1
|
Ramon R, Warli SM, Siregar GP, Prapiska FF, Kadar DD, Tala MRZ. Varicocele repair in improving spermatozoa, follicle-stimulating hormone, and luteinizing hormone parameters in infertile males with azoospermia: a systematic review and meta-analysis. Asian J Androl 2024:00129336-990000000-00199. [PMID: 38877692 DOI: 10.4103/aja202426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/11/2024] [Indexed: 06/16/2024] Open
Abstract
ABSTRACT Patients with azoospermia show a prevalence of varicocele of 10.9% and a 14.8% contribution to male infertility. Patients with azoospermia are thought to produce high-quality semen following varicocele treatment. Advising varicocelectomy prior to sperm retrieval in a reproductive program is still debated. This study reviewed the impact of varicocele repair on male infertility using several factors. A literature search was conducted using Scopus, PubMed, Embase, the Wiley Online Library, and Cochrane databases. Sperm concentration, sperm progression, overall sperm motility, sperm morphology, and follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were also compared. Outcomes were compared between those who received treatment for varicocele and those who did not. The data from the pooled analysis were presented as standardized mean difference (SMD) along with a 95% confidence interval (CI). Heterogeneity was evaluated using I2. Additionally, we conducted analyses for publication bias, sensitivity, and subgroup analysis as appropriate. Nine studies were included after screening relevant literature. Statistical analysis revealed a significant improvement in sperm concentration (SMD: 1.81, 95% CI: 0.84-2.77, P < 0.001), progressive sperm motility (SMD: 4.28, 95% CI: 2.34-6.22, P < 0.001), and sperm morphology (SMD: 3.59, 95% CI: 2.27-4.92, P < 0.001). Total sperm motility showed no significant difference following varicocele repair (SMD: 0.81, 95% CI: -0.61-2.22, P = 0.26). No significant differences were seen in serum FSH (SMD: 0.01, 95% CI: -0.16-0.19, P = 0.87) and LH (SMD: 0.19, 95% CI: -0.01-0.40, P = 0.07) levels as well. This study supports varicocele repair in infertile men with clinical varicocele, as reflected by the improvement in sperm parameters after varicocelectomy compared with no treatment. There were no significant improvements in serum FSH and LH levels.
Collapse
Affiliation(s)
- Ryan Ramon
- Department of Urology, Faculty of Medicine, Universitas Indonesia - Haji Adam Malik General Hospital, Medan 20136, Indonesia
| | - Syah Mirsya Warli
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara - Haji Adam Malik General Hospital, Medan 20136, Indonesia
- Department of Urology, Universitas Sumatera Utara Hospital - Universitas Sumatera Utara, Medan 20154, Indonesia
| | - Ginanda Putra Siregar
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara - Haji Adam Malik General Hospital, Medan 20136, Indonesia
| | - Fauriski Febrian Prapiska
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara - Haji Adam Malik General Hospital, Medan 20136, Indonesia
| | - Dhirajaya Dharma Kadar
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara - Haji Adam Malik General Hospital, Medan 20136, Indonesia
| | - Mohd Rhiza Z Tala
- Department of Obstetric and Gynaecology, Faculty of Medicine, Universitas Sumatera Utara, Haji Adam Malik General Hospital, Medan 20136, Indonesia
| |
Collapse
|
2
|
Belkovsky M, Sarmento EO, Novaes LFC, Passerotti CC, Pontes Junior J, Maximiano LF, Otoch JP, DA-Cruz JAS. Bilateral inguinal transabdominal pre-peritoneal laparoscopic hernioplasty associated to bilateral laparoscopic varicocelectomy in the same intervention: a feasibility study. Rev Col Bras Cir 2023; 50:e20233468. [PMID: 36995836 PMCID: PMC10519696 DOI: 10.1590/0100-6991e-20233468-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/28/2022] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Inguinal hernia and varicocele are common conditions in male population. Laparoscopy brings the opportunity to treat them simultaneously, through the same incision. However, there are different opinions about the risks for testicular perfusion of multiple procedures in the inguinal region. In this study, we assessed the feasibility of simultaneous laparoscopic procedures by studying clinical and surgical outcomes of patients undergoing bilateral inguinal hernioplasty using the transabdominal preperitoneal (TAPP) technique with and without concomitant bilateral laparoscopic varicocelectomy (VLB). METHODS a sample of 20 patients from the University Hospital of USP-SP with indirect inguinal hernia and varicocele with indication for surgical correction was selected. Patients were randomized into two groups, 10 undergoing TAPP (Group I) and 10 undergoing simultaneous TAPP and VLB (Group II). Data regarding total operative time, complications and postoperative pain was gathered and analyzed. RESULTS there was no statistical difference between groups regarding total operative time and postoperative pain. Only one complication (spermatic cord hematoma) was observed in Group I and no complications were observed in Group II. CONCLUSIONS simultaneous TAPP and VLB in was shown to be effective and safe, which provides a basis for conducting studies on larger scales.
Collapse
Affiliation(s)
- Mikhael Belkovsky
- - Faculdade de Medicina da USP, Técnica Cirúrgica e Cirurgia Experimental - Sâo Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Centro de Cirurgia Robótica - São Paulo - SP - Brasil
| | | | | | | | - José Pontes Junior
- - Faculdade de Medicina da USP, Técnica Cirúrgica e Cirurgia Experimental - Sâo Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Centro de Cirurgia Robótica - São Paulo - SP - Brasil
| | - Linda Ferreira Maximiano
- - Faculdade de Medicina da USP, Técnica Cirúrgica e Cirurgia Experimental - Sâo Paulo - SP - Brasil
| | - José Pinhata Otoch
- - Faculdade de Medicina da USP, Técnica Cirúrgica e Cirurgia Experimental - Sâo Paulo - SP - Brasil
| | | |
Collapse
|
3
|
Minas A, Razi M, Nasr-Esfahani MH, Hashemi-Asl SM, Tavalaee M. Oxidative Stress and Cell Cycle Arrest in Seminiferous Tubules Nearby Varicose Vessels: New Perspectives from Experimental Varicocele. Reprod Sci 2023:10.1007/s43032-023-01200-4. [PMID: 36821035 DOI: 10.1007/s43032-023-01200-4] [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: 11/08/2022] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
Varicocele (VCL) has been shown to induce severe oxidative stress in the testicular tissue resulting in 35% of males with primary infertility. To compare the exacerbating impacts of varicose on oxidative DNA damage and homeostatic antioxidant reactions in the seminiferous tubules (ST), enclosed and far from varicose vessels. Thirty mature Wistar rats were divided into control and VCL-induced groups. To approve VCL, the testicular diameters, volume, and blood circulation were measured using B-mode and Doppler ultrasonography. Next, to confirm oxidative stress (OS), the global homeostatic antioxidant biomarkers were evaluated. Moreover, the OS-induced oxidative DNA damage and homeostatic antioxidant reactions were compared between STs nearby and far from varicose vessels. Finally, to clarify the DNA damage-induced impact on the cell cycle progression, the global and local expressions of Cyclin D1, Cdk4, and p21 were examined. The VCL-induced group exhibited diminished global antioxidant status (marked with TAC, GPX, SOD, and CAT) and UNG and MPG expression levels. Moreover, the cross-sections of the VCL group represented a prominent reduction in the UNG, MPG, Cyclin D1, and cdk4, and upregulation in the p21 expression levels, more prominently in the STs nearby varicose vessels. Concerning severe oxidative DNA damage and intensive molecular changes in the STs nearby the varicose vessels, they can be considered the main cause of oxidative DNA damage in enclosed tubules. Thus, the varicose-mediated oxidative DNA damage negatively impacts the cell cycle progression in the tubules more intensively in the subcapsular area.
Collapse
Affiliation(s)
- Aram Minas
- Department of Surgery, Division of Urology, Human Reproduction Section, Universidade Federal de São Paulo- UNIFESP, São Paulo, Brazil
| | - Mazdak Razi
- Department of Basic Science, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran.
| | - Mohammad Hossein Nasr-Esfahani
- Department of Animal Biotechnology, Jahad Daneshgahi Biotechnology Research Institute, Royan Research Institute, Reproductive Medical Research Center, Isfahan, Iran
| | - Seyed Mohammad Hashemi-Asl
- Department of Surgery and Diagnostic Imaging, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Marziyeh Tavalaee
- Department of Animal Biotechnology, Jahad Daneshgahi Biotechnology Research Institute, Royan Research Institute, Reproductive Medical Research Center, Isfahan, Iran
| |
Collapse
|
4
|
BELKOVSKY MIKHAEL, SARMENTO EDGAROLIVEIRA, NOVAES LUISFELIPECOUTO, PASSEROTTI CARLOCAMARGO, PONTES JUNIOR JOSÉ, MAXIMIANO LINDAFERREIRA, OTOCH JOSÉPINHATA, DA-CRUZ JOSEARNALDOSHIOMI. Hernioplastia inguinal pré-peritoneal transabdominal bilateral e varicocelectomia laparoscópica bilateral na mesma intervenção: um estudo de viabilidade. Rev Col Bras Cir 2023. [DOI: 10.1590/0100-6991e-20233468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
RESUMO Introdução: hérnia inguinal e varicocele são doenças comuns na população masculina. O advento da laparoscopia traz a oportunidade de tratá-las simultaneamente, pelo mesmo acesso. Entretanto, existem divergências sobre os riscos para a perfusão testicular de múltiplos procedimentos na região inguinal. Neste estudo, avaliamos a viabilidade de procedimentos laparoscópicos simultâneos estudando resultados clínicos e cirúrgicos de pacientes submetidos à hernioplastia inguinal bilateral pela técnica transabdominal préperitoneal (TAPP) com e sem varicocelectomia laparoscópica bilateral (VLB) concomitante. Métodos: uma amostra de 20 pacientes do Hospital Universitário da USP-SP com hérnia inguinal indireta e varicocele com indicação de correção cirúrgica foi selecionada. Os pacientes foram randomizados em dois grupos, sendo 10 submetidos à TAPP (Grupo I) e 10 submetidos à TAPP e VLB simultâneas (Grupo II). O tempo operatório total, complicações e dor pós-operatória foram coletados e analisados. Resultados: não houve diferença estatística entre os grupos com relação ao tempo operatório total e à dor pós-operatória. Apenas uma complicação (hematoma do cordão espermático) foi observada no Grupo I e não foram observadas complicações no Grupo II. Conclusões: no mesmo procedimento, submeter pacientes à TAPP e à VLB no mesmo procedimento se mostrou eficaz e seguro, o que fornece embasamento para a realização de estudos em maiores escalas.
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Vinod A, Jacob P, Nair AT, V B R. Unilateral Angiokeratoma of Fordyce With Unilateral PEAKER: A Rare Presentation of an Uncommon Disease. Cureus 2022; 14:e28926. [PMID: 36225490 PMCID: PMC9542042 DOI: 10.7759/cureus.28926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 11/26/2022] Open
Abstract
Angiokeratomas are benign vascular lesions that can occur anywhere in the body. Fordyce angiokeratomas, also known as genital angiokeratomas, often develop on the vulva in women and the scrotum in males. A subtype of genital angiokeratoma in males is called penile angiokeratoma (PEAKER). In females, clitoral angiokeratoma (CLANKER) is the embryologic equivalent. As a result of the underlying pathophysiology, these lesions are often bilateral. Unilateral Fordyce angiokeratoma instances are infrequent, and unilateral PEAKER cases have never been previously documented. We describe a case of Fordyce's unilateral angiokeratoma with unilateral PEAKER. To the best of our knowledge, such a variation in presentation of this rare disease has not been previously reported.
Collapse
|
7
|
Sharma S, Shimpi RK. Estimation of haemodynamic changes in varicocele testis and results after microsurgical sub-inguinal varicocelectomy. Urologia 2021; 90:164-169. [PMID: 34963396 DOI: 10.1177/03915603211069013] [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] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Varicocele is among the most frequently encountered, surgically correctable causes of male infertility. Since varicocele is a primary abnormality of testicular vessels, a thorough understanding of haemodynamic changes in the microcirculation of varicocele testis is needed. OBJECTIVES To estimate changes in the microcirculation of varicocele testis and correlate them with symptomatic and semen parameters changes before and after varicocelectomy. MATERIAL AND METHODS This prospective, observational study includes 47 patients of age group 18-40 years who underwent microsurgical varicocelectomy during June 2016 to April 2018 at a tertiary medical institute. Testicular haemodynamic was evaluated using a colour spectral doppler study (PSV-Peak systolic velocity/ESV-End diastolic velocity/RI-Resistive index/PI-Pulsatility index). Semen analysis parameters and testicular blood flow were compared with pre-operative values. RESULTS RI in the capsular artery of varicocele affected testis, which was 0.61 ± 0.11 (mean ± SD), significantly reduced to 0.56 ± 0.09 (mean ± SD) in post-operative follow-up, indicating improved perfusion. Pre-operative sperm density was noted to be 15.94 ± 7.88 (mean ± SD), which improved to 28.41 ± 10.99, Progressive sperm motility from 33.81 ± 10.88 to 38.32 ± 9.21 and morphology from 36.13 ± 10.68 to 41.43 ± 9.29 on 6-month follow-ups (p < 0.05). CONCLUSION Varicocele testis is associated with altered testicular haemodynamic, which insults spermatogenesis. Microsurgical varicocelectomy with testicular artery and lymphatic preservation leads to correction of this altered haemodynamic state and improves the testicular microcirculation.
Collapse
Affiliation(s)
- Satyadeo Sharma
- Department of Urology, All India Institute of Medical Sciences, Raipur, India
| | | |
Collapse
|
8
|
Wood GJA, Cardoso JPG, Paluello DV, Nunes TF, Cocuzza M. Varicocele-Associated Infertility and the Role of Oxidative Stress on Sperm DNA Fragmentation. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:695992. [PMID: 36304050 PMCID: PMC9580684 DOI: 10.3389/frph.2021.695992] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/28/2021] [Indexed: 12/17/2022] Open
Abstract
Varicocele has been extensively described and studied as the most important reversible cause of male infertility. Its impact on semen parameters, pregnancy rates, and assisted reproductive outcomes have been associated with multifactorial aspects, most of them converging to increase of reactive oxygen species (ROS). More recently, sperm DNA fragmentation has gained significant attention and potential clinical use, although the body of evidence still needs further evolution. The associations between sperm DNA damage and a variety of disorders, including varicocele itself, share common pathways to ROS increase. This mini-review discusses different aspects related to the etiology of ROS and its relation to varicocele and potential mechanisms of DNA damage.
Collapse
Affiliation(s)
- Guilherme Jacom Abdulmassih Wood
- Huntington Medicina Reprodutiva, São Paulo, Brazil
- Division of Urology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- *Correspondence: Guilherme Jacom Abdulmassih Wood
| | - João Paulo Greco Cardoso
- Division of Urology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Davi Vischi Paluello
- Division of Urology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Marcello Cocuzza
- Division of Urology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
9
|
Abstract
Objective: To review the available literature and identify factors associated with successful outcomes after varicocele repair (VR) in the setting of non-obstructive azoospermia (NOA). Methods: The PubMed and EMBASE databases were searched for relevant articles. Primary outcomes were return of spontaneous spermatogenesis, sperm retrieval rates (SRRs), and unassisted and assisted pregnancy rates. Histopathological subtypes, when available, were used for subgroup analysis. Results: A total of 16 articles were finally included. The average sample size was 43 and average duration of follow-up was 10.5 months. The average rate of primary spermatogenesis after VR was 27.3%. The average SRR, across five studies in men with NOA undergoing microscopic testicular sperm extraction status after varicocelectomy, was 48.9% vs 32.1% for the untreated cohort groups, and the average spontaneous pregnancy rate was 5.24%. Histopathology subtype was a significant contributing factor when analysed. Conclusion: Varicocele repair should be considered in men with NOA, as it may allow some patients to avoid assisted reproductive technologies and improves success rates when utilised.
Collapse
Affiliation(s)
- Stephanie Jensen
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Edmund Y Ko
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| |
Collapse
|
10
|
Zhang L, Zhao X, Wang W. lncRNA and mRNA sequencing of the left testis in experimental varicocele rats treated with Morinda officinalis polysaccharide. Exp Ther Med 2021; 22:1136. [PMID: 34466146 PMCID: PMC8383328 DOI: 10.3892/etm.2021.10570] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/06/2021] [Indexed: 12/16/2022] Open
Abstract
Varicocele is a common disease of the male reproductive system. Morinda (M.) officinalis is a Chinese herbal medicine, whose main bioactive component M. officinalis polysaccharide (MOP) is believed to have a therapeutic effect on varicocele; however, the underlying molecular mechanisms of this effect are poorly understood. In the present study, 24 rats were randomly divided into three groups: i) Control group; ii) experimental varicocele group; and iii) 300 mg/kg MOP administration group. Analysis of mRNA and long non-coding RNA (lncRNA) expression in rat left testicular tissue was performed. The results suggested that a total of 144 mRNAs and 63 lncRNAs, 63 mRNAs and 148 lncRNAs, and 173 mRNAs and 54 lncRNAs were differentially expressed between the varicocele non-treatment and control groups, the varicocele treatment and varicocele non-treatment groups, and the varicocele treatment and control groups, respectively. Following validation by reverse transcription-quantitative PCR, the Yip1 domain family member 7 (YIPF7) gene was identified as a key mediator of varicocele pathogenesis and repair effect of MOP. Additionally, genes such as purinergic receptor P2X 4 (P2RX4), transmembrane protein 225B (TMEM255B) and Wnt family member 9B (WNT9B) were confirmed to be differentially expressed between the varicocele non-treatment and control groups. We hypothesize that TMEM255B could be a potential novel diagnostic biomarker for varicocele; WNT9B and P2RX4 likely play notable roles in the pathophysiology of the disease through the Wnt signaling pathway and regulation of transmembrane ion channels, respectively. In summary, the present study delineated the molecular mechanisms underlying varicocele pathogenesis and the therapeutic effect of MOP, identified a potential novel diagnostic marker and therapeutic target for varicocele, and provided feasible directions for further studies in the future.
Collapse
Affiliation(s)
- Lihong Zhang
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian 350108, P.R. China.,Key Laboratory of Aging and Neurodegenerative Disease, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian 350108, P.R. China.,Laboratory of Clinical Applied Anatomy, Fujian Medical University, Fuzhou, Fujian 350108, P.R. China
| | - Xiaozhen Zhao
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian 350108, P.R. China.,Key Laboratory of Aging and Neurodegenerative Disease, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian 350108, P.R. China.,Laboratory of Clinical Applied Anatomy, Fujian Medical University, Fuzhou, Fujian 350108, P.R. China
| | - Wei Wang
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian 350108, P.R. China.,Key Laboratory of Aging and Neurodegenerative Disease, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian 350108, P.R. China.,Laboratory of Clinical Applied Anatomy, Fujian Medical University, Fuzhou, Fujian 350108, P.R. China
| |
Collapse
|
11
|
Zhang L, Zhao X, Wang W. Disruption of anchoring junctions in the testes of experimental varicocele rats. Exp Ther Med 2021; 22:887. [PMID: 34194565 PMCID: PMC8237278 DOI: 10.3892/etm.2021.10319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/07/2021] [Indexed: 12/16/2022] Open
Abstract
Varicocele is a common disease of the male reproductive system and is the main cause of male infertility; however, the pathological mechanisms of varicocele remain unclear. The anchoring junctions (AJs) in the testies are located between Sertoli cells, or between Sertoli cells and germ cells. Intact and functional AJs are crucial for spermatogenesis. In the present study, the histomorphology, ultrastructure of AJ, cell cycle, expression of AJ structural proteins, and the level of AJ-associated signaling molecules were investigated in the left testes of experimental varicocele rats at 8 and 12 weeks after surgery. The results revealed that varicocele induced the loss of premature germ cells from the seminiferous epithelium. Furthermore, the results of the present study also revealed damage to the AJ ultrastructure, disorientation of the spermatid head, deregulation of the cell cycle, downregulation of AJ structural proteins, enhanced phosphorylation of focal adhesion kinase (FAK) at Tyr397 and its downstream adapter Src at Tyr416, and activation of the extracellular signal-regulated protein kinase 1 (ERK1) signaling pathway. Thus, the present study demonstrated that varicocele disrupted the structure and function of AJs in the left testes of rats, and that enhancement of FAK phosphorylation may contribute to AJ damage by activating ERK1 signaling, disrupting actin-based filament networks, and altering the balance of the apical ectoplasmic specialization-blood testis barrier functional axis. These findings provide important insights into the pathological mechanisms through which varicocele contributes to male infertility and could help to identify new therapeutic targets for varicocele.
Collapse
Affiliation(s)
- Lihong Zhang
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian 350122, P.R. China.,Key Laboratory of Aging and Neurodegenerative Disease, School of Basic Medical Sciences, Fuzhou, Fujian 350122, P.R. China.,Laboratory of Clinical Applied Anatomy, Fujian Medical University, Fuzhou, Fujian 350122, P.R. China
| | - Xiaozhen Zhao
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian 350122, P.R. China.,Key Laboratory of Aging and Neurodegenerative Disease, School of Basic Medical Sciences, Fuzhou, Fujian 350122, P.R. China.,Laboratory of Clinical Applied Anatomy, Fujian Medical University, Fuzhou, Fujian 350122, P.R. China
| | - Wei Wang
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian 350122, P.R. China.,Key Laboratory of Aging and Neurodegenerative Disease, School of Basic Medical Sciences, Fuzhou, Fujian 350122, P.R. China.,Laboratory of Clinical Applied Anatomy, Fujian Medical University, Fuzhou, Fujian 350122, P.R. China
| |
Collapse
|
12
|
Cantisani V, Di Leo N, Bertolotto M, Fresilli D, Granata A, Polti G, Polito E, Pacini P, Guiban O, Del Gaudio G, Dolcetti V, DʼAndrea V, Di Pierro GB, Verrengia M, Drudi FM, Catalano C. Role of multiparametric ultrasound in testicular focal lesions and diffuse pathology evaluation, with particular regard to elastography: Review of literature. Andrology 2021; 9:1356-1368. [PMID: 34114745 DOI: 10.1111/andr.13067] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/18/2021] [Accepted: 05/28/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ultrasound is the main requested technique for the assessment of traumatic, vascular, neoplastic, and inflammatory testicular pathology. Moreover, the role of ultrasound has broadened over the years along with the introduction of new techniques, such as contrast enhanced ultrasound and ultrasound elastography. OBJECTIVE An updated representation of the pre-existing Literature evidence for multiparametric ultrasound imaging with particular regard to elastography, in the evaluation of focal and diffuse testicular pathologies, has been presented. METHODS The search was performed in PubMed, Cochrane, EMBASE, Web of Science and Scopus databases from the earliest available article (1977) until January 2021. Based on the evidence of the Literature, the current role of US imaging for focal and diffuse testicular pathologies has been reported and illustrated, with emphasis on examination technique, classification, and pitfalls. RESULTS Multiparametric Ultrasound has a recognized role for testicle focal and diffuse disease. Elastography is nowadays recognized as an essential part of the multiparametric ultrasound examination. However, in the setting of testicular pathology this method showed some promising results in the setting of varicocoele and for focal lesions characterization. In the remaining field its role is still under debate. DISCUSSION B-mode ultrasound and color Doppler ultrasound have been for a long time the diagnostic gold standard for testicular pathologies. The introduction of both contrast enhanced ultrasound and elastography in the last two decades has brought to the emergence of the multiparametric ultrasound concept. These methods are currently able to increase diagnostic confidence especially for testicular lesions characterization, with different relevance depending on the pathology under consideration. CONCLUSION Multiparametric ultrasound testis assessment, with specific regard to elastography is nowadays recommended for focal and diffuse disease evaluation. Further and larger studies are however needed to validate these results and to understand if the role of elastography in testicular pathology may be broadened.
Collapse
Affiliation(s)
- Vito Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Nicola Di Leo
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Michele Bertolotto
- Department of Radiology, Ospedale di Cattinara, University of Trieste, Trieste, Italy
| | - Daniele Fresilli
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Antonio Granata
- Department of Nephrology and Dialysis, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Giorgia Polti
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Eleonora Polito
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pacini
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Olga Guiban
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giovanni Del Gaudio
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Dolcetti
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Vito DʼAndrea
- Department of Surgical Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giovanni Battista Di Pierro
- Department of Maternal-Infant and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Francesco Maria Drudi
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
13
|
Gur FM, Timurkaan S, Taskin E, Guven C, Gur HE, Senturk M, Dastan S, Nurdinov N, Unalan A, Cankut S, Tatyuz I. Thymoquinone improves testicular damage and sperm quality in experimentally varicocele-induced adolescent rats. Andrologia 2021; 53:e14033. [PMID: 33660882 DOI: 10.1111/and.14033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to investigate the protective and therapeutic effects of thymoquinone against the negative effects of varicocele on testicular tissue and sperm morphology. Five groups were formed by random selection from a total of 40 adult male Wistar rats (n = 8). Thymoquinone (5 mg/kg/day) was administered intraperitoneally to the varicocele-dimethyl sulfoxide-olive oil-thymoquinone (VT) group and the sham-thymoquinone group. At the end of the 60th day, all groups were anaesthetised and the left testis was removed from the body quickly. One half of the testis tissue, which was divided into two, was separated for biochemical and Western blot analysis, while the other half were fixed in Bouin's fixative. As a result of biochemical, molecular and histopathological analyses, a statistically significant increase was found in the varicocele group testicular tissues in the malondialdehyde level, apoptotic index, Bax expression, cytochrome c expression and Bax/Bcl-2 ratio compared with the sham group. In addition, histopathological changes characterised by partial or complete degeneration of the germinal epithelium were observed in the seminiferous tubules in the same group. Total oxidant status level and sperm count with abnormal morphology increased in varicocele group, whereas total antioxidant status level decreased. In the VT group, all of the biochemical, molecular and histopathological changes detected in the varicocele group were statistically significantly reduced. When the findings obtained in this study are evaluated, it can be said that thymoquinone has the potential to be used as a preventive and therapeutic pharmacological agent in the medical treatment of varicocele. Although the exact mechanism of action of thymoquinone has not been fully elucidated, the findings obtained in this study support the view that thymoquinone showed a cytoprotective effect by reducing apoptosis, oxidative stress and lipid peroxidation.
Collapse
Affiliation(s)
- Fatih Mehmet Gur
- Department of Histology-Embryology, Faculty of Medicine, Nigde Omer Halisdemir University, Nigde, Turkey
| | - Sema Timurkaan
- Department of Histology-Embryology, Faculty of Veterinary Medicine, Fırat University, Elazığ, Turkey
| | - Eylem Taskin
- Department of Physiology, Faculty of Medicine, Nigde Omer Halisdemir University, Nigde, Turkey
| | - Celal Guven
- Department of Biophysics, Faculty of Medicine, Nigde Omer Halisdemir University, Nigde, Turkey
| | - Hatice Emel Gur
- Department of Histology-Embryology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Meryem Senturk
- Department of Biochemistry, Faculty of Veterinary Medicine, Erciyes University, Kayseri, Turkey
| | - Sevgi Dastan
- Department of Biology, Science Faculty, Sivas Cumhuriyet University, Sivas, Turkey
| | - Nursultan Nurdinov
- Betul-Ziya Eren Genome and Stem Sell Center, Erciyes University, Kayseri, Turkey
| | - Adnan Unalan
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Nigde Omer Halisdemir University, Nigde, Turkey
| | - Senay Cankut
- Acıbadem Altunizade In Vitro Fertilization Center, Istanbul, Turkey
| | - Ilhan Tatyuz
- Department of Beekeeping, Ulukisla Vocational School, Nigde Omer Halisdemir University, Nigde, Turkey
| |
Collapse
|
14
|
Phan HT, Nguyen TX, Nguyen DV, Vu HA, Le DA, Pham NH. Efficacy of scroto-inguinal microsurgical varicocelectomy in treating male infertility. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00141-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractBackgroundVaricocele presents as the most frequent cause of infertility in men. Most reports showed that varicocelectomy has a significant impact on male fertility and reproductive outcome. This study aims to evaluate the safety and effectiveness of scrotal–inguinal microsurgical varicocelectomy in treating male infertility.MethodsWe prospectively studied preoperatively and postoperatively (at 3 and 6 months) 86 consecutive patients diagnosed with varicocele, abnormal semen parameters, and infertility, undergoing scrotal–inguinal microsurgical varicocelectomy. Semen test was performed before surgery and at 3 months and 6 months after surgery. The reproductive events were short-term followed up.ResultsThe median age of the patient was 32.9 ± 5.1 (20–43). Two cases (2.7%) had a minor infection of the scrotum incision, who were well treated by appropriate antibiotics. After operation, total sperm count and the percentage of motile sperms at 3 months and 6 months were significantly higher than those pre-varicocelectomy, respectively. In total, 26.7% (23/86) of all couples achieved a spontaneous pregnancy. Late complications such as testicular atrophy, hydroceles, and recurrent varicocele have not occurred.ConclusionsScrotal–inguinal microsurgical varicocelectomy is an acceptable method in treating male infertility due to high rate of reproductive outcomes and very low rate of complications.
Collapse
|
15
|
Ma Y, Zhou Y, Xiao Q, Zou SS, Zhu YC, Ping P, Chen XF. Seminal exosomal miR-210-3p as a potential marker of Sertoli cell damage in Varicocele. Andrology 2021; 9:451-459. [PMID: 33000559 DOI: 10.1111/andr.12913] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/13/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Varicocoele-associated stressors, such as hypoxia and heat, can damage cell function and viability, and some exosomal biomarkers released from impaired cells may reflect the cell status in testis. OBJECTIVES To find if seminal exosomal microRNAs can reflect the Sertoli cell function in varicocoele. MATERIALS AND METHODS Experimental left varicocoele rat model was established (n = 24), and patients with different grades of varicocoele (n = 104) were enrolled. Primary rat Sertoli cells were isolated with enzymatic hydrolysis. Exosomes were isolated from primary rat Sertoli cells, rat epididymis tissue, and human seminal plasma with polymer-based precipitation method. Exosomal microRNAs were quantified with qPCR. Inhibin-B was detected with enzyme immunoassay. The correlation analysis between microRNA and inhibin-B was evaluated with Spearman's correlation. RESULTS We screened 12 previously reported hypoxia-responsive microRNAs in the primary rat Sertoli cells and found that 4 exosomal microRNAs increased significantly in response to in vitro hypoxia treatment (P < .05). Of the 4 microRNAs, only miR-210-3p was upregulated in the rats with experimental varicocoele (P < .01). In the patients with varicocoele, we found that seminal exosomal miR-210-3p significantly increased in patients with grade II and III varicocoele (P < .01), and miR-210-3p negatively correlated with sperm count (P < .01) and seminal inhibin-B expression (r = -0.39, P < .01). For the 30 patients with microsurgical varicocelectomy, the operation notably decreased miR-210-3p (P < .01). DISCUSSION AND CONCLUSION Seminal exosomal miR-210-3p may be a novel, sensitive, and non-invasive biomarker of Sertoli cell damage in varicocoele.
Collapse
Affiliation(s)
- Yi Ma
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Yan Zhou
- Department of Central Lab, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qian Xiao
- Shanghai Human Sperm Bank, Shanghai, China
| | | | - Yin-Ci Zhu
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Ping Ping
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Xiang-Feng Chen
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
- Shanghai Human Sperm Bank, Shanghai, China
| |
Collapse
|
16
|
Tezerjani MD, Kalantar SM. Unraveling the dark matter, long non-coding RNAs, in male reproductive diseases: A narrative review. Int J Reprod Biomed 2020; 18:921-934. [PMID: 33349800 PMCID: PMC7749978 DOI: 10.18502/ijrm.v13i11.7959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/10/2020] [Accepted: 06/28/2020] [Indexed: 12/09/2022] Open
Abstract
Recent advances in human transcriptome have revealed the fundamental and functional roles of long non-coding RNA in the susceptibility to diverse diseases and pathological conditions. They participate in wide range of biological processes such as the modulating of chromatin structure, transcription, translation, and post-translation modification. In addition, based on their unique expression profiles and their association with clinical abnormalities such as those of related to male reproductive diseases, they can be used to develop therapeutic methods and biomarkers for screening of the diseases. In this study, we will review the identified lncRNAs and their molecular functions in the pathogenesis of male reproductive diseases such as prostate cancer, benign prostatic hyperplasia, prostatitis, testicular cancer, varicocele, and sperm abnormalities.
Collapse
Affiliation(s)
- Masoud Dehghan Tezerjani
- Abortion Research Centre, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Science, Yazd, Iran
| | - Seyed Mehdi Kalantar
- Abortion Research Centre, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Science, Yazd, Iran.,Department of Genetics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| |
Collapse
|
17
|
Srisajjakul S, Prapaisilp P, Bangchokdee S. Diagnostic clues, pitfalls, and imaging characteristics of '-celes' that arise in abdominal and pelvic structures. Abdom Radiol (NY) 2020; 45:3638-3652. [PMID: 32356005 DOI: 10.1007/s00261-020-02546-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
'-Celes' is an ancient Greek language suffix that means 'tumor,' 'hernia,' 'swelling,' or 'cavity.' There are many '-celes' in the abdomen and pelvis that may be encountered during routine imaging interpretation, including santorinicele, choledochocele, ureterocele, lymphocele, mucocele, rectocele, cystocele, peritoneocele, varicocele, spermatocele, hydrocele, hematocele, pyocele and syringocele. Most '-celes' are detected incidentally at imaging for other clinical indications, but some deserve more attention due to a range of clinical symptoms or functional disorder that can adversely affect patient quality of life. The objective of this article was to address all of the '-celes' that a general radiologist and abdominal radiologist should know and be able to recognize. Imaging characteristics, diagnostic clues, and pitfalls have been provided to improve diagnostic accuracy and patient outcomes.
Collapse
Affiliation(s)
- Sitthipong Srisajjakul
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
| | - Patcharin Prapaisilp
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Sirikan Bangchokdee
- Department of Internal Medicine, Pratumthani Hospital, 7 Ladlumkaew Muang District, Pratumtani, 12000, Thailand
| |
Collapse
|
18
|
Diagnosis and hormonal treatment of male infertility. Actas Urol Esp 2020; 44:321-327. [PMID: 32241672 DOI: 10.1016/j.acuro.2019.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/28/2019] [Indexed: 11/22/2022]
Abstract
Male infertility is a frequently observed medical condition that is related to the functioning of extremely complex organs such as the pituitary gland and the gonads. The diagnosis and proper management of infertile men is challenging for modern medicine, given the high expectations and demands of current patients, mainly due to the economic and emotional expenses aroused by this "relationship issue". In many cases, patients should receive therapies aimed at improving the functioning of that complex hormonal axis, instead of treating their underlying problem; thus, seeking to optimize the production of gametes with better conditions and improve fertilization rates without requiring assisted procedures.
Collapse
|
19
|
Turna O, Aybar MD. Testicular stiffness in varicocele: evaluation with shear wave elastography. Ultrasonography 2020; 39:350-355. [PMID: 32326674 PMCID: PMC7515660 DOI: 10.14366/usg.19087] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/07/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE This study was conducted to evaluate the potential role of shear wave elastography (SWE) in the evaluation of testes in patients with varicocele. METHODS A total of 116 testes of 58 patients with left-sided varicocele and 58 testes of 29 age-matched healthy controls were included in the study. The patients' testes were classified into groups A (normospermic) and B (oligospermic) based on the presence of oligospermia. The mean SWE values and volume of the testes with varicocele were compared with the contralateral normal testes of the patients and the testes of healthy controls. RESULTS The mean SWE value of the left testes in groups A (4.77±1.16 kPa) and B (6.15±1.96 kPa) exceeded that of the healthy controls (3.79±0.94 kPa) (P<0.001). The mean SWE value of the left testes in group B (6.15±1.96 kPa) exceeded that of group A (4.77±1.16 kPa) (P=0.002). No correlation was observed between testicular stiffness and the grade of varicocele (r=0.102, P=0.423). CONCLUSION The testes with varicocele were stiffer than the contralateral testes and the testes of healthy controls, and SWE might play an auxiliary role to conventional ultrasonography in assessing pathologic alterations in the testis owing to varicocele.
Collapse
Affiliation(s)
- Onder Turna
- Department of Radiology, Istanbul Mehmet Akif Ersoy Cardiovascular and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | | |
Collapse
|
20
|
Penile lymphedeme: a very rare complication due to bilateral subinguinal varicocelectomy. Int Urol Nephrol 2018; 51:261-262. [DOI: 10.1007/s11255-018-2041-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
|
21
|
Alizadeh M, Nasebakht A, Valizadeh R, Mohammadi Fallah M, Taghizadeh Afshari A, Rahimi MM, Daneshyar C. A preliminary evaluation of serum level of testosterone, LH, and FSH in patients with varicocele after varicocelectomy as a kidney-related disease. Ther Clin Risk Manag 2018; 14:1585-1590. [PMID: 30233193 PMCID: PMC6129023 DOI: 10.2147/tcrm.s161641] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Varicocele is a common problem with a high prevalence in population with primary and secondary infertilities. The adverse effects of varicocele on spermatogenesis and fertility are known, but the association between clinical varicocele and testosterone is not clear. Hence, we decided to evaluate the serum levels of testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in patients with varicocele after varicocelectomy. Methods In this study, 100 patients with varicocele were divided into two groups: hypogonadal patients with testosterone level <280 ng/dL and eugonadal patients with testosterone level >280 ng/dL. The serum levels of testosterone, FSH, and LH were measured before surgery and 3 months after surgery, and the results were analyzed using the SPSS software. P-value <0.05 was considered statistically significant. Results Patients with varicocele after puberty till 50 years were divided into two groups: hypogonadal (testosterone <280 ng/dL) and eugonadal (testosterone >280 ng/dL) patients who required varicocelectomy. The mean testosterone level before surgery in hypogonadal patients was 215.22±83.31 ng/dL, which reached 326.95±35.125 ng/dL after surgery (P<0.0001), which was significant. There was no significant decrease in the mean FSH level, but there was a significant decrease in the mean LH level after varicocelectomy. In eugonadal group, testosterone level before surgery was 471.90±145.71 ng/dL, which reached 469.57±145.61 ng/dL after surgery, which was not significant. Conclusion In our study, patients who underwent varicocelectomy had improved testosterone levels, so that this increase was more significant in hypogonadal patients than in eugonadal patients. Decrease in LH and FSH levels in all patients was seen after varicocelectomy, which can be due to increase in testosterone levels.
Collapse
Affiliation(s)
- Mansour Alizadeh
- Nephrology and Kidney Transplant Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Ali Nasebakht
- Nephrology and Kidney Transplant Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Rohollah Valizadeh
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran.,Student Research Committee, Department of Epidemiology, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ali Taghizadeh Afshari
- Nephrology and Kidney Transplant Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohsen Mohammad Rahimi
- Department of Kidney Transplantation, Nephrology and Kidney Transplant Research Center, Urmia University of Medical Sciences, Urmia, Iran,
| | - Chimen Daneshyar
- Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| |
Collapse
|
22
|
Asadi N, Kheradmand A, Gholami M, Moradi FH. Effect of ghrelin on the biochemical and histopathology parameters and spermatogenesis cycle following experimental varicocele in rat. Andrologia 2018; 50:e13106. [DOI: 10.1111/and.13106] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 05/21/2018] [Accepted: 06/11/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- Nematollah Asadi
- Razi Herbal Medicines Research Center; Lorestan University of Medical Sciences; Khorramabad Iran
- Animal Science Research Institute (ASRI); Jihad-e-Agriculture Ministry; Karaj Iran
| | - Arash Kheradmand
- Department of Clinical Sciences, School of Veterinary Medicine; Lorestan University; Khorramabad Iran
| | | | - Forouzan Hadipour Moradi
- Razi Herbal Medicines Research Center; Lorestan University of Medical Sciences; Khorramabad Iran
| |
Collapse
|
23
|
Pan MM, Hockenberry MS, Kirby EW, Lipshultz LI. Male Infertility Diagnosis and Treatment in the Era of In Vitro Fertilization and Intracytoplasmic Sperm Injection. Med Clin North Am 2018; 102:337-347. [PMID: 29406062 DOI: 10.1016/j.mcna.2017.10.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
As assisted reproductive technologies use increases, the evaluation of male factor infertility has often become overlooked. However, male evaluation remains critically important, with benefits seen in overall health, as well as in natural and assisted pregnancy and birth rates. A comprehensive assessment of the male partner should be offered to all couples seeking infertility care.
Collapse
Affiliation(s)
- Michael M Pan
- Scott Department of Urology, Baylor College of Medicine, 6624 Fannin Street #1700, Houston, TX 77030, USA.
| | - Mark S Hockenberry
- Scott Department of Urology, Center for Reproductive Medicine and Surgery, Baylor College of Medicine, 6624 Fannin Street #1700, Houston, TX 77030, USA
| | - Edgar W Kirby
- Scott Department of Urology, Center for Reproductive Medicine and Surgery, Baylor College of Medicine, 6624 Fannin Street #1700, Houston, TX 77030, USA
| | - Larry I Lipshultz
- Scott Department of Urology, Center for Reproductive Medicine and Surgery, Baylor College of Medicine, 6624 Fannin Street #1700, Houston, TX 77030, USA
| |
Collapse
|
24
|
Taghizadeh L, Eidi A, Mortazavi P, Rohani AH. Effect of selenium on testicular damage induced by varicocele in adult male Wistar rats. J Trace Elem Med Biol 2017; 44:177-185. [PMID: 28965574 DOI: 10.1016/j.jtemb.2017.08.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/29/2017] [Accepted: 08/02/2017] [Indexed: 01/01/2023]
Abstract
PROJECT Varicocele is an abnormal tortuosity and distension of the veins of the pampiniform plexus in the spermatic cord. It is the most common surgically correctable cause of male infertility. Several studies have revealed the effects of increased oxidative stress on serum, semen, and testicular tissues in patients with varicocele or in animal models. The aim of this study was to investigate the effects of sodium selenite on testicular damage induced by experimental left varicocele in male Wistar rats. PROCEDURE In the present study, the effects of oral administration of sodium selenite (at doses of 0.05, 0.1, 0.2, and 0.4mg/kg bw) were assessed in normal and varicocelized rats. RESULTS The varicocelized control rats showed decrease in sperm quality parameters, decreased activity of testes CAT, GPX and SOD, increased levels of MDA, and damage in testicular architecture. Administration of sodium selenite significantly reduced these changes to nearly normal levels, but did not change these parameters in normal rats. Histopathological studies further confirmed the protective effects of sodium selenite on varicocele-induced testicular damage in rats. Administrations of sodium selenite did not change these parameters in normal rats. CONCLUSIONS Taken together, the results of this study suggest that sodium selenite treatment may have beneficial effect on the testes of varicocelized rats.
Collapse
Affiliation(s)
- Leila Taghizadeh
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Akram Eidi
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran.
| | - Pejman Mortazavi
- Department of Pathology, Faculty of Specialized Veterinary Sciences, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Ali Haeri Rohani
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| |
Collapse
|
25
|
Ning JZ, Li W, Cheng F, Rao T, Yu WM, Ruan Y, Yuan R, Zhang XB, Du Y, Xiao CC. The protective effects of GYY4137 on ipsilateral testicular injury in experimentally varicocele-induced rats. Exp Ther Med 2017; 15:433-439. [PMID: 29387197 PMCID: PMC5768093 DOI: 10.3892/etm.2017.5417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/01/2017] [Indexed: 12/02/2022] Open
Abstract
The aim of the present study was to evaluate whether morpholin-4-ium 4 methoxyphenyl (morpholino) phosphonodithioate (GYY4137) exhibits a protective effect on ipsilateral testicular injury in experimentally varicocele (VC)-induced rats. A total of 48 rats were randomly divided into the following 6 groups (n=8 each): Group A (control group); group B (sham group); group C (VC group); group D (VC group administered 5 mg/kg/day GYY4137); group E (VC group administered 10 mg/kg/day GYY4137) and group F (VC group administered 20 mg/kg/day GYY4137). Indicators of oxidative stress, apoptosis and inflammation were measured to evaluate the effect of GYY4137 on ipsilateral testicular injury. Compared with groups A and B, rats in group C exhibited severe histological changes and an increase in oxidative stress, apoptosis and inflammation. By contrast, amelioration of testicular damage was evident in the group D, E and F that were treated with GYY4137. These results demonstrate that GYY4137 may be a promising therapy to treat VC as it alleviates oxidative stress, apoptosis and inflammation in experimentally VC-induced rats.
Collapse
Affiliation(s)
- Jin-Zhuo Ning
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Wei Li
- Department of Anesthesia, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Fan Cheng
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Ting Rao
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Wei-Min Yu
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Yuan Ruan
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Run Yuan
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Xiao-Bin Zhang
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Yang Du
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Cheng-Cheng Xiao
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| |
Collapse
|
26
|
Combined effects of varicocele and cell phones on semen and hormonal parameters. Wien Klin Wochenschr 2017; 130:335-340. [DOI: 10.1007/s00508-017-1277-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 09/18/2017] [Indexed: 12/11/2022]
|
27
|
Gonadal infection. ANNALS OF PEDIATRIC SURGERY 2017. [DOI: 10.1097/01.xps.0000521796.12885.c6] [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] Open
|
28
|
Treatment of varicoceles: techniques and outcomes. Fertil Steril 2017; 108:378-384. [DOI: 10.1016/j.fertnstert.2017.07.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/19/2017] [Indexed: 11/23/2022]
|
29
|
Ning JZ, Rao T, Cheng F, Yu WM, Ruan Y, Yuan R, Zhu SM, Du Y, Xiao CC. Effect of varicocelectomy treatment on spermatogenesis and apoptosis via the induction of heat shock protein 70 in varicocele‑induced rats. Mol Med Rep 2017; 16:5406-5412. [PMID: 28849011 PMCID: PMC5647084 DOI: 10.3892/mmr.2017.7239] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 06/13/2017] [Indexed: 12/20/2022] Open
Abstract
In the current study, the hypothesis that testicular varicocelectomy improves spermatogenesis and attenuates apoptosis via the induction of heat shock protein 70 (Hsp70) in a rat model of varicocele was investigated. Adult male Wistar rats (n=75) were randomly divided into 5 groups of 15 each: Control, sham, varicocele, varicocelectomy, and varicocelectomy plus Quercetin. A total of 6 weeks after the varicocelectomy, the left testis of all rats was removed for subsequent examination. Histological changes were compared between the groups. The expression of Hsp70 and apoptosis‑associated indicators were evaluated based on immunohistochemical, western blot and mRNA expression analyses. Compared with the varicocele group, the varicocelectomy group exhibited a markedly reduced Bcl‑2‑associated X protein/B‑cell lymphoma 2 (Bax/Bcl‑2) ratio, and had a decreased expression of caspase‑9, cytochrome c (cyt c) and caspase‑3 through the intrinsic signal transduction pathways. Quercetin treatment inhibited the protective effects of varicocelectomy. The expression of Hsp70 was increased in the varicocele group which was further elevated by the varicocelectomy. These results indicated that varicocelectomy can reduce the Bax/Bcl‑2 ratio, and decrease the levels of caspase‑9, cyt c and caspase‑3 via the mitochondrial signal transduction pathway. Such protective effects on left testis spermatogenesis and against apoptosis may be due to the induction of Hsp70. The findings of the present study suggested that varicocelectomy has a clear advantage in protecting testicular function and ameliorating spermatogenic cells apoptosis.
Collapse
Affiliation(s)
- Jin-Zhuo Ning
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Ting Rao
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Fan Cheng
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Wei-Min Yu
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Yuan Ruan
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Run Yuan
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Shao-Ming Zhu
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Yang Du
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Cheng-Cheng Xiao
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| |
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
Alves LDS, Oliveira FBD. Should azoospermic patients with varicocele disease undergo surgery to recover fertility? Rev Assoc Med Bras (1992) 2017; 63:332-335. [PMID: 28614535 DOI: 10.1590/1806-9282.63.04.332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 10/19/2016] [Indexed: 11/21/2022] Open
Abstract
Introduction: Varicocele disease is well-known cause of infertility in men. The presence of spermatic varices veins create a hostile environment to spermatogenesis. It results in reduced quality of the sperm production and in some cases can determine a total absence of sperm. The varicocelectomy procedure in patients with non-obstructive azoospermia (NOA) can raise the rates of sperm in the semen analysis. A positive rate for sperm, even if very low, may be sufficient to enable the capture of sperm intended for in-vitro fertilization without the use of donor sperm. Objetive: To evaluate the raise of sperm in NOA patients with varicocele disease who were submitted to a bilateral procedure to recovery sperm production. Method: We analized the sperm results of 25 NOA patients who undergone to a bilateral varicocelectomy procedure. Results: From a total of 25 patients, three (12%) recovered sperm count four months after procedure. One year after the procedure, five (20%) patients recovered sperm production. Conclusion: Patients with varicocele disease and azoospermia, without genetic changes or obstruction of the spermatic tract, should undergo surgical procedure to recover sperm.
Collapse
Affiliation(s)
- Leonardo de Souza Alves
- MD, Urologist, Faculdade de Ciências Médicas de Minas Gerais (FCM-MG). Director of Procriar - Instituto de Urologia e Andrologia. Full Member of the Sociedade Brasileira de Urologia (SBU), the American Urological Association (AUA), and the American Confederation of Urology (CAU). Full Member of the Colégio Brasileiro de Cirurgiões (CBC), Belo Horizonte, MG, Brazil
| | | |
Collapse
|
32
|
Santana VP, Miranda-Furtado CL, de Oliveira-Gennaro FG, Dos Reis RM. Genetics and epigenetics of varicocele pathophysiology: an overview. J Assist Reprod Genet 2017; 34:839-847. [PMID: 28523408 DOI: 10.1007/s10815-017-0931-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/19/2017] [Indexed: 11/26/2022] Open
Abstract
Varicocele is found in approximately 20% of adults and adolescents and in 19-41% of men seeking treatment for infertility. It is associated with a decrease in sperm count as well as sperm motility and morphology. The currently accepted description of the pathophysiology of varicocele does not explain all its clinical manifestations; therefore, other factors such as genetic and epigenetic changes, associated with the environment, might be involved in causing infertility and decrease in sperm quality. It has been reported that the varicocele-induced deterioration of testicular function is progressive and interferes with fertility; hence, early and efficient assessment of the genetic manifestations in patients would be important for developing future medical interventions. Chromosomal disorders, mutations, polymorphisms, changes in gene expression, and epigenetic changes have all been reported to be associated with varicocele. Several studies are underway to unravel the genetic basis of this disease, as it is important to understand the origin and the aggravating factors to ensure appropriate guidance and intervention. Here, we review the available literature regarding the genetic and epigenetic changes associated with varicocele, and how these alterations are related to the different clinical manifestations of the disease.
Collapse
Affiliation(s)
- Viviane Paiva Santana
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo (USP), 3900 Bandeirantes Ave, São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - Cristiana Libardi Miranda-Furtado
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo (USP), 3900 Bandeirantes Ave, São Paulo, Ribeirão Preto, 14049-900, Brazil
- Oswaldo Cruz Foundation (FIOCRUZ), Ceará, Fortaleza, Brazil
| | - Flavia Gaona de Oliveira-Gennaro
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo (USP), 3900 Bandeirantes Ave, São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - Rosana Maria Dos Reis
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo (USP), 3900 Bandeirantes Ave, São Paulo, Ribeirão Preto, 14049-900, Brazil.
| |
Collapse
|
33
|
Asadi N, Bahmani M, Kheradmand A, Rafieian-Kopaei M. The Impact of Oxidative Stress on Testicular Function and the Role of Antioxidants in Improving it: A Review. J Clin Diagn Res 2017; 11:IE01-IE05. [PMID: 28658802 DOI: 10.7860/jcdr/2017/23927.9886] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 10/25/2016] [Indexed: 01/10/2023]
Abstract
Oxidative stress is an important factor for development of male infertility because of very high rate of cell division and mitochondrial oxygen consumption in testicular tissue as well as comparably higher levels of unsaturated fatty acids in this tissue than in other tissues. Moreover, the level of oxygen pressure is low due to the weakness of testicular artery; therefore, there is a severe cell competition for oxygen. Therefore, the testicular tissue and male reproductive system are particularly susceptible to oxidative stress. On the other hand, exposure to X-ray, toxins and chemicals found in the environment as well as specific physical conditions such as varicocele can exacerbate the oxidative stress and induce apoptosis of germ cells and subsequently spermatogenesis. However, under normal conditions, the body's capacity to produce antioxidants for inhibiting adverse effects of oxidative stress is affected by metabolic process and genetic structure. Besides that, environmental factors such as diet, pollutants, and chemicals can affect this capacity. Thus, the body's antioxidant system alone is not able to neutralize all free radicals and prevent harmful complications of oxidative stress. Therefore, use of antioxidants and development of antioxidant therapy can break down the oxidative chain reaction and play a very significant role in increasing the body's capacity to fight free radical-induced oxidative stress, and therefore improve the process of spermatogenesis.
Collapse
Affiliation(s)
- Nematollah Asadi
- Student Research Committee of Razi Herbal Medicines Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran: Biotechnology laboratory of ASRI, Karaj, Iran
| | - Mahmoud Bahmani
- Leishmaniasis Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Arash Kheradmand
- Razi Herbal Medicines Research center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mahmoud Rafieian-Kopaei
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| |
Collapse
|
34
|
Yamacake KGR, Cocuzza M, Torricelli FCM, Tiseo BC, Frati R, Freire GC, Antunes AA, Srougi M. Impact of body mass index, age and varicocele on reproductive hormone profile from elderly men. Int Braz J Urol 2017; 42:365-72. [PMID: 27256193 PMCID: PMC4871400 DOI: 10.1590/s1677-5538.ibju.2014.0594] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 04/03/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To study the impact of obesity, age and varicocele on sexual hormones of adult and elderly men. MATERIALS AND METHODS 875 men who were screened for prostate cancer were enrolled in this study. Data recorded comprised age, body mass index (BMI), serum levels of total testosterone (TT), free testosterone (FT), sex hormone-binding globulin (SHBG), luteinizing hormone (LH) and follicular stimulating hormone (FSH). Patients were divided in groups according to their BMI in underweight, normal weight, overweight and obese grades 1, 2 or 3. First, it was studied the association between age, BMI, and hormone profile. Then, clinical varicocele was evaluated in 298 patients to assess its correlation to the others parameters. RESULTS Obese patients had lower levels of TT, FT and SHBG (p<0.001) compared to underweight or normal weight patients. There were no differences in age (p=0.113), FSH serum levels (p=0.863) and LH serum levels (p=0.218) between obese and non-obese patients. Obese grade 3 had lower levels of TT and FT compared to obese grade 1 and 2 (p<0.05). There was no difference in the SHBG levels (p=0.120) among obese patients. There was no association between varicocele and BMI; and varicocele did not impact on testosterone or SHBG levels. CONCLUSIONS Men with higher BMI have a lower serum level of TT, FT and SHBG. The presence of clinical varicocele as well as its grade has no impact on hormone profile in elderly men.
Collapse
Affiliation(s)
- K G R Yamacake
- Divisão de Urologia da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| | - M Cocuzza
- Grupo no Centro de Reprodução Humana da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| | - F C M Torricelli
- Divisão de Urologia da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| | - B C Tiseo
- Divisão de Urologia da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| | - R Frati
- Faculdade de Medicina de São Paulo, Universidade de São Paulo, Brasil
| | - G C Freire
- Divisão de Urologia da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| | - A A Antunes
- Divisão de Urologia da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| | - M Srougi
- Divisão de Urologia da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| |
Collapse
|
35
|
Lorenc T, Krupniewski L, Palczewski P, Gołębiowski M. The value of ultrasonography in the diagnosis of varicocele. J Ultrason 2016; 16:359-370. [PMID: 28138407 PMCID: PMC5269523 DOI: 10.15557/jou.2016.0036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/10/2016] [Accepted: 03/14/2016] [Indexed: 01/16/2023] Open
Abstract
A varicocele is described as pathologically enlarged, tortuous veins of the pampiniform plexus, leading to an increased testicular temperature and adrenal metabolite reflux into the testes. Varicocele can impair spermatogenesis and is considered to be the most common cause of male infertility. Patients may palpate a thickening in the scrotum or complain of dull scrotal or inguinal pain, which increases when standing or during erection. In the case of a sudden onset of varicocele in elderly men, it is necessary to exclude renal tumor and extend diagnostic ultrasound with the assessment of the abdominal cavity. The diagnosis of varicocele is based on medical history and physical examination, which involves palpation and observation of the scrotum at rest and during the Valsalva maneuver. Ultrasound is the imaging method of choice. The width and the number of vessels in the pampiniform plexus as well as the evaluation and measurement of regurgitation during the Valsalva maneuver are typical parameters analyzed during ultrasound assessment. However, diagnostic ultrasound is still a controversial method due to numerous and often divergent classification systems for varicocele assessment as well as its poor correlation with clinical manifestations. As a result of introduction of clear ultrasound criteria as well as the development of elastography and nuclear magnetic resonance, diagnostic imaging can play an important role in assessing the risk of damage to the testicular parenchyma, qualifying patients for surgical treatment and predicting the effects of therapy.
Collapse
Affiliation(s)
- Tomasz Lorenc
- 1 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Leszek Krupniewski
- 1 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Palczewski
- 1 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Marek Gołębiowski
- 1 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
36
|
Effects of Morinda officinalis Polysaccharide on Experimental Varicocele Rats. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:5365291. [PMID: 28090212 PMCID: PMC5206431 DOI: 10.1155/2016/5365291] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 11/14/2016] [Indexed: 12/16/2022]
Abstract
Morinda officinalis is a traditional Chinese herbal medicine, which has been used to tonify the kidney and strengthen yang for a long time in China. In this study, the effects of M. officinalis Polysaccharide (MOP) on experimental varicocele adolescent rats were investigated. The result showed that varicocele destroyed the structure of the seminiferous epithelium and decreased the TJ protein expression (Occludin, Claudin-11, and ZO-1), testosterone (T) concentration in the left testicular tissue and serum, and serum levels of inhibin B (INHB), while increasing the levels of cytokines (TGF-β3 and TNF-α) in the left testicular tissue, as well as serum levels of gonadotropin-releasing hormone (GnRH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and antisperm antibody (AsAb). MOP repaired the damaged seminiferous epithelium and TJ and reduced the levels of cytokines (TGF-β3 and TNF-α) as well as serum levels of GnRH, FSH, LH, and AsAb, while upregulating TJ protein expression, T level in the left testicular tissue and serum, and serum INHB levels. In summary, we conclude that MOP promotes spermatogenesis and counteracts the varicocele-induced damage to the seminiferous epithelium and TJ, probably via decreasing cytokines (TGF-β3 and TNF-α) levels and regulating the abnormal sex hormones levels in experimental varicocele rats.
Collapse
|
37
|
Chiles KA, Schlegel PN. Cost-effectiveness of varicocele surgery in the era of assisted reproductive technology. Asian J Androl 2016; 18:259-61. [PMID: 26732113 PMCID: PMC4770496 DOI: 10.4103/1008-682x.172644] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The advent of innovative techniques for addressing infertility has made for exciting times in the arena of andrology. The success of microTESE for retrieving sperm has enabled azoospermic men to have the opportunity to father biological children when it was previously impossible. The ability to offer a variety of assisted reproductive techniques that includes intracytoplasmic sperm injection has opened the door for couples with male factor infertility who were otherwise untreatable. With the multitude of options available to infertile couples, however, comes an unsurprising degree of controversy regarding what treatments should be offered and when. Complicating the picture is the question of if and when varicocele repair should be undertaken, and the financial implications of the treatment decisions that are made. The infertile couple with varicocele warrants careful consideration. The overall efficacy of varicocele repair as well as cost-effectiveness of repair compared to immediate microTESE in azoospermic men and assisted reproductive technology in men with suboptimal semen parameters will be reviewed.
Collapse
Affiliation(s)
| | - Peter N Schlegel
- Department of Urology, Weill Cornell Medical College, New York, USA
| |
Collapse
|
38
|
Abstract
Varicoceles are relatively common clinical problem that are associated with pain, testicular atrophy, and reduced fertility rates. After a brief historical perspective is presented, this article reviews the anatomy, indications, treatment options, and potential complications related to varicoceles.
Collapse
Affiliation(s)
- Brian F Baigorri
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
| | - Robert G Dixon
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
| |
Collapse
|
39
|
Lewis DS, Grimm LJ, Kim CY. Left renal vein compression as cause for varicocele: prevalence and associated findings on contrast-enhanced CT. ACTA ACUST UNITED AC 2016. [PMID: 26210372 DOI: 10.1007/s00261-015-0512-y] [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] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study is to determine the prevalence of left renal vein compression in patients with varicoceles. METHODS Abdominal and pelvis contrast-enhanced CT images from 100 male patients with varicoceles (mean age 50.6 years) and 100 matched control patients (mean age 49.8 years) were retrospectively reviewed. The diameter of the left renal vein was measured as it crosses between the aorta and superior mesenteric artery and was classified as compressed if there was greater than 50% narrowing. The diameter of the left gonadal vein was measured at the origin. Comparison of the prevalence of left renal vein compression was made via a Chi-squared test and the gonadal vein diameter via a t test. RESULTS The distribution of varicoceles was 68 on the left, 24 bilateral, and 8 on the right. Compression of the left renal vein was significantly more common in the left varicocele (78%, 53/68) than in the bilateral varicocele (42%, 10/24, p = 0.002), right varicocele (13%, 1/8, p < 0.001), or control group (10%, 10/100, p < 0.001). In the subgroup analysis, the gonadal vein diameter was significantly greater in the left varicocele (mean 5.6 mm) than in the bilateral varicocele (mean 4.6 mm, p = 0.018), right varicocele (mean 3.2 mm, p < 0.001), and control group (mean 3.1 mm, p < 0.001). CONCLUSION Left renal vein compression by the superior mesenteric artery is a major contributor to left-sided varicoceles.
Collapse
Affiliation(s)
- Douglas S Lewis
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA.
| | - Lars J Grimm
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA.
| | - Charles Y Kim
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA.
| |
Collapse
|
40
|
Sofimajidpour H, Ghaderi E, Ganji O. Comparison of the Effects of Varicocelectomy and Oral L-carnitine on Sperm Parameters in Infertile Men with Varicocele. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH : JCDR 2016; 10:PC07-10. [PMID: 27190879 DOI: 10.7860/jcdr/2016/18464.7557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/29/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Varicocele is defined as dilated and twisted veins of the pampiniform plexus in the spermatic cord. It is the most common cause of male infertility. There are various medical and surgical procedures for the treatment of this disease. AIM This study was aimed to compare the effects of oral administration of L-Carnitine and varicocelectomy on spermogram parameters. MATERIALS AND METHODS This study was conducted as a double blind clinical trial without randomization. Inclusion criteria were, all married infertile men with varicocele. Patients chose their treatment personally and spermogram was carried out for all patients before and after the third and sixth months of treatment. Then, the sperm parameters of the two groups were compared using repeated measures ANOVA. RESULTS In our study, trend of sperm count in the surgery group changed from 22 to 28.61 million (vs 34.6 to 45.37 in L-Carnitine group), motility changed from 21.74 to 35.38 percent (vs 33.9 to 47.48 in L-Carnitine group), normal sperm morphology changed from 46.25 to 60 percent (vs 56.61 to 69.7 in L-Carnitine group) and volume of semen changed from 3.5 to 4.17 cc (vs 2.95 to 4.33 in L-Carnitine group). These values were not statistically different between the two groups. CONCLUSION Based on the results of this study, we can say that medicinal treatment by administration of oral L-Carnitine is as effective as varicocelectomy in improving semen parameters and can be used as an alternative to surgery for varicocele grade II.
Collapse
Affiliation(s)
- Heshmatollah Sofimajidpour
- Associate Professor, Department of Urology, Faculty of Medicine, Kurdistan University of Medical Sciences , Sanandaj, Iran
| | - Ebrahim Ghaderi
- Assistant Professor, Department of Epidemiology, Faculty of Medicine Kurdistan University of Medical Sciences , Sanandaj, Iran
| | - Omid Ganji
- General Physician, School of Medicine, Kurdistan University of Medical Sciences , Sanandaj, Iran
| |
Collapse
|
41
|
Abstract
Testicular varicocele, a dilation of the veins of the pampiniform plexus thought to increase testicular temperature via venous congestion, is commonly associated with male infertility. Significant study has clarified the negative impact of varicocele on semen parameters and more recent work has shed light on its detrimental effects on the molecular and ultrastructural features of sperm and the testicular microenvironment, as well as more clearly defined the positive impacts of treatment on couples’ fertility. The relationship between varicocele and testicular endocrine function, while known for some time based on histologic evaluation, has become more apparent in the clinical setting with a growing link between varicocele and hypogonadism. Finally, in the pediatric setting, while future study will clarify the impact of varicocele on fertility and testicular function, recent work supports a parallel effect of varicocele in adolescents and adults, suggesting a re-evaluation of current treatment approaches in light of the progressive nature of the condition and potential increased risk of future disease.
Collapse
Affiliation(s)
- Alexander W Pastuszak
- Center for Reproductive Medicine; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | | |
Collapse
|
42
|
Marmar JL. The evolution and refinements of varicocele surgery. Asian J Androl 2016; 18:171-8. [PMID: 26732111 PMCID: PMC4770481 DOI: 10.4103/1008-682x.170866] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 11/04/2015] [Accepted: 11/13/2015] [Indexed: 12/20/2022] Open
Abstract
Varicoceles had been recognized in clinical practice for over a century. Originally, these procedures were utilized for the management of pain but, since 1952, the repairs had been mostly for the treatment of male infertility. However, the diagnosis and treatment of varicoceles were controversial, because the pathophysiology was not clear, the entry criteria of the studies varied among centers, and there were few randomized clinical trials. Nevertheless, clinicians continued developing techniques for the correction of varicoceles, basic scientists continued investigations on the pathophysiology of varicoceles, and new outcome data from prospective randomized trials have appeared in the world's literature. Therefore, this special edition of the Asian Journal of Andrology was proposed to report much of the new information related to varicoceles and, as a specific part of this project, the present article was developed as a comprehensive review of the evolution and refinements of the corrective procedures.
Collapse
Affiliation(s)
- Joel L Marmar
- Director of Men's Health Services, Planned Parenthood of Southern New Jersey, 317 S. Broadway, Camden, NJ 08103, USA
| |
Collapse
|
43
|
Micro- and macroscopic hematuria caused by renal vein entrapment: systematic review of the literature. Pediatr Nephrol 2016; 31:175-84. [PMID: 25627663 DOI: 10.1007/s00467-015-3045-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/05/2015] [Accepted: 01/05/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Hematuria secondary to renal vein entrapment is mentioned only passing in textbooks and reviews. METHODS We performed a search of the National Library of Medicine database for peer-reviewed publications using the terms "renal vein" or "nutcracker" and "hematuria". RESULTS We identified 187 published reports/studies that covered 736 patients, of whom 288 had microscopic hematuria and 448 had macroscopic hematuria. The patient cohort comprised 159 patients aged ≤17 years. Abdominal pain was absent in approximately 65% of all patients, and a clinically relevant left-sided varicocele was observed in 29% of the male patients. A normal pre-aortic left renal vein and an anomalous anatomy were noted in 680 and 56 patients, respectively. The body mass index (BMI) was lower in patients with renal vein entrapment than in the controls, with a regression of hematuria correlating with an increase in BMI. A surgical procedure was attempted in 34% of the patients, of which the most common were endovascular stenting and transposition of the renal vein distally into the vena cava. CONCLUSIONS In cases of unexplained hematuria with or without abdominal pain, clinicians should consider the diagnosis of renal vein congestion, especially in males with varicocele. Ultrasonic Doppler flow scanning is the recommended initial diagnostic modality in these patients. Expectation management is advised in the great majority of cases.
Collapse
|
44
|
Tromp EE, Kouwenhoven STP, Quint KD, Gmelig Meijling KA, Genders RE. Unilateral scrotal angiomas: An expression of underlying varicocele. Scand J Urol 2015; 50:88-9. [PMID: 26175040 DOI: 10.3109/21681805.2015.1064471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The current case report describes a 35-year-old man who presented with unilateral scrotal angiomas. The presence of unilateral scrotal angiomas was associated with an underlying varicocele on the ipsilateral side due to increased venous pressure. In case of unilateral scrotal angiomas further examination for underlying pathology is necessary.
Collapse
Affiliation(s)
- Elise E Tromp
- a 1 Department of Dermatology Leiden University Medical Centre , Leiden, The Netherlands.,b 2 Alrijne Hospital , Leiden, The Netherlands
| | - Stijn T P Kouwenhoven
- a 1 Department of Dermatology Leiden University Medical Centre , Leiden, The Netherlands
| | - Koen D Quint
- a 1 Department of Dermatology Leiden University Medical Centre , Leiden, The Netherlands.,c 3 DDL Diagnostic Laboratory , Rijswijk, The Netherlands
| | | | - Roel E Genders
- a 1 Department of Dermatology Leiden University Medical Centre , Leiden, The Netherlands.,d 4 Roosevelt Clinics , Leiden, The Netherlands
| |
Collapse
|
45
|
Hewedy ESS, Sweilm MA, Abd El-Naby NM, Hassan AM, Fawzy MM, Agrama MS. Serum and seminal plasma inhibin-B level in infertile men with varicocele. HUMAN ANDROLOGY 2015; 5:18-22. [DOI: 10.1097/01.xha.0000459553.60734.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
46
|
Ko EY, Sabanegh ES, Agarwal A. Male infertility testing: reactive oxygen species and antioxidant capacity. Fertil Steril 2014; 102:1518-27. [DOI: 10.1016/j.fertnstert.2014.10.020] [Citation(s) in RCA: 159] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/14/2014] [Accepted: 10/14/2014] [Indexed: 02/07/2023]
|
47
|
Report on varicocele and infertility: a committee opinion. Fertil Steril 2014; 102:1556-60. [PMID: 25458620 DOI: 10.1016/j.fertnstert.2014.10.007] [Citation(s) in RCA: 157] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/02/2014] [Indexed: 01/08/2023]
Abstract
This document discusses the evaluation and management of varicoceles in the male partners of infertile couples, and presents the controversies and recommendations regarding this condition. This document replaces the ASRM Practice Committee document titled "Report on Varicocele and Infertility," last published in 2008, and was developed in conjunction with the Society for Male Reproduction and Urology (Fertil Steril 2008;90:S247-9).
Collapse
|
48
|
Cho KS, Seo JT. Effect of varicocelectomy on male infertility. Korean J Urol 2014; 55:703-9. [PMID: 25405011 PMCID: PMC4231146 DOI: 10.4111/kju.2014.55.11.703] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 08/18/2014] [Indexed: 11/25/2022] Open
Abstract
Varicocele is the most common cause of male infertility and is generally correctable or at least improvable by various surgical and radiologic techniques. Therefore, it seems simple and reasonable that varicocele should be treated in infertile men with varicocele. However, the role of varicocele repair for the treatment of subfertile men has been questioned during the past decades. Although varicocele repair can induce improvement of semen quality, the obvious benefit of spontaneous pregnancy has not been shown through several meta-analyses. Recently, a well-designed randomized clinical trial was introduced, and, subsequently, a novel meta-analysis was published. The results of these studies advocate that varicocele repair be regarded as a standard treatment modality in infertile men with clinical varicocele and abnormal semen parameters, which is also supported by current clinical guidelines. Microsurgical varicocelectomy has been regarded as the gold standard compared to other surgical techniques and radiological management in terms of the recurrence rate and the pregnancy rate. However, none of the methods has been proven through well-designed clinical trials to be superior to the others in the ability to improve fertility. Accordingly, high-quality data from well-designed studies are needed to resolve unanswered questions and update current knowledge. Upcoming trials should be designed to define the best technique and also to define how to select the best candidates who will benefit from varicocele repair.
Collapse
Affiliation(s)
- Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Tae Seo
- Department of Urology, Cheil General Hospital & Women's Healthcare Center, Catholic Kwandong University College of Medicine, Seoul, Korea
| |
Collapse
|
49
|
|
50
|
Moazzam A, Sharma R, Agarwal A. Relationship of spermatozoal DNA fragmentation with semen quality in varicocele-positive men. Andrologia 2014; 47:935-44. [PMID: 25346327 DOI: 10.1111/and.12360] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 01/08/2023] Open
Abstract
The aim of the study was to assess the semen quality and levels of spermatozoal nuclear DNA fragmentation in subfertile subjects clinically diagnosed with varicocele, subfertile subjects without varicocele and healthy fertile controls. Semen samples were obtained from 302 subjects. Of them, 115 were healthy fertile controls having normal semen characteristics, 121 subfertile men diagnosed with varicocele, both, clinically and on ultrasonography, while 66 subjects were subfertile with no varicocele. Spermatozoal concentration, percentage motility, morphology and DNA fragmentation were measured. In the study population, deterioration in semen quality-decreased spermatozoal concentration, percentage motility and normal morphology was seen in subfertile subjects, especially with varicocele. Highest spermatozoal DNA fragmentation was observed in varicocele-positive subjects as compared with varicocele-negative subjects and healthy fertile controls. Significant negative correlation was seen between spermatozoal DNA fragmentation and concentration (r = -0.310), motility (r = -0.328) normal morphology, WHO method (r = -0.221) and Tygerberg strict criteria (r = -0.180) in the varicocele-positive subfertile subjects. In conclusion, this study suggests existence of a negative relationship between spermatozoal DNA fragmentation and semen quality in varicocele-positive subfertile subjects.
Collapse
Affiliation(s)
- A Moazzam
- Center for Research in Molecular Medicine, University of Lahore, Lahore, Pakistan
| | - R Sharma
- Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - A Agarwal
- Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|