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Fallara G, Tang S, Pang KH, Pozzi E, Belladelli F, Schifano N, Capogrosso P, Alnajjar HM, Montorsi F, Salonia A, Castiglione F, Muneer A. Treatment of Persistent or Recurrent Varicoceles: A Systematic Review. Eur Urol Focus 2022:S2405-4569(22)00250-4. [DOI: 10.1016/j.euf.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/18/2022] [Accepted: 11/03/2022] [Indexed: 11/27/2022]
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Soetandar A, Noegroho BS, Siregar S, Adriansjah R, Mustafa A. Microsurgical varicocelectomy effects on sperm DNA fragmentation and sperm parameters in infertile male patients: A systematic review and meta-analysis of more recent evidence. Arch Ital Urol Androl 2022; 94:360-365. [DOI: 10.4081/aiua.2022.3.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Varicocele is known to have impacts in infertility cases and sperm quality. This review aimed to evaluate the effects of microsurgical varicocelectomy on sperm DNA fragmentation index (DFI) and sperm parameters. Methods: Open full English text articles from January 2017 to October 2021 were searched from online database including PubMed, EMBASE, Scopus, Cochrane Library and Google Scholar. Results: Systematic search resulted in 277 potential papers. After throughout paper analysis, 5 studies were included in this review. From all five analyzed studies, microsurgical varicocelectomy was statistically proven to reduce DNA fragmentation index by 5.46% (mean difference -5.46; 95% CI: -4.79, -6.13; p < 0.00001). Moreover, the procedure also significantly improved other sperm parameters (sperm concentration +8.23%, sperm motility +7.17%, sperm progressive motility +2.77%, sperm morphology +0.64%). Conclusion: Microsurgical varicocelectomy significantly improves spermatogenesis as reflected by biomarkers of infertile men including semen parameters and sperm DNA fragmentation (SDF).
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Mahdi M, Majzoub A, Khalafalla K, To J, Aviles‐Sandoval M, Elbardisi H, AlSaid S, Agarwal A, Henkel R, Arafa M. Effect of redo varicocelectomy on semen parameters and pregnancy outcome: An original report and meta‐analysis. Andrologia 2022; 54:e14525. [DOI: 10.1111/and.14525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/23/2022] [Accepted: 06/21/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Mohamed Mahdi
- Department of Urology Hamad Medical Corporation Doha Qatar
| | - Ahmad Majzoub
- Department of Urology Hamad Medical Corporation Doha Qatar
- Clinical Urology Weill Cornell Medicine –Qatar Doha Qatar
| | - Kareim Khalafalla
- Department of Urology Hamad Medical Corporation Doha Qatar
- Department of Urology University of Illinois at Chicago Chicago Illinois USA
| | - Jason To
- College of Alameda Alameda California USA
| | | | - Haitham Elbardisi
- Department of Urology Hamad Medical Corporation Doha Qatar
- Clinical Urology Weill Cornell Medicine –Qatar Doha Qatar
- College of Medicine Qatar University Doha Qatar
| | - Sami AlSaid
- Department of Urology Hamad Medical Corporation Doha Qatar
- Clinical Urology Weill Cornell Medicine –Qatar Doha Qatar
| | - Ashok Agarwal
- American Center for Reproductive Medicine Cleveland Clinic Cleveland Ohio USA
| | - Ralf Henkel
- Department of Metabolism Digestion and Reproduction at Imperial College London London UK
| | - Mohamed Arafa
- Department of Urology Hamad Medical Corporation Doha Qatar
- Clinical Urology Weill Cornell Medicine –Qatar Doha Qatar
- Andrology Department Cairo University Cairo Egypt
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Fabiani A, Pavia MP, Stramucci S, Antezza A, De Stefano V, Castellani D. Do sclero-embolization procedures have advantages over surgical ligature in treating varicocele in children, adolescents and adults? Results from a systematic review and meta-analysis. Andrologia 2022; 54:e14510. [PMID: 35750057 DOI: 10.1111/and.14510] [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: 05/10/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022] Open
Abstract
We aimed to systematically review complications, and recurrence rate of varicocele treatment by comparing the surgical ligature versus sclero-embolization techniques in children, adolescents and adults. The secondary outcomes were the evaluation of semen parameters and spontaneous pregnancy rate in adults. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Continuous variables were pooled using the inverse variance of the mean difference (MD) with a fixed effect, and 95% confidence interval (CI). The incidences of complications were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as Odds Ratio (OR), and 95% CI. Statistical significance was set two-tail p-value < 0.05. Twenty studies were included. Incidence of postoperative hydrocele was significantly higher in the surgical ligation group (OR 3.06 95% CI 1.06-8.88, p = 0.04). Incidence of postoperative orchiepidydimitys was significantly higher in sclero-embolization group (OR 0.26 95% CI 0.08-0.85, p = 0.02). Presence of normal spermatozoa was significantly higher sclero-embolization group compared with the surgical ligature group (MD 2.54% 95% CI 0.43-4.65, p = 0.02). No difference was found in overall complications, wound infection, testis pain, surgical site hematoma, total sperm count, sperm motility, pregnancy and recurrence rate. This review confirms that current data does still not support the superiority of one type of treatment over other ones.
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Affiliation(s)
| | | | - Silvia Stramucci
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University of the Marche Region, Ancona, Italy
| | - Angelo Antezza
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University of the Marche Region, Ancona, Italy
| | - Virgilio De Stefano
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University of the Marche Region, Ancona, Italy
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University of the Marche Region, Ancona, Italy
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Morini D, Spaggiari G, Daolio J, Melli B, Nicoli A, De Feo G, Valli B, Viola D, Garganigo S, Magnani E, Pilia A, Polese A, Colla R, Simoni M, Aguzzoli L, Villani MT, Santi D. Improvement of sperm morphology after surgical varicocele repair. Andrology 2021; 9:1176-1184. [PMID: 33825345 PMCID: PMC8360177 DOI: 10.1111/andr.13012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/11/2021] [Accepted: 03/31/2021] [Indexed: 12/14/2022]
Abstract
Background A causative relationship between varicocele and impairment of semen quality has been largely investigated in the context of male infertility, although its clinical benefit remains controversial. Objective To investigate the effect of varicocele correction on detailed morphologic microscopic semen parameters in a large homogeneous cohort of patients and to evaluate which factors could predict semen improvement after the surgical treatment. Materials and methods An observational, retrospective cohort study was carried out including all patients undergoing surgical treatment for varicocele from September 2011 to March 2020 in the same clinical centre. Enrolled males performed at least one semen analysis before and one after surgical varicocele correction. Primary outcome was the detailed morphologic microscopic sperm evaluation. Secondary outcomes were conventional semen analyses. Results A total of 121 males (mean age 24.6 ± 6.1 years) were enrolled. Using detailed morphologic microscopic sperm evaluation, a significant morphological improvement was recorded, with a reduction in head and tail abnormalities. Moreover, a significant increase in sperm concentration (p = 0.015) and percentage of progressive and total motility (p = 0.022 and p = 0.039) were observed after surgery. The multivariate logistic analysis identified the ultrasonography varicocele degree before surgery as a main predictor of the sperm concentration improvement (p = 0.016), with the highest improvement for varicocele of I and II degree. Discussion For the first time, the detailed morphologic microscopic sperm evaluation highlights a relevant reduction in sperm abnormalities after varicocele surgery, showing its potential application in clinical practice.
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Affiliation(s)
- Daria Morini
- Department of Obstetrics and Gynaecology, Fertility Centre, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giorgia Spaggiari
- Unit of Endocrinology, Department of Medical Specialties, Ospedale Civile of Baggiovara, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Jessica Daolio
- Department of Obstetrics and Gynaecology, Fertility Centre, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Beatrice Melli
- Department of Obstetrics and Gynaecology, Fertility Centre, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,International PhD School in Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, Modena, Italy
| | - Alessia Nicoli
- Department of Obstetrics and Gynaecology, Fertility Centre, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gaetano De Feo
- Department of Obstetrics and Gynaecology, Fertility Centre, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Barbara Valli
- Department of Obstetrics and Gynaecology, Fertility Centre, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Domenico Viola
- Department of Urology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Simona Garganigo
- Chemical-Clinical and Endocrinology Analysis Laboratory Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Elena Magnani
- Chemical-Clinical and Endocrinology Analysis Laboratory Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Annalisa Pilia
- Chemical-Clinical and Endocrinology Analysis Laboratory Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Alessandra Polese
- Chemical-Clinical and Endocrinology Analysis Laboratory Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Rossana Colla
- Chemical-Clinical and Endocrinology Analysis Laboratory Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Manuela Simoni
- Unit of Endocrinology, Department of Medical Specialties, Ospedale Civile of Baggiovara, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Aguzzoli
- Department of Obstetrics and Gynaecology, Fertility Centre, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria Teresa Villani
- Department of Obstetrics and Gynaecology, Fertility Centre, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Daniele Santi
- Unit of Endocrinology, Department of Medical Specialties, Ospedale Civile of Baggiovara, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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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.
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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
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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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Abd El Rahman SH, Rashed LA, Akl EM, Mostafa T. Assessment of seminal YKL-40 in infertile men with varicocele. Andrologia 2020; 52:e13756. [PMID: 32654211 DOI: 10.1111/and.13756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 02/05/2023] Open
Abstract
Several studies attempted to explain the negative impact of varicocele on spermatogenesis and fertilisation processes. YKL-40 is a novel glycoprotein biomarker that had been associated with several diseases. This quasi-interventional study aimed to assess the seminal levels of YKL-40 in infertile men with varicocele before and after varicocelectomy. Overall, 50 men were included in this study divided into 20 healthy fertile men and 30 infertile oligoasthenoteratozoospermic (OAT) men with varicocele that underwent varicocelectomy. All participants were subjected to history taking, clinical examination and scrotal Doppler. Also, semen analysis and seminal YKL-40 assessment were carried out in the start and 6 months after varicocele surgical repair. The results showed a significant increase in the mean seminal YKL-40 level in infertile OAT men with varicocele compared with the healthy fertile men. Six months post-varicocelectomy, the mean seminal KYL-40 level exhibited significant decreases correlated with improved sperm parameters. Overall, seminal levels of YKL-40 showed significant negative correlations with sperm concentration, total sperm motility and sperm normal morphology. It could be concluded that seminal YKL-40 is elevated in infertile OAT men with varicocele where varicocelectomy induces decreased seminal YKL-40 levels correlated with improved semen parameters.
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Affiliation(s)
- Sherine H Abd El Rahman
- Department of Dermatology, Venereology & Andrology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Laila A Rashed
- Department of Biochemistry and Molecular Biology Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Essam M Akl
- Department of Dermatology, Venereology & Andrology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Taymour Mostafa
- Department of Andrology & Sexology, Faculty of Medicine, Cairo University, Cairo, Egypt
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