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Wang S, Lu R, Shi H, Chen J, Sun M, Ding J, Lv Q, Wang C, Ren J, Zhou G, Tang Z. Safety and efficacy of acupuncture for varicocele-induced male infertility: a systematic review protocol. BMJ Open 2022; 12:e063381. [PMID: 36456023 PMCID: PMC9716984 DOI: 10.1136/bmjopen-2022-063381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Varicocele (VC) is a common clinical disease in andrology. Among a number of ways for VC treatment, surgery is the most common one, but the measurable benefit of surgical repair was slight. A growing exploration of complementary therapies has been conducted in clinical research on acupuncture for VC, but there is no relevant systematic review and meta-analysis to assess the efficacy and safety of acupuncture for VC. METHODS AND ANALYSIS All relevant publications published from database inception through August 2022 will be searched in three English-language databases (Embase, CENTRAL, MEDLINE) and four Chinese-language databases (China National Knowledge Infrastructure, China Science and Technology Journal Database, Chinese Biomedical Literature Database and Wanfang Data). Randomised controlled trials in English and Chinese concerned with acupuncture for patients with VC will be included. The input clinical data will be processed by the Review Manager software (RevMan). The literature will be appraised with the Cochrane Collaboration risk of bias tool. The Grading of Recommendations Assessment, Development and Evaluation system (GRADE system) will be used to evaluate the quality of evidence. ETHICS AND DISSEMINATION This study is a secondary study based on clinical studies so it does not relate to any individual patient information or infringe the rights of participants. Hence no ethical approval is required. The results will be reported in peer-reviewed journals or disseminated at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42022316005.
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Affiliation(s)
- Sijia Wang
- Department of Traditional Chinese Medicine, Yixing People's Hospital, Yixing, Jiangsu, China
| | - Rongchen Lu
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Hongshuo Shi
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jiangnan Chen
- Department of Traditional Chinese Medicine, Yixing People's Hospital, Yixing, Jiangsu, China
| | - Miaomiao Sun
- Department of Traditional Chinese Medicine, Yixing People's Hospital, Yixing, Jiangsu, China
| | - Jing Ding
- Department of Traditional Chinese Medicine, Yixing People's Hospital, Yixing, Jiangsu, China
| | - Qiang Lv
- Department of Traditional Chinese Medicine, Yixing People's Hospital, Yixing, Jiangsu, China
| | - Chenyao Wang
- Department of Traditional Chinese Medicine, Yixing People's Hospital, Yixing, Jiangsu, China
| | - Jianjun Ren
- Department of Traditional Chinese Medicine, Yixing People's Hospital, Yixing, Jiangsu, China
| | - Guangming Zhou
- Department of Traditional Chinese Medicine, Yixing People's Hospital, Yixing, Jiangsu, China
| | - Zhian Tang
- Department of Traditional Chinese Medicine, Yixing People's Hospital, Yixing, Jiangsu, China
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Sary RG, Mohamed RH, Khalil KM, Al-Lethie ALA, Hussein HA. Relationship between angioarchitecture of the testicular artery and spermiogram parameters in Egyptian buffalo bulls (bubalus bubalis). Reprod Domest Anim 2020; 55:343-350. [PMID: 31944422 DOI: 10.1111/rda.13635] [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: 10/11/2019] [Accepted: 12/30/2019] [Indexed: 11/28/2022]
Abstract
The current study aimed to investigate the effect of testicular artery angioarchitecture on the spermiogram parameters in Egyptian Buffalo bulls. Eight adult buffalo bulls aged between 2 and 8 years were used for semen evaluation. For anatomical studies, the masculine gonads were collected after slaughtering 30 adult bulls and prepared for injection by different masses (Urographine® , Latex and Epoxy) through the testicular artery. The mass activity of the ejaculate was assessed immediately after collection. The sperm motility in fresh bull ejaculate was more than 80%. The overall mean percentage of sperm abnormalities was <18%. The recorded sperm abnormalities were mostly secondary one including distal protoplasmic droplet, fragmented tail, detached head, detached galea capitis and bent tail. The highest percentage of sperm viability was recorded just after sperm collection (alive > 85%). The results revealed that testicular artery can be divided into three parts (abdominal, funicular and marginal parts) along its course. The coils of the funicular part forming a cone-like structure with its base fixed to the head of the testis. Two epididymal branches to the head and tail of epididymis emanate from the funicular part which continues as pars marginalis on the lateral surface of testis before its division into the lateral and medial testicular arteries on approaching the tail extremity of the testis. The increase in the length of the testicular artery with increase in the size of the testes played a great role in the degree of complexity of the architectural vascular patterns. The degree of complexity is affected by the number of coils formed by the vessel. The increase in the convolutions of the vessel will reduce the speed of blood flow to the gonads. Thus in turn will enabling the thermoregulatory mechanism to work more efficiently and will affect the semen value.
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Affiliation(s)
- Ramadan G Sary
- Anatomy and Embryology Department, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Ragab H Mohamed
- Theriogenology Department, Faculty of Veterinary Medecine, Aswan University, Aswan, Egypt
| | - Karim M Khalil
- Anatomy and Embryology Department, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Al-Lethie A Al-Lethie
- Department of Surgery, Anaesthesiology and Radiology, Faculty of Veterinary Medicine, Aswan University, Aswan, Egypt
| | - Hassan A Hussein
- Theriogenology Department, Faculty of Veterinary Medecine, Assiut University, Assiut, Egypt
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Lyu KL, Zhuang JT, Li PS, Gao Y, Zhao L, Zhang YD, Zhou MK, Yu JW, Feng X, Sun XZ, Deng CH, Tu XA. A novel experience of deferential vessel-sparing microsurgical vasoepididymostomy. Asian J Androl 2019; 20:576-580. [PMID: 29974884 PMCID: PMC6219301 DOI: 10.4103/aja.aja_46_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Microsurgical longitudinal intussusception vasoepididymostomy (LIVE) has been widely used to treat epididymal obstructive azoospermia since 2004. Although the deferential vasculature plays an important role in supplying blood to the testis and epididymis, little attention has been paid to the potential benefits of sparing the deferential vessels during the anastomosis in LIVE. This study aimed to evaluate the efficacy and safety of deferential vessel-sparing LIVE in humans. From December 2013 to December 2015, 69 azoospermic men with epididymal obstruction due to a genital infection, trauma, or idiopathic factors underwent deferential vessel-sparing LIVE in the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. The outcomes of these patients were analyzed retrospectively. The mean age was 31.1 years for men and 28.3 years for their partners. Fifty-nine (85.5%, 59/69) men were followed up after surgery for approximately 16 months. Patency was noted and confirmed by semen analysis (>10 000 sperm/ml) in 83.1% (49/59) of men. The natural pregnancy rate was 40.7% (24/59) by the end of the study, with 87.5% (21/24) of these natural pregnancies achieved within 12 months after surgery. No severe adverse events or complications were observed. In this study, we present a novel technique for sparing the deferential vessels during LIVE. The preliminary outcomes show this technique to be safe with favorable patency and pregnancy rates.
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Affiliation(s)
- Kun-Long Lyu
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510000, China.,Department of Urology and Andrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Jin-Tao Zhuang
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510000, China
| | - Philip S Li
- Center for Male Reproductive Medicine and Microsurgery, Department of Urology, Weill Cornell Medicine of Cornell University, New York, NY 10065, USA
| | - Yong Gao
- Center for Reproductive Medicine, Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510000, China
| | - Liang Zhao
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510000, China
| | - Ya-Dong Zhang
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510000, China
| | - Ming-Kuan Zhou
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510000, China
| | - Jing-Wei Yu
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510000, China
| | - Xin Feng
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510000, China
| | - Xiang-Zhou Sun
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510000, China
| | - Chun-Hua Deng
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510000, China
| | - Xiang-An Tu
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510000, China
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Al-Kandari AM, Khudair A, Arafa A, Zanaty F, Ezz A, El-Shazly M. Microscopic subinguinal varicocelectomy in 100 consecutive cases: Spermatic cord vascular anatomy, recurrence and hydrocele outcome analysis. Arab J Urol 2018; 16:181-187. [PMID: 29713549 PMCID: PMC5922226 DOI: 10.1016/j.aju.2017.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 12/02/2017] [Accepted: 12/11/2017] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the detailed vascular anatomy of the spermatic cord during subinguinal microscopic varicocelectomy and to assess the outcome of the cases with regard to varicocele recurrence and hydrocele formation. Patients and methods In all, 100 varicocele cases including 74 left-sided and 26 bilateral, comprising 126 spermatic cord units with clinically palpable varicoceles underwent microscopic subinguinal varicocelectomy. Detailed description of vascular anatomy of the spermatic cords was reported. The number of spermatic, cremasteric, and inguinal veins was recorded. A record of testicular arteries and lymphatics was noted. Testicular delivery was done in all the cases and assessment of the gubernacular veins was reported. The patients underwent clinical evaluation, as well as scrotal Doppler ultrasonography, to detect varicocele recurrence and hydrocele formation. The mean (range) postoperative evaluation period was 6 (3–12) months. Results The mean number of spermatic veins was 14 on both sides. The mean number of spermatic arteries on both sides was 1.3. For lymphatics, the mean number was around three on both sides. The gubernacular veins were noted in 75% of the cases on the left side (mean number of 1.2) and in 85% on the right-side, (mean number of 1). The mean number of cremasteric veins on the left and right sides was 1.4 and 1.2, respectively. Finally, inguinal floor vessels were noted in 9% on the left-side and were not seen in the right-side cases. The incidence of varicocele recurrence was 2% and for hydrocele that was not clinically significant was 0.07%. Conclusion Microscopic subinguinal varicocelectomy accurately evaluated the detailed vascular anatomy of the spermatic cord, achieving excellent surgical outcome with minimal varicocele recurrence and hydrocele formation. Microscopic subinguinal varicocelectomy should be the ‘gold standard’ for varicocelectomy.
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Affiliation(s)
| | | | | | - Fouad Zanaty
- Department of Urology, Menoufia University, Menofia Governorate, Egypt
| | - Ahmed Ezz
- Department of Urology, Al-Salam Hospital, Kuwait City, Kuwait
| | - Mohamed El-Shazly
- Department of Urology, Menoufia University, Menofia Governorate, Egypt
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Tatem AJ, Brannigan RE. The role of microsurgical varicocelectomy in treating male infertility. Transl Androl Urol 2017; 6:722-729. [PMID: 28904905 PMCID: PMC5583050 DOI: 10.21037/tau.2017.07.16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Varicoceles are the most common cause of male infertility. They afflict 15–20% of the general male population and 40% of males with primary infertility. Although multiple treatment modalities exist, including radiographic embolization and laparoscopy, open subinguinal microsurgical varicocelectomy is currently the gold standard of treatment for this condition. In this article, we discuss the role of varicocelectomy in the treatment of the modern infertile male and present a practical, safe, and reproducible technique for the microsurgical approach.
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Affiliation(s)
- Alexander J Tatem
- Department of Urology, Indiana University, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Robert E Brannigan
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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Lee JK, Ryu HY, Paick JS, Kim SW. Anatomical factors affecting the time required for microsurgical subinguinal varicocelectomy. SPRINGERPLUS 2016; 5:1031. [PMID: 27441150 PMCID: PMC4938811 DOI: 10.1186/s40064-016-2689-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 06/25/2016] [Indexed: 11/10/2022]
Abstract
Background Microsurgical subinguinal varicocelectomy (MSV) is considered an effective and less morbid procedure, but the difficulty in preserving testicular arteries is a limitation of this procedure. We identified the microanatomy encountered during MSV and clarify its significance to the difficulty of the procedure. Methods Three hundred and twenty-six patients who underwent left MSV were evaluated. Detailed intraoperative microanatomy was recorded for each case. A classification system was used to assess the anatomical relationship between the internal spermatic artery and the varicose veins as follows: type I (non-adherent to the veins), type II (adherent to the veins), and type III (surrounded by veins). Type III cases were further divided into types III-a (an arterial pulse) and III-b (a blurred arterial pulse). A linear regression analysis of the factors associated with the length of the operation was used to determine the difficulty of the surgery. Results A mean number of 8.2 internal spermatic veins were ligated. Internal spermatic arteries were classified as type I in 14 % of patients, type II in 57 %, and type III in 29 % (III-a in 20 % and III-b in 9 %). A large number of internal spermatic veins and higher internal spermatic artery type were observed significantly more often in grade 3 varicoceles (p < 0.05). The types of internal spermatic arteries (ρ = 0.458) and numbers of internal spermatic veins (ρ = 0.431), cremasteric veins (ρ = 0.197), and gubernacular veins (ρ = 0.119) were significantly associated with the length of the operation (p < 0.05). Conclusions Anatomical factors were associated with the varicocele grade and surgical difficulty. These findings are helpful to perform MSV.
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Affiliation(s)
- Jung Keun Lee
- Department of Urology, College of Medicine, Seoul National University, 110 Daehak-ro, Jungno-Gu, Seoul, 110-744 Republic of Korea
| | - Ho Young Ryu
- Department of Urology, College of Medicine, Seoul National University, 110 Daehak-ro, Jungno-Gu, Seoul, 110-744 Republic of Korea
| | - Jae-Seung Paick
- Department of Urology, College of Medicine, Seoul National University, 110 Daehak-ro, Jungno-Gu, Seoul, 110-744 Republic of Korea
| | - Soo Woong Kim
- Department of Urology, College of Medicine, Seoul National University, 110 Daehak-ro, Jungno-Gu, Seoul, 110-744 Republic of Korea
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Qi X, Wang K, Zhou G, Xu Z, Yu J, Zhang W. The role of testicular artery in laparoscopic varicocelectomy: a systematic review and meta-analysis. Int Urol Nephrol 2016; 48:955-65. [PMID: 26971102 DOI: 10.1007/s11255-016-1254-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/23/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE We performed this meta-analysis to evaluate the efficacy and safety of artery preserving versus artery non-preserving in laparoscopic varicocelectomy. METHODS All publications up until October 2015 were searched in PubMed, EMBASE, Ovid, Web of Science, and Cochrane library. Randomized controlled trials (RCTs) and cohort studies (CSs) that compared the difference in two operative approaches in laparoscopic varicocelectomy were included. Statistical analysis was performed using Stata version 12.0. RESULTS A total of four RCTs and ten CSs involving 503 cases with artery preserving and 911 cases with artery non-preserving met our inclusion criteria. Meta-analysis showed that artery preserving had higher recurrence rate [risk ratio (RR) = 2.91, 95 % confidence interval (CI) 1.83-4.61; P = 0.000], lower incidence of hydrocele formation (RR = 0.18; 95 % CI 0.08-0.42; P = 0.000), and prolonged operating time [standard mean difference (SMD) = 1.27; 95 % CI 0.17-2.37; P = 0.023], compared with artery non-preserving in laparoscopic varicocelectomy. The results were similar in postoperative catch-up growth (RR = 1.00; 95 % CI 0.86-1.17; P = 0.985) and testicular atrophy (RR = 0.36; 95 % CI 0.09-1.54; P = 0.169). Besides, no significant difference was found in sperm concentration, motility, and normal morphology between two groups, as well as on postoperative pregnancy rate (RR = 0.95; 95 % CI 0.65-1.40; P = 0.809). CONCLUSION With the advantages of less recurrence, easier operating and less time spending, and comparable results in other respects, artery non-preserving is preferable to artery preserving in laparoscopic varicocelectomy, although there is a relatively high incidence of hydrocele formation. Considering the limitation of included studies, more large-scaled RCTs are required to confirm the present findings.
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Affiliation(s)
- Xiaokang Qi
- Department of Urology, Subei People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China.,Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Kunpeng Wang
- Department of Urology, The First People's Hospital of Lianyungang City, No. 182 North Tongguan Road, Xinpu District, Lianyungang, 222002, Jiangsu, China
| | - Guangchen Zhou
- Department of Urology, Subei People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
| | - Zhen Xu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Junjie Yu
- Department of Urology, Subei People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
| | - Wei Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
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[Evolution of the therapeutic management of varicoceles: Analysis of French national coding database (2006-2014)]. Prog Urol 2016; 26:139-44. [PMID: 26826770 DOI: 10.1016/j.purol.2015.12.006] [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: 07/06/2015] [Revised: 12/10/2015] [Accepted: 12/24/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The varicocele is a venous abnormality frequently found in humans (1/10). Although the recommendations for management of this pathology are clear, two therapeutic options can be discussed: surgery or radiological embolisation. We wanted to study the evolution of the therapeutic management of varicocele using the French national coding database. METHODS Analysis of database from the "Agence technique de l'information sur l'hospitalisation" (ATIH) (number of surgical procedures and interventional radiology used in the treatment of varicocele for the period 2006-2014). The common classification of medical procedures (CCAM) was used to extract the codes for surgery and radiological embolisation. Then we recorded the corresponding "Groupes homogènes de malades" (GHM), excluding those with a different primary diagnosis of varicocele cure. RESULTS The number of surgical procedures and radiological embolisation performed for the treatment of varicocele increased from 3626 to 4007 procedures (+10.5%) between 2006 and 2014. While the frequency of interventional radiology (embolization pampiniform plexus) increased by 73.9%, surgery procedures (by direct approach or laparoscopy) decreased by 31.4% throughout the study (2006-2014). Thus in 2006, 60.2% of therapeutic procedures were performed surgically and 39.8% by radiological embolisation. In 2014, 37.4% of therapeutic procedures were performed surgically and 62.6% by embolization. CONCLUSION The analysis of French national database has confirmed a change in the therapeutic management of varicocele between 2006 and 2014. The minimally invasive treatment by radiological embolisation is currently favored in France and surgery pushed into the background. In 2014, more than one therapeutic management out of two was performed in interventional radiology. LEVEL OF EVIDENCE 4.
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Zhang Y, Yang X, Wu X, Zhang H, Chen S, Gao X. Microsurgical varicocelectomy with transfixing of the difficult-to-isolate periarterial vein using microsutures. Urology 2015; 85:948-52. [PMID: 25709049 DOI: 10.1016/j.urology.2014.12.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 12/14/2014] [Accepted: 12/29/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To address difficulty in isolating the adhered periarterial vein in microsurgical subinguinal varicocelectomy, we introduced the transfixing microsuture method as well as to evaluate the impact of this technical modification on the surgical success of varicocele repair. MATERIALS AND METHODS We retrospectively evaluated 4 patients with a mean age of 31.5 years who underwent subinguinal varicocelectomy with transfixion of the difficult-to-isolate periarterial vein (a 9-0 transfixing microsuture was placed transversely through the periarterial vein as near to the adjacent border between the testicular artery and adherent vein as possible; then, it was knotted to nick or completely ligate the lumen.) The incidence of recurrence or persistence, postoperative hydrocele formation, sperm improvement, and symptom release was analyzed. RESULTS In 4 cases, the periarterial vein transfixing procedures were performed with a mean follow-up of 6 months. No postoperative recurrence or hydrocele was identified postoperatively. One patient reported no symptom improvement, but there was significant improvement in the symptoms and/or semen parameters in the other 3 patients. Postoperative ultrasonography evaluation revealed that there was no postoperative varicocele recurrence or persistence, no hydrocele formation, and no testicular atrophy. CONCLUSION When the adhered periarterial vein is difficult to isolate and ligate, transfixing the vein with a microsuture in microsurgical subinguinal varicocelectomy is a viable compromise that reduces the incidence of postoperative recurrence or persistence without serious complications.
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Affiliation(s)
- Yan Zhang
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Xiaojian Yang
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao Wu
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hao Zhang
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shitao Chen
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xin Gao
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Micali S, Ghaith A, Martorana E, Zordani A, Territo A, Bianchi G. Bilateral spermatic cord en bloc ligation by laparoendoscopic single-site surgery: preliminary experience compared to conventional laparoscopy. BMC Urol 2014; 14:83. [PMID: 25341821 PMCID: PMC4219038 DOI: 10.1186/1471-2490-14-83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 10/15/2014] [Indexed: 11/10/2022] Open
Abstract
Background Laparo Endoscopic Single-site Surgery (LESS) represents an evolution of minimally invasive surgery and aims to improve cosmetic outcome and reduce surgical trauma and complications associated with traditional laparoscopy. This study was performed to present our preliminary experience in bilateral spermatic cord ligation with the LESS technique and compare the results with the outcomes of conventional laparoscopic surgery. Methods Between June 2007 and May 2013, 24 patients were referred to our institute for bilateral varicocelectomy. The indications for this type of procedure were bilateral varicocele with impairment of semen parameters or chronic bilateral testicular pain. All procedures were performed via the same surgeon. The patients were divided into two groups according to the type of laparoscopic surgery. Group A included 10 patients underwent LESS technique while group B included the remaining 14 patients that underwent conventional laparoscopy. Results The comparison between the two techniques showed some important advantages for LESS: shorter operating time (45.4 min vs. 88.3 (P < .001), shorter hospital stay (16.6 hours vs. 51.4 hours) (P < .001), early return to the normal activity (2.3 days vs. 4.7 days) and better cosmetic outcomes. No conversions from LESS to conventional laparoscopy were necessary and blood loss was insignificant in all patients. All patients in the LESS group reported full satisfaction with the cosmetic outcome, whereas 85.7% of patients after conventional laparoscopy were fully satisfied with cosmesis. Conclusions Bilateral spermatic cord ligation with LESS is an alternative to conventional laparoscopy. The procedure was successfully performed in all patients. The trans-umbilical approach offers the advantage of a better cosmetic result, shorter hospital stay and less postoperative pain.
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Affiliation(s)
| | | | - Eugenio Martorana
- Department of Urology, University of Modena & Reggio Emilia, Via del Pozzo, 71, Modena 41124, Italy.
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Abstract
Surgery for male infertility includes three main areas: varicocele surgery, recanalization of seminal tract, sperm retrieval.Varicocele treatment in infertily is still controversial. Recent scientific evidence appears to demonstrate that in selected cases varicocele treatment is beneficial in improving semen parameters and pregnancy rate. The key for the success of treatment seems to be a correct indication. It is our opinion that varicocele should be treated in presence of abnormal semen parameters, when clinically significant, and in adolescents with atrophy of the affected testis. So far, no specific technique, either surgical, microsurgical or sclerotherapic, can be considered the gold standard. Good results in our hands have been obtained with the microsurgical lymphatic sparing high ligation of internal spermatic vein.Innovations in surgery for seminal tract obstructions include the new tubular invagination techniques for epididimovasostomy, which showed excellent results with a simplified and time-saving microsurgical approach. In distal obstructions, a new transperineal ultrasound-guided approach has been proposed for the diagnostic work-up and treatment. Advantages of this technique and of the TURED must be balanced with those of immediate sperm retrieval for ART.In sperm retrieval, microTESE represents the most important surgical evolution in non-obstructive azoospermia. We have recently proposed a new stepwise approach starting with a minimal equatorial incision for conventional testicular biopsy which is extended to perform microTESE only when no sperm is retrieved. In this way microTESE is offered only to patients who really need it. Another field of innovation is sperm retrieval for ICSI in patients with Klinefelter Syndrome.
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Treatment of bilateral varicocele and other scrotal comorbidities using a single scrotal access: our experience on 34 patients. BIOMED RESEARCH INTERNATIONAL 2014; 2014:403603. [PMID: 25140311 PMCID: PMC4130299 DOI: 10.1155/2014/403603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/06/2014] [Indexed: 12/02/2022]
Abstract
Introduction. Varicocele is the main cause of infertility in male and the most correctable cause of it too. In this study, we present our experience on 34 patients affected by bilateral varicocele and other scrotal comorbidities treated underwent surgery with a scrotal access. Materials and Methods. 34 patients were enrolled with clinical palpable and infraclinical (ultrasonic doppler scanning) bilateral varicocele and other comorbidities like right hydrocele, left hydrocele, bilateral hydrocele, and epididymal cyst. They all underwent scrotal bilateral varicocelectomy under local anesthesia. Results and Discussion. At 6 months, no other complications were reported. No case of testicular atrophy was observed. None had recurrence of varicocele. All scrotal comorbidities were treated as well. Conclusion. Scrotal access with local anesthesia is a safe and useful technique to treat patients with bilateral varicocele and other scrotal comorbidities.
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Patel AP, Lowe GJ, Zynger DL. Rethinking the value of sending vasectomy specimens for histologic examination: an analysis of arterial vasculature and failure to transect the vas deferens. Am J Clin Pathol 2014; 141:360-6. [PMID: 24515763 DOI: 10.1309/ajcpaphjeg2j5mif] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES The testicular, deferential, and cremasteric arteries and their branches surround the vas deferens (VD), leaving them susceptible to injury during vasectomy. Literature describing the caliber of arteries seen in vasectomy specimens is lacking, making it difficult to categorize the significance of an observed artery. We aimed to establish reference values for arterial size typically encountered in vasectomy specimens and assess our institutional experience with failure to transect the VD. METHODS The luminal diameter of the largest artery in 231 consecutive VD specimens from 116 patients was measured microscopically. For comparison, the diameter of the largest artery within 10 spermatic cord cross-sections from inguinal orchiectomies was obtained. The immediate vasectomy failure rate based on histologic assessment was calculated using specimens from 2008 to 2012. RESULTS The luminal diameter of the largest artery encountered in a vasectomy specimen was 1.00 mm or less in 96.5% of cases. Artery sizes greater than or equal to 2.50 mm were only seen in spermatic cord resections. From 2008 to 2012, three (0.36%) of 837 patients undergoing vasectomy had specimens that showed failure to transect both VD. CONCLUSIONS Although the American Urologic Association and European Association of Urology state that histologic evaluation of vasectomy specimens is not required, we encourage the surgeon to send VD specimens for histologic examination. Doing so allows early identification of the failure to transect the VD and the resection of surrounding vasculature, providing quality control feedback to the surgeon.
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Affiliation(s)
- Abhishek P. Patel
- Departments of Urology, The Ohio State University Medical Center, Columbus, OH
| | - Gregory J. Lowe
- Departments of Urology, The Ohio State University Medical Center, Columbus, OH
| | - Debra L. Zynger
- Pathology, The Ohio State University Medical Center, Columbus, OH
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Tian RH, Ma M, Zhu Y, Yang S, Wang ZQ, Zhang ZS, Wan CF, Li P, Liu YF, Wang JL, Liu Y, Yang H, Zhang ZZ, Liu LH, Gong YH, Li FH, Hu HL, He ZP, Huang YR, Li Z. Effects of aescin on testicular repairment in rats with experimentally induced varicocele. Andrologia 2013; 46:504-12. [PMID: 23682825 DOI: 10.1111/and.12107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2013] [Indexed: 12/19/2022] Open
Affiliation(s)
- R. H. Tian
- Department of Urology; Shanghai Human Sperm Bank, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - M. Ma
- Department of Urology; Shanghai Human Sperm Bank, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - Y. Zhu
- Department of Urology; Shanghai Human Sperm Bank, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - S. Yang
- Department of Urology; Shanghai Human Sperm Bank, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - Z. Q. Wang
- Department of Urology; Shanghai Human Sperm Bank, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - Z. S. Zhang
- Department of Ultrasonography; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - C. F. Wan
- Department of Ultrasonography; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - P. Li
- Department of Urology; Shanghai Human Sperm Bank, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - Y. F. Liu
- Department of Urology; Shanghai Human Sperm Bank, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - J. L. Wang
- Department of Urology; Shanghai Human Sperm Bank, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - Y. Liu
- Clinical Stem Cell Centre, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - H. Yang
- Clinical Stem Cell Centre, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - Z. Z. Zhang
- Clinical Stem Cell Centre, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - L. H. Liu
- Clinical Stem Cell Centre, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - Y. H. Gong
- Clinical Stem Cell Centre, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - F. H. Li
- Department of Ultrasonography; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - H. L. Hu
- Department of Urology; Shanghai Human Sperm Bank, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - Z. P. He
- Clinical Stem Cell Centre, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - Y. R. Huang
- Department of Urology; Shanghai Human Sperm Bank, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - Z. Li
- Department of Urology; Shanghai Human Sperm Bank, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
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Kang DH, Lee JY, Chung JH, Jo JK, Lee SH, Ham WS, Cho KS, Lee KS, Kim TH, Lee SW. Laparoendoscopic single site varicocele ligation: comparison of testicular artery and lymphatic preservation versus complete testicular vessel ligation. J Urol 2012; 189:243-9. [PMID: 23174253 DOI: 10.1016/j.juro.2012.09.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Indexed: 12/20/2022]
Abstract
PURPOSE We compared postoperative outcomes in patients treated with laparoendoscopic single site varicocele ligation with or without testicular artery and lymphatic preservation. MATERIALS AND METHODS A total of 80 patients with left varicocele were randomly divided into 2 groups and treated with laparoendoscopic single site varicocele ligation with preservation of the testicular artery and lymphatics (40 in group 1) or complete ligation of the testicular vessels and lymphatics (40 in group 2). Operative time, hospital stay, return to normal activity, postoperative visual analog scale pain scores and complications were analyzed. In patients with subfertility preoperative and 3-month postoperative semen analyses were performed. In patients with scrotal pain preoperative and 12-month postoperative visual analog scale pain scores were analyzed. RESULTS A total of 35 patients per group completed the study. Hospital stay, return to normal activity and postoperative pain scores did not differ between the groups. No major complications were observed. Mean ± SD operative time was 60.7 ± 10.7 and 48.6 ± 6.0 minutes in groups 1 and 2, respectively (p <0.001). Patients with subfertility, including 22 in group 1 and 21 in group 2, showed improved semen parameters 3 months postoperatively but postoperative values did not differ between the groups. The 17 patients in each group with scrotal pain showed decreased pain scores 12 months postoperatively with no difference between the groups. CONCLUSIONS Laparoendoscopic single site varicocele ligation is feasible. No differences in postoperative outcomes and complications were observed when preserving or not preserving the testicular artery and lymphatics.
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Affiliation(s)
- Dong Hyuk Kang
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
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17
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Zheng YQ, Zhang XB, Zhou JQ, Cheng F, Rao T, Yao Y. The effects of artery-ligating and artery-preserving varicocelectomy on the ipsilateral testes in rats. Urology 2008; 72:1179-84. [PMID: 18514768 DOI: 10.1016/j.urology.2008.03.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Revised: 03/20/2008] [Accepted: 03/21/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate the effects of artery-ligating varicocelectomy (ALV) and artery-preserving varicocelectomy (APV) on the ipsilateral testes in experimental varicocele (EV) rats. METHODS Fifty adolescent male Sprague-Dawley rats (6 weeks old, weighing 170 +/- 10 g) were randomly divided into 4 groups: EV without treatment group (EV group), EV with ALV group (EV+ALV group), EV with APV group (EV+APV group), and a control group. EV was induced by partial ligation of the left renal vein to an external diameter of 50% of its original at the position of medialis to both the adrenal and internal spermatic veins. ALV was performed by total ligation of the dilated left internal spermatic vein, along with the internal spermatic artery. APV was performed by ligation of the dilated left internal spermatic vein only. Johnsen's score, ultrastructure of seminiferous tubules, and intratesticular testosterone concentration (ITC) of the left testes were measured. RESULTS ITC and Johnsen's score in the control group were significantly higher than those in the EV group (P < .05) and markedly higher than those in the EV+ALV group (P < .01), and no statistical difference compared with those in the EV+APV group (P > .05). Ultrastructural abnormalities of seminiferous tubules were observed in the EV group, especially in the EV+ALV group. CONCLUSIONS APV was able to repair the varicocele-induced lesions of ipsilateral testes; whereas, the ALV caused further lesions.
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Affiliation(s)
- Yi-Qun Zheng
- Department of Urology, Renmin Hospital, Wuhan University, Wuhan, China
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Lee JW, Paick JS, Kim SW. Microsurgical Subinguinal Varicocelectomy: Comparison of Pediatric and Adult Patients. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.11.1029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jeong Woo Lee
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Seung Paick
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Soo Woong Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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Goldstein M, Tanrikut C. Microsurgical management of male infertility. ACTA ACUST UNITED AC 2006; 3:381-91. [PMID: 16835626 DOI: 10.1038/ncpuro0524] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Accepted: 05/18/2006] [Indexed: 02/07/2023]
Abstract
The introduction of microsurgical techniques has revolutionized the treatment of male infertility. As a result of technical advances and innovation over the past 10-15 years, previously infertile couples are now able to conceive naturally or to parent their own biological children with the aid of assisted reproductive technologies. This article reviews the indications, techniques, and outcomes of the various microsurgical procedures currently used to optimize male fertility. The most up-to-date methods of microsurgical vasal and epididymal reconstruction, sperm retrieval, and varicocele repair are discussed.
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Affiliation(s)
- Marc Goldstein
- Weill Medical College of Cornell University, New York, NY 10021, USA.
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