365 DOI: 10.1111/and.13842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 12/21/2022] Open
Abstract
Assisted reproductive technologies (ART) are considered as one of the primary management options to address severe male factor infertility. The purpose of this study was to identify the research trends in the field of male infertility and ART over the past 20 years (2000-2019) by analysing scientometric data (the number of publications per year, authors, author affiliations, journals, countries, type of documents, subject area and number of citations) retrieved using the Scopus database. We used VOS viewer software to generate a network map on international collaborations as well as a heat map of the top scientists in this field. Our results revealed a total of 2,148 publications during this period with Cleveland Clinic Foundation contributing the most (n = 69). The current scientometric analysis showed that the research trend on ART has been stable over the past two decades. Further in-depth analysis revealed that density gradient centrifugation (46%) and intracytoplasmic sperm injection (59.2%) are the most reported techniques for sperm separation and ART, respectively. Additionally, azoospermia was the most studied clinical scenario (60.6%), with majority of articles reporting pregnancy rate (47.25%) as the primary reproductive outcome for ART. This study provides insight into the current focus of research in the area of male infertility and ART as well as the areas that require further research in future.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Saradha Baskaran
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Kristian Leisegang
- School of Natural Medicine, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | - Cătălina Barbăroșie
- Department of Genetics, Faculty of Biology, University of Bucharest, Bucharest, Romania
| | | | - Kathy Amy Robert
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Rafael Ambar
- Department of Urology, Sexual and Reproductive Medicine, Faculdade de Medicina do ABC, Santo André, Brazil
| | - Concetta Iovine
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | | | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa.,Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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29
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Varicocele Embolization: An Assessment of the Quality and Readability of Online Patient Information. Acad Radiol 2020; 27:841-846. [PMID: 31494004 DOI: 10.1016/j.acra.2019.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 07/29/2019] [Accepted: 08/04/2019] [Indexed: 11/23/2022]
Abstract
AIMS AND OBJECTIVES Varicocele embolization is a growing treatment modality owing to the safety, efficacy, and quick return to work following the procedure. The internet is the most dominant source of information for many. We aimed to assess the quality of information accessible by patients considering treatment. MATERIALS AND METHODS A list of applicable, commonly used searchable terms was generated. Each term was assessed across the five most-used English language search engines to determine the two most commonly used terms. These two terms were then investigated across each search engine, with the first 25 web pages returned by each engine included for analysis. Duplicate web pages, nontext content such as video or audio, and web pages behind paywalls were excluded. Web pages were analyzed for quality and readability using validated tools including DISCERN score, JAMA Benchmark Criteria, HONcode Certification, Flesch Reading Ease Score, Flesch-Kincaid Grade Level, and Gunning-Fog Index. Secondary features including age, rank, author, and publisher were recorded. RESULTS The most common applicable terms were "Testicular embolization" (378,300 results) and "Varicocele embolization" (375,800 results). Mean DISCERN quality of information provided by websites is "fair"; Adherence to JAMA Benchmark Criteria was 13.5%. Flesh-Kincaid readability tests demonstrated an average "9th grade" reading level. Scientific journals showed the highest quality scores, but were least up to date with an average web page age of 11.2 years. Web pages produced by "for-profit" organizations were the second most current (average age 2.7 years), but displayed the lowest quality of information scores. CONCLUSION While quality of online information available to patients is "fair," adherence to JAMA benchmark criteria is poor. "For-profit" organization websites are far more numerous and significantly more up-to-date, yet showed significantly lower quality of information scores. Scientific journals were unsurprisingly of higher quality, yet more challenging for the general public to read. These findings call for the production of high-quality and comprehensible content regarding interventional radiology, where physicians can reliably direct their patients for information.
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30
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Sansone A, Fegatelli DA, Pozza C, Fattorini G, Lauretta R, Minnetti M, Romanelli F, Lucatelli P, Corona M, Bezzi M, Lombardo F, Lenzi A, Gianfrilli D. Effects of percutaneous varicocele repair on testicular volume: results from a 12-month follow-up. Asian J Androl 2020; 21:408-412. [PMID: 30604693 PMCID: PMC6628742 DOI: 10.4103/aja.aja_102_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Varicocele is a common finding in men. Varicocele correction has been advocated for young patients with testicular hypotrophy, but there is a lack of morphofunctional follow-up data. We assessed whether percutaneous treatment of left varicocele is associated with testicular "catch-up growth" in the following 12 months by retrospectively reviewing data from an electronic database of 10 656 patients followed up in our clinic between 2006 and 2016. We selected all young adults (<35 years) with left varicocele who underwent percutaneous treatment, had a minimum of 12 months' ultrasound imaging follow-up, and had no other conditions affecting testicular volume. One hundred and fourteen men (mean±standard deviation [s.d.] of age: 22.8 ± 5.4 years) met the inclusion and exclusion criteria. Left testicular hypotrophy (LTH), defined as a ≥20% difference between left and right testicular volume at baseline, was observed in 26 (22.8%) men. Participants with LTH (mean±s.d.: 14.5 ± 2.7 ml) had lower baseline testicular volume compared to those without LTH (mean±s.d.: 15.7 ± 3.8 ml; P = 0.032). Repeated measures mixed models showed a significant interaction between LTH and time posttreatment when correcting for baseline left testicular volume (β = 0.114, 95% confidence interval [CI]: 0.018-0.210, P = 0.020), resulting in a catch-up growth of up to 1.37 ml per year (95% CI: 0.221-2.516). Age at intervention was also associated with reduced testicular volume (-0.072 ml per year, 95% CI: -0.135--0.009; P = 0.024). Percutaneous treatment of left varicocele in young adults with LTH can result in catch-up growth over 1 year of follow-up. The reproductive and psychological implications of these findings need to be confirmed in longer and larger prospective studies.
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Affiliation(s)
- Andrea Sansone
- Department of Experimental Medicine, Sapienza University of Rome, Rome 00161, Italy
| | - Danilo Alunni Fegatelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome 00161, Italy
| | - Carlotta Pozza
- Department of Experimental Medicine, Sapienza University of Rome, Rome 00161, Italy
| | - Giorgio Fattorini
- Department of Experimental Medicine, Sapienza University of Rome, Rome 00161, Italy
| | - Rosa Lauretta
- Unit of Endocrinology, Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Marianna Minnetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome 00161, Italy
| | - Francesco Romanelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome 00161, Italy
| | - Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza - University of Rome, Rome 00161, Italy
| | - Mario Corona
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza - University of Rome, Rome 00161, Italy
| | - Mario Bezzi
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza - University of Rome, Rome 00161, Italy
| | - Francesco Lombardo
- Department of Experimental Medicine, Sapienza University of Rome, Rome 00161, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Rome 00161, Italy
| | - Daniele Gianfrilli
- Department of Experimental Medicine, Sapienza University of Rome, Rome 00161, Italy
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31
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Pinar U, Pettenati C, Hurel S, Pietak M, Dariane C, Audenet F, Legendre C, Rozenberg A, Méjean A, Timsit MO. Persistent orchialgia after laparoscopic living-donor nephrectomy: an underestimated complication requiring information adjustment. World J Urol 2020; 39:621-627. [PMID: 32363451 DOI: 10.1007/s00345-020-03228-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/24/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Laparoscopic living-donor nephrectomy (LLDN) is the gold-standard procedure for kidney procurement. Ipsilateral orchialgia has barely been described. Some authors reported that ligation of gonadal vein (GV) above iliac vessel bifurcation could prevent orchialgia. We aimed to assess incidence and duration of orchialgia after LLDN in male donors despite distal ligation of GV. METHODS Patients who underwent LLDN from 2014 to 2017 were included. Standard procedure consisted in distal ligation of GV, close to the renal vein confluence and proximal ureteral ligation. Patients' demographics, per-operative data, and post-operative consultation reports were retrospectively reviewed. Orchialgia and scrotal symptoms were assessed through a non-validated questionnaire by phone interview. RESULTS Sixty-nine donors were included. Orchialgia incidence and testicular swelling were 31.9% (n = 22) and 15.9% (n = 11), respectively. Median symptom duration was 15.5 months. Orchialgia led to medical consultation in 41.7% (n = 10) of cases. All patients declared having been informed, prior to donation, about possible residual pain but not specifically orchialgia. CONCLUSION Orchialgia after LLDN affects more than 30% of donors, despite distal ligation of GV and led less than 50% of them to medical consultation, suggesting a large underestimation in clinical practice. Emphasis should be put on this complication during pre-donation information.
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Affiliation(s)
- Ugo Pinar
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France. .,Université de Paris, APHP Centre, Paris, France.
| | - Caroline Pettenati
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Université de Paris, APHP Centre, Paris, France
| | - Sophie Hurel
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Université de Paris, APHP Centre, Paris, France
| | - Michel Pietak
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Université de Paris, APHP Centre, Paris, France
| | - Charles Dariane
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Université de Paris, APHP Centre, Paris, France
| | - François Audenet
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Université de Paris, APHP Centre, Paris, France
| | - Christophe Legendre
- Université de Paris, APHP Centre, Paris, France.,Department of Nephrology and Renal Transplantation, Hôpital Necker-Enfants malades, AP-HP, 149 rue de Sèvres, 75015, Paris, France
| | - Alain Rozenberg
- Université de Paris, APHP Centre, Paris, France.,Department of Anaesthesiology, Hôpital Necker-Enfants malades, AP-HP, 149 rue de Sèvres, 75015, Paris, France
| | - Arnaud Méjean
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Université de Paris, APHP Centre, Paris, France
| | - Marc-Olivier Timsit
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Université de Paris, APHP Centre, Paris, France
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Jin L, Yao Q, Wu S, Dai G, Xiang H, Liu X, Xue B. Evaluation of clinical effects of microsurgical subinguinal varicocelectomy with and without testicular delivery. Andrologia 2020; 52:e13605. [PMID: 32339320 DOI: 10.1111/and.13605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/18/2020] [Accepted: 03/25/2020] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to access whether microsurgical subinguinal varicocelectomy (MSV) with testicular delivery has a better therapeutic effect than MSV without testicular delivery, including semen quality, serum testosterone (T) level and International Index of Erectile Function (IIEF)-5 score in infertility male patients with varicocele. In this prospective study, 181 patients were included and they chose the treatment by themselves. A total of 114 patients who received MSV without testicular delivery (TD) and 67 patients who received MSV with TD were followed-up 6 months after the operation. Semen parameters, serum T level and IIEF-5 scores were recorded before and 6 months after the operation. Results showed that MSV with or without TD could improve semen quality, serum T level and IIEF-5 score. For semen quality 6 months after the operation, there was no significant difference between patients received MSV with or without TD. But in patients with varicocele of grade III, MSV without testicular delivery improved the sperm concentration and motility more. And patients received MSV without TD have a higher T level 6 months after the operation, especially in patients ≤27 years. MSV with TD is not superior to that without, but this should be verified in more samples and a better designed randomised controlled study in the future.
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Affiliation(s)
- Lu Jin
- Department of Urology, Second Affiliated Hospital of Soochow University, Jiangsu, China.,The Laboratory of Andrology, Second Affiliated Hospital of Soochow University, Jiangsu, China
| | - Qiu Yao
- Department of Urology, Second Affiliated Hospital of Soochow University, Jiangsu, China.,The Laboratory of Andrology, Second Affiliated Hospital of Soochow University, Jiangsu, China
| | - Shujun Wu
- Department of Operating Room, Second Affiliated Hospital of Soochow University, Jiangsu, China
| | - Guangcheng Dai
- Department of Urology, Second Affiliated Hospital of Soochow University, Jiangsu, China.,The Laboratory of Andrology, Second Affiliated Hospital of Soochow University, Jiangsu, China
| | - Han Xiang
- Department of Urology, Second Affiliated Hospital of Soochow University, Jiangsu, China.,The Laboratory of Andrology, Second Affiliated Hospital of Soochow University, Jiangsu, China
| | - Xiaolong Liu
- Department of Urology, Second Affiliated Hospital of Soochow University, Jiangsu, China.,The Laboratory of Andrology, Second Affiliated Hospital of Soochow University, Jiangsu, China
| | - Boxin Xue
- Department of Urology, Second Affiliated Hospital of Soochow University, Jiangsu, China.,The Laboratory of Andrology, Second Affiliated Hospital of Soochow University, Jiangsu, China
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Sheehan M, Briody H, O'Neill DC, Bowden D, Davis NF, Given M, Mohan P, Lee MJ. Pain relief after varicocele embolization: The patient's perspective. J Med Imaging Radiat Oncol 2020; 64:215-219. [PMID: 32048477 DOI: 10.1111/1754-9485.13001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/09/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Long-term efficacy of treatment with varicocele embolization is poorly documented from the patient's perspective. This study assessed patients' perceived changes in pain scores pre- and post-testicular vein embolization. In addition, the effect of testicular vein embolization on quality of life (QoL) parameters was assessed. METHODS All patients treated with embolization for varicocele-related orchalgia were analysed (2009-2015). A standardized pain impact questionnaire was used to assess pain scores pre- and post-procedure. The primary outcome was to assess patients' pain relief post-varicocele embolization. The secondary outcome was patients' perceived efficacy of the embolization procedure in terms of improvement in QoL parameters. RESULTS Sixty patients underwent varicocele embolization due to persistent orchalgia; of which 44 responded to the questionnaire. The mean pre-procedural pain score was 5.4/10 (range of 1.5-9). Post-procedure questionnaire was performed at a median of 58 months (range 28-106 months). At 1, 6 and 12 months post-procedure, the mean pain score was 1.57, 0.55 and 0.3, respectively. 50% (n = 22) reported complete pain relief 1-month post-embolization while 89% (n = 39) of patients reported complete resolution of pain at 1 year. Among the measured QoL parameters; varicocele embolization resulted in significant improvement in return to work, housework, socializing, exercise, sexual relations, and sleeping post-embolization (P < 0.01). CONCLUSION Varicocele embolization results in a durable reduction in pain scores compared to their pre-operative values. Information from this study will allow clinicians to convey the potential improvements in pain parameters to patients undergoing embolization of symptomatic varicoceles.
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Affiliation(s)
- Mark Sheehan
- Department of Radiology, Beaumont Hospital, Dublin 9, Ireland
| | - Hayley Briody
- Department of Radiology, Beaumont Hospital, Dublin 9, Ireland
| | | | - Dermot Bowden
- Department of Radiology, Beaumont Hospital, Dublin 9, Ireland
| | - Niall F Davis
- Department of Urology and Transplant Surgery, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons (RCSI), Dublin, Ireland
| | - Mark Given
- Department of Radiology, Beaumont Hospital, Dublin 9, Ireland
| | - Ponnusamy Mohan
- Department of Urology and Transplant Surgery, Beaumont Hospital, Dublin 9, Ireland
| | - Michael J Lee
- Department of Radiology, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons (RCSI), Dublin, Ireland
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Machen GL, Johnson D, Nissen MA, Naber E, Sandlow JI. Time to improvement of semen parameters after microscopic varicocelectomy: When it occurs and its effects on fertility. Andrologia 2019; 52:e13500. [DOI: 10.1111/and.13500] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/06/2019] [Accepted: 11/14/2019] [Indexed: 01/22/2023] Open
Affiliation(s)
| | - Dane Johnson
- Division of Urology Washington University in St Louis St Louis MO USA
| | | | - Evan Naber
- Department of Urology Medical College of Wisconsin Milwaukee WI USA
| | - Jay I. Sandlow
- Department of Urology Medical College of Wisconsin Milwaukee WI USA
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Lipshultz LI, Ramasamy R, Sandlow JI, Hotaling J, Eisenberg M, Niederberger C, Brannigan RE. Microsurgical varicocelectomy: novel applications to optimize patient outcomes. Fertil Steril 2019; 112:632-639. [DOI: 10.1016/j.fertnstert.2019.08.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 11/30/2022]
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Xia YQ, Ning JZ, Cheng F, Yu WM, Rao T, Ruan Y, Yuan R, Du Y. GYY4137 a H 2S donor, attenuates ipsilateral epididymis injury in experimentally varicocele-induced rats via activation of the PI3K/Akt pathway. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2019; 22:729-735. [PMID: 32373293 PMCID: PMC7196355 DOI: 10.22038/ijbms.2019.30588.7372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The current study was aimed to investigate the effect of morpholin-4-ium 4 methoxyphenyl (morpholino) phosphinodithioate (GYY4137) on ipsilateral epididymis injury in a rat model of experimental varicocele (VC). MATERIALS AND METHODS Sixty Wistar rats were randomly assigned to sham, sham plus GYY4137, VC and VC plus GYY4137 groups. Sperm quality parameters, including sperm count, motility and viability were evaluated after 4 weeks. Histological changes were measured by hematoxylin and eosin staining between the groups. The oxidative stress levels were estimated by determining epididymal superoxide dismutase (SOD) and malondialdehyde (MDA). The apoptosis status and the expression of phosphatidylinositol 3'-OH kinase (PI3K)/Akt were analyzed by immunohistochemical analysis, western blot and RT-qPCR. RESULTS VC resulted in the decrease of sperm parameters, significant histological damage and higher levels of oxidative stress and apoptosis. Compared to the VC group, GYY4137 markedly ameliorated these observed changes. In addition, treatment with GYY4137 obviously reduced the levels of caspase-3 and Bax and increased the levels of the phosphorylation of PI3K p85 and Akt. CONCLUSION Our data demonstrated that GYY4137 may alleviate the sperm damage and epididymis injury in experimentally VC-induced rats by activation of the PI3K/Akt pathway.
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Affiliation(s)
- Yu-Qi Xia
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Jin-Zhuo Ning
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Fan Cheng
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Wei-Min Yu
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Ting Rao
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Yuan Ruan
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Run Yuan
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Yang Du
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
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Morinda Officinalis Polysaccharides Attenuate Varicocele-Induced Spermatogenic Impairment through the Modulation of Angiogenesis and Relative Factors. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:8453635. [PMID: 31110554 PMCID: PMC6487148 DOI: 10.1155/2019/8453635] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/28/2019] [Indexed: 01/07/2023]
Abstract
Evidence supporting best treatment practices for varicocele is lacking. The effects of a water-soluble polysaccharide extracted from Morinda officinalis (MOP) on the progression of varicocele were evaluated in the present study. The extracted MOP was confirmed as having a high purity of 98% with scant protein contamination, and it mainly consisted of glucose, lactose, and xylose at a molar ratio of 7.63:1.23:0.95 glucose:lactose:xylose. MOPs were administered to experimental left varicocele rats immediately after surgery at doses ranging from 25 to 200 mg/kg. As detected by sperm analysis and histopathological staining, the intragastric administration of 100 mg/kg MOPs significantly improved the sperm parameters of bilateral cauda epididymis, attenuated seminiferous epithelial structures, and inhibited germ cell apoptosis. The results of immunofluorescence and immunoblot showed that administration of 100 mg/kg MOPs effectively inhibited angiogenesis in the bilateral testes but modulated the expression of vascular endothelial growth factor (VEGF), matrix metalloproteinase 2 (MMP2), and MMP9 mildly. These results indicate that inhibition of angiogenesis may be one of the mechanisms by which MOP exerts its inhibitive activities on the progression of varicocele, whereas a relative upregulation of VEGF and MMP-9 may be crucial for the spermatogenetic protective effects of 100 mg/kg MOP administration.
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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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Al-Mohammady AA, El-Sherbiny AF, Mehaney AB, Ghobara YA. Varicocele repair in patients prepared for intracytoplasmic sperm injection: To do or not to do? Andrologia 2018; 51:e13185. [PMID: 30375021 DOI: 10.1111/and.13185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/25/2018] [Accepted: 09/30/2018] [Indexed: 12/01/2022] Open
Abstract
PURPOSE This study sought to evaluate the impact of varicocele repair on intracytoplasmic sperm injection outcomes. PATIENTS AND METHODS A prospective comparative study was conducted at the Assisted Reproduction Unit, International Islamic Center for Population Studies and Researches, Al-Azhar University. This study included 100 non-azoospermic infertile men with a history of varicocele who were scheduled for intracytoplasmic sperm injection, half of them had already undergone prior subinguinal varicocelectomy at least 12 months prior to ICSI without clinically evident recurrence (treated group 1), and the other half has any grade of an unrepaired clinical varicocele (untreated group 2) at sperm injection. All cases were clinically evaluated and eligible for analysis by using inclusion and exclusion criteria. ICSI outcomes compared between the two groups, including fertilisation rate, embryo development rate and pregnancy outcome. RESULTS Our study did not show any significant difference between treated and untreated groups regarding the mean values of fertilisation (0.7759 ± 0.2708 vs. 0.7119 ± 0.3057, p = 0.2708), embryo development (0.7759 ± 0.2708 vs. 0.6991 ± 0.3211, p = 0.1990) or different embryo grades. There was no statistically significant difference between groups regarding pregnancy occurrence rates (p = 0.0928). CONCLUSION Infertile men scheduled for ICSI do not seem to benefit from varicocele repair as regard to the outcomes of ICSI.
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Affiliation(s)
- Abdelshakour A Al-Mohammady
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed F El-Sherbiny
- Department of Andrology, International Islamic Center for Population Studies and Research, Al-Azhar University, Cairo, Egypt
| | - Amira B Mehaney
- Department of Embryology, International Islamic Center for Population Studies and Research, Al-Azhar University, Cairo, Egypt
| | - Yasser A Ghobara
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Silber S. The varicocele argument resurfaces. J Assist Reprod Genet 2018; 35:1079-1082. [PMID: 29589295 PMCID: PMC6030012 DOI: 10.1007/s10815-018-1160-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 03/13/2018] [Indexed: 11/19/2022] Open
Abstract
A recent series of articles and reviews published in Fertility and Sterility have rekindled the more than half century debate on varicocelectomy. Every one of these articles favored strongly the repair of varicocele for male infertility. Since my review paper on this issue in 2001, published in Human Reproduction Update, and since advent of ICSI in 1993, I had thought that most reproductive physicians felt negatively about the benefit of varicocelectomy. However, more recent urological papers are causing this negative view to be re-evaluated. It is now advocated by some urologists that varicocelectomy improves sperm count and testosterone levels, and even improves the results with ICSI. Thus, it may be appropriate to revisit older studies again and review the newer ones in this never ending controversy. Newer studies are re-opening the door to review and possibly re-instate varicocelectomy. This dilemma may never be fully resolved, but it is important to keep an open mind.
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Affiliation(s)
- Sherman Silber
- Infertility Center of St. Louis, St. Luke's Hospital, Saint Louis, MO, USA.
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