Nationwide survey to evaluate the prevalence of varicoceles in South Korean middle school boys: a population based study

Association between body mass index and varicocele among 211 989 Chinese reproductive-age males

Objectives

To explore the relationship between body mass index and varicocele, the range of body mass index that leads to increased odds of varicocele, and the association between body mass index with the position and grade of varicocele.

Methods

We conducted a cross‐sectional study of 211 989 Chinese males aged 18–65 years participated in the National Free Pre‐conception Check‐up Projects from January 2013 to December 2018. Univariate and multivariate logistic regression models were constructed to assess the association between body mass index and varicocele.

Results

Overweight and obese males had 13.1% (odds ratio 0.869, 95% confidence interval 0.838–0.902) and 32.3% (odds ratio 0.677, 95% confidence interval 0.632–0.725) lower odds of varicocele than those with normal body mass index, respectively. The association between them was non‐linear, and males with body mass index of 17.74 to 23.09 kg/m² had an increased odds of varicocele. The overweight and obese males had lower odds of left and bilateral varicocele, but the right varicocele odds was increased by 63.3% in obese males.

Conclusion

Body mass index was associated with the odds of varicocele among reproductive‐age males, but the odds varied by position. The effects of weight management and varicocele on fertility should be taken into account in fertility guidance.

10-year experience of Paediatric varicocele embolization in a tertiary centre with long-term follow-up

INTRODUCTION

Paediatric varicocele embolization has many benefits over surgical ligation, but lacks published long-term data. We investigated technical and clinical outcomes in this under reported patient group.

OBJECTIVE

To evaluate technical success, complications and recurrence rates following varicocele embolization in paediatric patients.

MATERIALS AND METHODS

A single-centre retrospective review of procedural data and electronic notes of consecutive patients referred for varicocele embolization over a 10-year period was performed (February 2010-March 2020). The primary outcomes were technical success and clinical efficacy (lack of symptom recurrence). Secondary outcomes included complications, testicular vein size reduction and procedural parameters including radiation exposure. Chi-square analysis was used to identify predictors of clinical success. Follow-up involved outpatient clinical assessment and telephone interview.

RESULTS

40 patients (median age 15) were referred for left-sided symptomatic varicocele. Technical embolization success was achieved in 36/40 patients (90%), with 4 procedures abandoned (inaccessible vein). Embolization technique was platinum-based coils ± sclerosant. There were no immediate or long-term procedural complications. 32/36 patients completed short term follow-up at a median interval of 2.8 months. 30/32 (93.78%) experienced early clinical success. We found a significant reduction in peritesticular vein size following embolization (pre-3.70 vs post-2.56 mm, p = 0.00017) and a significant relationship between varicocele grade and early clinical success (χ2 = 4.2, p = 0.04), but not pre-treatment peritesticular vein size (χ2 = 0.02, p = 0.88). 33/36 patients completed long-term follow-up (median 4.2 years, range 0.36-9.9 years) producing a late clinical success rate of 93.9% (31/33). No post procedural complications including hydroceles were identified.

DISCUSSION

This study demonstrates technical success, matching rates described in adult patients which is reassuring and in support of embolization in the younger patient cohort. More importantly, the overall clinical success rate is comparable with previous embolization studies. Reassuringly, all symptom recurrences occurred early in follow-up, and there is a cogent argument for a single follow-up appointment at this juncture. Our long-term average follow-up duration, primarily gained via telephone interview, exceeds other studies. Although our study has the longest follow-up for varicocele embolization in children, it is limited by a few patients being lost to early and long-term follow-up. This is a recognised issue faced by studies attempting to follow-up benign conditions with a high clinical success rate.

CONCLUSION

Paediatric varicocele embolization is a successful alternative to surgical ligation, with no complications and good clinical outcomes over a long-term follow-up.

The association between body mass index and varicocele: A meta-analysis

Objective:

Recently, several studies have found that obesity had a protective effect against varicocele, but no meta-analysis has confirmed this finding. Therefore, we conducted this meta-analysis to investigate the association between body mass index (BMI) and varicocele.

Material and Methods:

We searched for studies in PubMed, Science Direct and the Cochrane Library from inception until February 2018. The association between BMI and varicocele was assessed by pooling the odds ratios (ORs).

Results:

Eleven eligible studies with a total study population of 1.376.658 participants were included in our analysis. According to BMI, the subjects were defined as belonging to the obese, overweight and underweight groups. Our results showed that the obese group had a lower risk of varicocele when compared with the normal weight group (odds ratio [OR] 0.46, 95% confidence intervals [CIs] 0.37-0.58). Additionally, an overweight BMI had a protective effect against varicocele (OR 0.70, 95% CIs, 0.56-0.86). However, underweight patients had a more than 30% higher risk of varicocele (OR 1.31, 95% CI, 1.04-1.64). Furthermore, there was no publication bias in any of the analyses.

Conclusions:

Our study demonstrates that BMI is negatively associated with the presence of varicocele.

Effect of somatometric parameters on the prevalence and severity of varicocele: a systematic review and meta-analysis

BACKGROUND

Published studies have shown contradictory results regarding the relationship between somatometric parameters and varicoceles. We performed a systematic review and meta-analysis to investigate the possible effects of age, height, weight, and body mass index (BMI) on the presence and severity of varicoceles.

METHODS

Databases including EMBASE, MEDLINE, PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), Web of Science, and Google Scholar were systematically searched to identify relevant articles published up to March 2020. Two researchers independently identified eligible articles and extracted data. Cochran's Q statistic and I² statistics were used to assess heterogeneity. Meta-analysis was performed using StataSE 12.0 software (StataCorp LP, USA). Random-effects models were used to obtain the weighted mean differences (WMDs) and 95% confidence intervals (CIs). Publication bias was assessed using Begg's funnel plot and Egger's regression test.

RESULTS

The search strategy produced 272 articles, of which 18 articles were eligible according to the inclusion/exclusion criteria. A total of 56,325 patients with varicocele and 1,334,694 patients without varicocele were included in the meta-analysis to evaluate the effect of somatometric parameters on the presence and severity of varicocele. The overall results demonstrated that the presence of varicoceles was significantly associated with height (WMD = 1.41, 95% CI = 1.07 to 1.74, P < 0.001) and inversely correlated with BMI (WMD = - 1.35, 95% CI = -1.67 to - 1.03, P < 0.001) but not with age (WMD = -0.93, 95% CI = -2.19 to 0.33, P = 0.149) or weight (WMD = 0.24, 95% CI = -2.24 to 2.72, P = 0.850). The severity of varicocele was inversely correlated with increased BMI but not with age.

CONCLUSION

The presence of varicoceles was significantly associated with height and inversely correlated with BMI.

Epidemiology of varicocele

Varicocele is a common problem in reproductive medicine practice. A varicocele is identified in 15% of healthy men and up to 35% of men with primary infertility. The exact pathophysiology of varicoceles is not very well understood, especially regarding its effect on male infertility. We have conducted a systematic review of studies evaluating the epidemiology of varicocele in the general population and in men presenting with infertility. In this article, we have identified some of the factors that can influence the epidemiological aspects of varicoceles. We also recognize that varicocele epidemiology remains incompletely understood, and there is a need for well-designed, large-scale studies to fully define the epidemiological aspects of this condition.

Varicocele and infertility: Role of pressure flow dynamics

Varicocele is prevalent in infertile individuals as well as in normal adolescents and adults. It has an increasing trend with growing age. Infertile individuals with varicocele, develop varying degrees of sperm abnormalities that range from mild to severe semen abnormalities, even azoospermia may develop. The main proposed features of these abnormalities are incompetence of one-way valves of the draining veins of testes, that allow backflow of blood into testes. This backflow produces abnormally high intra-testicular pressure and temperature, that has been confirmed by thermography and pressure estimation in various studies. Microsurgical varicocelectomy may reverse the pathologic effects on spermatogenesis in most patients, which points towards the cause and effect relationship of varicocele with testicular damage. We propose that the prolonged effect of gravity might or may not be the initiating factor for varicocele, as in our experience, around 1/4^th of hypogonadotropic hypogonadism patients who had no varicocele before treatment, developed varicocele within 3 to 6 mo of treatment with gonadotropins. Occasionally varicocele is produced by “Nutcracker phenomenon”, which is compression of left renal vein between the abdominal aorta and superior mesenteric artery. The deleterious effects of varicocele may develop slowly, causing delayed secondary infertility or rapidly, leading to azoospermia or individual may be spared of damage due to unknown factors that need further research.

[Variocele in adolescents]

Up to 20% of adolescents have a varicocele. Often a varicocele is an incidental finding during a physical examination. However, adolescents with a varicocele might suffer from pain or they may have noticed a difference in the volume of the testes. The diagnostic investigation of the ejaculate in adolescents is difficult because no age-dependent spermiogram standard values exist. Endocrinological tests are also difficult because of the physiological variability of testosterone and gonadotropins during adolescence. The difference in testes volume normalizes in half of the boys without any therapy during maturation. Most adolescents with a varicocele have a normal semen analysis. The sperm parameters are the most important factor for treatment decision making.If sperm concentration, motility, and morphology are normal, active surveillance with regular control examinations are recommended even if the volume of the testis is divergent. Pathologic sperm parameters should lead to an operative treatment. The microsurgical subinguinal technique is the method of choice due to the low complication and reoperation rates. The sperm concentration, morphology, and motility increase postoperatively as well as the volume of the testis. It is not clear whether the improved sperm parameters lead to improved spontaneous pregnancy rates later in life. Whether scrotal pain decreases after operative therapy is uncertain because of the subjectivity of pain.Until now there are only a few studies with small and very heterogeneous case numbers so that no clear recommendation for the treatment of a varicocele in adolescents can be made. The difficulty in the treatment decision-making is preventing reduced fertility, while avoiding overtreatment.

[Varicocele in adolescents]

Testicular varicocele is present in 15 % of adolescent boys. The very impact of this pathology and who will be at risk of developing into infertility remains unclear. Research on the pathophysiology, results of surgical or radiological interventions and potential predictors for long-term impairment of spermatogenesis and thus fertility is still ongoing. Indications for treatment are mainly based on differences in testicular volumes as semen parameters are most often not available; however, whether testicular volume is a valuable prognostic parameter for later fertility remains questionable. Approximately 50 % of adolescent patients with varicocele experience spontaneous increase of testicular volume without any intervention.

The evolving role of laparoscopic surgery in paediatric urology

OBJECTIVES

We review the various applications of laparoscopic and robotic-assisted laparoscopy in paediatric urology, as the laparoscopic and robotic approach in this population is gradually being recognised.

METHODS

We searched PubMed for human studies in English that were published between 1990 and the present, focusing on laparoscopic nephrectomies and partial nephrectomies, laparoscopic and robotic pyeloplasties and ureteric reimplantation, laparoscopic orchidopexy and varicocelectomy. We also reviewed robotic-assisted laparoscopic urological major reconstructions. Key articles were reviewed, extracting the indications, techniques, and the advantages and disadvantages.

RESULTS AND CONCLUSIONS

Laparoscopy has a defined place in modern paediatric urological surgery. Laparoscopic nephrectomies, pyeloplasties and abdominal exploration for the evaluation and management of impalpable undescended testicles have become the standard of care. Robotic-assisted laparoscopic surgery is developing as a safe and effective option even for infant patients.