1
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Lira Neto FT, Roque M, Esteves SC. Effect of varicocele and varicocelectomy on sperm deoxyribonucleic acid fragmentation rates in infertile men with clinical varicocele. Minerva Obstet Gynecol 2024; 76:49-69. [PMID: 36222786 DOI: 10.23736/s2724-606x.22.05169-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Varicocele is the leading cause of male infertility. It can affect sperm quantity and quality through various non-mutually exclusive pathophysiological mechanisms, mainly oxidative stress. Excessive production of reactive oxygen species may overwhelm the sperm's defenses against oxidative stress and harm the sperm's DNA. Excessive sperm DNA breaks, so-called sperm DNA fragmentation, result from the oxidative stress cascade and are commonly found in the ejaculates of men with varicocele and fertility-related issues. Measuring sperm DNA fragmentation can provide valuable information on the extent of harm and might help select candidates for surgical treatment. Varicocelectomy is beneficial for alleviating oxidative stress-associated infertility and improving sperm DNA integrity. However, reproductive outcomes of infertile men with elevated sperm DNA fragmentation rates and surgically treated varicoceles remain poorly studied, and there is a need for well-designed trials to determine the impact of sperm DNA fragmentation reduction on natural and medically assisted reproduction.
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Affiliation(s)
- Filipe T Lira Neto
- AndrosRecife, Andrology Clinic, Recife, Brazil
- Department of Urology, Prof. Fernando Figueira Institute of Integrative Medicine, Recife, Brazil
| | - Matheus Roque
- Department of Reproductive Medicine, Mater Prime, São Paulo, Brazil
| | - Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, Brazil -
- Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, Brazil
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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2
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Kaltsas A, Dimitriadis F, Zachariou D, Zikopoulos A, Symeonidis EN, Markou E, Tien DMB, Takenaka A, Sofikitis N, Zachariou A. From Diagnosis to Treatment: Comprehensive Care by Reproductive Urologists in Assisted Reproductive Technology. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1835. [PMID: 37893553 PMCID: PMC10608107 DOI: 10.3390/medicina59101835] [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: 07/31/2023] [Revised: 09/28/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023]
Abstract
Infertility is a global health concern, with male factors playing an especially large role. Unfortunately, however, the contributions made by reproductive urologists in managing male infertility under assisted reproductive technology (ART) often go undervalued. This narrative review highlights the important role played by reproductive urologists in diagnosing and treating male infertility as well as any barriers they face when providing services. This manuscript presents a comprehensive review of reproductive urologists' role in managing male infertility, outlining their expertise in diagnosing and managing male infertility as well as reversible causes and performing surgical techniques such as sperm retrieval. This manuscript investigates the barriers limiting urologist involvement such as limited availability, awareness among healthcare professionals, and financial constraints. This study highlights a decrease in male fertility due to lifestyle factors like sedentary behavior, obesity, and substance abuse. It stresses the significance of conducting an evaluation process involving both male and female partners to identify any underlying factors contributing to infertility and to identify patients who do not require any interventions beyond ART. We conclude that engaging urologists more effectively in infertility management is key to optimizing fertility outcomes among couples undergoing assisted reproductive technology treatments and requires greater education among healthcare providers regarding the role urologists and lifestyle factors that could have an effect on male fertility.
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Affiliation(s)
- Aris Kaltsas
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.K.); (A.Z.); (N.S.)
| | - Fotios Dimitriadis
- Department of Urology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (F.D.); (E.N.S.)
| | - Dimitrios Zachariou
- Third Orthopaedic Department, National and Kapodestrian University of Athens, KAT General Hospital, 14561 Athens, Greece;
| | - Athanasios Zikopoulos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.K.); (A.Z.); (N.S.)
| | - Evangelos N. Symeonidis
- Department of Urology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (F.D.); (E.N.S.)
| | - Eleftheria Markou
- Department of Microbiology, University Hospital of Ioannina, 45500 Ioannina, Greece;
| | - Dung Mai Ba Tien
- Department of Andrology, Binh Dan Hospital, Ho Chi Minh City 70000, Vietnam;
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan;
| | - Nikolaos Sofikitis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.K.); (A.Z.); (N.S.)
| | - Athanasios Zachariou
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.K.); (A.Z.); (N.S.)
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Tian D, Yang C, Xie B, Li H, Li J, Yang D, Zhu Z. Effects of Varicocele Surgical Repair on Serum Hormone and Inhibin B Levels for Patients With Varicocele: A Systematic Review and Meta-Analysis. Am J Mens Health 2023; 17:15579883231199400. [PMID: 37694823 PMCID: PMC10496478 DOI: 10.1177/15579883231199400] [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: 02/21/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/12/2023] Open
Abstract
Varicocele surgical repair can improve the function of the testis for patients with varicocele. We carried out a systematic review and meta-analysis to assess the effects of varicocele surgical repair on serum hormones and inhibin B levels in patients with varicocele. A literature search was performed in August 2022, and no language or geographic region restrictions were applied. The search included the following databases: PubMed, Embase, and Medline. A literature review was performed to identify all published clinical trials assessing serum hormone and inhibin B levels before and after varicocele surgical repair. The reference lists of retrieved studies were also investigated. A systematic review and meta-analysis were conducted. Eight articles were selected from 162 articles, including 452 patients. The combined analysis showed that after surgical treatment, mean serum testosterone, inhibin B, and sperm concentration levels increased compared with preoperative levels (p < .05). After surgical treatment, mean serum follicle-stimulating hormon (FSH), and Luteinizing hormone (LH) levels decreased compared with preoperative levels (p < .05). This meta-analysis demonstrates that varicocele surgical repair can improve testicular function, increase serum testosterone, and inhibin B levels and decrease serum FSH and LH levels in patients with varicocele. This might be related to the improvement of infertility. A large-scale multicenter randomized controlled study is needed for further confirmation.
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Affiliation(s)
- Daxue Tian
- Department of Urology, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Chenchen Yang
- Department of Urology, Tengzhou Central People’s Hospital, Tengzhou, China
| | - Bing Xie
- Department of Medical Engineering, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Haijuan Li
- Department of Clinical Nutrition, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Jie Li
- Department of Anesthesiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Diandong Yang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Zaisheng Zhu
- Department of Urology, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
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4
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Alfozan M. Effect of Varicocelectomy on Serum Follicle-Stimulating Hormone and Testosterone; The Interrelationship Between Hormonal Variables. Res Rep Urol 2023; 15:47-53. [PMID: 36721463 PMCID: PMC9884447 DOI: 10.2147/rru.s383114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
Purpose The present study was conducted to analyze the effect of varicocelectomy on serum follicle-stimulating hormone (FSH) and testosterone. The interrelationship between seminal and hormonal variables is also investigated. Patients and Methods A prospective cohort study was conducted on patients of the urology clinic from 2012 to 2017. The study was conducted in the Security Forces Hospital, in Riyadh, Saudi Arabia. Infertile patients who had already undergone the FSH examination and testosterone twice were included in the study. Statistical Package for Social Sciences (SPSS) version 21.0 was used to analyze the data. Results A total of 186 patients were studied which reveals that the age group of 21-30 years was higher than other age groups 80 (43%), micro varicocelectomy was performed in 138 (74%) of patients and 79 (47%) patients had one-year infertility. The study assessed the effect of varicocelectomy on sperm count and motility serum FSH, testosterone, luteinizing hormone (LH), and prolactin, and it was found that none of the variables showed significant association after varicocelectomy, except for luteinizing hormone (P-value = 0.014). Testosterone levels in patients who had FSH ≤10 were also evaluated and it was found that the level of testosterone was increased with a decreased level of FSH (P-value = 0.005). Conclusion It was concluded from our results that after varicocelectomy, those patients who had FSH levels ≤10 were found to have increased testosterone levels. LH was also found to be significant; however, other hormones were not found to be significant. This may occur due to the reason that we have the majority of the participants in the age group 21-30. Further prospective studies are needed to evaluate the association with ample sample size.
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Affiliation(s)
- Mohammed Alfozan
- Department of Surgery, College of Medicine, Prince Sattam bin Abdulaziz University, Alkharj, 11942, Saudi Arabia,Correspondence: Mohammed Alfozan, Email
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Adams Y, Amidu N, Afoko AA. Changes in testicular arterial hemodynamic, gonadotropin levels, and semen parameters among varicocele patients randomized to varicocelectomy or observed in Tamale, Ghana. Urologia 2022:3915603221127116. [DOI: 10.1177/03915603221127116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: A randomized trial to compared testicular blood flow parameters, gonadal hormones, and semen characteristics among three groups; surgery group ( n = 127); observed group ( n = 114); and healthy controls ( n = 33). Methods: The blood flow parameter selected was resistive index (RI) measured using color Doppler ultrasonography. Serum total testosterone, FSH, LH were measured, and semen analysis performed at baseline and repeated 12 months of follow-up. The data was computed using GraphPad Prism (v8.0) at an alpha of 0.05. Results: In the observed group, increased +0.0060 in the right (R_RI) and in the left (L_RI) +0.0026 capsular arteries from baseline measurement to 12 months follow-up. Surgery group, reduced –0.079 in the right (R_RI) and −0.0731 in the left (L_RI) capsular arteries ( p < 0.0001). At 12 months, the changes for both left and right RIcap in the surgery group did not reach the values of the controls. In the surgery group, L_RIcap ( r = −0.63; p < 0.0001) and R_RIcap ( r = −0.49; p = 0.004) correlated with total testosterone, FSH ( r = 0.57; p = 0.001 for left; r = 0.52; p = 0.002 for right), and LH ( r = 0.61; p = 0.0002 for left; r = 0.41; p = 0.020 for right). Furthermore, L_RIcap correlated with changes in sperm count ( r = −0.46; p = 0.008) and sperm concentration ( r = −0.35; p = 0.011) in the surgery group. Conclusion: Microsurgical sub-inguinal varicocelectomy improves blood supply to the testicular tissues evidenced by reduced resistive index in the surgery group. Resistive index in the left capsular artery can be used to evaluate the success of surgery because it correlates with total testosterone, FSH, LH, and semen quality.
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Affiliation(s)
- Yussif Adams
- Department of Biomedical Laboratory Science, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Nafiu Amidu
- Department of Biomedical Laboratory Science, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Akisibadek Alekz Afoko
- Department of Surgery, Tamale Teaching Hospital
- Department of Surgery, School of Medicine, University for Development Studies, Tamale, Ghana
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Park YW, Lee JH. Long-term efficacy of varicocele repair in middle-aged men with erectile dysfunction (ED) and low testosterone: Five cases with follow-up from 16 to 60 months. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221078724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report five cases of middle-aged men with low testosterone levels and erectile dysfunction (ED) who were successfully treated with varicocelectomy with long-term follow-up. All five patients presented to our clinic with ED. Upon initial physical examination, each patient had varicoceles on his scrotum, and two consecutive morning samplings showed testosterone levels below 400 ng/mL. Age at varicocelectomy was from 40 to 53 years. Four patients underwent microscopic subinguinal varicocelectomy, whereas one patient underwent inguinal varicocelectomy. After surgery, testosterone increased in all cases, and the normal testosterone level was maintained during follow-up (16–60 months). In addition, all cases reported improvement of ED after surgery. In our clinical cases, microscopic varicocelectomy increased serum testosterone levels and improved erectile function, and this increase and improvement continued up to a follow-up of 60 months. Varicocelectomy would be a good option to treat testosterone deficiency in men with varicocele.
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Affiliation(s)
- Yeon Won Park
- Department of Urology, National Police Hospital, South Korea
| | - Jun Ho Lee
- Department of Urology, Nowon Eulji Medical Center, Eulji University, South Korea
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Marinaro J, Goldstein M. Microsurgical Management of Male Infertility: Compelling Evidence That Collaboration with Qualified Male Reproductive Urologists Enhances Assisted Reproductive Technology (ART) Outcomes. J Clin Med 2022; 11:jcm11154593. [PMID: 35956208 PMCID: PMC9369943 DOI: 10.3390/jcm11154593] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
A male factor plays a significant role in a couple's reproductive success. Today, advances in reproductive technology, such as intracytoplasmic sperm injection (ICSI), have allowed it to be possible for just a single sperm to fertilize an egg, thus, overcoming many of the traditional barriers to male fertility, such as a low sperm count, impaired motility, and abnormal morphology. Given these advances in reproductive technology, it has been questioned whether a reproductive urologist is needed for the evaluation and treatment of infertile and subfertile men. In this review, we aim to provide compelling evidence that collaboration between reproductive endocrinologists and reproductive urologists is essential for optimizing a couple's fertility outcomes, as well as for improving the health of infertile men and providing cost-effective care.
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Affiliation(s)
- Jessica Marinaro
- Department of Urology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Marc Goldstein
- Center for Male Reproductive Medicine and Microsurgery, Weill Cornell Medicine, 525 East 68th St., Starr Pavilion, 9th Floor (Starr 900), New York, NY 10065, USA
- Correspondence:
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Bellastella G, Carotenuto R, Caiazzo F, Longo M, Cirillo P, Scappaticcio L, Carbone C, Arcaniolo D, Maiorino MI, Esposito K. Varicocele: An Endocrinological Perspective. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:863695. [PMID: 36303641 PMCID: PMC9580708 DOI: 10.3389/frph.2022.863695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/24/2022] [Indexed: 12/02/2022] Open
Abstract
Varicocele affects 15% of male population but it is more frequently identified in patients searching medical care for infertility. The impact of varicocele on semen production and fertility is known, but the relationship between clinical varicocele and impaired hormonal production is not clear. In published literature there are some studies regarding hormonal alterations in patients with varicocele but no review in which all the hormonal findings are explained. The aim of this review is to evaluate, by most common search engine, what is known about hormonal alterations in varicocele-bearing patients, to verify if a cause-effect relationship is documented and to give a useful contribution to in clinical management of this kind of patients. We found contradictory results about hormonal status from literature. Some studies confirmed a decrease of testosterone levels and higher FSH and LH levels that normalize after varicocelectomy, others found lower than normal levels of dihydrotestosterone due to decreased activity of epididymal 5-α-reductase. Lower circulating Anti-Müllerian Hormone levels, accompanied by a decreased Inhibin-B level, were reported as indicators of the decreased Sertoli cells function in varicocele-bearing adult patients. The finding of higher basal 17-OH-progesterone concentrations in patients with varicocele was explained by some authors with a testicular C-17,20-lyase deficiency. There is no doubt that varicocele could led to hormonal alterations. This review proposes that the impaired free sexual steroid levels are the result of a slight, deep-rooted defect in the testes of a certain amount of men with varicocele but further multicentre, randomized controlled studies remain mandatory to better clarify the hormonal features of patients with varicocele and to assess the utility of hormonal evaluation for establishing the duration of varicocele and for better identifying patients who need surgical correction.
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Affiliation(s)
- Giuseppe Bellastella
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,”Naples, Italy
- *Correspondence: Giuseppe Bellastella
| | - Raffaela Carotenuto
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Francesco Caiazzo
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Miriam Longo
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Paolo Cirillo
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Lorenzo Scappaticcio
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Carla Carbone
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Davide Arcaniolo
- Urology Unit, Department of Woman Child and of General and Specialist Surgery, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Maria Ida Maiorino
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Katherine Esposito
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,”Naples, Italy
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Cannarella R, Condorelli RA, Perelli S, Calogero AE, Greco E, Aversa A, La Vignera S. Is Chronic Varicocele a Risk Factor for Secondary Hyperparathyroidism? J Clin Med 2022; 11:jcm11030716. [PMID: 35160168 PMCID: PMC8836852 DOI: 10.3390/jcm11030716] [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: 11/17/2021] [Revised: 01/05/2022] [Accepted: 01/27/2022] [Indexed: 12/02/2022] Open
Abstract
Objective: To assess whether varicocele affects testicular 25-hydroxylase activity. Methods: Twenty normozoospermic patients with bilateral varicocele (grade III according to the Dubin and Amelar classification) without indications to undergo varicocele repair (normal sperm parameters and testicular volume; no scrotal pain) were consecutively enrolled and followed-up for four years. Serum levels of parathyroid hormone (PTH), calcium, and 25-hydroxy-cholecalciferol [25(OH)D] along with serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone (TT), conventional sperm parameters, sperm DNA fragmentation (SDF) rate, and testicular volume (TV) were measured annually for three years. PTH, calcium, and 25(OH)D serum levels over time were compared with those of age- and body mass index (BMI)-matched control group of twenty varicocelectomized patients. Main results: Both intra- and between-group analyses showed that serum PTH levels increased significantly over time in parallel with a significant decline in 25(OH)D levels. Serum calcium levels did not change significantly. At the same time, signs of mild Leydig and Sertoli cell dysfunction were found, such as an increase in gonadotropins and decreased TT and VT. However, conventional sperm parameters and SDF rate did not change significantly. Conclusion: This prospective controlled study provides the first evidence of a negative impact of bilateral grade III varicocele on testicular 25-hydroxylase activity. Accordingly, the patients included in this study showed a significant increase in PTH and a decrease in 25(OH)D levels over time. Patients with varicocele deserve endocrinologic counseling.
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Affiliation(s)
- Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (R.C.); (R.A.C.); (S.P.); (A.E.C.)
| | - Rosita A. Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (R.C.); (R.A.C.); (S.P.); (A.E.C.)
| | - Sarah Perelli
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (R.C.); (R.A.C.); (S.P.); (A.E.C.)
| | - Aldo E. Calogero
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (R.C.); (R.A.C.); (S.P.); (A.E.C.)
| | - Emanuela Greco
- Department of Health Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Antonio Aversa
- Department of Experimental and Clinical Medicine, University “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (R.C.); (R.A.C.); (S.P.); (A.E.C.)
- Correspondence: ; Fax: +39-95-3781180
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Mahdavinezhad F, Farmani AR, Pakniat H, Taghavi S, Gharaei R, Valipour J, Amidi F. COVID-19 and varicocele: the possible overlap factors and the common therapeutic approaches. Am J Reprod Immunol 2021; 87:e13518. [PMID: 34967487 DOI: 10.1111/aji.13518] [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: 07/20/2021] [Revised: 12/02/2021] [Accepted: 12/27/2021] [Indexed: 12/15/2022] Open
Abstract
Varicocele is recognized as one of the main attributable causes of male infertility which can affect spermatogenesis by various pathophysiological mechanisms. Recent studies have identified oxidative stress and reduction in antioxidant, hyperthermia, hypoxia, hormonal dysfunction, and inflammatory conditions as major factors in the pathophysiology of varicocele, all of which have known direct associations with the coronavirus disease 2019 (COVID-19) and can significantly increase the risk of detrimental COVID-19-related outcomes. Emerging data have shown an association between COVID-19 and inflammation, overproduction of cytokine, and other pathophysiological processes. The present review, summarizes the current understanding of the pathophysiology of varicocele and investigates the potential correlation between the severity of COVID-19 and the varicocele disease. In addition, various possible treatments which can be effective in both diseases were examined. Despite numerous challenges associated with the prevalence of COVID-19 in healthcare systems in infected countries, special attention should be given to maintaining a high level of care for complex patients with a pre-existing disease such as varicocele and providing appropriate practical advice for optimal control of the COVID-19 disease. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Forough Mahdavinezhad
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Farmani
- Department of Tissue Engineering, Faculty of Advanced Technologies, Tehran University of Medical Sciences, Tehran, Iran.,Tissue Engineering Department, School of Advanced Technologies in Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Hamideh Pakniat
- Department of Obstetrics and Gynecology, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Saeed Taghavi
- Iran Polymer and Petrochemical Institute, Tehran, Iran
| | - Roghaye Gharaei
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Jamal Valipour
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fardin Amidi
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Department of Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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11
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Lira Neto FT, Roque M, Esteves SC. Effect of varicocelectomy on sperm deoxyribonucleic acid fragmentation rates in infertile men with clinical varicocele: a systematic review and meta-analysis. Fertil Steril 2021; 116:696-712. [PMID: 33985792 DOI: 10.1016/j.fertnstert.2021.04.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/04/2021] [Accepted: 04/06/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the effect of varicocelectomy on sperm deoxyribonucleic acid fragmentation (SDF) rates in infertile men with clinical varicocele. DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENT(S) Infertile men with clinical varicocele subjected to varicocelectomy. INTERVENTION(S) Systematic search using PubMed/Medline, EMBASE, Cochrane's central database, Scielo, and Google Scholar to identify relevant studies published from inception until January 2021. We included studies comparing SDF rates before and after varicocelectomy in infertile men with clinical varicocele. MAIN OUTCOME MEASURE(S) The primary outcome was the difference between the SDF rates before and after varicocelectomy. A meta-analysis of weighted data using random-effects models was performed. Results were reported as weighted mean differences (WMD) with 95% confidence intervals (CIs). Subgroup analyses were performed on the basis of the SDF assay, varicocelectomy technique, preoperative SDF levels, varicocele grade, follow-up time, and study design. RESULT(S) Nineteen studies involving 1,070 patients provided SDF data. Varicocelectomy was associated with reduced postoperative SDF rates (WMD -7.23%; 95% CI: -8.86 to -5.59; I2 = 91%). The treatment effect size was moderate (Cohen's d = 0.68; 95% CI: 0.77 to 0.60). The pooled results were consistent for studies using sperm chromatin structure assay, terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling, sperm chromatin dispersion test, and microsurgical varicocele repair. Subgroup analyses showed that the treatment effect was more pronounced in men with elevated vs. normal preoperative SDF levels, but the impact of varicocele grade remained equivocal. Meta-regression analysis demonstrated that SDF decreased after varicocelectomy as a function of preoperative SDF levels (coefficient: 0.23; 95% CI: 0.07 to 0.39). CONCLUSION(S) We concluded that pooled results from studies including infertile men with clinical varicocele indicated that varicocelectomy reduced the SDF rates. The treatment effect was greater in men with elevated (vs. normal) preoperative SDF levels. Further research is required to determine the full clinical implications of SDF reduction for these men.
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Affiliation(s)
- Filipe Tenório Lira Neto
- Andros Recife, Andrology Clinic, Recife, Brazil; Department of Urology, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
| | - Matheus Roque
- Department of Reproductive Medicine, Mater Prime, 04029-200 São Paulo, Brazil
| | - Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, 13075-460 Campinas, Brazil; Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, Brazil; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
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12
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Kang C, Punjani N, Lee RK, Li PS, Goldstein M. Effect of varicoceles on spermatogenesis. Semin Cell Dev Biol 2021; 121:114-124. [PMID: 33965333 DOI: 10.1016/j.semcdb.2021.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/05/2021] [Indexed: 12/12/2022]
Abstract
Varicoceles are dilated veins within the spermatic cord and a relatively common occurrence in men. Fortunately, the large majority of men are asymptomatic, however, a proportion of men with varicoceles can suffer from infertility and testosterone deficiency. Sperm and testosterone are produced within the testis, and any alteration to the testicular environment can negatively affect the cells responsible for these processes. The negative impact of varicoceles on testicular function occurs mainly due to increased oxidative stress within the testicular parenchyma which is thought to be caused by scrotal hyperthermia, testicular hypoxia, and blood-testis barrier disruption. Management of varicoceles involves ligation or percutaneous embolization of the dilated veins. Repair of varicoceles can improve semen parameters and fertility, along with serum testosterone concentration. In this review, we discuss the pathophysiology of varicoceles, their impact on testicular function, and management.
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Affiliation(s)
- Caroline Kang
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, 525 East 68th Street, Starr 900, New York, NY 10065, United States.
| | - Nahid Punjani
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, 525 East 68th Street, Starr 900, New York, NY 10065, United States.
| | - Richard K Lee
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, 525 East 68th Street, Starr 900, New York, NY 10065, United States.
| | - Philip S Li
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, 525 East 68th Street, Starr 900, New York, NY 10065, United States.
| | - Marc Goldstein
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, 525 East 68th Street, Starr 900, New York, NY 10065, United States.
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13
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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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14
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Neto FTL, Marques RA, de Freitas Cavalcanti Filho A, Araujo LCN, Lima SVC, Pinto L, Silva RO. 1H NMR-based metabonomics for infertility diagnosis in men with varicocele. J Assist Reprod Genet 2020; 37:2233-2247. [PMID: 32715373 PMCID: PMC7492286 DOI: 10.1007/s10815-020-01896-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 07/16/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE "Omics" techniques have been used to understand and to identify biomarkers of male infertility. We report on the first metabonomics models created to diagnose varicocele and infertility among men with varicocele. METHODS We recruited 35 infertile men with varicocele (VI group), 21 fertile men with varicocele (VF group) and 24 fertile men without varicocele (C group). All men underwent standard semen analysis, scrotal duplex ultrasonography, and sexual hormone level measurement. Hydrogen-1 nuclear magnetic resonance (1H NMR) spectra of seminal plasma were used to create metabonomics models to discriminate between men with and without varicocele, and between fertile and infertile men with varicocele. RESULTS Using the statistical formalisms partial least square discriminants analysis and genetic algorithm-based linear discriminant analysis (GA-LDA), we created two models that discriminated the three groups from each other with accuracy of 92.17%. We also created metabonomics models using orthogonal partial least square discriminants analysis and GA-LDA that discriminated VF group from VI group, with an accuracy of 94.64% and 100% respectively. We identified 19 metabolites that were important in group segregation: caprate, 2-hydroxy-3-methylvalerate, leucine, valine, 3-hydroxybutyrate, lactate, alanine, 4-aminobutyrate, isoleucine, citrate, methanol, glucose, glycosides, glycerol-3-phosphocoline, n-acetyltyrosine, glutamine, tyrosine, arginine, and uridine. CONCLUSIONS 1HNMR-based metabonomics of seminal plasma can be used to create metabonomics models to discriminate between men with varicocele from those without varicocele, and between fertile men with varicocele from those infertile with varicocele. Furthermore, the most important metabolites for group segregation are involved in the oxidative stress caused by varicocele.
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Affiliation(s)
- Filipe Tenorio Lira Neto
- Department of Surgery, Universidade Federal de Pernambuco, Rua Guilherme Salazar, n 150, apt 601E, Recife, PE ZIP 52061-275 Brazil
- Instituto de Medicina Integral Prof. Fernando Figueira, Rua dos Coelho, 300, Coelhos, Recife, PE ZIP 50070-902 Brazil
| | - Ronmilson Alves Marques
- Fundamental Chemistry Department, Universidade Federal de Pernambuco, Av. Jornalista Anibal Fernandes, s/n° Cidade Universitária, Recife, PE ZIP 50740-560 Brazil
| | | | | | - Salvador Vilar Correia Lima
- Department of Surgery, Universidade Federal de Pernambuco, Hospital das Clínicas - Campus UFPE, Av. Prof. Moraes Rego,”s/n° - Bloco “A” - Térreo Cidade Universitária, Recife, PE ZIP 50670-420 Brazil
| | - Licarion Pinto
- Fundamental Chemistry Department, Universidade Federal de Pernambuco, Av. Jornalista Anibal Fernandes, s/n° Cidade Universitária, Recife, PE ZIP 50740-560 Brazil
| | - Ricardo Oliveira Silva
- Fundamental Chemistry Department, Universidade Federal de Pernambuco, Av. Jornalista Anibal Fernandes, s/n° Cidade Universitária, Recife, PE ZIP 50740-560 Brazil
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15
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Çayan S, Akbay E, Saylam B, Kadıoğlu A. Effect of Varicocele and Its Treatment on Testosterone in Hypogonadal Men with Varicocele: Review of the Literature. Balkan Med J 2020; 37:121-124. [PMID: 32070086 PMCID: PMC7161614 DOI: 10.4274/balkanmedj.galenos.2020.2020.1.85] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Varicocele might cause deterioration in Leydig cell functions, and it is a significant risk factor for hypogonadism. Some controversial issues have been raised in the treatment of hypogonadal men with varicoceles. Symptomatic hypogonadal men with varicoceles have two options: testosterone replacement therapy or varicocele treatment. Both approaches have some advantages and disadvantages. This review summarizes the effect of varicoceles on total plasma testosterone level and addresses whether varicocele repair is effective to improve testosterone levels in hypogonadal men with varicoceles. Experience from large clinical studies in the literature suggests that varicocele repair may increase serum testosterone level in men with varicoceles and testosterone deficiency. Varicocele repair could be offered to men with clinically palpable varicocele and hypogonadism. As the treatment method, microsurgical varicocele repair could be preferred to provide the best improvement. Another advantage of varicocele repair for hypogonadism, instead of exogenous testosterone treatment, is its ability to preserve the fertility status in men who may desire a child in the future. However, further studies are required to clarify varicocel-related Leydig cell dysfunction and to advise hypogonadal patients about the sufficient effectiveness of varicocele repair.
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Affiliation(s)
- Selahittin Çayan
- Department of Urology, Mersin University School of Medicine, Mersin, Turkey
| | - Erdem Akbay
- Department of Urology, Mersin University School of Medicine, Mersin, Turkey
| | - Barış Saylam
- Department of Urology, Mersin University School of Medicine, Mersin, Turkey
| | - Ateş Kadıoğlu
- Department of Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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16
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Nicopoullos J, Vicens-Morton A, Lewis SEM, Lee K, Larsen P, Ramsay J, Yap T, Minhas S. Novel use of COMET parameters of sperm DNA damage may increase its utility to diagnose male infertility and predict live births following both IVF and ICSI. Hum Reprod 2019; 34:1915-1923. [DOI: 10.1093/humrep/dez151] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 06/19/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
STUDY QUESTION
Do the Comet parameters of the proportions of sperm with low or high DNA damage improve the power of the test in the diagnosis of male infertility and/or prediction of IVF and ICSI live birth rates?
SUMMARY ANSWER
The mean Comet score and the scores for proportions of sperm with high or low DNA damage were useful in diagnosing male infertility and provided additional discriminatory information for the prediction of both IVF and ICSI live births.
WHAT IS KNOWN ALREADY
Sperm DNA damage impacts adversely on male fertility and IVF outcomes.
STUDY DESIGN, SIZE, DURATION
A retrospective study was performed involving a total of 457 participants (381 patients and 76 fertile donors). Data was collected from a fertility clinic between 2015 and 2017.
PARTICIPANTS/MATERIALS, SETTING, METHODS
A total of 381 consecutive male partners of couples attending for ART and 76 fertile donors were included in the study. DNA fragmentation was measured by the alkaline Comet assay. Receiver operator characteristic curve analysis (area under the ROC curve (AUC)) was used to determine the value of average Comet score (ACS), low Comet score (LCS) and high Comet score (HCS) to diagnose male factor infertility. In total, 77 IVF and 226 ICSI cycles were included to determine thresholds for each parameter (AUC analysis) and to compare live birth rates (LBRs) following each ART.
MAIN RESULTS AND THE ROLE OF CHANCE
ACS, HCS and LCS were predictive of male infertility (AUC > 0.9, P < 0.0001). IVF LBRs declined once DNA damage exceeded the threshold levels. HCS showed the sharpest decline. Following ICSI, the highest LBRs were in men whose DNA damage levels approached the fertile range. Trends differed in IVF. LBRs decreased as damage increased whereas in ICSI the LBRs decreased but then remained stable.
LIMITATIONS, REASONS FOR CAUTION
Since this is the first study to show the impact of sperm DNA damage on ICSI live births, a prospective study should be performed (stratifying patients to IVF or ICSI based on these thresholds) to validate this study.
WIDER IMPLICATIONS OF THE FINDINGS
Our study presents novel information towards elucidating the genetic basis of male infertility and secondly on relevance of the extent of DNA damage as an impending factor in both IVF and ICSI success.
STUDY FUNDING/COMPETING INTEREST(S)
This study was supported by Examenlab Ltd, The Lister Clinic, Cryos International and Imperial College London NHS Trust. No external funding was obtained for this study. SL and KL are employees of Examenlab Ltd, a university spin-out company with a commercial interest in sperm DNA damage. No other author has a conflict of interest to declare.
TRIAL REGISTRATION NUMBER
Non-applicable.
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Affiliation(s)
- James Nicopoullos
- Fertility department, Lister Fertility Clinic, Chelsea Bridge Rd, London, UK
| | - Andrew Vicens-Morton
- Urology department, Guy’s Hospital, Great Maze Pond, London, UK
- Urology department, Parc de Salut Mar, Passeig Marítim de la Barceloneta, Barcelona, Spain
| | - Sheena E M Lewis
- Examenlab, Weavers Court Business Park, Linfield Road, Belfast, Northern Ireland, UK
| | - Kathryn Lee
- Examenlab, Weavers Court Business Park, Linfield Road, Belfast, Northern Ireland, UK
| | - Peter Larsen
- Cryos International, Vesterbro Torv 1, 8000 Aarhus, Denmark
| | - Jonathan Ramsay
- Urology department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London UK
| | - Tet Yap
- Urology department, Guy’s Hospital, Great Maze Pond, London, UK
| | - Suks Minhas
- Urology department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London UK
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17
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Cannarella R, Calogero AE, Condorelli RA, Giacone F, Aversa A, La Vignera S. Management and Treatment of Varicocele in Children and Adolescents: An Endocrinologic Perspective. J Clin Med 2019; 8:E1410. [PMID: 31500355 PMCID: PMC6780349 DOI: 10.3390/jcm8091410] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/25/2019] [Accepted: 09/03/2019] [Indexed: 11/16/2022] Open
Abstract
Pediatric varicocele has an overall prevalence of 15%, being more frequent as puberty begins. It can damage testicular function, interfering with Sertoli cell proliferation and hormone secretion, testicular growth and spermatogenesis. Proper management has a pivotal role for future fertility preservation. The aim of this review was to discuss the diagnosis, management and treatment of childhood and adolescent varicocele from an endocrinologic perspective, illustrating the current evidence of the European Society of Pediatric Urology (ESPU), the European Association of Urology (EAU), the American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM) scientific societies. According to the ASRM/ESPU/AUA practice committee, the treatment of adolescent varicocele is indicated in the case of decreased testicular volume or sperm abnormalities, while it is contraindicated in subclinical varicocele. The recent EAS/ESPU meta-analysis reports that moderate evidence exists on the benefits of varicocele treatment in children and adolescents in terms of testicular volume and sperm concentration increase. No specific phenotype in terms of testicular volume cut-off or peak retrograde flow (PRF) is indicated. Based on current evidence, we suggest that conservative management may be suggested in patients with PRF < 30 cm/s, testicular asymmetry < 10% and no evidence of sperm and hormonal abnormalities. In patients with 10-20% testicular volume asymmetry or 30 < PRF ≤ 38 cm/s or sperm abnormalities, careful follow-up may ensue. In the case of absent catch-up growth or sperm recovery, varicocele repair should be suggested. Finally, treatment can be proposed at the initial consultation in painful varicocele, testicular volume asymmetry ≥ 20%, PRF > 38 cm/s, infertility and failure of testicular development.
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Affiliation(s)
- Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy
| | - Filippo Giacone
- Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy
| | - Antonio Aversa
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy.
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18
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Abstract
The relationship between varicoceles and subfertility is well-established, but recent evidence suggests that varicoceles may cause global testicular dysfunction. This has led to exploration into expanding the indications for varicocelectomy. This review examines the literature regarding varix ligation as a treatment for non-obstructive azoospermia, elevated DNA fragmentation, and hypogonadism.
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Affiliation(s)
- G Luke Machen
- Department of Urology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Jay I Sandlow
- Department of Urology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
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19
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Abstract
Varicoceles exert deleterious effect on testicular function. The condition has been associated with male infertility, testicular hypotrophy and pain. These comprises the common indications for varicocele repair currently. Significant improvement in semen parameters and pregnancy outcomes had been suggested by reports decades ago. However, selection of the best candidates remains an issue since not all patients respond positively to treatment. Consensus has been reached in recent decade after the publication of a series of meta-analyses. Significant improvement in pregnancy outcomes were reported in patients with clinical varicocele and abnormal semen parameters. Varicocelectomy in adolescents with testicular hypotrophy was supported by the positive implication on catch-up growth and semen parameters. However, little is known about the treatment effect of adolescence varicocelectomy on long term fertility and paternity rate. Recent studies on outcome of varicocele repair for pain consistently demonstrated a resolution rate of approximately 90% and support varicocele-associated pain as an indication for surgery. Alternate indications for varicocele repair have been proposed in recent decade. Despite the encouraging preliminary data, most studies were uncontrolled retrospective series. Although varicocelectomy may not obviate the need for assisted reproductive techniques in patients with non-obstructive azoospermia, it potentially increases sperm retrieval rate. The significant increase in serum testosterone after varicocelectomy in patients with androgen deficiency may open an alternative treatment for hypogonadism. The adjunctive role of varicocelectomy before assisted reproduction and the significant decrease in sperm DNA fragmentation after varicocele repair deserve further well-designed controlled studies.
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Affiliation(s)
- Chak-Lam Cho
- Department of Surgery, Union Hospital, Hong Kong, China
| | - Sandro C Esteves
- Andrology and Human Reproduction Clinic ANDROFERT, Referral Center for Male Reproduction, Campinas, Brazil
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Department of Urology, Cleveland Clinic, Cleveland, OH, USA -
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20
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McCullough A, Elebyjian L, Ellen J, Mechlin C. A retrospective review of single-institution outcomes with robotic-assisted microsurgical varicocelectomy. Asian J Androl 2019; 20:189-194. [PMID: 29086759 PMCID: PMC5858106 DOI: 10.4103/aja.aja_45_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We report the largest single-center experience with robotic-assisted microscopic varicocelectomy (RAMV) in male infertility. From August 2012 to February 2015, men with infertility of at least a year and varicoceles underwent RAMV by a single surgeon. Varicocele was diagnosed on physical examination and confirmed by ultrasound by a single ultrasonographer. Preoperative hormone panel, semen analyses, and testicular Doppler ultrasound were obtained from all men and repeated at 3 months. One hundred and forty consecutive men (258 varicocelectomies) were included. Mean age and duration of infertility was 36.4 and 2.8 years, respectively. Median total and free testosterone increased by 145 ng dl−1 and 4.3 pcg ml−1 (44.3%), respectively (P < 0.0001). Median sperm concentration increased by 37.3% (P < 0.03). Median sperm motility and morphology did not significantly change. Median left and right testicular volume increased by 22.3% (P < 0.0001) and 12.6% (P < 0.0006), respectively. Hydroceles occurred 0.8% of procedures. We had no testicular artery injuries. Persistence of varicocele by Doppler ultrasound was 9.6%. Only 37.3% of patients required pain medications postoperatively. We concluded that RAMV is a safe and effective alternative for varicocele repair with outcomes comparable to historical traditional microsurgical approach.
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Affiliation(s)
- Andrew McCullough
- Institute of Urology, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Leon Elebyjian
- Division of Urology, Albany Medical College, Albany, NY 12208, USA
| | | | - Clay Mechlin
- Urology Associates of Central Missouri, Columbia, MO 65201, USA
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21
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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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22
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Bernie HL, Goldstein M. Varicocele Repair Versus Testosterone Therapy for Older Hypogonadal Men with Clinical Varicocele and Low Testosterone. Eur Urol Focus 2018; 4:314-316. [PMID: 30316825 DOI: 10.1016/j.euf.2018.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/17/2018] [Accepted: 09/28/2018] [Indexed: 01/16/2023]
Abstract
As men age, serum testosterone levels decrease. This reduction in testosterone levels may cause symptoms leading to hypogonadism. In addition, the presence of a varicocele can impair Leydig cell function, resulting in decreased testosterone production in men. Varicocelectomy and testosterone replacement therapy are both viable treatment options for hypogonadism in elderly male patients. The correct modality of treatment will vary for each patient, but education is essential in order to help men understand their options. Testosterone therapy (TTh) with laboratory monitoring will likely appeal to many men who want to avoid surgery, but for men with hypogonadism and a varicocele, a one-time low-risk microsurgery with the potential to negate the need for further therapy presents an attractive alternative to lifelong TTh. PATIENT SUMMARY: Varicocelectomy and testosterone therapy (TTh) are viable treatment options for hypogonadism in elderly male patients. Treatment modality will vary for each patient, but education is essential to help them understand their options. Although TTh with laboratory monitoring may appeal to men wanting to avoid surgery, those with hypogonadism and a varicocele would likely prefer a one-time low-risk microsurgery to lifelong TTh.
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Affiliation(s)
- Helen Levey Bernie
- Sexual and Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Urology and Center for Male Reproductive Medicine and Surgery, Weill Cornell Medical College, New York, NY, USA.
| | - Marc Goldstein
- Department of Urology and Center for Male Reproductive Medicine and Surgery, Weill Cornell Medical College, New York, NY, USA
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23
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Abstract
Improved understanding of the pathogenesis and natural history of many urologic disorders, as well as advances in fertility preservation techniques, has increased the awareness of and options for management of fertility threats in pediatric patients. In children, fertility may be altered by oncologic conditions, by differences in sexual differentiation, by gonadotoxic drugs and other side effects of treatment for nonurologic disorders, and by urologic conditions, such as varicocele and cryptorchidism. Although fertility concerns are best addressed in a multidisciplinary setting, pediatric urologists should be aware of the underlying pathophysiology and management options to properly counsel and advocate for patients.
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Affiliation(s)
- Kathleen Kieran
- Division of Urology, Seattle Children's Hospital, 4800 Sand Point Way Northeast, OA.9.220, Seattle, WA 98105, USA.
| | - Margarett Shnorhavorian
- Division of Urology, Seattle Children's Hospital, 4800 Sand Point Way Northeast, OA.9.220, Seattle, WA 98105, USA
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24
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Alizadeh M, Nasebakht A, Valizadeh R, Mohammadi Fallah M, Taghizadeh Afshari A, Rahimi MM, Daneshyar C. A preliminary evaluation of serum level of testosterone, LH, and FSH in patients with varicocele after varicocelectomy as a kidney-related disease. Ther Clin Risk Manag 2018; 14:1585-1590. [PMID: 30233193 PMCID: PMC6129023 DOI: 10.2147/tcrm.s161641] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Varicocele is a common problem with a high prevalence in population with primary and secondary infertilities. The adverse effects of varicocele on spermatogenesis and fertility are known, but the association between clinical varicocele and testosterone is not clear. Hence, we decided to evaluate the serum levels of testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in patients with varicocele after varicocelectomy. Methods In this study, 100 patients with varicocele were divided into two groups: hypogonadal patients with testosterone level <280 ng/dL and eugonadal patients with testosterone level >280 ng/dL. The serum levels of testosterone, FSH, and LH were measured before surgery and 3 months after surgery, and the results were analyzed using the SPSS software. P-value <0.05 was considered statistically significant. Results Patients with varicocele after puberty till 50 years were divided into two groups: hypogonadal (testosterone <280 ng/dL) and eugonadal (testosterone >280 ng/dL) patients who required varicocelectomy. The mean testosterone level before surgery in hypogonadal patients was 215.22±83.31 ng/dL, which reached 326.95±35.125 ng/dL after surgery (P<0.0001), which was significant. There was no significant decrease in the mean FSH level, but there was a significant decrease in the mean LH level after varicocelectomy. In eugonadal group, testosterone level before surgery was 471.90±145.71 ng/dL, which reached 469.57±145.61 ng/dL after surgery, which was not significant. Conclusion In our study, patients who underwent varicocelectomy had improved testosterone levels, so that this increase was more significant in hypogonadal patients than in eugonadal patients. Decrease in LH and FSH levels in all patients was seen after varicocelectomy, which can be due to increase in testosterone levels.
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Affiliation(s)
- Mansour Alizadeh
- Nephrology and Kidney Transplant Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Ali Nasebakht
- Nephrology and Kidney Transplant Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Rohollah Valizadeh
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran.,Student Research Committee, Department of Epidemiology, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ali Taghizadeh Afshari
- Nephrology and Kidney Transplant Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohsen Mohammad Rahimi
- Department of Kidney Transplantation, Nephrology and Kidney Transplant Research Center, Urmia University of Medical Sciences, Urmia, Iran,
| | - Chimen Daneshyar
- Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
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25
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D'Andrea S, Barbonetti A, Castellini C, Martorella A, Minaldi E, Viktor Giordano A, Carducci S, Necozione S, Francavilla F, Francavilla S. Reproductive hormones and sperm parameters after varicocele repair: An observational study. Andrologia 2018; 50:e13118. [DOI: 10.1111/and.13118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/03/2018] [Accepted: 07/03/2018] [Indexed: 12/11/2022] Open
Affiliation(s)
- Settimio D'Andrea
- Andrology Unit, Department of Life, Health and Environment Sciences; University of L'Aquila; L'Aquila Italy
| | - Arcangelo Barbonetti
- Andrology Unit, Department of Life, Health and Environment Sciences; University of L'Aquila; L'Aquila Italy
| | - Chiara Castellini
- Andrology Unit, Department of Life, Health and Environment Sciences; University of L'Aquila; L'Aquila Italy
| | - Alessio Martorella
- Andrology Unit, Department of Life, Health and Environment Sciences; University of L'Aquila; L'Aquila Italy
| | - Elisa Minaldi
- Andrology Unit, Department of Life, Health and Environment Sciences; University of L'Aquila; L'Aquila Italy
| | - Aldo Viktor Giordano
- Interventional Radiology Unit; University Hospital San Salvatore; L'Aquila Italy
| | - Sergio Carducci
- Interventional Radiology Unit; University Hospital San Salvatore; L'Aquila Italy
| | - Stefano Necozione
- Division of Epidemiology, Department of Life, Health and Environment Sciences; University of L'Aquila; L'Aquila Italy
| | - Felice Francavilla
- Andrology Unit, Department of Life, Health and Environment Sciences; University of L'Aquila; L'Aquila Italy
| | - Sandro Francavilla
- Andrology Unit, Department of Life, Health and Environment Sciences; University of L'Aquila; L'Aquila Italy
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26
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Hassanin AM, Ahmed HH, Kaddah AN. A global view of the pathophysiology of varicocele. Andrology 2018; 6:654-661. [DOI: 10.1111/andr.12511] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 03/20/2018] [Accepted: 05/16/2018] [Indexed: 02/06/2023]
Affiliation(s)
- A. M. Hassanin
- Department of Andrology and Sexology; Faculty of Medicine; Cairo University; Cairo Egypt
| | - H. H. Ahmed
- Department of Andrology and Sexology; Faculty of Medicine; Cairo University; Cairo Egypt
| | - A. N. Kaddah
- Department of Andrology and Sexology; Faculty of Medicine; Cairo University; Cairo Egypt
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27
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Gomaa MD, Motawaa MA, Al-Nashar AM, El-Sakka AI. Impact of Subinguinal Varicocelectomy on Serum Testosterone to Estradiol Ratio in Male Patients With Infertility. Urology 2018; 117:70-77. [DOI: 10.1016/j.urology.2018.03.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/04/2018] [Accepted: 03/22/2018] [Indexed: 02/02/2023]
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28
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Jangkhah M, Farrahi F, Sadighi Gilani MA, Hosseini SJ, Dadkhah F, Salmanyazdi R, Chehrazi M. Effects of Varicocelectomy on Serum Testosterone Levels among Infertile Men with Varicocele. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2018; 12:169-172. [PMID: 29707936 PMCID: PMC5936617 DOI: 10.22074/ijfs.2018.5058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 08/16/2017] [Indexed: 11/04/2022]
Abstract
Background The main purpose of this study is to evaluate the effects of varicocelectomy on serum testosterone levels and semen quality in infertile men who suffer from varicocele. MATERIALS AND METHODS This prospective study enrolled 115 subjects with clinical varicocele grades II and III and 240 fertile men as the control group. Total volume of testosterone serum level (ng/dl) and semen quality were compared before and after microscopic varicocelectomy. We normalized testosterone serum levels for age, grade, and testis size basis. SPSS 20 software was used to analyze the data. All results of continuous variables were reported as mean ± SD. Statistical significance was set at a P<0.05. RESULTS The mean ages of individuals who participated in the treatment (32.2 ± 5.23) and control (32.8 ± 5.27) groups were similar. There were similar mean values for adjusted testosterone levels between the varicocele (567 ± 222 ng/ml) and control (583 ± 263 ng/ml) groups. In the varicocele group, the adjusted testosterone levels insignificantly increased to 594 ± 243 ng/ml. Among semen parameters, only mean sperm concentration significantly increased after varicocelectomy. CONCLUSION Despite increases in sperm concentration, adjusted testosterone levels did not significantly improve after varicocelectomy.
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Affiliation(s)
- Meysam Jangkhah
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.,Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.Electronic Address:
| | - Faramarz Farrahi
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran. Electronic Address:
| | - Mohammad Ali Sadighi Gilani
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.,Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Jalil Hosseini
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.,Infertility and Reproductive Health Research Center, Shahid Beheshti Medical University, Tehran, Iran
| | - Farid Dadkhah
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Reza Salmanyazdi
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mohammad Chehrazi
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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29
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Lundy SD, Sabanegh ES. Varicocele management for infertility and pain: A systematic review. Arab J Urol 2018; 16:157-170. [PMID: 29713547 PMCID: PMC5922006 DOI: 10.1016/j.aju.2017.11.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 12/18/2022] Open
Abstract
Despite being first described two thousand years ago, the varicocele remains a controversial multifaceted disease process with numerous biological consequences including infertility, hypogonadism, and chronic orchidalgia. The underlying mechanisms remain poorly understood and likely include hypoxia, oxidative stress, hyperthermia, anatomical aberrations, and genetics as primary components. Despite a high prevalence amongst asymptomatic fertile men, varicoceles paradoxically also represent the most common correctable cause for male infertility. In this systematic review we discuss the rich historical aspects of the varicocele and the contemporary data regarding its clinical manifestations. We performed a systematic literature review with the goal of comparing outcomes and complication rates of each of the major surgical approaches as they relate to infertility and pain. We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-compliant systematic literature review for manuscripts focused on varicocele and its biological consequences. We identified 112 studies suitable for qualitative analysis and included 56 of these for quantitative analysis, with an emphasis on infertility and chronic pain outcomes. Taken together, the clinical work to date suggests that the highest fertility rates and the lowest complication rates are associated with the microsurgical subinguinal surgical approach to varicocelectomy. In all, 26-40% of patients undergoing varicocelectomy will successfully achieve short-term spontaneous pregnancy, and up to 90% of all patients undergoing varicocelectomy for pain will have improvement and/or resolution of their symptoms. Taken together, the data support an ongoing role for varicocelectomy in both of these clinical arenas.
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Affiliation(s)
- Scott D. Lundy
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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30
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Lo EM, Rodriguez KM, Pastuszak AW, Khera M. Alternatives to Testosterone Therapy: A Review. Sex Med Rev 2017; 6:106-113. [PMID: 29174957 DOI: 10.1016/j.sxmr.2017.09.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 09/17/2017] [Accepted: 09/24/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Although testosterone therapy (TTh) is an effective treatment for hypogonadism, recent concerns regarding its safety have been raised. In 2015, the US Food and Drug Administration issued a warning about potential cardiovascular risks resulting from TTh. Fertility preservation is another reason to search for viable alternative therapies to conventional TTh, and in this review we evaluate the literature examining these alternatives. AIMS To review the role and limitations of non-testosterone treatments for hypogonadism. METHODS A literature search was conducted using PubMed to identify relevant studies examining medical and non-medical alternatives to TTh. Search terms included hypogonadism, testosterone replacement therapy, testosterone therapy, testosterone replacement alternatives, diet and exercise and testosterone, varicocele repair and testosterone, stress reduction and testosterone, and sleep apnea and testosterone. MAIN OUTCOME MEASURES Review of peer-reviewed literature. RESULTS Medical therapies examined include human chorionic gonadotropins, aromatase inhibitors, and selective estrogen receptor modulators. Non-drug therapies that are reviewed include lifestyle modifications including diet and exercise, improvements in sleep, decreasing stress, and varicocele repair. The high prevalence of obesity and metabolic syndrome in the United States suggests that disease modification could represent a viable treatment approach for affected men with hypogonadism. CONCLUSIONS These alternatives to TTh can increase testosterone levels and should be considered before TTh. Lo EM, Rodriguez KM, Pastuszak AW, Khera M. Alternatives to Testosterone Therapy: A Review. Sex Med Rev 2018;6:106-113.
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Affiliation(s)
- Eric M Lo
- Baylor College of Medicine, Houston, TX, USA
| | | | - Alexander W Pastuszak
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
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31
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Vakalopoulos I, Kampantais S, Lymperi S, Grivas N, Ioannidis A, Mykoniatis I, Nikolaou V, Dimitriadis G. Should we expand the indications for varicocele treatment? Transl Androl Urol 2017; 6:931-942. [PMID: 29184794 PMCID: PMC5673807 DOI: 10.21037/tau.2017.08.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Current guidelines suggest that treatment of varicocele should be considered in patients with clinically palpable disease and abnormal semen parameters. However, the clinicians are often challenged with the decision whether to treat varicocele in patients with testicular pain or low testosterone levels. Moreover, varicocele is highly associated with DNA fragmentation due to the oxidative stress and it has been demonstrated that surgical repair of varicocele ameliorates oxidative stress markers and consequently the sperm DNA integrity. These new markers could have an adjunctive role to standard semen parameters especially when normal semen analysis is found in adult men with conventional methods. This review presents a contemporary overview of the rationale for varicocele treatment, as well as of the relationship between varicocele and other novel parameters such as DNA fragmentation index and reactive oxygen species. We will also discuss data from several recent series demonstrating that surgical treatment and especially microsurgical approach could resolve testicular pain, increase testosterone levels and fertility rate both in patients with non-obstructive azoospermia as well as in normozoospermia men. The correlation with progressive testicular failure will be also examined. We hope that this overview will provide clinicians with an evidence-based approach to managing these unanswered and conflicting topics.
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Affiliation(s)
- Ioannis Vakalopoulos
- 1 Urologic Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Nikolaos Grivas
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Anastasios Ioannidis
- 1 Urologic Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Mykoniatis
- 1 Urologic Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios Nikolaou
- 1 Urologic Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Dimitriadis
- 1 Urologic Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
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32
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Clavijo RI, Carrasquillo R, Ramasamy R. Varicoceles: prevalence and pathogenesis in adult men. Fertil Steril 2017; 108:364-369. [PMID: 28865534 DOI: 10.1016/j.fertnstert.2017.06.036] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 06/29/2017] [Indexed: 11/28/2022]
Abstract
Varicocele, or dilation of the pampiniform venous plexus, affects up to 15% of men. However, few of these men encounter problems with fertility. This discrepancy between men with varicocele and the number of adversely affected men has led to abundant research to identify the mechanisms for formation of varicocele as well as the pathologic mechanisms by which varicoceles affect fertility potential. In this review, we discuss the prevalence of varicocele in adults, the anatomic features of varicocele, the leading theories as to how varicocele can negatively affect fertility potential, and finally, the current literature on the impact of varicocele on testosterone production.
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Affiliation(s)
- Raul I Clavijo
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Robert Carrasquillo
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida.
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33
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Tatem AJ, Brannigan RE. The role of microsurgical varicocelectomy in treating male infertility. Transl Androl Urol 2017; 6:722-729. [PMID: 28904905 PMCID: PMC5583050 DOI: 10.21037/tau.2017.07.16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Varicoceles are the most common cause of male infertility. They afflict 15–20% of the general male population and 40% of males with primary infertility. Although multiple treatment modalities exist, including radiographic embolization and laparoscopy, open subinguinal microsurgical varicocelectomy is currently the gold standard of treatment for this condition. In this article, we discuss the role of varicocelectomy in the treatment of the modern infertile male and present a practical, safe, and reproducible technique for the microsurgical approach.
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Affiliation(s)
- Alexander J Tatem
- Department of Urology, Indiana University, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Robert E Brannigan
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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34
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Wan X, Wang H, Ji Z. Microsurgical varicocelectomy for clinical varicocele: A review for potential new indications. Andrologia 2017; 49. [PMID: 28671268 DOI: 10.1111/and.12827] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- X. Wan
- Department of Liver Surgery; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - H. Wang
- Department of Urology; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Z. Ji
- Department of Urology; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
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35
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Sack BS, Schäfer M, Kurtz MP. The Dilemma of Adolescent Varicoceles: Do They Really Have to Be Repaired? Curr Urol Rep 2017; 18:38. [PMID: 28315171 DOI: 10.1007/s11934-017-0686-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The primary indication for varicocele repair in adults, that of failed paternity, must be substituted in the adolescent population with surrogate parameters of testicular size differential and semen analysis. Making recommendations based on these two parameters is incredibly difficult because studies often have contradictory findings, different patient populations, and lack of long-term follow up of the key endpoint, paternity. Therefore, it is not a surprise that recommendations for adolescent varicocele repair are general (with some exceptions) and necessarily so because of limitations in quality of evidence. Apart from pain, all indications for varicocele repair in adolescence remain controversial. This highlights the most important task for future studies: to prevent pediatric urologists from allowing a potentially damaging process to go untreated, while at the same time avoiding unnecessary intervention on a highly prevalent condition.
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Affiliation(s)
- Bryan S Sack
- Department of Pediatric Urology, Boston Children's Hospital/Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Mattias Schäfer
- Department of Pediatric Urology, Boston Children's Hospital/Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.,Department of Pediatric Surgery and Pediatric Urology, Cnopf'sche Kinderklinik, St. Johannis-Muehlgasse 19, 90419, Nuremberg, Germany
| | - Michael P Kurtz
- Department of Pediatric Urology, Boston Children's Hospital/Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
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36
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Chen X, Yang D, Lin G, Bao J, Wang J, Tan W. Efficacy of varicocelectomy in the treatment of hypogonadism in subfertile males with clinical varicocele: A meta-analysis. Andrologia 2017; 49. [PMID: 28378913 DOI: 10.1111/and.12778] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 01/14/2023] Open
Affiliation(s)
- X. Chen
- Department of Urology; Nanfang Hospital; Southern Medical University; Guangzhou China
| | - D. Yang
- Department of Urology; Nanfang Hospital; Southern Medical University; Guangzhou China
| | - G. Lin
- Department of Urology; Nanfang Hospital; Southern Medical University; Guangzhou China
| | - J. Bao
- Department of Urology; Nanfang Hospital; Southern Medical University; Guangzhou China
| | - J. Wang
- Department of Urology; Nanfang Hospital; Southern Medical University; Guangzhou China
| | - W. Tan
- Department of Urology; Nanfang Hospital; Southern Medical University; Guangzhou China
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37
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Yamacake KGR, Cocuzza M, Torricelli FCM, Tiseo BC, Frati R, Freire GC, Antunes AA, Srougi M. Impact of body mass index, age and varicocele on reproductive hormone profile from elderly men. Int Braz J Urol 2017; 42:365-72. [PMID: 27256193 PMCID: PMC4871400 DOI: 10.1590/s1677-5538.ibju.2014.0594] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 04/03/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To study the impact of obesity, age and varicocele on sexual hormones of adult and elderly men. MATERIALS AND METHODS 875 men who were screened for prostate cancer were enrolled in this study. Data recorded comprised age, body mass index (BMI), serum levels of total testosterone (TT), free testosterone (FT), sex hormone-binding globulin (SHBG), luteinizing hormone (LH) and follicular stimulating hormone (FSH). Patients were divided in groups according to their BMI in underweight, normal weight, overweight and obese grades 1, 2 or 3. First, it was studied the association between age, BMI, and hormone profile. Then, clinical varicocele was evaluated in 298 patients to assess its correlation to the others parameters. RESULTS Obese patients had lower levels of TT, FT and SHBG (p<0.001) compared to underweight or normal weight patients. There were no differences in age (p=0.113), FSH serum levels (p=0.863) and LH serum levels (p=0.218) between obese and non-obese patients. Obese grade 3 had lower levels of TT and FT compared to obese grade 1 and 2 (p<0.05). There was no difference in the SHBG levels (p=0.120) among obese patients. There was no association between varicocele and BMI; and varicocele did not impact on testosterone or SHBG levels. CONCLUSIONS Men with higher BMI have a lower serum level of TT, FT and SHBG. The presence of clinical varicocele as well as its grade has no impact on hormone profile in elderly men.
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Affiliation(s)
- K G R Yamacake
- Divisão de Urologia da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| | - M Cocuzza
- Grupo no Centro de Reprodução Humana da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| | - F C M Torricelli
- Divisão de Urologia da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| | - B C Tiseo
- Divisão de Urologia da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| | - R Frati
- Faculdade de Medicina de São Paulo, Universidade de São Paulo, Brasil
| | - G C Freire
- Divisão de Urologia da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| | - A A Antunes
- Divisão de Urologia da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| | - M Srougi
- Divisão de Urologia da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
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38
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39
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Tian D, Huang W, Yan H, Zong H, Zhang Y. Effect of Varicocelectomy on Serum FSH and LH Levels for Patients with Varicocele: a Systematic Review and Meta-analysis. Indian J Surg 2016; 80:233-238. [PMID: 29973753 DOI: 10.1007/s12262-016-1571-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/16/2016] [Indexed: 12/21/2022] Open
Abstract
Varicocelectomy can improve the function of testicular Leydig cell for patients with varicocele. We carried out a systematic review and meta-analysis to assess effect of varicocelectomy on serum FSH and LH levels for patients with varicocele. A literature review was performed to identify all published randomized preoperation-postoperation clinical trials of assessing serum FSH and LH levels before and after varicocelectomy. The search included the following databases: PUBMED and EMBASE. The reference lists of retrieved studies were also investigated. A systematic review and meta-analysis were conducted. Five studies were selected from 149 studies, including 312 patients. The meta-analysis showed that serum FSH level (95% confidence interval 0.19-0.77, P = 0.001) and serum LH level (95% confidence interval 0.25-0.91, P = 0.0005) were higher preoperation than postoperation. Serum FSH level decreased by 0.48 ng/dL after varicocelectomy. The mean decrease of the serum FSH was from 0.1 to 4.8 ng/dL. And serum LH decreased by 0.58 ng/dL. The mean decrease of the serum LH was from 0.2 to 2.1 ng/dL. This meta-analysis proves that varicocelectomy perhaps can decrease serum FSH and LH levels in patients with varicocele. And it might be related to the improvement of the function of Leydig cell. But it remains to need a large-scale multicenter randomized controlled study to be further confirmed.
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Affiliation(s)
- Daxue Tian
- Department of Urology, Beijing Tian-Tan Hospital, Capital Medical University, No. 6 Tiantan Xi Li, Dongcheng District, Beijing, 100050 China
| | - Wei Huang
- Department of Urology, Beijing Tian-Tan Hospital, Capital Medical University, No. 6 Tiantan Xi Li, Dongcheng District, Beijing, 100050 China
| | - Huilei Yan
- Department of Urology, Beijing Tian-Tan Hospital, Capital Medical University, No. 6 Tiantan Xi Li, Dongcheng District, Beijing, 100050 China
| | - Huantao Zong
- Department of Urology, Beijing Tian-Tan Hospital, Capital Medical University, No. 6 Tiantan Xi Li, Dongcheng District, Beijing, 100050 China
| | - Yong Zhang
- Department of Urology, Beijing Tian-Tan Hospital, Capital Medical University, No. 6 Tiantan Xi Li, Dongcheng District, Beijing, 100050 China
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Whelan P, Levine L. Effects of varicocelectomy on serum testosterone. Transl Androl Urol 2016; 5:866-876. [PMID: 28078218 PMCID: PMC5182225 DOI: 10.21037/tau.2016.08.06] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/20/2016] [Indexed: 01/12/2023] Open
Abstract
Varicocele is most often surgically repaired due to male infertility, however, has recently been linked to low serum testosterone. This paper serves to review the current literature regarding varicocele and its subsequent repair on serum testosterone. Twenty-eight human studies were identified with fifteen showing improved serum testosterone after repair. The majority of the studies that demonstrated improvement had preoperative testosterone levels that were low or below normal. Additionally, multiple well-designed studies with control groups not undergoing surgical repair demonstrated significant difference between groups. This improvement was less observed in studies with normal preoperative serum testosterone. A majority of these patients studied were presenting for infertility. It remains to be determined if these findings can be reproduced in men without infertility. The findings suggest that microsurgical varicocele repair can improve serum testosterone in men with low levels preoperatively in appropriately counseled men. It remains to be seen whether varicocele repair can help prevent the development of low testosterone in the future or which patients are at risk of developing low testosterone due to varicocele.
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Affiliation(s)
- Patrick Whelan
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Laurence Levine
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA
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Dabaja AA, Goldstein M. When is a varicocele repair indicated: the dilemma of hypogonadism and erectile dysfunction? Asian J Androl 2016; 18:213-6. [PMID: 26696437 PMCID: PMC4770488 DOI: 10.4103/1008-682x.169560] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
In the past, the indications for varicocelectomy are primarily for infertility with abnormal semen parameters, testicular hypotrophy/atrophy in adolescents, and/or pain. The surgical treatment of varicocele for hypogonadism is controversial and debated. Recently, multiple reports in the literature have suggested that varicocele is associated with hypogonadism and varicocele repair can increase testosterone levels. Men with hypogonadal symptoms should have at least two serum testosterone levels. Microsurgical varicocelectomy may be beneficial for men with clinically palpable varicoceles with documented hypogonadism. In this review, we summarize the most recent literature linking varicocele to hypogonadism and sexual dysfunction and the impact of repair on serum testosterone levels. We performed a search of the published English literature. The key words used were “varicocele and hypogonadism” and “varicocele surgery and testosterone.” We included published studies after 1998. We, also, evaluated the effect of surgery on the changes in the serum testosterone level regardless of the indication for the varicocele repair.
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Affiliation(s)
| | - Marc Goldstein
- Department of Male Reproductive Medicine, Weill Cornell Medical College, New York, USA
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Fraietta R, Zylbersztejn DS, Cedenho AP. Asymptomatic male with grade 3 left varicocele and two children desiring vasectomy with low testosterone. Asian J Androl 2016; 18:312. [PMID: 26459783 PMCID: PMC4770505 DOI: 10.4103/1008-682x.164196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Daniel Suslik Zylbersztejn
- Department of Surgery, Division of Urology, Human Reproduction Section, São Paulo Federal University, São Paulo Hospital, Rua Napoleão de Barros, 715 - 2° Andar, CEP: 04024 002, São Paulo, Brazil
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Ji B, Jin XB. Varicocele is associated with hypogonadism and impaired erectile function: a prospective comparative study. Andrologia 2016; 49. [PMID: 27595632 DOI: 10.1111/and.12683] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2016] [Indexed: 12/11/2022] Open
Affiliation(s)
- B. Ji
- Department of Urology; Provincial Hospital Affiliated to Shandong University; Jinan Shandong China
- Department of Urology; Qingdao 3rd People's Hospital; Qingdao Shandong China
| | - X.-b. Jin
- Department of Urology; Provincial Hospital Affiliated to Shandong University; Jinan Shandong China
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Abstract
Testicular varicocele, which is defined as the dilation of the veins draining the testicle, has long been associated with a detrimental effect on testicular function. Despite a lack of high-quality, prospective data, recent evidence has shed light on potential links between varicocele and male infertility and serum testosterone levels. Similarly, varicocele repair has increasingly been shown to have a beneficial impact on pregnancy rates, semen parameters, and on improving serum testosterone in adult men. Numerous studies have assessed the optimal technique for varicocele repair and the bulk of the evidence has shown the microsurgical inguinal/subinguinal approach to have the highest success rates, the lowest overall complication rates, and the lowest recurrence rates. The management of varicocele in adolescents remains a clinical conundrum, but contemporary evidence suggests early deleterious effects of varicocele on testicular function in some patients. Well-designed prospective trials are critical to delineate the true impact and role of varicocele repair on male infertility and hypogonadism in adult and adolescent men.
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Affiliation(s)
- Phil V Bach
- Weill Cornell Medical College, New York, NY, 10065, USA
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Improvements in Patient-reported Sexual Function After Microsurgical Varicocelectomy. Urology 2016; 110:104-109. [PMID: 27196029 DOI: 10.1016/j.urology.2016.04.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 02/22/2016] [Accepted: 04/04/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate whether varicocelectomy improves both serum testosterone and sexual function, as assessed by the Male Sexual Health Questionnaire (MSHQ). METHODS A retrospective chart review of patients who have undergone varicocelectomy and had both pre- and postoperative MSHQ was performed. The MSHQ is a clinically validated questionnaire that assesses erectile function, ejaculatory function, and sexual satisfaction, with higher scores indicating better function. Clinical parameters pre and postvaricocelectomy were compared with paired t test. RESULTS Thirty-four patients met study criteria. Seventeen patients (50%) presented for infertility, and the remaining 13 had symptomatic varicocele associated with hypogonadism. Average postsurgical follow-up was 20.6 ± 12.5 months. The majority of men in the study had bilateral varicoceles and left grade III varicoceles. Significant improvements in the total MSHQ score (3.9 ± 8.7, P = .027), the MSHQ erectile function (1.2 ± 2.3, P = .007), and the MSHQ ejaculatory function (1.4 ± 3.1, P = .018) domains were seen. Fifteen (44%) men saw improvement in their erectile function and 18 (53%) saw improvement in ejaculatory function. The improvement in serum testosterone was also significant (136.0 ± 201.3 ng/dL, P = .007). CONCLUSION Microsurgical repair of varicocele not only improves testosterone, but also improves patient-reported erectile and ejaculatory functions. Patients can confidently be counseled that varicocelectomy has the potential to improve sexual function along with serum testosterone.
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Han H, Zhou XG, Qian XS, Feng SJ, Tian L, Zhang XD. Significant alterations of serum hormone levels in the spermatic vein plexus of patients with varicoceles. Andrologia 2016; 48:1108-1112. [PMID: 26840997 DOI: 10.1111/and.12546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- H. Han
- Department of Urology; Beijing Chao-Yang Hospital; Capital Medical University; Beijing China
| | - X.-G. Zhou
- Department of Urology; Beijing Chao-Yang Hospital; Capital Medical University; Beijing China
| | - X.-S. Qian
- Department of Urology; Beijing Chao-Yang Hospital; Capital Medical University; Beijing China
| | - S.-J. Feng
- Department of Urology; Beijing Chao-Yang Hospital; Capital Medical University; Beijing China
| | - L. Tian
- Department of Urology; Beijing Chao-Yang Hospital; Capital Medical University; Beijing China
| | - X.-D. Zhang
- Department of Urology; Beijing Chao-Yang Hospital; Capital Medical University; Beijing China
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Abstract
PURPOSE Varicocele is one of the most common genital conditions referred to pediatric urologists. Most adolescents with varicocele are asymptomatic and their fertility future (and surgery benefit) is largely unknown. This review assesses varicocele evaluation, management and indications for repair, as well as types and success of varicocelectomy. MATERIALS AND METHODS A systematic literature review was performed on Embase™, PubMed® and Google Scholar™ for adolescent varicocele. Original research articles and relevant reviews were examined, and a synopsis of these data was generated for a comprehensive review of clinical adolescent varicocele management. RESULTS The prevalence of adolescent varicocele is similar to the adult population. While ultrasound is the most sensitive method for determining testicular volumes, orchidometer measurement may be adequate to gauge significant discordance. Significant hypotrophy of the affected testis with poor total testicular volume may indicate a testis at risk and warrant surgical repair. Similar findings have been noted with an associated high peak retrograde venous flow. Testicular hypotrophy often resolves following surgery but may also improve spontaneously if followed through adolescence. Continued scrotal pain despite adequate support or serial abnormal semen analysis in Tanner stage V boys is an indication for varicocelectomy. Artery and lymphatic sparing techniques (microscopic subinguinal or laparoscopic) are associated with the lowest risk of recurrence and complications. CONCLUSIONS Overtreatment and under treatment are medically and financially costly. Abnormal serial semen analysis with or without testicular hypotrophy is an indication for varicocele repair. If observation remains the treatment, followup with an adult urologist should be encouraged until paternity is achieved.
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Affiliation(s)
- Thomas F Kolon
- Department of Urology (Surgery), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Effects of Varicocele on Serum Testosterone and Changes of Testosterone After Varicocelectomy: A Prospective Controlled Study. Urology 2014; 84:1081-7. [DOI: 10.1016/j.urology.2014.05.029] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/01/2014] [Accepted: 05/27/2014] [Indexed: 11/18/2022]
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Abstract
Varicocele is present in 15% to 20% of the general population, but in approximately 35% to 40% of males presenting for an evaluation of their infertility. Indeed it is well known that varicocele can cause testicular damage and infertility. No evidence indicates a varicocele treatment in infertile men who have normal semen analysis or in men with subclinical varicocele. In this situation, varicocelectomy cannot be recommended. Varicocele repair may be effective in men with subnormal semen analysis, a clinical varicocele and otherwise unexplained infertility, but we need further randomized studies to confirm that this subgroup of infertile couples will benefit from treatment. There is no doubt about the standard indications of varicocelectomy, but recent literature seems to go towards new indications of varicocele repair. The aim of this review is to give a look at the literature to analyze the proper indications to varicocelectomy for the proper patient.
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