A morphometric and ultrastructural study of the changes in the lamina propria in adolescents with varicocele

Perspectives in Pediatric Pathology, Chapter 20. Adolescent Varicocele

Varicocele is characterized by elongation, dilatation, and tortuosity of the veins draining the testis and its covers, causing circulatory reflux along the inner spermatic vein [ 1 ]. Varicocele results in progressive testicular lesions and, if untreated, can lead to testicular atrophy [ 2 ]. Varicocele is considered the most frequently identified cause of male infertility [ 3 ]. The mechanisms involved in varicocele formation are not well known and probably are multiple, differing from one patient to another.

Efficacy of naringenin against permethrin-induced testicular toxicity in rats

Permethrin (PM), a synthetic pyrethroid insecticide, has broad toxicity spectra. We aimed to investigate the effects of PM on the testes of adult albino rats, examine the recovery response and evaluate the efficacy of naringenin (NG) supplementation. Adult male albino rats were randomly assigned to five groups of six each: control, NG (50 mg/kg), PM (70 mg/kg), recovery (after subsequent withdrawal of PM) and NG-PM group. All treatments were given by oral gavage for 6 weeks and another 3 weeks for the recovery group. At the time of sacrifice, each testis was weighed. Biochemical analysis of epididymal sperm count and serum testosterone level was performed. Testes were processed for histological, ultrastructural and c-Kit immunohistochemical study. PM toxicity was evidenced by a highly significant decrease in testicular weight, epididymal sperm count and serum testosterone level compared to control. Furthermore, testicular structure abnormalities and reduced c-Kit immunoreactions were observed. Stoppage of PM in the recovery group partially reversed PM-induced changes. There was a mild decrease in testicular weight and biochemical parameters compared to control. The structure of seminiferous tubules was partially retained. The NG-PM group showed an overall improvement in testicular weight and biochemical alterations which were confirmed by light and electron microscopic examination. In conclusion, PM induced testicular toxicity, which was ameliorated by NG co-administration. However, stoppage of PM exposure was associated with partial recovery.

Free radicals in adolescent varicocele testis

We examine the relationship between the structure and function of the testis and the oxidative and nitrosative stress, determined by an excessive production of free radicals and/or decreased availability of antioxidant defenses, which occur in the testis of adolescents affected by varicocele. Moreover, the effects of surgical treatment on oxidative stress were provided. We conducted a PubMed and Medline search between 1980 and 2014 using “adolescent,” “varicocele,” “free radicals,” “oxidative and nitrosative stress,” “testis,” and “seminiferous tubules” as keywords. Cross-references were checked in each of the studies, and relevant articles were retrieved. We conclude that increased concentration of free radicals, generated by conditions of hypoxia, hyperthermia, and hormonal dysfunction observed in adolescent affected by varicocele, can harm germ cells directly or indirectly by influencing nonspermatogenic cells and basal lamina. With regard to few available data in current literature, further clinical trials on the pre- and postoperative ROS and RNS levels together with morphological studies of the cellular component of the testis are fundamental for complete comprehension of the role played by free radicals in the pathogenesis of adolescent varicocele and could justify its pharmacological treatment with antioxidants.

Morphological and surgical overview of adolescent testis affected by varicocele

Varicocele is a common pathology of the testis frequently associated with infertility. For its management, a fine morphological study of the testis, both macroscopically and microscopically, and an accurate choice of surgical procedure are mandatory. The present review focuses its attention on the anatomic substrates of adolescent varicocele and its pathophysiologic modifications. The comprehensive assessment of all the reported alterations should be considered by the clinician before deciding the type of treatment and the timing.

Ultrastructure of the seminiferous tubules in oligoasthenoteratozoospermic men associated with varicocele

Varicocele is associated with venous reflux that may cause increased heat and interstitial pressure within the testes, with variable pathological effects on spermatogenesis. This study aimed to study the ultrastructural testicular changes in the seminiferous tubules of 20 infertile severe oligoasthenoteratozoospermia (OAT) men associated with varicocele and five patients with obstructive azoospermia without varicocele as controls. They were subjected to testicular biopsy which was evaluated by transmission electron microscopy. Ultrastructurally, the seminiferous epithelium in the testicular biopsies of infertile severe OAT men associated with varicocele was variably affected in the form of thickening of the peritubular connective tissue, vacuolation of Sertoli cell and germ cell cytoplasm, presence of degenerated and apoptotic cells among the germinal epithelium, altered spermatids and abnormal spermatozoa. It is concluded that varicocele in severe OAT men is associated with ultrastructural changes in the seminiferous tubule.

Varicocele and infertility: why a prevention?

The varicocele is the abnormal dilation of the veins of the pampiniform plexus, resulting from an altered venous drainage, and it is considered one of the main causes of male infertility. In this paper we review the most recent observations on the histological, endocrinological, biochemical and clinical alterations reported in adolescents with left idiopathic varicocele. Data indicate that varicocele progressively impairs the reproductive function of the testis. Treatment could improve a number of such damages.

Genitourinary issues in the male college student: a case-based approach

Five percent of all ambulatory visits by men 18 years of age or older include genitourinary symptoms as a reason for the visit. In this article, using typical, unusual, or otherwise instructive cases, the authors review a select group of genitourinary issues in the college-age male. Warts (human papilloma virus), is the most common sexually transmitted infection, and it may mimic other disease. Testicular cancer is one of the most serious diseases to confront health care providers. Varicoceles are the most common scrotal mass. Urethritis is a common presentation of sexually transmitted infection in the young adult male. Acute prostatitis is an unusual condition in the young adult, but it is easily treatable. Sexual dysfunction causes great distress in the young adult, but a systematic approach usually leads to a treatable psychological or environmental cause. With understanding of these medical conditions, the practitioner should feel comfortable addressing the most challenging genitourinary health needs of this population.

Controversies in male adolescent health: varicocele, circumcision, and testicular self-examination

PURPOSE OF REVIEW

The authors review three common clinical controversies encountered by primary care providers of adolescent males: management of varicoceles, the role of circumcision in the acquisition and transmission of sexually transmitted infections, and the value of teaching testicular self-examination.

RECENT FINDINGS

Recent findings in adolescent varicoceles have advanced knowledge regarding the cause of varicoceles, the mechanism by which they may lead to infertility, new screening methods, and optimal surgical management. Accumulating evidence shows circumcision to be protective against acquisition and transmission of sexually transmitted infections, and preliminary work also indicates the potential for protection against the spread of AIDS in Africa. Testicular self-examination remains an unproven screening modality that is suboptimally performed by at-risk patients.

SUMMARY

This review updates the provider on these topics and clarifies issues involved in these controversies

Varicocele and sport in the adolescent age. Preliminary report on the effects of physical training

The effect of physical training on the natural history of varicocele has received little attention. The aim of the present pilot study was to evaluate the prevalence of idiopathic varicocele in young athletes, in the attempt to find a correlation between the training workload and the clinical grade of varicocele. We evaluated 150 adolescents with an age of 10-16 yr (median age: 13 yr). All these subjects were athletes practicing different sport at agonistic level. One hundred and fifty non-athlete adolescents of matched age (median: 13.5 yr) were used as controls. All underwent physical examination, and if a varicocele was suspected, the diagnosis was confirmed or excluded by echo-color-Doppler examination. The young athletes were stratified into two groups according to the different time spent for training: Group 1-6 h training per week; Group 2-7 to 12 h per week. Statistical analysis was performed. A p<0.05 was considered significant. The physical examination revealed a clinical varicocele on the left side in 20 athletes. A significant positive correlation was observed between the Group 2 and the highest grade of varicocele (r2=0.9918, p=0.0041). In the adolescent group used as control we observed a varicocele in 16 cases. A positive correlation was observed between the number of athletes with varicocele and the highest grade of varicocele (r2=0.96, p=0.02). Sport training does not modify the prevalence of varicocele compared to the general population, but physical activity has to be considered as an aggravating factor in the natural history of varicocele. In countries where sport eligibility is necessary for agonistic sport practice, varicocele should be then considered as a conditioning factor.

Distribution of type IV collagen subtypes in human testes and their association with spermatogenesis

OBJECTIVE

To evaluate the expression of type IV collagen [alpha1(IV) to alpha6(IV)] in testes and the association with spermatogenesis.

DESIGN

Retrospective immunohistochemical study.

SETTING

Division of Urology, Department of Organs Therapeutics, Faculty of Medicine, in a university hospital.

PATIENT(S)

Testicular biopsy specimens were obtained from 24 patients with varicocele, 5 with Sertoli cell-only syndrome (SCO), and 5 normal volunteers.

INTERVENTION(S)

Collection of testicular tissue and blood and semen sampling.

RESULT(S)

Expression of type IV collagen subtypes assessed by immunohistochemistry and clinical parameters such as seminogram and hormonal findings. In normal testes, the alpha1(IV) chain was seen in the basement membrane (BM) of seminiferous tubules as strongly stained irregular, wavy double lines, and the alpha2(IV) chain was slightly detected, whereas other testes showed little staining. In patients with varicocele and Sertoli cell-only syndrome, the BM was thicker and alpha1(IV) and alpha2(IV) chains were stained more intensely in the BM of seminiferous tubules than in normal testes. The expression of alpha1(IV) chain, not alpha2(IV), significantly correlated positively with the BM thickness, and negatively with sperm concentration, tubular diameter, and Johnsen score.

CONCLUSION(S)

Overabundance of the alpha1(IV) chain is associated with increased BM thickness and possibly related to spermatogenic dysfunction.

Preliminary report on nitric oxide-mediated oxidative damage in adolescent varicocele

BACKGROUND

The current study was designed to characterize the process of nitric oxide (NO) and peroxynitrite generation through the determination of nitrotyrosine concentration in the dilated veins of varicoceles in adolescents.

METHODS

Ten adolescents with a median age of 13 years (range 12-17) affected by a left idiopathic varicocele (grade II and III) were studied. Whole blood samples were withdrawn from a peripheral vein at time of induction of anaesthesia, and from a dilated spermatic vein before ligation. Peripheral blood samples from five adolescents undergoing minor surgical procedures were used as controls. The nitrotyrosine concentration was evaluated by a sandwich enzyme-linked immunosorbent assay (ELISA), using a monoclonal anti-nitrotyrosine antibody and Western blot analysis.

RESULTS

Plasma nitrotyrosine concentrations were significantly greater in the spermatic vein when compared with the peripheral vein (P = 0.031). Nitrotyrosine in plasma of controls did not show any significant difference in comparison with peripheral samples from varicocele patients. Western blot analysis confirmed the above data.

CONCLUSIONS

In adolescents with a varicocele, there is an increase in nitrotyrosine concentration within the spermatic vein that can cause protein nitration and cytotoxicity via its reaction with various molecular targets. This could have repercussions on both sperm and testis function. We conclude that an oxidative stress status is present and should be considered as an indication for varicocele treatment in the adolescent.

Nitric oxide production is increased in the spermatic veins of adolescents with left idiophatic varicocele

BACKGROUND/PURPOSE

The existence of an excessive release of nitric oxide (NO) within dilated spermatic veins has been recorded in adults with varicocele suggesting a high oxidative stress. The authors investigated whether NO overproduction is already present in the dilated veins of adolescent varicocele and which enzymatic isoforms in the spermatic vein could be expressed.

METHODS

The study group consisted of 10 adolescent patients affected by left idiophatic varicocele of grade II and III. The increase in NO production was established by determination of serum concentration of L-hydroxyarginine (L-NHA) and Nitrite/nitrate (NOx). Both endothelial and inducible NOsynthase (NOS) were investigated by Western blot analysis and by immunohistochemical localization using specific monoclonal fluorescein conjugated antibodies.

RESULTS

Serum L-NHA levels were significantly greater in the spermatic veins when compared with the peripheral veins 176.8 +/- 32.3 micromol/L versus 3.38 +/- 0.64 micromol/L (P =.0004 Similarly, NOx levels were increased, respectively, 68.2 +/- 16.7 nmol/mL versus 12.9 +/- 2.65 nmol/mL (P =.029). Endothelial NOS was localized in the spermatic vein of varicocele patients, but not overexpressed; the inducible isoform was not detected.

CONCLUSIONS

Adolescents with varicocele already present an increase in NO within dilated veins. The dilated spermatic vein is not the major source for the increase in NO level. These results could have an implication in the natural history of adolescent varicocele and in programming the ideal time for surgical treatment.

Immunofluorescence distribution of actin-associated proteins in human seminiferous tubules of adolescent testes, normal and pathologic

The aim of our study on human seminiferous tubules of adolescent testes was to study the localization of two actin-associated proteins of the adherens junctions, such as vinculin and talin, and to verify if there were modifications in their pattern in varicocele, a frequent disease of the testis in adolescent age. The study group consisted of 8 biopsies from normal testes (i.e., adolescents operated on for hydrocele or inguinal hernia) and 20 biopsies from pathological testes (i.e., adolescents operated on for idiophatic left varicocele). Biopsies were evaluated by indirect immunofluorescence using anti-human vinculin and anti-human talin antibodies. Observation was recorded with a Leica TCS 4D upright confocal microscope. In the normal testes, there was a strong positive immunoreactivity for vinculin, which was localized in the interstitial cells of Leydig, and both basal pole and lateral cell surface of Sertoli cells; the pattern of talin immunoreactivity was the same except that the lateral cell surface of Sertoli cells was not stained. In the varicocele group the pattern was different. Vinculin immunoreactivity showed small patches of fluorescence only in the cytoplasm of Sertoli cells while talin immunoreactivity showed a scanty distribution at the basal surface of Sertoli cells. These results confirm that, similarly to other tissues, vinculin is expressed at cell-cell and cell-matrix adherens junctions, while talin is present at cell-matrix adherens junctions in human seminiferous tubules of normal adolescents. Varicocele alters the patterns of these two proteins both quantitatively and qualitatively.

Ultrastructural and immunohistochemical study of basal lamina of the testis in adolescent varicocele

OBJECTIVE

To evaluate a possible involvement of the extracellular matrix (ECM) in the testes of adolescents with varicocele.

DESIGN

Cross-sectional study.

SETTING

University-based medical center.

PATIENT(S)

Twenty-four adolescents aged between 13 and 18 years underwent surgical treatment for repair of left idiopathic varicocele.

INTERVENTION

A testis biopsy was performed at time of surgery.

MAIN OUTCOME MEASURE(S)

Transmission electron microscopy study of basal lamina and immunofluorescence studies of collagen type IV and laminin, two major components of basal lamina.

RESULT(S)

Transmission electron microscopy observations showed an uneven profile of the basal lamina with a variable thickness. Immunofluorescence studies showed an irregular immunofluorescent line that appeared interrupted in some observations. Collagen type IV showed some areas of strong immunostaining with other areas with reduced immunoreactivity.

CONCLUSION(S)

Our ultrastructural and immunohistochemical observations highlight focal damage at the level of peritubular basal lamina, but this damage is not as severe as that described in adult varicocele. Initial involvement of basal lamina could represent one of the mechanisms responsible for varicocele-induced histologic alterations of the testes.