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Falcone M, Bocu K, Keskin H, Solorzano Vazquez JF, Banthia R, Mahendran T, Deger MD, Kv V, Mirko P, Harraz AM, Saleh R, Shah R, Agarwal A. Anti-sperm Antibody Positivity in Men with Varicocele: A Systematic Review and Meta-Analysis. World J Mens Health 2024; 42:42.e43. [PMID: 38606868 DOI: 10.5534/wjmh.240003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/22/2024] [Accepted: 02/02/2024] [Indexed: 04/13/2024] Open
Abstract
PURPOSE Despite the significant role of varicocele in the pathogenesis of male infertility, its association with anti-sperm antibodies (ASA) remains controversial. This systematic review and meta-analysis (SRMA) aims to investigate the frequency of ASA positivity in men with varicocele. MATERIALS AND METHODS This SRMA is conducted in accordance with the Meta-analysis of Observational Studies in Epidemiology guidelines. We investigated the frequency of ASA positivity in ejaculates or serum of men with varicocele as compared to men without varicocele (controls). A literature search was performed using the Scopus and PubMed databases following the Population Exposure Comparison Outcome, Study Design model. Data extracted from eligible studies were meta-analyzed and expressed as odds ratios (ORs) and confidence intervals (CIs). RESULTS Out of 151 abstracts identified during the initial screening, 6 articles met the inclusion criteria and were included in the meta-analysis. Using mixed antiglobulin reaction (MAR) assay, 61 out of the 153 (39.8%) patients with varicocele tested positive for ASA in their ejaculates as compared to 22 out of the 129 control subjects (17%, OR=4.34 [95% CI: 1.09-17.28]; p=0.04). Using direct or indirect immunobead test, 30 out of 60 cases diagnosed with varicocele (50%) had shown ASA positivity in their ejaculates as compared to 16 out of 104 controls (15.4%, OR=3.57 [95% CI: 0.81-15.68]; p=0.09). Using enzyme-linked immunosorbent assay (ELISA), out of 89 varicocele patients, 33 (37.1%) tested positive for serum ASA as compared to 9 out of 57 participants in the control group (15.8%, OR=7.87 [95% CI: 2.39-25.89]; p<0.01). CONCLUSIONS This SRMA indicates that ASA positivity is significantly higher among men with varicocele when tested by direct method (MAR) or indirect method (ELISA). This data suggests an immunological pathology in infertile men with varicocele and may have implications for the management of these patients.
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Affiliation(s)
- Marco Falcone
- Department of Urology, Molinette Hospital, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Turin, Torino, Italy
- Global Andrology Forum, Moreland Hills, OH, USA
| | - Kadir Bocu
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Silopi State Hospital, Sirnak, Turkey
| | - Hakan Keskin
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, School of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Ravi Banthia
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Tara Mahendran
- Global Andrology Forum, Moreland Hills, OH, USA
- Andrology Center, Coimbatore, India
| | - Muslim Dogan Deger
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Edirne Sultan 1st Murat State Hospital, Edirne, Turkey
| | - Vinod Kv
- Global Andrology Forum, Moreland Hills, OH, USA
- Centre for Urological Research and Evaluation, Thiruvananthapuram, India
| | - Preto Mirko
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Molinette Hospital A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Ahmed M Harraz
- Global Andrology Forum, Moreland Hills, OH, USA
- Sabah Al Ahmad Urology Center, Kuwait City, Kuwait
- General Surgery Department, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ramadan Saleh
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
- Ajyal IVF Center, Ajyal Hospital, Sohag, Egypt
| | - Rupin Shah
- Global Andrology Forum, Moreland Hills, OH, USA
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Ashok Agarwal
- Global Andrology Forum, Moreland Hills, OH, USA
- Cleveland Clinic Foundation, Cleveland, OH, USA.
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2
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Galea M, Brincat MR, Calleja-Agius J. A review of the pathophysiology and evidence-based management of varicoceles and pelvic congestion syndrome. HUM FERTIL 2023; 26:1597-1608. [PMID: 37190955 DOI: 10.1080/14647273.2023.2212846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 04/25/2023] [Indexed: 05/17/2023]
Abstract
Pelvic congestion syndrome (PCS) in females and varicoceles in males may be regarded as closely related conditions since the main pathophysiological cause for both processes is pelvic venous insufficiency. Varicoceles are more prevalent amongst sub-fertile males, with an approximate incidence of 15% in the general male population. PCS is commonly diagnosed amongst premenopausal multiparous women, representing one of the leading causes of chronic pelvic pain. Both conditions appear to be predominantly left-sided and are associated with oxidative stress and pro-inflammatory cascades with subsequent effects on fertility. Clinical examination and pelvic ultrasonography play an essential role in the assessment of varicoceles, PCS and chronic pelvic pain. Venography is generally considered as a gold-standard procedure for both conditions. There is still much debate on how these conditions should be managed. This review article provides a comparative analysis of the underlying pathophysiological mechanisms of both PCS and varicoceles, their impact on fertility, as well as their clinical management.
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Affiliation(s)
- Matteo Galea
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Mark R Brincat
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
- Department of Obstetrics and Gynaecology, Mater Dei Hospital, Msida, Malta
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Minas A, de Oliveira Rodrigues L, Camargo M, Bertolla RP. Insight into inflammation involvement in varicocele: A narrative review. Am J Reprod Immunol 2023; 90:e13786. [PMID: 37881120 DOI: 10.1111/aji.13786] [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: 03/01/2023] [Revised: 09/07/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Varicocele is one of the main causes of male infertility. Although the pathophysiology mechanism of varicocele is very well described and understood, there are some unanswered questions that remains unknown. Some studies have previously described the state of testicular inflammation and sperm in animal models, especially the mouse model, and the seminal plasma of men with varicocele, with or without changes in semen parameters. METHODS OF STUDY This review intended to verify the role of inflammatory mechanism in varicocele, using clinical studies as well as animal model studies on the effect of inflammation caused by varicocele on the function of testicular somatic and germ cells. RESULTS In-vivo studies confirmed whether anti-inflammatory molecules could treat the semen of men with varicocele and rats with varicocele. The use of different anti-inflammatory agents in mouse model studies provided a new perspective for future clinical studies to investigate the effect of concurrent treatment with surgery to improve surgical outcomes. CONCLUSION Similar to animal model studies, previously conducted clinical trials have demonstrated the effectiveness of anti-inflammatory therapy in varicocele patients. However, clinical trials using anti-inflammatory are needed to be conducted agents to evaluate different aspects of this therapeutical approach in varicocele patients.
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Affiliation(s)
- Aram Minas
- Department of Surgery, Division of Urology, Human Reproduction Section, São Paulo Federal University, São Paulo, Brazil
| | - Larissa de Oliveira Rodrigues
- Department of Surgery, Division of Urology, Human Reproduction Section, São Paulo Federal University, São Paulo, Brazil
| | - Mariana Camargo
- Department of Surgery, Division of Urology, Human Reproduction Section, São Paulo Federal University, São Paulo, Brazil
| | - Ricardo Pimenta Bertolla
- Department of Surgery, Division of Urology, Human Reproduction Section, São Paulo Federal University, São Paulo, Brazil
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Huang WC, Huang CP, Lai CM, Ku FY, Hsu HN, Yang CT, Wang YY, Laih CY. Increased intraoperative vein ligation in microsurgical varicocelectomy is associated with pain improvement. Medicine (Baltimore) 2023; 102:e35170. [PMID: 37746984 PMCID: PMC10519527 DOI: 10.1097/md.0000000000035170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/24/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Varicocele is a major cause of male infertility. However, few studies have discussed the potential associations between the pain caused by varicocele and preoperative and intraoperative factors. The aim of this study was to evaluate factors potentially associated with changes in pain score after microsurgical varicocelectomy. This retrospective study was conducted between August 2020 and August 2022 at China Medical University Hospital in Taichung, Taiwan. Patient characteristics including age, body mass index, semen analysis, testicular volume, and the number of veins ligated were collected. Preoperative and intraoperative factors were analyzed to determine if they were correlated with changes in numeric rating scale (NRS) after microsurgical varicocelectomy. A total of 44 patients with clinical varicocele underwent subinguinal microsurgical varicocelectomy and were analyzed. The overall pain resolution rate was 91%, and the average satisfaction score after surgery was 9.2 according to their subjective feelings. Multivariate analysis revealed that severe varicocele grade (odds ratio [OR] 16.5, 95% confidence interval [CI] 3.01-90.47; P = .018) and the number of veins ligated (OR 6, 95% CI 1.6-22.48; P = .013), were significantly associated with changes in NRS after surgery. In addition, the area under the receiver operating characteristic curve for changes in NRS and the total number of veins ligated was 0.869. Microsurgical varicocelectomy had a high success rate for scrotal pain and satisfaction. Severe varicocele grade and the number of veins ligated in microsurgical varicocelectomy were associated with postoperative pain improvement.
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Affiliation(s)
- Wei-Chun Huang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
| | - Chi-Ping Huang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Chun-Ming Lai
- Department of Computer Science, Tunghai University, Taichung, Taiwan
| | | | - Hsu-Ning Hsu
- Department of Gynecology and Obstetrics, China Medical University Hospital, Taichung, Taiwan
| | - Chao-Tung Yang
- Department of Computer Science, Tunghai University, Taichung, Taiwan
| | - Yun-Yi Wang
- Department of Computer Science, Tunghai University, Taichung, Taiwan
| | - Chun-Yo Laih
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
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5
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Pitrone P, Silipigni S, Stagno A, Cinquegrani A, Cattafi A, Bottari A. Retrograde sclerotherapy of male varicocele with veno-venous shunts - incidence and management: a single-centre experience. Br J Radiol 2023; 96:20221061. [PMID: 36745115 PMCID: PMC10161912 DOI: 10.1259/bjr.20221061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The aim of our study is to compare the incidence of veno-venous shunts in male varicocele and evaluate the possibility to exclude them with manual compression or/and scrotal ligation in order to carry out the procedure of retrograde sclero-embolization. METHODS In our retrospective study, all patients undergone retrograde sclerotherapy for varicocele in our Interventional Radiology Unit in the last four years were evaluated. Collaterals toward other venous shunts were identified and how many and which patients would be able to complete the procedure safely were considered. RESULTS Of the 91 patients, as many as 22 (i.e., 24.17%) patients presented anatomical variants, consisting on shunting into left iliac vein (9 [9.89%]), lumbar left veins (3 [3.29%]), right iliac vein (1 [1.09%]), both iliac veins (1 [1.09%]), left femoral vein (1 [1.09%]) or a more proximal portion of the ISV itself without shunting (3 [3.29%]). Patients with duplication could benefit from a more distal injection in order to prevent back-flow; of the 19 left, nine successfully underwent sclerotherapy with manual compression or/and scrotal ligation, whereas in 10 flow through the collaterals could not be interrupted and patients were demanded for surgery. CONCLUSIONS Many patients with abnormal communications between the internal spermatic vein and the iliac veins (that is, shunts towards the iliac veins) may as well undergo retrograde sclerotherapy safely if compression/ligation is applied. ADVANCES IN KNOWLEDGE No large previous study highlighted the impact of veno-venous shunts in technical feasibility of retrograde sclerotherapy of varicocele.
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Affiliation(s)
- Pietro Pitrone
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, Section of Radiological Sciences, University of Messina, Messina, Italy
| | - Salvatore Silipigni
- Department of Imaging, Interventional Radiology Unit, University Hospital "G. Martino", Messina, Italy
| | - Alberto Stagno
- Department of Imaging, Interventional Radiology Unit, University Hospital "G. Martino", Messina, Italy
| | - Antonella Cinquegrani
- Department of Imaging, Interventional Radiology Unit, University Hospital "G. Martino", Messina, Italy
| | - Antonino Cattafi
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, Section of Radiological Sciences, University of Messina, Messina, Italy
| | - Antonino Bottari
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, Section of Radiological Sciences, University of Messina, Messina, Italy.,Department of Imaging, Interventional Radiology Unit, University Hospital "G. Martino", Messina, Italy
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Chung E. Postvaricocele Embolization Pain Syndrome: A Case Series Report and Review of Current Treatment Strategies. J Endovasc Ther 2022:15266028221086472. [PMID: 35341383 DOI: 10.1177/15266028221086472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Orchialgia is not an uncommon complaint among men with varicocele, but postvaricocele embolization-related testicular pain has not been widely investigated. This study evaluates the phenomenon of postvaricocele embolization pain (PVEP) syndrome and examines the current strategies to treat this unusual complication. METHODS AND MATERIALS A prospectively collected database of patients with PVEP who presented to a tertiary center was analyzed between January 2011 and January 2020 following internal ethics approval. Patient demographics, including other complications related to embolization, analgesic requirements, and pain scores (on a 10-point visual analog score), treatment strategies, Patient Global Impression of Improvement (PGI-I) score and overall satisfaction score (on a 5-point scale), were reviewed. All patients were reviewed for a minimum of 12 months. RESULTS A total of 20 men with a mean age of 33.8 (18-45) years old, presented with PVEP over 10 years. Most men received embolization on an average of 26.6 (18-48) months. The reasons for varicocele embolization include either isolated or combined orchialgia (15 men), subfertility (5 men), and cosmesis (6 men). Eighteen (90%) men underwent microscopic spermatic cord denervation (MSCD) and 2 patients elected for conservative measures. The average pain scores pre-MSCD and post-MSCD were 6.9 (4-9) and 1.4 (0-4) (p<0.001) with a significant reduction in analgesia requirements. Immediate improvement in pain score was reported in all the patients and this persisted at the 12 months review. Most men reported a high satisfaction score (of 4/5) and only one patient reported no change in symptoms after MSCD. CONCLUSION PVEP is a unique complication and patients should be counseled on the potential risk of persistent orchialgia following embolization for varicocele. The MSCD appears to be an effective treatment option with high success and satisfaction rates.
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Affiliation(s)
- Eric Chung
- AndroUrology Centre, Brisbane, Queensland, Australia.,AndroUrology Centre, Sydney, New South Wales, Australia.,Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia.,Macquarie University Hospital, Sydney, New South Wales, Australia
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7
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Li M, Li J, Zhang C, Hou S, Weng B. MIR210HG is aberrantly expressed in the seminal plasma of varicocele patients and associated with varicocele-related dyszoospermia. Andrologia 2022; 54:e14277. [PMID: 35146790 DOI: 10.1111/and.14277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 02/06/2023] Open
Abstract
This study aimed to confirm the expression of the seminal plasma long noncoding RNAs (lncRNAs) microRNA210 host gene (MIR210HG) in varicocele (VC) patients, to further explore the association between MIR210HG and VC severity and to evaluate whether MIR210HG can predict VC-related dyszoospermia. Semen samples from 188 VC patients and 92 healthy men were collected. Quantitative reverse transcriptase PCR detected seminal plasma MIR210HG levels. Receiver operating characteristic analysis assessed the ability of MIR210HG to screen patients with VC, or to screen VC patients with abnormal semen quality. Logistic analysis assessed the value of MIR210HG in predicting dyszoospermia in VC patients. The levels of MIR210HG in seminal plasma of VC patients were upregulated, which could screen VC patients. In addition, the levels of seminal plasma MIR210HG were upregulated with VC severity and were downregulated at 6 months after surgery in VC patients. Moreover, elevated MIR210HG levels in VC patients with abnormal semen quality could screen patients with abnormal semen quality and could independently predict the occurrence of dyszoospermia in VC patients. Seminal plasma MIR210HG expression is upregulated in VC patients, is associated with the severity of VC and may function as an independent predictor of VC-related dyszoospermia.
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Affiliation(s)
- Monong Li
- Urology Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Jinli Li
- Urology Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Changcun Zhang
- Urology Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Sichuan Hou
- Urology Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Bowen Weng
- Urology Surgery, Qingdao Municipal Hospital, Qingdao, China
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8
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Brahmbhatt A, Macher J, Shetty AN, Chughtai K, Baah NO, Dogra VS. Sonographic Evaluation of Pelvic Venous Disorders. Ultrasound Q 2021; 37:219-228. [PMID: 34478419 DOI: 10.1097/ruq.0000000000000576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Pelvic venous disorders are a group of interrelated conditions characterized by venous incompetence. These conditions often manifest with nonspecific symptoms that overlap with many gynecological, gastrointestinal, and urologic diseases. Clinical diagnosis can be difficult, and imaging can play a vital role in differentiating etiology. Sonographic evaluation is often the first step in evaluating these symptoms. Special attention to possible underlying pelvic venous disorders can reveal characteristic findings, support diagnosis, and guide treatment. Here we review pelvic congestion syndrome, nutcracker syndrome, May-Thurner syndrome, and other venous disorders, with a specific focus on sonographic findings and considerations.
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9
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Ediz C, Temel MC, Şahin Ediz S, Akan S, Yenigürbüz S, Pehlivanoğlu M, Yılmaz Ö. Contribution of pre-varicocelectomy color Doppler ultrasonography finding to surgery and its correlation with semen parameters. ACTA ACUST UNITED AC 2021; 93:227-232. [PMID: 34286561 DOI: 10.4081/aiua.2021.2.227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/03/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study aimed to determine the contribution of color Doppler ultrasonography (CDUS) performed before varicocelectomy to the success of surgical treatment and to evaluate the correlation between CDUS findings and semen parameters. METHODS A total of 84 patients diagnosed with grade 3 left varicocele in our clinic between 2016 and 2018 were evaluated. The patients in whom the decision for varicocelectomy was based on only physical examination (PE) findings and abnormal semen analysis (SA) were defined as Group 1, while the patients undergoing varicocelectomy based on PE, CDUS and SA findings were defined as Group 2. The patients diagnosed with varicocele based on PE and CDUS findings who were included in a followup protocol due to normal semen parameters were defined as Group 3. RESULTS In Group 1, there was a total of 28 patients and the mean number of ligated internal spermatic veins was 4.53 (range, 2-10). In Group 2, there was a total of 30 patients and the number of ligated internal spermatic veins was 3.76 (range, 1-8). No statistically significant difference was found between Group 1 and 2 in terms of the number of internal spermatic veins ligated during varicocelectomy. No statistically significant correlation was found between semen parameters and the number of veins ligated during varicocelectomy in Group 1 and 2 and between semen parameters and CDUS findings group 2 and 3. CONCLUSIONS In patients with primary grade 3 varicocele, diagnosed by physical examination there is no need for additional imaging in primary cases.
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Affiliation(s)
- Caner Ediz
- Department of Urology, Sultan Abdulhamid Han Education and Research Hospital, Istanbul.
| | - Muhammed Cihan Temel
- Department of Urology, Sultan Abdulhamid Han Education and Research Hospital, Istanbul.
| | - Suna Şahin Ediz
- Department of Radiology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul.
| | - Serkan Akan
- Department of Urology, Sultan Abdulhamid Han Education and Research Hospital, Istanbul.
| | - Serkan Yenigürbüz
- Department of Urology, Sultan Abdulhamid Han Education and Research Hospital, Istanbul.
| | - Mehmet Pehlivanoğlu
- Department of Urology, Sultan Abdulhamid Han Education and Research Hospital, Istanbul.
| | - Ömer Yılmaz
- Department of Urology, Sultan Abdulhamid Han Education and Research Hospital, Istanbul.
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Punjani N, Wald G, Gaffney CD, Goldstein M, Kashanian JA. Predictors of varicocele-associated pain and its impact on semen parameters following microsurgical repair. Andrologia 2021; 53:e14121. [PMID: 34118088 DOI: 10.1111/and.14121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/19/2021] [Accepted: 04/28/2021] [Indexed: 11/30/2022] Open
Abstract
Our study aimed to assess for predictors of varicocele-associated pain and whether it predicts semen parameters after microsurgical varicocelectomy. We assessed all men diagnosed with a varicocele by two surgeons from 2017 to 2020, excluding those who did not undergo surgical treatment. Patients were stratified based on the presence of pain at clinical assessment, and these groups were compared. Logistic regression models were utilised to assess for predictors of pain. A total of 313 men were included, with relatively similar proportions completed by both surgeons (48.2% and 51.8%). A total of 98 (31.3%) had typical varicocele-associated pain at the time of assessment. The pain group was younger than the no pain group (30.5 versus. 35.0, respectively, p < .01), and those with pain had greater varicocele grades (p = .008). Although not statistically different, there was a greater portion of left-sided only varicoceles in the pain group (p = .09). No significant differences were demonstrated between sperm concentration, motility, volume or morphology pre-operatively, or post-operatively between groups. Younger age and varicocele grade were predictive of varicocele-associated pain. In conclusion, almost 1/3 of men presented with varicocele-associated pain. Pain does not predict response to varicocelectomy, but these men tend to be younger, and have higher grade varicoceles.
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Affiliation(s)
- Nahid Punjani
- Center for Male Reproductive Medicine and Surgery, Institution for Reproductive Medicine and Department of Urology, Weill Cornell Medicine, New York, NY, USA.,Department of Urology, Center for Male Reproductive Medicine and Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Gal Wald
- Weill Cornell Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Christopher D Gaffney
- Department of Urology, Center for Male Reproductive Medicine and Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Marc Goldstein
- Center for Male Reproductive Medicine and Surgery, Institution for Reproductive Medicine and Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - James A Kashanian
- Department of Urology, Center for Male Reproductive Medicine and Surgery, Weill Cornell Medicine, New York, NY, USA
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Abstract
PURPOSE OF REVIEW The aim of this review is to provide an overview of surgical treatment options for male infertility including varicocelectomy, treatment of ejaculatory duct obstruction, vasovasostomy, and sperm extraction, and to review recent advances in techniques and technologies that may improve operative outcomes. RECENT FINDINGS Microscopic subinguinal varicocelectomy has been shown to have the highest success rates with lowest rates of complications, and may be facilitated by the use of Doppler, indocyanine green angiography, and the 4K3D operating video microscope. The standard treatment for ejaculatory duct obstruction by transurethral resection of the ejaculatory ducts has changed little over time, but vesiculoscopy may allow for temporary dilation of an obstruction to allow for natural conception, while also offering diagnostic capabilities. Use of the robotic platform has gained popularity for vasectomy reversals but controversy remains regarding the cost-effectiveness of this option. Recently, a reinforcing suture technique has been described for vasovasostomy to minimize anastomotic breakdown and reversal failure. Finally, gray-scale and color-enhanced ultrasound may improve ability to predict successful sperm retrieval during extraction procedures. SUMMARY Though the fundamentals of surgical treatment options for male infertility have changed little with time, technological advancements have contributed to improved surgical outcomes over recent years.
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12
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Kizilkan Y, Duran MB, Senel S, Yikilmaz TN, Akbelen B, Toksoz S. The effect of ejaculation time on varicose vein diameter and reflux level. Andrologia 2021; 53:e14090. [PMID: 33913191 DOI: 10.1111/and.14090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/31/2021] [Accepted: 04/11/2021] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to investigate whether the time interval between ejaculation and scrotal Doppler ultrasonography affects the results of the varicose vein diameter and reflux time. Age, medication use, operation history, physical examination and semen analysis findings, varicose vein diameters and the presence of reflux and reflux time were evaluated prospectively in the patients older than 18 years of age who presented to the urology outpatient clinic with infertility and underwent scrotal Doppler ultrasonography and semen analysis. The time interval between the two scrotal Doppler ultrasonography for semen analysis was noted, the two results were compared. The patients were divided into four groups according to the time interval between ejaculation and scrotal Doppler ultrasonography. The study included 81 varicocele cases, with 57 left-sided and 12 bilateral varicocele. The varicose vein diameters were significantly larger after ejaculation than before ejaculation (p < .001). Similarly, the reflux time after ejaculation in all patients was significantly higher in scrotal Doppler ultrasonography performed before and after ejaculation at rest and during Valsalva manoeuvre (p < .001). In conclusion, the results of the present study suggest that a waiting time of at least 90 min must be allowed between ejaculation and scrotal Doppler ultrasonography.
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Affiliation(s)
| | - Mesut Berkan Duran
- Department of Urology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Samet Senel
- Department of Urology, Ankara City Hospital, Ankara, Turkey
| | | | - Behcet Akbelen
- Department of Radiology, Hatay State Hospital, Hatay, Turkey
| | - Serdar Toksoz
- Department of Urology, Hatay State Hospital, Hatay, Turkey
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13
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Fukui K, Saito T, Fuchimoto Y. Pediatric laparoscopic varicocelectomy using indocyanine green (ICG) fluorescence imaging. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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14
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Al-Gadheeb A, El-Tholoth HS, Albalawi A, Althobity A, AlNumi M, Alafraa T, Jad A. Microscopic subinguinal varicocelectomy for testicular pain: a retrospective study on outcomes and predictors of pain relief. Basic Clin Androl 2021; 31:1. [PMID: 33413080 PMCID: PMC7788765 DOI: 10.1186/s12610-020-00119-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background Approximately 2–10% of patients with varicocele complain of pain. Varicocelectomy for testicular pain is a surgical choice when conservative therapy fails to relieve the pain. Different variables have been reported as prognostic factors for pain relief following varicocele ligation. Moreover, the success rate of varicocelectomy for testicular pain has varied among studies. This retrospective study aimed to investigate the predictors and success rate of microscopic subinguinal varicocelectomy performed for the treatment of painful varicocele. Results Among the 132 patients, 83.3% reported pain relief. A significant association was identified between varicocelectomy for unilateral testicular pain and pain resolution (P < 0.0001); no other factors were predictors of pain relief. Conclusions Microscopic subinguinal varicocelectomy for testicular pain is an effective surgical alternative. Varicocelectomy for unilateral testicular pain may predict postoperative pain relief in appropriately selected patients.
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Affiliation(s)
- Abdullah Al-Gadheeb
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Hossam S El-Tholoth
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz Albalawi
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Mussa AlNumi
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Tala Alafraa
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Amr Jad
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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15
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Arab D, Doustmohammadi H, Ardestani Zadeh A. Dietary supplements in the management of varicocele-induced infertility: A review of potential mechanisms. Andrologia 2020; 53:e13879. [PMID: 33108825 DOI: 10.1111/and.13879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/10/2020] [Accepted: 09/16/2020] [Indexed: 12/30/2022] Open
Abstract
Varicocele is a main cause of lower production of spermatozoon and infertility with multiple pathophysiological mechanisms. In the past decades, the use of dietary supplements has significantly increased due to both the modern lifestyle and the food shortages of the industrialised countries. The purpose of this review paper is to collect scientific evidences from basic and clinical studies which support the use of dietary supplements to define the clinical framework for patients with varicocele. In the present review, we used keywords such as dietary supplements, varicocele, male infertility, oxidative stress, DNA fragmentation, sperm parameters to find the proper articles. The standard search biomedical engines were used for seeking the papers. The use of dietary supplements such as minerals, vitamins and antioxidants has an essential role in the prevention and treatment of varicocele by increasing the levels of antioxidant enzymes (e.g. peroxidase, superoxide dismutase and catalase) and decreasing the levels of inflammatory markers (e.g. tumour necrosis factor-α, interleukin-6 and interleukin-1) in testis. According to the results, the dietary supplements may alleviate the spermatogenesis in varicocele patients through different mechanisms such as suppression of stress oxidative and inflammation in testicular tissue.
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Affiliation(s)
- Davood Arab
- Clinical Research Development Center, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, Iran.,Department of Surgery, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | - Hoda Doustmohammadi
- Department of Anatomy, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Arash Ardestani Zadeh
- Clinical Research Development Center, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, Iran.,Department of Surgery, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, Iran
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16
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Alfehaid O, Fallatah M, Aljuhayman A, Alhathal N. Bilateral persistent sinus tracts formation post bilateral microsurgical inguinal varicocelectomy: A case report. Urol Case Rep 2020; 33:101395. [PMID: 33102093 PMCID: PMC7574156 DOI: 10.1016/j.eucr.2020.101395] [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: 08/12/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 12/03/2022] Open
Abstract
Varicocele is a common case encountered in urology practice accounting for 15–20% of the general population. We are reporting a rare case of infected inguinal wounds post bilateral microsurgical varicocelectomy which led to persistent bilateral wound sinus formation. After multiple bedside wound debridement and sinus tract excision in operation theater, the patient's wounds were healed. We advise managing post-operative subcutaneous collections very closely to avoid such complications. When it happens and wound debridement is planned, we advise not to leave any dead space behind via using fat flaps.
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Affiliation(s)
- Omar Alfehaid
- King Faisal Specialized Hospital and Research Center, Riyadh, Saudi Arabia
| | - Moayid Fallatah
- King Faisal Specialized Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed Aljuhayman
- College of Medicine, Majmaah University, Riyadh Province, Saudi Arabia
| | - Naif Alhathal
- King Faisal Specialized Hospital and Research Center, Riyadh, Saudi Arabia
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17
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Ultrasound evaluation of varicoceles: systematic literature review and rationale of the ESUR-SPIWG Guidelines and Recommendations. J Ultrasound 2020; 23:487-507. [PMID: 32720266 PMCID: PMC7588576 DOI: 10.1007/s40477-020-00509-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/11/2020] [Indexed: 02/02/2023] Open
Abstract
Although often asymptomatic and detected incidentally, varicocele is a relatively common problem in patients who seek medical attention for infertility problems. Ultrasound (US) is the imaging modality of choice for evaluation, but there is no consensus on the diagnostic criteria, classification, and examination technique. In view of this uncertainty, the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology (ESUR-SPIWG) undertook a systematic review of the available literature on this topic, to use as the basis for evidence-based guidelines and recommendations. This paper provides the results of the systematic review on which guidelines were constructed.
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18
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Yetkin E, Ozturk S, Cuglan B, Turhan H. Symptoms in Dilating Venous Disease. Curr Cardiol Rev 2020; 16:164-172. [PMID: 32164514 PMCID: PMC7536814 DOI: 10.2174/1573403x16666200312101245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/08/2020] [Accepted: 02/14/2020] [Indexed: 11/22/2022] Open
Abstract
Lower extremity venous diseases or insufficiency include clinically deteriorating conditions with morphological and functional alterations of the venous system, including venous hypertension, vascular wall structural abnormality, and venous valvar incompetency in association with an inflammatory process. In fact, the same pathophysiological processes are the main underlying mechanisms of other venous insufficiencies in different vascular territories such as Peripheral Varicose Vein (PVV), varicocele, Pelvic Varicosities or Congestion Syndrome (PCS) and Hemorrhoidal Disease (HD). Regarding the anatomical continuity of lower extremity venous system, urogenital system (pampiniform plexus in male and broad ligament and ovarian veins in female) and anorectal venous system, it is reasonable to expect common symptoms such as pain, burning sensation, pruritis, swelling, which arise directly from the involved tissue itself. High coexistence rate of PVV, varicocele/PCS and HD between each other underlines not only the same vascular wall abnormality as an underlying etiology but also the existence of common symptoms originating from the involved tissue in dilating venous disease. Accordingly, it might be reasonable to query the common symptoms of venous dilating disease in other venous vascular regions in patients with complaints of any particular venous territory.
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Affiliation(s)
- Ertan Yetkin
- Address correspondence to this author at the Department of Cardiology, Istinye University Liv Hospital, Istanbul, Turkey; Tel: +90 532 713 6721; E-mail:
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19
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Oztekin U, Turan Y, Selmi V. The association between high‐grade varicocele and endothelial dysfunction. Andrologia 2019; 51:e13424. [DOI: 10.1111/and.13424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/19/2019] [Accepted: 08/22/2019] [Indexed: 01/23/2023] Open
Affiliation(s)
- Unal Oztekin
- Department of Urology Faculty of Medicine Yozgat Bozok University Yozgat Turkey
| | - Yasar Turan
- Department of Cardiology Faculty of Medicine Yozgat Bozok University Yozgat Turkey
| | - Volkan Selmi
- Department of Urology Faculty of Medicine Yozgat Bozok University Yozgat Turkey
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20
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Yu X, Li T, Zhuang Z, Li Y, Xie D, Li Z, Yuan X, Yang C. Treatment of varicocele with Fu's subcutaneous needling: A case report. Medicine (Baltimore) 2019; 98:e16983. [PMID: 31567934 PMCID: PMC6756634 DOI: 10.1097/md.0000000000016983] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 07/04/2019] [Accepted: 08/07/2019] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Fu's subcutaneous needling (FSN) is an innovative therapy of traditional acupuncture. FSN has been widely applied for the treatment of pain symptoms by relieving local muscle tension and promoting local blood circulation. Varicocele (VCL) is a disease that commonly occurs in male adolescents. Patients with VCL can suffer from pain in the scrotum, inguinal area, or unilateral testis, which could be an indication for FSN. In this study, we present a unique case, in which a 30-year-old male patient with VCL benefitted from FSN. PATIENT CONCERNS A 30-year-old male complained of dull pain and swelling in the testicular area for 4 months. No significant abnormalities were identified in his genitalia by physical examination. DIAGNOSES The patient was diagnosed with VCL, with his symptoms and signs of dull pain and swelling in the testicular area, and ultrasound also demonstrated the left-side VCL. INTERVENTIONS FSN was performed successfully twice a week on a different day without postoperative complications. The total course lasted 8 weeks. OUTCOMES The patient experienced obvious relief of his testicular pain and swelling after each treatment course. All his symptoms resolved and disappeared after 4 treatment courses. After the 8-week treatment course, the color ultrasound after treatment demonstrated improved anastomotic blood flow rates in his left spermatic vein. No narrow or thrombotic parts were observed post-treatment compared to the color ultrasound before treatment. The patient was followed up at 1, 3, and 6 months after treatment. During the follow-up period, his previous symptoms disappeared without recurrence. LESSONS FSN significantly improved the patent's symptoms of testicular pain and abnormal dilatation and tortuosity of the spermatic veins. FSN might exert its therapeutic effect by improving the relaxation of muscle oppression and increasing the local blood reperfusion to resume blood stream. Due to the limitation of a single clinical observation case, a randomized clinical trial with a sufficient follow-up time is needed.
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Affiliation(s)
- Xiaojiang Yu
- The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine
| | - Ting Li
- Guangzhou University of Traditional Chinese Medicine
| | | | - Yingxian Li
- The Affiliated Hospital of South China University of Technology
| | - Dongming Xie
- The Affiliated Hospital of South China University of Technology
| | - Zikang Li
- The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine
| | - Xueya Yuan
- The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine
| | - Chaojie Yang
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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21
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Perdikakis E, Tzortzis V, Fezoulidis I, Rountas C. Intravascular Ultrasound for Evaluation of Left Gonadal Vein Anatomic Variations During Coil Embolization. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1619-1627. [PMID: 30244482 DOI: 10.1002/jum.14827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/24/2018] [Indexed: 06/08/2023]
Abstract
We illustrate the intravascular ultrasound (US) findings in the evaluation of left gonadal vein anatomic variations. During a 2-year period, 4 consecutive patients (mean age, 37 years; range, 28-45 years) with left-sided varicocele underwent embolization. Intravascular US examinations and retrograde venography were performed to assess varicocele anatomy. Anatomic variants were recorded and categorized. A comparison between intravascular US and fluoroscopic findings was performed. The Fisher exact test was used for statistical analysis (P < .05). Technical success was achieved in all cases. There was a statistically significant difference in the maximum gonadal vein diameter between venography and intravascular US (P = .0087). Intravascular US showed left gonadal vein anatomic variations and better ability in the evaluation of the vein diameter.
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Affiliation(s)
- Evangelos Perdikakis
- Department of Radiology, 424 General Military Hospital of Thessaloniki, Thessaloniki, Greece
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22
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Akkoç A, Aydın C, Topaktaş R, Altın S, Uçar M, Topçuoğlu M, Buğra Şentürk A. Retroperitoneal high ligation versus subinguinal varicocelectomy: Effectiveness of two different varicocelectomy techniques on the treatment of painful varicocele. Andrologia 2019; 51:e13293. [DOI: 10.1111/and.13293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/19/2019] [Accepted: 03/22/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Ali Akkoç
- Department of Urology, Faculty of Medicine Alanya Alaaddin Keykubat University Antalya Turkey
| | - Cemil Aydın
- Department of Urology, Faculty of Medicine Hitit University Çorum Turkey
| | - Ramazan Topaktaş
- Department of Urology University of Health Sciences, Haydarpasa Numune Research & Training Hospital İstanbul Turkey
| | - Selçuk Altın
- Department of Urology Necip Fazıl City Hospital Kahramanmaraş Turkey
| | - Murat Uçar
- Department of Urology, Faculty of Medicine Alanya Alaaddin Keykubat University Antalya Turkey
| | - Murat Topçuoğlu
- Department of Urology, Faculty of Medicine Alanya Alaaddin Keykubat University Antalya Turkey
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23
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Yan S, Shabbir M, Yap T, Homa S, Ramsay J, McEleny K, Minhas S. Should the current guidelines for the treatment of varicoceles in infertile men be re-evaluated? HUM FERTIL 2019; 24:78-92. [PMID: 30905210 DOI: 10.1080/14647273.2019.1582807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Male infertility is a major health burden worldwide. In the United Kingdom, the diagnostic and treatment pathway for male factor fertility is fragmented with wide variance in management and funding protocols. There is now a focus on potential overtreatment of couples with IVF and failure to treat male factors before considering assisted reproductive technology (ART). Despite this, contemporary Urological guidelines are not definitive in the indications for varicocele treatment, whilst the current National Institute for Health and Care Excellence (NICE) guidelines do not advocate surgical intervention. While controversy exists concerning the effects of varicocele treatment on natural pregnancy rates, there is growing evidence that varicocele treatment can have additional positive effects on fertility by reducing their impact on sperm DNA fragmentation and improving ART outcomes. Studies have demonstrated that azoospermic men may become oligospermic following varicocele intervention, obviating the need for surgical sperm retrieval. Sperm retrieval rates also increase following varicocele treatment in men with non-obstructive azoospermia. The contemporary literature demonstrates a clear clinical benefit for treating varicoceles in infertile men, which may be more cost-effective than proceeding to immediate ART. This review comprehensively evaluates the current indications for varicocele treatment, and it is proposed that these should be redefined in contemporary guidelines to reflect current advances in male fertility research.
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Affiliation(s)
- Sylvia Yan
- The Urology Centre, Guy's Hospital, London, UK
| | - Maj Shabbir
- The Urology Centre, Guy's Hospital, London, UK
| | - Tet Yap
- The Urology Centre, Guy's Hospital, London, UK
| | - Sheryl Homa
- Department of Biosciences, University of Kent, Canterbury, UK
| | - Jonathan Ramsay
- Department of Men's Health and Andrology, Imperial College Healthcare, London, UK
| | - Kevin McEleny
- Newcastle Fertility Centre, The Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
| | - Suks Minhas
- Department of Men's Health and Andrology, Imperial College Healthcare, London, UK
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24
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Two Case Reports of Varicocele Rupture during Sexual Intercourse and Review of the Literature. Case Rep Urol 2019; 2018:4068174. [PMID: 30643660 PMCID: PMC6311255 DOI: 10.1155/2018/4068174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/26/2018] [Indexed: 11/30/2022] Open
Abstract
Varicocele is characterized by the dilatation of the veins of the spermatic cord. Its prevalence in general male population is 15% while in the infertile population the prevalence rises up to 25%. The varicocele is considered an etiological factor for male infertility. Although different pathophysiological patterns have been proposed, there is no consensus in the urological society to date. In most of the cases varicocele is asymptomatic but sometimes gives mild symptoms as dull pain at the scrotal region. A rare complication of this condition is the spontaneous or traumatic rupture and hematoma formation, either as spermatic cord hematoma or as scrotal hematoma. We are presenting two cases of varicocele rupture, presented with acute painful swelling of the left inguinal and scrotal region during sexual intercourse. Imaging studies revealed a scrotal hematoma in the first case and a spermatic cord hematoma in the second case, without signs of active bleeding. Both patients were treated conservatively and recovered uneventfully. Subsequently, we reviewed the literature in an effort to find the key points for the diagnosis and treatment of this condition.
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25
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Paick S, Choi WS. Varicocele and Testicular Pain: A Review. World J Mens Health 2019; 37:4-11. [PMID: 29774668 PMCID: PMC6305863 DOI: 10.5534/wjmh.170010] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/28/2018] [Accepted: 04/11/2018] [Indexed: 11/24/2022] Open
Abstract
Varicocele is the dilatation of the scrotal portion of pampiniform plexus and the internal spermatic venous system. About 15% of men suffer from scrotal varicocele and 2% to 10% of them complain of pain. The probable mechanisms for pain include compression of the surrounding neural fibers by the dilated venous complex, elevated testicular temperature, increased venous pressure, hypoxia, oxidative stress, hormonal imbalances, and the reflux of toxic metabolites of adrenal or renal origin. Testicular pain associated with varicoceles is typically described as a dull, aching, or throbbing pain in the testicle, scrotum, or groin; rarely, it can be acute, sharp, or stabbing. The management of testicular pain associated with varicocele starts with a conservative, non-surgical approach and a period of observation. Varicocelectomy in carefully selected candidates with clinically palpable varicocele resolves nearly 80% of all cases of testicular pain. Microsurgical techniques for varicocelectomy have gained popularity with minimal complication rates and favorable outcomes. The grade of varicocele, the nature and duration of pain, body mass index, prior conservative management, and the type of surgical method used, are predictors for the success of varicocelectomy.
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Affiliation(s)
- Sunghyun Paick
- Department of Urology, Konkuk University School of Medicine, Seoul, Korea
| | - Woo Suk Choi
- Department of Urology, Konkuk University School of Medicine, Seoul, Korea.
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26
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Zavattaro M, Ceruti C, Motta G, Allasia S, Marinelli L, Di Bisceglie C, Tagliabue MP, Sibona M, Rolle L, Lanfranco F. Treating varicocele in 2018: current knowledge and treatment options. J Endocrinol Invest 2018; 41:1365-1375. [PMID: 30284221 DOI: 10.1007/s40618-018-0952-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/11/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE Varicocele is defined as a state of varicosity and tortuosity of the pampiniform plexus around the testis caused by retrograde blood flow through the internal spermatic vein. The prevalence of clinically relevant varicocele ranges from 5 to 20% in the male population and is often associated with infertility and reduction of sperm quality. In this review, the pathophysiology and clinical aspects of varicocele are reviewed along with therapeutic options and treatment effects on sperm parameters and fertility both in adult and in pediatric/adolescent subjects. METHODS We conducted a Medline and a PubMed search from 1965 to 2018 to identify publications related to varicocele clinical aspects, treatment procedures and treatment outcomes. Keywords used for the search were: "varicocele", "varicocelectomy", "sclerotherapy", "male infertility", "subfertility", and "semen abnormalities". RESULTS Data from a large number of studies in adolescent and adult males indicate that varicocele correction improves semen parameters in the majority of patients, reducing oxidative stress and improving sperm nuclear DNA integrity either with surgical or percutaneous approach. CONCLUSIONS Varicocele repair seems to represent a cost-effective therapeutic option for all males (both adolescent and adults) with a clinical varicocele in the presence of testicular hypotrophy, worsening sperm alterations or infertility. On the other hand, some investigators questioned the role of varicocelectomy in the era of assisted reproduction. Thus, a better understanding of the pathophysiology of varicocele-associated male subfertility is of paramount importance to elucidating the deleterious effects of varicocele on spermatogenesis and possibly formulating new treatment strategies.
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Affiliation(s)
- M Zavattaro
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - C Ceruti
- Division of Urology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - G Motta
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - S Allasia
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - L Marinelli
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - C Di Bisceglie
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M P Tagliabue
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M Sibona
- Division of Urology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - L Rolle
- Division of Urology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - F Lanfranco
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
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27
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Guercio C, Patil D, Mehta A. Hypogonadism is independently associated with varicocele repair in a contemporary cohort of men in the USA. Asian J Androl 2018; 21:244247. [PMID: 30381578 PMCID: PMC6337954 DOI: 10.4103/aja.aja_61_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 06/20/2018] [Indexed: 12/01/2022] Open
Abstract
We aimed to identify demographic and clinical predictors of varicocele repair in a contemporary cohort of men in the USA. We queried the 2009-2015 MarketScan Database using relevant ICD9, ICD10, and CPT codes to identify all 18-45 year olds with varicoceles. Differences in age, area of residence, clinical characteristics, and medical management between men who did and did not undergo varicocelectomy (open, laparoscopic, or microsurgical) during the study period were compared using unpaired t-tests and Chi-squared tests for continuous and categorical variables, respectively. Multivariable logistic regression analysis was used to evaluate age, semen analyses, and serum hormone assessment as predictors of varicocele repair. SAS version 9.4 was used for all statistical analyses. Significance was set at P < 0.05. Approximately 40% of men with varicoceles underwent repair, primarily through an open approach. Men who underwent repair were more likely to have a diagnosis of male infertility (15.5% vs 7.9%, P < 0.001) and male hypogonadism (3.4% vs 0.9%) and were more likely to complete semen analyses (36.1% vs 12.2%, P < 0.001) and serum testosterone evaluation (42.5% vs 18.8%, P < 0.001). In multivariable regression models, the strongest predictors of varicocele repair were semen analysis (OR = 2.78, 95% CI: 2.56-3.02), age 18-25 years (OR = 2.66, 95% CI: 2.36-2.98), and serum testosterone evaluation (OR = 1.67, 95% CI: 1.51-1.86). Although male infertility remains the most important indication for varicocele repair, male hypogonadism is emerging as an independent predictor of varicocelectomy, which may represent a change in the clinical management of varicoceles in the USA.
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Affiliation(s)
- Cailey Guercio
- Department of Urology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Akanksha Mehta
- Department of Urology, Emory University School of Medicine, Atlanta, GA 30322, USA
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28
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Perdikakis E, Fezoulidis I, Tzortzis V, Rountas C. Varicocele embolization: Anatomical variations of the left internal spermatic vein and endovascular treatment with different types of coils. Diagn Interv Imaging 2018; 99:599-607. [PMID: 29910172 DOI: 10.1016/j.diii.2018.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 05/28/2018] [Accepted: 05/28/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE To present anatomical variations of left internal spermatic vein and a comparison between treatments with hydrogel-coated and non-coated platinum coils in patients with varicocele. MATERIALS AND METHODS A total of 153 men (mean age, 27.5±6.7 [SD] years; range: 18-45 years) with left sided varicocele underwent coil embolization. Anatomic variants of gonadal vein were categorized into five subtypes (I-V). Additional venous collaterals were also recorded. Three types of coils were used (hydrogel coated platinum coils, fibered coils and non-coated platinum coils). Technical success, tolerance, efficacy and safety of hydrogel coated platinum coils were recorded. Comparison between different types of coils used was made. Fisher's exact test was used for statistical analysis. RESULTS Varicoceles were classified as type I (26.1%), type II (13.7%), type III (32.1%), type IV (18.3%) and type V (9.8%). The internal spermatic vein - renal vein angle ranged from 32°-128° (mean angle, 93.5°). Technical success was achieved in 145 patients (94.8%) without complications. The mean number of coils used was 3 (range: 1-6 coils). A total of 260 hydrogel coated platinum coils in 95 patients and 135 non-coated coils in 50 patients were deployed with no complications. No differences were noted between the different types of coils used regarding embolic efficacy and safety. A 6.2% (9/145) recurrence rate and a 33.3% (14/42) fertility rate were observed. Clinical success regarding symptom relief after painful varicocele embolization was 100% (36/36) for technically successful cases. CONCLUSION Varicocele embolization with the use of hydrogel coated or non-coated platinum coils is technically feasible and safe without complications. No superiority of one type of coil over the other was found.
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Affiliation(s)
- E Perdikakis
- Department of Radiology, 424 GMTH Military Hospital of Thessaloniki, Thessaloniki, Greece.
| | - I Fezoulidis
- Department of Radiology, University of Thessaly, Larisa, Greece
| | - V Tzortzis
- Department of Urology, University of Thessaly, Larisa, Greece
| | - C Rountas
- Department of Radiology, University of Thessaly, Larisa, Greece
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Owen RC, McCormick BJ, Figler BD, Coward RM. A review of varicocele repair for pain. Transl Androl Urol 2017; 6:S20-S29. [PMID: 28725614 PMCID: PMC5503918 DOI: 10.21037/tau.2017.03.36] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A dilation of the pampiniform venous plexus in the scrotum above the testicle, called a varicocele, affects approximately 15% of the general male population. While the majority is asymptomatic, pain results in up to 10% of cases of varicoceles. The pain associated with varicoceles is typically mild and is described as heavy, achy, or dull—and is usually isolated to the testicle or spermatic cord. Guidelines clearly recommend varicocele repair in males with varicoceles, infertility, and an abnormal semen analysis. While chronic, severe pain is an additional indication for repair, a careful evaluation to rule out other etiologies in addition to a period of conservative management are necessary prior to surgical treatment because of the high incidental prevalence of varicoceles in the general population. Several techniques for varicocele repair have been described, including retroperitoneal, laparoscopic, inguinal, and subinguinal. Additionally, recent adjuncts to improve visualization and identification of critical structures including the operating microscope and microvascular Doppler ultrasound have improved success and complication rates. With careful patient selection, outcomes of varicocele repair with regard to pain are excellent, with over 90% of patients experiencing symptomatic relief. After failure of conservative treatments, a varicocele associated with pain should be considered for repair, and the microsurgical subinguinal approach is the gold standard surgical treatment, offering excellent outcomes while minimizing risk of complications.
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Affiliation(s)
- Ryan C Owen
- Department of Urology, UNC School of Medicine, Chapel Hill, NC, USA
| | | | - Bradley D Figler
- Department of Urology, UNC School of Medicine, Chapel Hill, NC, USA
| | - Robert M Coward
- Department of Urology, UNC School of Medicine, Chapel Hill, NC, USA.,UNC Fertility LLC, Raleigh, NC, USA
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