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Liu L, Huang W, Luo K, Zeng Y, Shao Y, Long Z. Relationship between semen parameters, serum InhB, and INSL-3 levels, and the degree of varicocele. Clinics (Sao Paulo) 2024; 79:100339. [PMID: 38330789 PMCID: PMC10864834 DOI: 10.1016/j.clinsp.2024.100339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/12/2023] [Accepted: 01/18/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Varicocele is an abnormal expansion of the pampininias venous plexus in the scrotum, resulting in impaired sperm production and reduced sperm quality. The exact pathophysiological mechanism leading to varicocele-related infertility has not been fully elucidated. Although treatable, varicocele may lead to male infertility. OBJECTIVE To investigate the relationship between semen parameters, serum InhB and INSL-3 levels, and the degree of varicocele in male patients. METHODS Serum InhB and INSL-3 were detected. To evaluate the relationship between semen parameters and serum InhB and INSL-3 levels. To evaluate the value of semen parameters and serum InhB and INSL-3 levels in distinguishing disease severity in patients with varicocele. RESULTS Serum INSL-3 in patients with varicocele decreased with the severity of the disease. Serum INSL-3 was positively correlated with total sperm count and frequency of normal sperm morphology. There was a weak correlation between serum InhB and semen volume, concentration, and total sperm. Patients with different disease severity were similar within the groups, with partial overlap or similarity between varicocele Grade I and Grade II, and significant differences between Grade III and Grade I and II. Semen volume, concentration, total sperm, normal sperm morphology, and serum InhB and INSL-3 levels could distinguish the degree of varicocele. CONCLUSION Semen parameters and the combination of serum InhB and INSL-3 levels in patients with varicocele are closely related to the severity of the disease. Serum INSL-3 is expected to be a potential biomarker for early clinical intervention.
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Affiliation(s)
- Lei Liu
- Department of Urinary Surgery, The First people's hospital of Zunyi City (The third affiliated hospital of Zunyi Medical University), Zunyi, Guizhou Province, China
| | - WenJie Huang
- Department of Urinary Surgery, The First people's hospital of Zunyi City (The third affiliated hospital of Zunyi Medical University), Zunyi, Guizhou Province, China.
| | - KeBing Luo
- Department of Urinary Surgery, The First people's hospital of Zunyi City (The third affiliated hospital of Zunyi Medical University), Zunyi, Guizhou Province, China
| | - YiZhou Zeng
- Department of Urinary Surgery, The First people's hospital of Zunyi City (The third affiliated hospital of Zunyi Medical University), Zunyi, Guizhou Province, China
| | - YunHao Shao
- Department of Urinary Surgery, The First people's hospital of Zunyi City (The third affiliated hospital of Zunyi Medical University), Zunyi, Guizhou Province, China
| | - ZongMin Long
- Department of Urinary Surgery, The First people's hospital of Zunyi City (The third affiliated hospital of Zunyi Medical University), Zunyi, Guizhou Province, China
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Lourdaux PJ, Vaganée D, Leysen C, De Wachter S, De Win G. Evolution of testicular asymmetry during puberty in adolescents without and with a left varicocele. BJU Int 2023; 131:348-356. [PMID: 36196674 DOI: 10.1111/bju.15914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the evolution of the Testicular Atrophy Index (TAI) in adolescent boys with and without a left varicocele with special attention for the currently postulated cut-off value of 20%. SUBJECTS AND METHODS During 2015-2019, 364 adolescent boys aged 11-16 years were recruited. Genital examination and scrotal ultrasonography were repeatedly performed (≥4 month intervals). Testicular volume (TV) was calculated using the Lambert formula (length × width × height × 0.71). TAI was calculated using the formula: [(TVright - TVleft)/TVlargest (right, left)] × 100. RESULTS The final study population comprised 239 participants, 161 (67.36%) controls and 78 (32.64%) adolescent boys with left varicocele. The mean (sd) number of measurements per participant was 3.82 (1.08). A TAI of ≥20% at first measurement occurred in 9.94% and 35.90%, respectively. Of these, only 31.25% and 46.43% had a TAI of ≥20% at the last measurement, respectively. Nevertheless, the risk of ending up with a TAI of ≥20% was significantly higher if a TAI of ≥20% was recorded at first measurement (P = 0.041 and P = 0.002, respectively). The normalisation rate did not differ significantly between the groups (P = 0.182). Normalisation occurred most frequently in Tanner Stages III and IV. Normalisation was mostly (≥74%) due to catch-up growth of the left testis, in contrast to growth retardation of the right testis, in both groups. The TAI seems to be a fluctuating parameter. CONCLUSION A TAI of ≥20% is a phenomenon seen in boys with and without varicocele but is more common in boys with varicocele. Although normalisation of a high TAI is frequently seen, both adolescent boys with and without a left varicocele who have an initial TAI of ≥20% have a higher risk of a TAI of ≥20% in the future. As the TAI is a fluctuating parameter during pubertal development, it's use as indicator for varicocelectomy based on a single measurement during pubertal development is questioned.
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Affiliation(s)
- Pieter-Jan Lourdaux
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Donald Vaganée
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Department of Urology, Faculty of Medicine and Health Sciences, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Wilrijk, Belgium
| | - Cynthia Leysen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Department of Urology, Faculty of Medicine and Health Sciences, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Wilrijk, Belgium
| | - Gunter De Win
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Department of Urology, Faculty of Medicine and Health Sciences, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Wilrijk, Belgium
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Liu MY, Gray E, Hahn ME, Shiehmorteza M. Scrotal Ultrasound: Updates on Testicular Microlithiasis, Incidental Non-Palpable Lesions, Varicoceles and Testicular Infarction. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00372-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zampieri N, Bianchi F, Vestri E, Patanè S, Camoglio FS. Varicocele in paediatric age: Is the scientific community on the correct pathway? Andrologia 2020; 53:e13844. [PMID: 33125748 DOI: 10.1111/and.13844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 08/27/2020] [Accepted: 08/30/2020] [Indexed: 12/01/2022] Open
Abstract
Varicocele is the primary cause of male infertility and the interests of research about varicocele have changed in the last years. The aim of the study was to analyse how topics of interests about varicocele have changed in the last two decades. Literature about paediatric varicocele between 2000 and 2018 was reviewed, and the subjects of the articles were analysed, selecting the main and secondary topics of each article. A study of their prevalence over the years was performed. In the research, 625 articles were found but only 169 provided data in the paediatric age. The total percentage of exclusively paediatric works was 27.04%, being above average in Europe, North and South America. The main subject both for Europe and North America was surgical technique, while for Asia it was videolaparoscopy. The main issue in South America was fertility; Africa and Oceania do not have enough publications to make statistics. Paediatric articles account for less than one-third of overall articles. The first interest of research is surgical technique. In Europe, the topics seem to exclude fertility potential.
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Affiliation(s)
- Nicola Zampieri
- Pediatric Surgery Unit, Pediatric Fertility Lab, Department of Surgery, Dentistry, Pediatrics and Gynaecology, Woman and Child Hospital, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Federica Bianchi
- Pediatric Surgery Unit, Pediatric Fertility Lab, Department of Surgery, Dentistry, Pediatrics and Gynaecology, Woman and Child Hospital, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Elettra Vestri
- Pediatric Surgery Unit, Pediatric Fertility Lab, Department of Surgery, Dentistry, Pediatrics and Gynaecology, Woman and Child Hospital, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Simone Patanè
- Pediatric Surgery Unit, Pediatric Fertility Lab, Department of Surgery, Dentistry, Pediatrics and Gynaecology, Woman and Child Hospital, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Francesco Saverio Camoglio
- Pediatric Surgery Unit, Pediatric Fertility Lab, Department of Surgery, Dentistry, Pediatrics and Gynaecology, Woman and Child Hospital, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
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Erdoğan H, Durmaz MS, Özbakır B, Cebeci H, Özkan D, Gökmen İE. Experience of using shear wave elastography in evaluation of testicular stiffness in cases of male infertility. J Ultrasound 2020; 23:529-534. [PMID: 31997228 DOI: 10.1007/s40477-020-00430-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/17/2020] [Indexed: 01/28/2023] Open
Abstract
PURPOSE The purpose of this study was to determine quantitative testicular tissue stiffness values in normal and infertile men using shear wave elastography (SWE), and to evaluate the relationship between infertility and testicular stiffness value. METHODS In total, 100 testes of 50 infertile patients with abnormal semen parameters were classified as group A, and 100 testes of 50 control subjects were classified as group B. These two groups were compared in terms of age, testicular volume, and SWE values. The group B testes were randomly chosen from patients who had applied for ultrasonography for any reason, and who had no testis disease and no history of infertility. RESULTS The mean age of the patients was 27.83 years, and no significant difference in age was found between the groups (P = 0.133). No significant difference in testicular volume was found between the groups (P = 0.672). The SWE values were significantly higher in group A than in group B (P = 0.000 for both m/s and kPa values). SWE values had a negative correlation with mean testicular volume in group A (for m/s values: P = 0.043; for kPa values: P = 0.024). CONCLUSION SWE can be a useful technique for assessing testicular stiffness in infertile patients to predict parenchymal damage in testicular tissue that leads to an abnormality in sperm quantity. In addition, decreased testicular volume, together with increased SWE values, can reflect the degree of parenchymal damage.
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Affiliation(s)
- Hasan Erdoğan
- Department of Radiology, Aksaray University Training and Research Hospital, 68200, Aksaray, Turkey.
| | - Mehmet Sedat Durmaz
- Department of Radiology, University of Health Sciences Konya Training and Research Hospital, 42130, Konya, Turkey
| | - Bora Özbakır
- Department of Radiology, Isparta City Hospital, 32200, Isparta, Turkey
| | - Hakan Cebeci
- Department of Radiology, Faculty of Medicine, Selcuk University, 42130, Konya, Turkey
| | - Deniz Özkan
- Department of Radiology, Aksaray University Training and Research Hospital, 68200, Aksaray, Turkey
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Mancini M, Carrafiello G, Melchiorre F, Pelliccione F, Andreassi A, Mantellassi G, Ahmed Said Z, Pecori Giraldi F, Banderali G, Folli F. Early varicocelectomy by percutaneous scleroembolization improves seminiferous tubules spermatozoa release in the adolescent phase of testicular growth. Andrologia 2019; 51:e13286. [DOI: 10.1111/and.13286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 02/27/2019] [Accepted: 03/05/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Mario Mancini
- Pediatric and Adolescent Andrological Unit, Department of Pediatrics San Paolo Hospital, ASST Santi Paolo e Carlo, Università degli Studi di Milano Milan Italy
| | - Gianpaolo Carrafiello
- Department of Diagnostic and Interventional Radiology San Paolo Hospital, ASST Santi Paolo e Carlo Milan Italy
- Department of Health Science Università degli Studi di Milano Milan Italy
| | - Fabio Melchiorre
- Department of Diagnostic and Interventional Radiology San Paolo Hospital, ASST Santi Paolo e Carlo Milan Italy
- Department of Health Science Università degli Studi di Milano Milan Italy
| | - Fiore Pelliccione
- Pediatric and Adolescent Andrological Unit, Department of Pediatrics San Paolo Hospital, ASST Santi Paolo e Carlo, Università degli Studi di Milano Milan Italy
| | - Alice Andreassi
- Pediatric and Adolescent Andrological Unit, Department of Pediatrics San Paolo Hospital, ASST Santi Paolo e Carlo, Università degli Studi di Milano Milan Italy
| | - Gianna Mantellassi
- Pediatric and Adolescent Andrological Unit, Department of Pediatrics San Paolo Hospital, ASST Santi Paolo e Carlo, Università degli Studi di Milano Milan Italy
| | - Zakaria Ahmed Said
- Department of Health Science Università degli Studi di Milano Milan Italy
- Departmental Unit of Diabetes and Metabolic Diseases San Paolo Hospital, ASST Santi Paolo e Carlo Milan Italy
| | - Francesca Pecori Giraldi
- Neuroendocrinology Research Laboratory Istituto Auxologico Italiano IRCCS Milan Italy
- Department of Clinical Sciences and Community Health Università degli Studi di Milano Milan Italy
| | - Giuseppe Banderali
- Department of Pediatrics San Paolo Hospital, ASST Santi Paolo e Carlo, Università degli Studi di Milano Milan Italy
| | - Franco Folli
- Department of Health Science Università degli Studi di Milano Milan Italy
- Departmental Unit of Diabetes and Metabolic Diseases San Paolo Hospital, ASST Santi Paolo e Carlo Milan Italy
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Zhang Y, Li S, Li S. Relationship between cadmium content in semen and male infertility: a meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:1947-1953. [PMID: 30460654 DOI: 10.1007/s11356-018-3748-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/12/2018] [Indexed: 06/09/2023]
Abstract
Meta-analysis with high-quality studies can provide superior evidence. In this paper, we use meta-analysis to analyze the relationship between cadmium (Cd) content in semen and male infertility, and then objectively evaluate the effect of Cd on sperm quality. The objectives of this study were to update our understanding of infertility and to provide evidence to treat and prevent the infertility. We searched potentially relevant studies that were published from establishing database data to April 2018. Articles came from the databases of CNKI, Wanfang, VIP, PubMed, CMCI, and EMBASE. A total of 11 articles were included. We gathered the mean and variance of the infertility group and the control group to compare the Cd content in two groups. In total, the 11 studies include 1707 subjects, 1093 of which were in the infertility group and 614 of which were in the control group. We can get some information from this meta-analysis: SMD = 0.50 (95% Cl 0.39-0.61), Z = 8.92, P < 0.05; the funnel plot of the meta-analysis shows incomplete symmetry, which may have the publication bias. Therefore, the high content of Cd in semen is a causative factor of infertility. The Cd content in semen can be used as an indicator of sperm quality.
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Affiliation(s)
- Yiming Zhang
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, 150030, People's Republic of China
| | - Shiping Li
- College of Animal Science and Technology, Northeast Agricultural University, Harbin, 150030, People's Republic of China.
| | - Shu Li
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, 150030, People's Republic of China.
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9
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Kurtz MP, Diamond DA. Measuring testicular asymmetry in healthy adolescent boys. BJU Int 2018; 122:530-531. [DOI: 10.1111/bju.14375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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A Novel Method for Investigating the Role of Reflux Pattern in Color Doppler Ultrasound for Grading of Varicocele. Sci Rep 2018; 8:6517. [PMID: 29695731 PMCID: PMC5916946 DOI: 10.1038/s41598-018-24890-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 04/10/2018] [Indexed: 11/09/2022] Open
Abstract
Varicocele is the most common correctable cause of infertility. Color Doppler Ultrasound (CDUS) has a sensitivity of 97% and specificity of 94% for diagnosing this condition. This study aimed to propose a new pattern of scrotal Doppler for predicting the severity of varicocele. An observational study was conducted from January 2016 to January 2017 on 120 testes units in 60 patients. Scrotal CDUS and semen analysis were done in all participants. Patients were evaluated for reflux pattern, pampiniform venous plexus diameter, and venous reflux time. The ultrasonography parameters and semen analysis data were compared to assess the correlations between the results. The reflux pattern and vein diameters had a significant correlation. Also, a significant correlation was detected between the reflux pattern and reflux time. There was a significant correlation between the reflux pattern and two parameters of semen analysis namely sperm count and its motility. In conclusion, the reflux pattern classification suggested in this study can be used as a useful predictor of varicocele severity and sperm parameters in patients with varicocele.
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11
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Vaganée D, Daems F, Aerts W, Dewaide R, van den Keybus T, De Baets K, De Wachter S, De Win G. Testicular asymmetry in healthy adolescent boys. BJU Int 2018; 122:654-666. [DOI: 10.1111/bju.14174] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Donald Vaganée
- Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
- Department of Urology; Antwerp University Hospital; Edegem Belgium
| | - Frederik Daems
- Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
| | - William Aerts
- Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
| | - Rosina Dewaide
- Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
| | | | - Karen De Baets
- Department of Urology; Antwerp University Hospital; Edegem Belgium
| | - Stefan De Wachter
- Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
- Department of Urology; Antwerp University Hospital; Edegem Belgium
| | - Gunter De Win
- Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
- Department of Urology; Antwerp University Hospital; Edegem Belgium
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12
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Vakalopoulos I, Kampantais S, Lymperi S, Grivas N, Ioannidis A, Mykoniatis I, Nikolaou V, Dimitriadis G. Should we expand the indications for varicocele treatment? Transl Androl Urol 2017; 6:931-942. [PMID: 29184794 PMCID: PMC5673807 DOI: 10.21037/tau.2017.08.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Current guidelines suggest that treatment of varicocele should be considered in patients with clinically palpable disease and abnormal semen parameters. However, the clinicians are often challenged with the decision whether to treat varicocele in patients with testicular pain or low testosterone levels. Moreover, varicocele is highly associated with DNA fragmentation due to the oxidative stress and it has been demonstrated that surgical repair of varicocele ameliorates oxidative stress markers and consequently the sperm DNA integrity. These new markers could have an adjunctive role to standard semen parameters especially when normal semen analysis is found in adult men with conventional methods. This review presents a contemporary overview of the rationale for varicocele treatment, as well as of the relationship between varicocele and other novel parameters such as DNA fragmentation index and reactive oxygen species. We will also discuss data from several recent series demonstrating that surgical treatment and especially microsurgical approach could resolve testicular pain, increase testosterone levels and fertility rate both in patients with non-obstructive azoospermia as well as in normozoospermia men. The correlation with progressive testicular failure will be also examined. We hope that this overview will provide clinicians with an evidence-based approach to managing these unanswered and conflicting topics.
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Affiliation(s)
- Ioannis Vakalopoulos
- 1 Urologic Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Nikolaos Grivas
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Anastasios Ioannidis
- 1 Urologic Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Mykoniatis
- 1 Urologic Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios Nikolaou
- 1 Urologic Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Dimitriadis
- 1 Urologic Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Jacobson DL, Johnson EK. Varicoceles in the pediatric and adolescent population: threat to future fertility? Fertil Steril 2017; 108:370-377. [DOI: 10.1016/j.fertnstert.2017.07.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/21/2017] [Accepted: 07/13/2017] [Indexed: 11/28/2022]
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Keene DJB, Cervellione RM. Antegrade sclerotherapy in adolescent varicocele patients. J Pediatr Urol 2017; 13:305.e1-305.e6. [PMID: 28215837 DOI: 10.1016/j.jpurol.2016.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 12/29/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In the 1970s, Tauber described the antegrade sclerotherapy technique to treat varicoceles, and reported a 10% recurrence rate. The present study aimed to evaluate paediatric success rates and the effect of modifications to the surgical technique. METHODS A prospective study was performed of all adolescent patients undergoing antegrade sclerotherapy surgery. Each patient had an idiopathic varicocele with spontaneous venous reflux on Doppler examination, and underwent cannulation of a pampiniform plexus vein via a scrotal incision under general anaesthetic. Aethoxysklerol® 3% (2 ml/kg) maximum 3 ml was injected into the pampiniform plexus vein under fluoroscopic monitoring. Success was assessed by clinical examination and Doppler ultrasound 3, 6 and 9 months after surgery. Data were presented as median (interquartile range). Patients were split into three groups: Group A - liquid sclerotherapy with Y connector; Group B - liquid sclerotherapy direct to cannula; and Group C - foam sclerotherapy direct to cannula. Fisher's exact test was used to compare the success rates in each group. RESULTS A total of 91 patients underwent antegrade sclerotherapy. The median age was 14.8 years (range 13.7-15.5). Eleven persistent varicoceles occurred and were diagnosed by Doppler ultrasound. The success rate of surgery was 58% in Group A, 90% in Group B and 96% in Group C. Success was significantly higher in Group B and Group C compared with Group A. No testicular atrophy occurred; two wound infections, two haematomas and one hydrocele were recorded (Table). CONCLUSION Introduction of antegrade sclerotherapy in the adolescent population resulted in a safe and cost-effective method for the management of adolescent varicocele. Several modifications to the technique have been introduced to achieve a high success rate (96%) with minimal complications.
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Affiliation(s)
- D J B Keene
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Oxford Road, Manchester, UK
| | - R M Cervellione
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Oxford Road, Manchester, UK.
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15
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Sack BS, Schäfer M, Kurtz MP. The Dilemma of Adolescent Varicoceles: Do They Really Have to Be Repaired? Curr Urol Rep 2017; 18:38. [PMID: 28315171 DOI: 10.1007/s11934-017-0686-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The primary indication for varicocele repair in adults, that of failed paternity, must be substituted in the adolescent population with surrogate parameters of testicular size differential and semen analysis. Making recommendations based on these two parameters is incredibly difficult because studies often have contradictory findings, different patient populations, and lack of long-term follow up of the key endpoint, paternity. Therefore, it is not a surprise that recommendations for adolescent varicocele repair are general (with some exceptions) and necessarily so because of limitations in quality of evidence. Apart from pain, all indications for varicocele repair in adolescence remain controversial. This highlights the most important task for future studies: to prevent pediatric urologists from allowing a potentially damaging process to go untreated, while at the same time avoiding unnecessary intervention on a highly prevalent condition.
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Affiliation(s)
- Bryan S Sack
- Department of Pediatric Urology, Boston Children's Hospital/Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Mattias Schäfer
- Department of Pediatric Urology, Boston Children's Hospital/Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.,Department of Pediatric Surgery and Pediatric Urology, Cnopf'sche Kinderklinik, St. Johannis-Muehlgasse 19, 90419, Nuremberg, Germany
| | - Michael P Kurtz
- Department of Pediatric Urology, Boston Children's Hospital/Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
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16
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Mahdavi A, Heidari R, Khezri M, Shiravi A, Pirjani R, Saheb Kashaf R. Can Ultrasound Findings be a Good Predictor of Sperm Parameters in Patients With Varicocele? A Cross-Sectional Study. Nephrourol Mon 2016; 8:e37103. [PMID: 27878108 PMCID: PMC5111092 DOI: 10.5812/numonthly.37103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/09/2016] [Accepted: 06/18/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Varicocele, one of the most common causes of sperm abnormalities in men, is the dilation of the testicular vein (the pampiniform venous plexus) by more than 2 mm. Ultrasonography is the primary imaging procedure for varicocele diagnosis. The venous diameter is evaluated using B-mode sonography, and venous reflux is assessed using color Doppler sonography. OBJECTIVES In this study, we investigated the association of ultrasound findings with sperm parameters in patients with varicocele. METHODS Ninety-nine patients with clinically diagnosed varicocele were included in this study, which was performed at a university imaging center. Patients were evaluated for pampiniform venous plexus diameter, venous reflux, and testicular size on both sides. Semen analysis was performed for all patients. The ultrasonography parameters and semen analysis data were compared to assess the correlations between the results. RESULTS The semen analysis parameters, including semen volume and sperm morphology, count, and motility, significant correlations with the diameter of the varicocele vein but were not correlated with testes size. In addition, the patients with reflux of longer than 1 s and those with reflux of less than 1 s had significant differences in sperm parameters and varicocele size. CONCLUSIONS Our study showed that ultrasonography findings can be a good predictor of sperm parameters in patients with varicocele.
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Affiliation(s)
- Ali Mahdavi
- Department of Radiology, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Reza Heidari
- School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mehrdad Khezri
- Department of Radiology, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Abolfazl Shiravi
- Department of Radiology, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Reyhaneh Pirjani
- School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
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Keene DJB, Fitzgerald CT, Cervellione RM. Sperm concentration and forward motility are not correlated with age in adolescents with an idiopathic varicocele and symmetrical testicular volumes. J Pediatr Surg 2016; 51:293-5. [PMID: 26811206 DOI: 10.1016/j.jpedsurg.2015.10.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 10/30/2015] [Indexed: 11/18/2022]
Abstract
AIM Idiopathic varicocele is a common condition that may impair fertility. Its treatment in children and adolescents is reserved for those patients who develop symptoms or testicular growth arrest. We evaluated the trends in sperm parameters among adolescent varicocele patients with symmetrical testicular volumes who have not undergone varicocelectomy. METHOD Data were prospectively collected from a single institution (2009 to 2014). Post-pubertal patients aged 12 to 17years produced semen samples by masturbation. Outcomes measured were semen volume, sperm concentration, and forward motility. Additional variables recorded included: a) testicular volume (ultrasound measurement), b) clinical varicocele grade, c) venous Doppler grading. Linear regression analysis was performed using Fisher's transformation. P<0.05 was considered significant, and data are presented as median (IQ range). RESULTS Forty-one patients with a median age of 15.4 (15.0-15.9) years each provided a sperm sample during the study period. Thirty-five had grade 3 (visible) varicocele, and 6 had grade 2 (palpable) varicocele. All patients had spontaneous venous reflux on Doppler ultrasound, and none had undergone varicocelectomy prior to producing the sperm sample. Table 1 summarizes the sperm parameters according to patient age. The overall median sperm concentration was 37 (16-64) millions/ml and was not correlated with age. The overall median forward motility was 55% (44-64) and was not correlated with age. Thirty-four patients had normal sperm parameters, which remained within the WHO range of normality. CONCLUSIONS Following the European Association of Urology guidelines does not cause progressive deterioration of sperm parameters between the age of 12 and 17years.
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Affiliation(s)
- David J B Keene
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Cheryl T Fitzgerald
- Department of Reproductive Medicine, St Mary's Hospital, Manchester, United Kingdom
| | - Raimondo M Cervellione
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, United Kingdom.
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18
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Fine RG, Gitlin J, Reda EF, Palmer LS. Barriers to use of semen analysis in the adolescent with a varicocele: Survey of patient, parental, and practitioner attitudes. J Pediatr Urol 2016; 12:41.e1-6. [PMID: 26342542 DOI: 10.1016/j.jpurol.2015.06.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 06/08/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The American Society for Reproductive Medicine Practice Committee recommends obtaining a semen analysis (SA) in pediatric patients presenting with a varicocele in the absence of significant testicular atrophy. Among infertile adults with a varicocele, surgery is indicated in the presence of abnormal semen analysis regardless of testicular atrophy. Despite these two statements, semen analysis is not widely utilized by pediatric urologists in the USA managing a patient with a varicocele. OBJECTIVE We explored the attitudes of patients, parents, and practitioners toward SA to identify potential barriers to the use of SA in the evaluation of the adolescent varicocele. STUDY DESIGN We conducted a survey of Society for Pediatric Urology members regarding their management of adolescent varicoceles, with focus on the utilization of SA. The survey consisted of 14 multiple choice questions and two open-ended questions regarding use of SA in practice, barriers to its use, indications for varicocelectomy, and demographics. We also surveyed patients presenting for initial evaluation of a varicocele, as well as their parents, regarding their knowledge about SA and their attitude towards obtaining it. Statistical analysis was performed (p < 0.05 significant). RESULTS The practitioner survey response rate was 53% (168). Only 13.1% routinely incorporated SA in their practice, with 48% of all responders having some degree of discomfort asking for a SA. Of practitioners who cited discomfort, 90% never order a SA for patients with varicoceles. From the 46% of physicians who ordered a SA, we noted significant practice variability (see Figure). The patient/parent survey demonstrated that this population was uncomfortable with the notion of obtaining a SA, with most patients/parents citing lack of knowledge about SA as the main barrier. Patient and parent knowledge was found to correlate. DISCUSSION This study uniquely addresses an issue that has not been discussed in the adolescent varicocele literature to date. It can increase awareness of the option of incorporating SA data in management of the adolescent who presents with a varicocele. CONCLUSION Recognizing and then breaking through the barriers to obtaining a SA, would improve patient care, providing a direct assessment of the impact of a varicocele on fertility potential and thus best determining which patients require surveillance versus surgical intervention. This study suggested that the barriers to SA are surmountable.
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Affiliation(s)
- Ronnie G Fine
- Cohen Children's Medical Center of New York, Hofstra North Shore-LIJ School of Medicine, Lake Success, NY, USA.
| | - Jordan Gitlin
- Cohen Children's Medical Center of New York, Hofstra North Shore-LIJ School of Medicine, Lake Success, NY, USA
| | - Edward F Reda
- Cohen Children's Medical Center of New York, Hofstra North Shore-LIJ School of Medicine, Lake Success, NY, USA
| | - Lane S Palmer
- Cohen Children's Medical Center of New York, Hofstra North Shore-LIJ School of Medicine, Lake Success, NY, USA
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19
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Abstract
What to do with the adolescent varicocele? With merging the information obtained from an extensive review of the literature with our own clinical research, I believe that we already have knowledge enough to say that the adolescent with a varicocele often is in the midst of a progressive disease process. Strong evidence already exists that well more than the majority of Tanner 5 boys with a varicocele and 20% asymmetry will already have abnormally low total motile sperm counts (TMCs) and likely abnormally low sperm concentration as well. There are now many studies in addition to common sense to support the value of % asymmetry as a marker of future abnormal sperm parameters. While we know that some boys at lower Tanner stages who present with asymmetry will have catch-up growth during adolescence, we also know that almost all boys with 15% asymmetry or greater in conjunction with a Doppler detected peak retrograde flow (PRF) of 38 cm/s or greater will end up with greater than 20% asymmetry on follow-up. There also are some boys of concern with less asymmetry but instead have small testes bilaterally, perhaps as a result of the left varicocele slowing the growth of the right testicle and/or an associated undetected or overlooked palpable right varicocele that is also negatively affecting the right testicle. Fortunately, we now have another marker available, i.e., total testicular volume (TTV), to assist in decision making for the adolescent falling into this scenario. Once markers are in place in an early Tanner stage boy with a varicocele that indicate that abnormal semen parameters will likely be present when a Tanner 5 stage of development is reached, there is no reason to wait until the child is older so that a semen analysis can be comfortably requested for the documentation. One argument in favor of waiting is that abnormal semen parameters in a Tanner 5 male usually are reversible. However, how do we know that once abnormal parameters are reversed they then will stay normal in a testicle that already has incurred damage. In other words, I feel it is best to operate once the indicators are in place. We do not want to be suddenly surprised when that individual when older has difficulty fathering a child at a time in life when surgery might be too late to resolve what has taken years to develop. Within this manuscript I will try to document my reasons for the aforementioned rationale.
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Affiliation(s)
- Kenneth I Glassberg
- Department of Urology, Columbia University Medical Center, New York, NY 10032, USA
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20
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Keene DJB, Cervellione RM. Intravenous methylene blue venography during laparoscopic paediatric varicocelectomy. J Pediatr Surg 2014; 49:308-11; discussion 311. [PMID: 24528974 DOI: 10.1016/j.jpedsurg.2013.11.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 11/10/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION One of the challenges of varicocele surgery is to prevent hydrocele formation while still ensuring success. Methylene blue has been used to identify and preserve lymphatic vessels, and venography has been a standard component of sclerotherapy and percutaneous retrograde techniques. The authors have combined both approaches during laparoscopic varicocelectomy and report their experience. METHODS A prospective study was performed of adolescents with idiopathic varicocele and spontaneous venous reflux on Doppler ultrasound. A pampiniform plexus vein was cannulated via scrotal incision before creating the pneumoperitoneum. A mixture of methylene blue and Omnipaque™ was injected into the pampiniform plexus with fluoroscopic screening. Laparoscopic selective vein ligation was then performed using 5mm endoscopic clips or a bipolar vessel sealing device such as Plasmakinetic™ or Ligasure™. Venography was repeated to confirm complete ligation of the internal testicular veins. Patients were followed-up at 3, 6, and 9 months post-surgery with clinical examination and Doppler ultrasound. Data are presented as median (interquartile range). RESULTS Twenty-four patients underwent laparoscopic selective vein ligation with venography and methylene blue injection. The median age was 14.7 (14.6-15.7) years. The recurrence rate was 12%. No patients developed a hydrocele. The length of surgery was 120 (100-126) minutes. CONCLUSION Intra-operative intra-venous methylene blue injection and venography helps to identify venous duplications of the internal testicular veins and enhances the success rate of laparoscopic selective vein ligation. This approach prevents hydrocele formation but has a 12% recurrence rate, which appears to be higher than some techniques described in the literature.
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Affiliation(s)
- David J B Keene
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, United Kingdom.
| | - Raimondo M Cervellione
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, United Kingdom
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Christman MS, Zderic SA, Kolon TF. Comparison of Semen Analyses in Youths with a History of Cryptorchidism or Varicocele. J Urol 2013; 190:1561-5. [DOI: 10.1016/j.juro.2013.02.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Matthew S. Christman
- Naval Medical Center San Diego (MSC), San Diego, California
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stephen A. Zderic
- Naval Medical Center San Diego (MSC), San Diego, California
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Thomas F. Kolon
- Naval Medical Center San Diego (MSC), San Diego, California
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Abstract
PURPOSE OF REVIEW This review provides timely and relevant information to address the indications for repair of the adolescent varicocele. In this review, we summarize the most recent available evidence and provide clinical guidelines. RECENT FINDINGS The indications for adolescent varicocelectomy commonly include testicular hypotrophy and pain but become confusing and contradictory when discussing potential infertility as an indication for repair. The preponderance of patients with varicocele in the infertile population leads to the search for causality and reversibility. However, in the era of assisted reproduction, the question of early prevention of infertility is brought to the forefront of discussion. Recent attempts have been made to determine the patient parameters that predict future infertility. Current publications have focused on predictors for clinically significant varicoceles that would benefit from intervention, such as hormonal profile and peak retrograde flow. Contradictory evidence exists regarding the significance of testicular asymmetry in adolescence. SUMMARY Substantial effort has been made to tease out the clinically significant adolescent varicocele. However, definitive evidence regarding fertility outcomes and adolescent varicocele repair remains limited and controversial. Large-scale, long-term follow-up studies are necessary to determine the true benefit of adolescent varicocele repair on decreasing the risk of fertility problems in adulthood.
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Abstract
Testicular varicocele is present in 15 % of adolescent boys. The very impact of this pathology and who will be at risk of developing into infertility remains unclear. Research on the pathophysiology, results of surgical or radiological interventions and potential predictors for long-term impairment of spermatogenesis and thus fertility is still ongoing. Indications for treatment are mainly based on differences in testicular volumes as semen parameters are most often not available; however, whether testicular volume is a valuable prognostic parameter for later fertility remains questionable. Approximately 50 % of adolescent patients with varicocele experience spontaneous increase of testicular volume without any intervention.
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Affiliation(s)
- K Czeloth
- Abteilung für Klinische Andrologie, Centrum für Reproduktionsmedizin und Andrologie
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Current world literature. Curr Opin Urol 2012; 22:521-8. [PMID: 23034511 DOI: 10.1097/mou.0b013e3283599868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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