1
|
Gonzalez-Daza SJ, Díaz-Hung AM, García-Perdomo HA. Association between varicocele and hypogonadism, or erectile dysfunction: A systematic review and meta-analysis. Actas Urol Esp 2024:S2173-5786(24)00084-2. [PMID: 38960064 DOI: 10.1016/j.acuroe.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/09/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE To assess the association between varicocele and hypogonadism, or erectile dysfunction. METHODS We searched MEDLINE, EMBASE, LILACS, CENTRAL, and other sources. We included cohort, case-control, and cross-sectional studies. The primary outcome was the association between varicocele and hypogonadism, or erectile dysfunction, and the secondary outcome included semen analysis. We assessed the risk of bias with the Newcastle-Ottawa Scale. We performed statistical analysis in Review Manager 5.3 and reported information about the Odds Ratio (OR) with a 95% confidence interval. We produced a forest plot for the primary outcome. RESULTS We included ten studies in qualitative analysis and six studies in quantitative analysis. Most of the cross-sectional studies showed a low risk of bias, not so for the two case-control studies, which represented a high risk of bias. Most of the reports described a correlation between having varicocele and presenting low testosterone levels: the meta-analysis showed that there is a significant association between varicocele and hypogonadism (OR 3.27 95%CI 1.23 to 8.68). Regarding varicocele and erectile, only one study showed a significant difference in erectile function in comparison to varicocele patients and men without varicocele. CONCLUSION There is an association between varicocele presence and hypogonadism, although more studies are needed. Besides, not much is reported about an association between varicocele and erectile dysfunction, but impairment can occur through hormone disturbances.
Collapse
Affiliation(s)
- S J Gonzalez-Daza
- Grupo de Investigación UROGIV, Escuela de Medicina, Universidad del Valle, Cali, Colombia
| | - A M Díaz-Hung
- Grupo de Investigación UROGIV, Escuela de Medicina, Universidad del Valle, Cali, Colombia; Unidad de Urología, Departamento de Cirugía, Escuela de Medicina, Universidad del Valle, Cali, Colombia
| | - H A García-Perdomo
- Grupo de Investigación UROGIV, Escuela de Medicina, Universidad del Valle, Cali, Colombia; Unidad de Urología, Departamento de Cirugía, Escuela de Medicina, Universidad del Valle, Cali, Colombia.
| |
Collapse
|
2
|
Gül M, Russo GI, Kandil H, Boitrelle F, Saleh R, Chung E, Kavoussi P, Mostafa T, Shah R, Agarwal A. Male Infertility: New Developments, Current Challenges, and Future Directions. World J Mens Health 2024; 42:502-517. [PMID: 38164030 PMCID: PMC11216957 DOI: 10.5534/wjmh.230232] [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: 08/16/2023] [Accepted: 08/27/2023] [Indexed: 01/03/2024] Open
Abstract
There have been many significant scientific advances in the diagnostics and treatment modalities in the field of male infertility in recent decades. Examples of these include assisted reproductive technologies, sperm selection techniques for intracytoplasmic sperm injection, surgical procedures for sperm retrieval, and novel tests of sperm function. However, there is certainly a need for new developments in this field. In this review, we discuss advances in the management of male infertility, such as seminal oxidative stress testing, sperm DNA fragmentation testing, genetic and epigenetic tests, genetic manipulations, artificial intelligence, personalized medicine, and telemedicine. The role of the reproductive urologist will continue to expand in future years to address different topzics related to diverse questions and controversies of pathophysiology, diagnosis, and therapy of male infertility, training researchers and physicians in medical and scientific research in reproductive urology/andrology, and further development of andrology as an independent specialty.
Collapse
Affiliation(s)
- Murat Gül
- Department of Urology, Selcuk University School of Medicine, Konya, Turkey
- Global Andrology Forum, Moreland Hills, OH, USA
| | - Giorgio Ivan Russo
- Urology Section, University of Catania, Catania, Italy
- Global Andrology Forum, Moreland Hills, OH, USA
| | - Hussein Kandil
- Fakih IVF Fertility Center, Abu Dhabi, UAE
- Global Andrology Forum, Moreland Hills, OH, USA
| | - Florence Boitrelle
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France
- Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
- Global Andrology Forum, Moreland Hills, OH, USA
| | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
- Ajyal IVF Center, Ajyal Hospital, Sohag, Egypt
- Global Andrology Forum, Moreland Hills, OH, USA
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
- Global Andrology Forum, Moreland Hills, OH, USA
| | - Parviz Kavoussi
- Department of Reproductive Urology, Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA
- Global Andrology Forum, Moreland Hills, OH, USA
| | - Taymour Mostafa
- Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
- Global Andrology Forum, Moreland Hills, OH, USA
| | - Rupin Shah
- Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
- Well Women's Centre, Sir HN Reliance Foundation Hospital, Mumbai, India
- Global Andrology Forum, Moreland Hills, OH, USA
| | - Ashok Agarwal
- Global Andrology Forum, Moreland Hills, OH, USA
- Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
3
|
Mulati Y, Li X, Maimaitiming A, Apizi A, Wang Y. Is there any predictive value of testicular shear wave elastic modulus in testicular functions for varicocele patients? Andrologia 2022; 54:e14393. [PMID: 35277869 DOI: 10.1111/and.14393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Yelisudan Mulati
- Urology Department The First Affiliated Hospital of Xinjiang Medical University Xinjiang Medical University Urumqi Xinjiang China
| | - Xiaodong Li
- Urology Department Xinjiang Clinical Research Center for Genitourinary System The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Abulaiti Maimaitiming
- Urology Department Xinjiang Clinical Research Center for Genitourinary System The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Aireti Apizi
- Urology Department Xinjiang Clinical Research Center for Genitourinary System The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| | - Yujie Wang
- Urology Department Xinjiang Clinical Research Center for Genitourinary System The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China
| |
Collapse
|
4
|
Relationship between Varicocele and Male Hypogonadism: A Review with Meta-Analysis. ENDOCRINES 2022. [DOI: 10.3390/endocrines3010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The relationship between varicocele and hypogonadism becomes clearer everyday thanks to the most recent literature, particularly with regards to the impact of varicocele repair on serum testosterone level improvement in hypogonadal patients. We selected English articles published from 1964 to September 2021. The search terms “varicocele” and “hypogonadism” were used as filters. A total of 102 studies have been obtained. For the meta-analysis, the pooled mean differences (MDs) for continuous variables and the ln(OR) were used for data pooling observational studies. A total of 15 articles have been finally included: nine retrospective and six observational. Testosterone levels pre- and after surgery were reported in four studies. There was statistically significant heterogeneity in these studies (chi2 = 267.09, I2 = 72%; p = 0.01). Mean differences of total testosterone was statistically different in men pre- and after-surgery (mean difference = 106.76; p < 0.0001). It is indeed established that altered environments caused by varicocele cause pantesticular insult, but it has not been unequivocally determined whether men with varicocele are at increased risk for the development of clinical hypogonadal symptoms.
Collapse
|
5
|
Wang Y, Zhang R, Pan W, Xu Z, Yang H, Luo Q, Ye X, Cheng X. Effects of L-carnitine combined with pancreatic kininogenase on thioredoxin 2, thioredoxin reductase 1, and sperm quality in patients with oligoasthenospermia. Transl Androl Urol 2021; 10:3515-3523. [PMID: 34532275 PMCID: PMC8421838 DOI: 10.21037/tau-21-680] [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: 06/17/2021] [Accepted: 08/18/2021] [Indexed: 11/06/2022] Open
Abstract
Background To study the effects of L-carnitine (LC) combined with pancreatic kininogenase on thioredoxin 2 (Trx 2), thioredoxin reductase 1 (TrxR 1), and sperm quality in patients with oligoasthenospermia. Methods A total of 300 male infertility patients with oligoasthenospermia who were treated in the andrology clinic of our hospital from December 2019 to December 2020 were randomly divided into an LC group and combined treatment group, and 50 males with normal semen were selected as a control group. The computer-assisted semen analysis system (CASA) was used to detect the total number, vitality, and forward motility of the sperm before and after treatment, and sperm morphology was detected by the Diff-Quik method of the sperm staining kit. Sperm chromatin dispersion (SCD) method was used to detect sperm DNA fragments, and Western-blot was used to detect the protein expression of Trx 2 and TrxR 1. Results There were no significant differences in sperm density, motility rate, forward motile sperm rate, and DNA fragmentation rate in oligoasthenospermia patients before treatment (P>0.05). However, after 1 month of treatment, the sperm density, motility rate, and forward motile sperm rate were all higher than before treatment (P<0.05), while the DNA fragmentation rate was lower than before treatment. At the same time, each index of semen in the combination group was higher than that in the LC group (P<0.05), and the total effective rate in the combination group was significantly higher than in the LC group (P<0.01). The expression of Trx2 protein in oligoasthenospermia patients was significantly increased (P<0.05), while the expression of TrxR1 protein was significantly decreased (P<0.05). After 3 months of treatment, the expression of Trx2 protein was significantly decreased (P<0.05), while the expression of TrxR1 protein was significantly increased (P<0.05). Conclusions The results suggest Trx 2 and TrxR 1 may be candidate protein markers for oligoasthenospermia. LC combined with pancreatic kininogenase in the treatment of male oligoasthenospermia can effectively promote sperm maturation, enhance sperm motility, and improve semen quality, which has high application value.
Collapse
Affiliation(s)
- Yang Wang
- Department of Pharmacy, Ma'anshan Maternal and Child Health Hospital, Anhui, China
| | - Rui Zhang
- Department of Andrology, Ma'anshan Maternal and Child Health Hospital, Anhui, China
| | - Weijun Pan
- Department of reproductive center, Ma'anshan Maternal and Child Health Hospital, Anhui, China
| | - Zhe Xu
- Department of Pharmacy, Ma'anshan Maternal and Child Health Hospital, Anhui, China
| | - Huan Yang
- Department of Pharmacy, Ma'anshan Maternal and Child Health Hospital, Anhui, China
| | - Qi Luo
- Department of Pharmacy, Ma'anshan Maternal and Child Health Hospital, Anhui, China
| | - Xiping Ye
- Department of Reproduction laboratory, Ma'anshan Maternal and Child Health Hospital, Anhui, China
| | - Xianfeng Cheng
- Department of Laboratory Medicine, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| |
Collapse
|
6
|
Saylam B, Çayan S, Akbay E. Effect of microsurgical varicocele repair on sexual functions and testosterone in hypogonadal infertile men with varicocele. Aging Male 2020; 23:1366-1373. [PMID: 32475203 DOI: 10.1080/13685538.2020.1769589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To investigate effect of microsurgical varicocele repair on sexual functions and serum total testosterone level in infertile hypogonadal men with varicocele, and also to determine factors that might predict improvement in total testosterone level after surgery. METHODS The study included 202 infertile hypogonadal men (total testosterone level of <3.5 ng/mL) with varicocele who underwent microsurgical sub-inguinal varicocele repair. RESULTS Mean serum total testosterone level significantly increased from 2.55 ± 0.66 ng/mL to 3.72 ± 1.34 ng/mL after varicocelectomy (p = .000), and 105 patients (52%) had serum total testosterone level of ≥3.5 ng/mL after the surgery. Mean international index of erectile functions (IIEF-EF) score significantly increased from 27.47 ± 2.96 to 28.61 ± 2.02, post-operatively (p = .000). Of the patients who had pre-operative IIEF-EF score of ≤26, 65.5% had IIEF-EF score of ≥26 after varicocelectomy. Of the patients who had pre-operative decreased libido, 86.6% had post-operative increased libido. Only older patient age was the predictor for having total testosterone level of ≥3.5 ng/mL after the surgery (p = .031). CONCLUSIONS Data suggest that serum total testosterone level, IIEF-EF score and sexual libido significantly increase after varicocele surgery. As the age increases, total testosterone level increased after varicocele surgery. Therefore, varicocele repair could be offered to hypogonadal men with clinically varicocele.
Collapse
Affiliation(s)
- Barış Saylam
- Department of Urology, Mersin City Research and Educational Hospital, Mersin, Turkey
| | - Selahittin Çayan
- Department of Urology, University of Mersin School of Medicine, Mersin, Turkey
| | - Erdem Akbay
- Department of Urology, University of Mersin School of Medicine, Mersin, Turkey
| |
Collapse
|
7
|
Zhu J, Ou N, Song Y, Hu R, Zhang W, Liang Z, Yang Y, Liu X. Identification and verification of key genes in varicocele rats through high-throughput sequencing and bioinformatics analysis. Andrologia 2020; 52:e13662. [PMID: 32459877 DOI: 10.1111/and.13662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/02/2020] [Accepted: 05/05/2020] [Indexed: 12/15/2022] Open
Abstract
Varicocele (VC) is the most common treatable cause of infertility, but it is difficult to distinguish fertile from infertile VC populations because the pathogenesis is unclear. In order to study the related mechanism of VC causing male sterility, we made VC rat model by surgery, analysed the rat epididymal spermatozoa and used the transcriptome sequencing to compare all the mRNA expression differences in testicular tissue between VC rats and control rats. The differentially expressed genes (DEGs) of testicular tissue were also screened by the limma package in R software (version 3.6.1). The 273 DEGs were identified from the four profile data sets including 124 up-regulated genes and 149 down-regulated genes in the VC group compared to control group. We found that Sod1, Casp9, Atg7, Casp3 and Sirt1 in module 1 had higher degrees of connectivity in the first 10 hub genes. Gene ontology (GO) functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis demonstrated that Sod1, Casp9, Atg7, Casp3 and Sirt1 are enriched in regulation of oxidative stress-induced cell death (GO:1,903,201) and Amyotrophic lateral sclerosis (KEGG:05,014). From the above evidence, we speculate that hypoxia plays an important role in the occurrence and development of VC, and it induced the abnormal expression of autophagy and apoptosis-related proteins may involve in the development of VC-associated infertility. Sod1, Casp9, Atg7, Casp3 and Sirt1 as well as their module are hub genes for VC, which will have attractive applications to provide new treatment targets for VC.
Collapse
Affiliation(s)
- Jun Zhu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Ningjing Ou
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuxuan Song
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Rui Hu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Zhang
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhen Liang
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yongjiao Yang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| |
Collapse
|