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Kavoussi PK, Gupta C, Shah R. Varicocele and nonobstructive azoospermia. Asian J Androl 2024:00129336-990000000-00216. [PMID: 39104262 DOI: 10.4103/aja202444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 04/18/2024] [Indexed: 08/07/2024] Open
Abstract
Approximately 15% of men in the general population have varicoceles, and varicoceles are diagnosed in 40% of men presenting for fertility evaluations. One percent of men in the general population are azoospermic, and 15% of men presenting for fertility evaluations are diagnosed with azoospermia. This article aims to review the impact of varicoceles on testicular function in men with azoospermia, the impact of varicocele repair on the semen parameters of azoospermic men, and the impact of varicocele repair on sperm retrieval and pregnancy outcomes when the male partner remains azoospermic after varicocele repair.
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Affiliation(s)
- Parviz K Kavoussi
- Department of Reproductive Urology, Austin Fertility and Reproductive Medicine/Westlake IVF, Austin, TX 78746, USA
| | - Chirag Gupta
- Department of Urology, Matratva Fertility and Andrology Clinic, Jaipur National University, Jaipur, Rajasthan 302017, India
| | - Rupin Shah
- Department of Urology/Andrology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra 400050, India
- Department of Urology/Andrology, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra 400004, India
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2
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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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3
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Munoz-Lopez C, Wong A, Lewis K, Bole R, Vij SC, Lundy SD. The Evolving Landscape of Male Varicocele Pathophysiology in the Era of Multi-Omics: A Narrative Review of the Current Literature. BIOLOGY 2024; 13:80. [PMID: 38392299 PMCID: PMC10886418 DOI: 10.3390/biology13020080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/24/2024]
Abstract
Male-factor infertility is implicated in over half of the millions of cases of infertility worldwide, and varicoceles are the most common correctable cause of male-factor infertility. The pathophysiologic mechanism for varicoceles is complex and next-generation technologies offer promising insights into the molecular underpinnings of this condition. In this narrative review, we highlight historical and contemporary paradigms associated with varicoceles, with an emphasis on the biological underpinnings of this disease. Specifically, we review the literature describing the underlying causes of varicoceles, discuss the molecular and cellular mechanisms causing pathological changes in some (but not all) men, and highlight key articles regarding the next-generation analyses (e.g., transcriptome, epigenome, proteome, and microbiome) being applied to better understand the condition and its treatment. These data demonstrate an ongoing evolution of the knowledge of varicoceles and the potential for improved personalized care in the future for men with this condition.
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Affiliation(s)
- Carlos Munoz-Lopez
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH 44195, USA
| | - Anne Wong
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH 44195, USA
| | - Kieran Lewis
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH 44195, USA
| | - Raevti Bole
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Sarah C Vij
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Scott D Lundy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Marquardt N, Ros CTD. Can we recommend varicocele surgery for men with hypogonadism? Int Braz J Urol 2023; 49:637-643. [PMID: 37506035 PMCID: PMC10482463 DOI: 10.1590/s1677-5538.ibju.2023.0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 05/23/2023] [Indexed: 07/30/2023] Open
Affiliation(s)
- Nilson Marquardt
- Pontifícia Universidade Católica do Rio Grande do SulDepartamento de UrologiaPorto AlegreRSBrasilDepartamento de Urologia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Carlos Teodósio Da Ros
- Pontifícia Universidade Católica do Rio Grande do SulDepartamento de UrologiaPorto AlegreRSBrasilDepartamento de Urologia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
- Universidade Luterana do BrasilDisciplina de UrologiaCanoasRSBrasilDisciplina de Urologia, Universidade Luterana do Brasil – ULBRA, Canoas, RS, Brasil
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5
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Songur MS, Caniklioğlu M. Evaluation of Retinal Changes in Varicocele Patients With Optical Coherence Tomography Angiography. Cureus 2021; 13:e20019. [PMID: 34987907 PMCID: PMC8716129 DOI: 10.7759/cureus.20019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 11/05/2022] Open
Abstract
Objective: To evaluate the macula and optic disc in varicocele patients with optical coherence tomography angiography (OCTA). Methods: The right eyes of 30 patients with varicocele and 30 healthy volunteers were evaluated. Superficial and deep capillary plexus vascular densities, foveal avascular zone (FAZ) width, and optic disc parameters were measured with OCTA. Results: There was a significant decrease in vascular density in the superficial and deep capillary plexus in the varicocele group compared to the control group, but no difference was found in FAZ and optic disc parameters. Conclusion: Patients with varicocele have reduced microvascular density in the retina; therefore, it may be beneficial to perform a detailed eye examination with OCTA in these patients.
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Kavoussi PK, Abdullah N, Gilkey MS, Hunn C, Machen GL, Chen SH, Kavoussi KM, Esqueda A, Wininger JD, Kavoussi SK. The impact of ipsilateral testicular atrophy on semen quality and sperm DNA fragmentation response to varicocele repair. Asian J Androl 2021; 23:146-149. [PMID: 32930104 PMCID: PMC7991813 DOI: 10.4103/aja.aja_50_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Varicoceles adversely impact semen quality and sperm DNA fragmentation, which typically improve with surgical repair. Some men with varicoceles have ipsilateral testicular atrophy due to damage from the varicocele. This study assessed semen quality and the sperm DNA fragmentation index (DFI) response to varicocele repair in men with ipsilateral testicular atrophy (TA) versus men with no testicular atrophy (NTA). Semen parameter values and DFI in both groups were compared preoperatively and postoperatively. The Mann–Whitney U test and the Wilcoxon signed-rank test were used where appropriate. There were 20 men in the TA group and 121 men in the NTA group with no difference in age, varicocele grade, or preoperative semen parameter values between the two groups. The NTA group had a higher preoperative DFI than the TA group. Both groups showed improvement in semen quality postoperatively, only the TA group showed a significant improvement in DFI, whereas the NTA group showed significant improvements in several parameter values and DFI. The change from preoperative to postoperative parameter values when comparing the two groups revealed a difference in total sperm motile count and DFI, with a larger mean improvement in the NTA group than in the TA group. Both TA and NTA groups showed improved semen quality and DFI after varicocele repair, but the NTA group had more improvement than the TA group. However, only total motile count (TMC) and DFI had a significantly greater mean change in preoperative to postoperative response in the NTA group than in the TA group.
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Affiliation(s)
- Parviz K Kavoussi
- Austin Fertility and Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX 78746, USA
| | - Natasha Abdullah
- Austin Fertility and Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX 78746, USA
| | - Melissa S Gilkey
- Austin Fertility and Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX 78746, USA
| | - Caitlin Hunn
- Austin Fertility and Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX 78746, USA
| | - G Luke Machen
- Austin Fertility and Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX 78746, USA
| | - Shu-Hung Chen
- Austin Fertility and Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX 78746, USA
| | - Keikhosrow M Kavoussi
- Austin Fertility and Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX 78746, USA
| | - Amy Esqueda
- Austin Fertility and Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX 78746, USA
| | - J David Wininger
- Austin Fertility and Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX 78746, USA
| | - Shahryar K Kavoussi
- Austin Fertility and Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Building B, Suite 200, Austin, TX 78746, USA
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Ultrasound evaluation of varicoceles: systematic literature review and rationale of the ESUR-SPIWG Guidelines and Recommendations. J Ultrasound 2020; 23:487-507. [PMID: 32720266 PMCID: PMC7588576 DOI: 10.1007/s40477-020-00509-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/11/2020] [Indexed: 02/02/2023] Open
Abstract
Although often asymptomatic and detected incidentally, varicocele is a relatively common problem in patients who seek medical attention for infertility problems. Ultrasound (US) is the imaging modality of choice for evaluation, but there is no consensus on the diagnostic criteria, classification, and examination technique. In view of this uncertainty, the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology (ESUR-SPIWG) undertook a systematic review of the available literature on this topic, to use as the basis for evidence-based guidelines and recommendations. This paper provides the results of the systematic review on which guidelines were constructed.
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Rocher L, Gennisson JL, Baranger J, Rachas A, Criton A, Izard V, Bertolloto M, Bellin MF, Correas JM. Ultrasensitive Doppler as a tool for the diagnosis of testicular ischemia during the Valsalva maneuver: a new way to explore varicoceles? Acta Radiol 2019; 60:1048-1056. [PMID: 30396287 DOI: 10.1177/0284185118810981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Varicocele is among the most common causes of male infertility because of various mechanism, including hypoxia. Purpose To evaluate testicular vascularization (TV) with ultrasensitive Doppler before and during the Valsalva maneuver (VM) and correlate TV changes to varicocele’s spermatic venous reflux graduated by color Doppler. Material and Methods From January to February 2016, 69 men (135 testis) referred for scrotal ultrasound were prospectively enrolled. An institutional review board approved the study. As gold standard, the spermatic venous reflux in the supratesticular region was assessed with color Doppler ultrasound and graded from 0 to III. A new ultra-sensitive Doppler (USD) sequence was performed on testicular parenchyma in an axial view. The TV changes before and during the VM were qualitatively graded from 0 to 2 using a visual scale by consensus. The vessels surface was quantified using customized MATLAB® software, and compared to the testicular delineated surface, resulting in a vessels surface ratio (VSR). The absolute and relative VSR difference before and during the VM was calculated. The qualitative scale and the quantitative VSR changes were compared with the spermatic venous reflux grade using an analysis of variance. Results A strong correlation has been found between the spermatic venous reflux grade and TV decrease during the VM using USD, for qualitative graduation as well as for quantitative measurement ( P < 0.0001). Conclusion TV assessed by USD decreased significantly during the VM in patients with varicocele; this decrease was significantly associated with spermatic venous reflux grade.
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Affiliation(s)
- Laurence Rocher
- Department of Adult Diagnostic and Interventional Radiology, Bicetre University Hospital, Le Kremlin Bicêtre, France
- Paris South Medical University, Le Kremlin Bicêtre, France
- Institut Langevin, ESPCI Paris, PSL Research University, Paris, France
- UMR8081, IR4M, Orsay Cedex, France
| | - Jean-Luc Gennisson
- Institut Langevin, ESPCI Paris, PSL Research University, Paris, France
- UMR8081, IR4M, Orsay Cedex, France
| | - Jérôme Baranger
- Institut Langevin, ESPCI Paris, PSL Research University, Paris, France
| | - Antoine Rachas
- Service de Santé publique et d’épidémiologie, Hôpitaux Paris Sud, Le Kremlin Bicêtre, France
| | - Aline Criton
- Supersonic Imagine, Aix en Provence cedex, France
| | - Vincent Izard
- Department of Urology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | | | - Marie-France Bellin
- Department of Adult Diagnostic and Interventional Radiology, Bicetre University Hospital, Le Kremlin Bicêtre, France
- Paris South Medical University, Le Kremlin Bicêtre, France
- UMR8081, IR4M, Orsay Cedex, France
| | - Jean-Michel Correas
- Institut Langevin, ESPCI Paris, PSL Research University, Paris, France
- Paris Descartes University, Paris, France
- Department of Adult Radiology, Necker University Hospital, Paris, France
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9
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Tian L, Han H, Lei HE, Qian XS, Feng SJ, Zhang XD. Significant alterations of 6-keto prostaglandin F 1a and NO levels in spermatic vein plexus patients with varicocele. Andrologia 2018; 50:e12993. [PMID: 29460974 DOI: 10.1111/and.12993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2018] [Indexed: 01/10/2023] Open
Abstract
To investigate the level variation of correlative factors between the spermatic vein plexus and peripheral blood in patients with varicocele, a total of 22 patients diagnosed with varicocele were enrolled in the study. All patients were performed a testicular artery-sparing microsurgical varicocelectomy. During the operation, a blood sample from the left spermatic vein plexus and a peripheral blood sample were collected. A radioimmunoassay was used to determine the 6-keto prostaglandin F1a (6-keto-PGF1a ). A colorimetric method was performed to determine the NO. The enzyme immunoassay method was used to determine the creatinine, urea nitrogen, adrenaline, noradrenaline, dopamine and 5-HT. The mean age of all patients was 29.3 ± 7.8 years. Compared with the level of 6-keto-PGF1a and NO in the peripheral blood, 6-keto-PGF1a and NO were significantly increased in left spermatic vein plexus (347.3 (230.8-415.1) versus 99.7 (80.4-119.9) pg/ml and 192.3 ± 178.5 versus 107.1 ± 73.6 μmol/L, p < .05). There were no differences in the level of creatinine, urea nitrogen, adrenaline, noradrenaline, dopamine and 5-HT between the peripheral blood and left spermatic vein plexus (p > .05). The 6-keto-PGF1a and NO concentrations in left spermatic vein plexus were significantly higher than that in peripheral blood patients with varicocele.
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Affiliation(s)
- L Tian
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - H Han
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - H-E Lei
- 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
| | - X-D Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Elzanaty S, Johansen C. Microsurgical Subinguinal Varicocele Repair of Grade II-III Lesions Associated with Improvements of Testosterone Levels. Curr Urol 2017; 10:45-49. [PMID: 28559777 DOI: 10.1159/000447150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 02/09/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The results of reports on the association between varicocele repair and testosterone levels were conflicting. The aim of the present study is, therefore, to investigate the impact of varicocele repair on testosterone levels. MATERIALS AND METHODS The study is based on 20 men who experienced microsurgical subinguinal varicoceles repair because of chronic dull scrotal pain. All hormonal profiles available in the clinical records were reviewed. Follow-up evaluation was done at 1 and 12 months after surgery. Men were classified into groups based on the preoperative testosterone levels: euogonadal (serum levels of testosterone > 12 nmol/l), hypogonadal men (serum levels of testosterone ≤ 12 nmol/l). RESULTS Microsurgical subinguinal varicocele repair was associated with a significant improvements of testosterone levels at 1 and 12 months after surgery as compared to the preoperative levels (13 nmol/l vs. 18 nmol/l, p = 0.03; 13 nmol/l vs. 15 nmol/l, p = 0.01). The same trend was seen in men who were classified as being hypogonadal (7.0 nmol/l vs. 15 nmol/l, p = 0.01; 7.0 nmol/l vs. 10 nmol/l, p = 0.02). No significant improvements in testosterone levels were observed in euogonadal men (p > 0.05). CONCLUSION Microsurgical subinguinal varicocele repair was associated with a significant improvements of testosterone levels in men with grade II-III lesions and low preoperative testosterone values.
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Affiliation(s)
- Saad Elzanaty
- Department of Translational Medicine, Division of Urological Research, Skåne University Hospital, Lund University, Malmö, Sweden
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de Los Reyes T, Locke J, Afshar K. Varicoceles in the pediatric population: Diagnosis, treatment, and outcomes. Can Urol Assoc J 2017; 11:S34-S39. [PMID: 28265315 DOI: 10.5489/cuaj.4340] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Varicocele is commonly encountered in adolescents. There are still many controversies regarding pathophysiology, health effects, clinical significance, and optimum treatment of this condition. This article reviews the current evidence pertaining to children and adolescents with varicocele. This group present a unique and somehow challenging situation, since they are still going through pubertal changes that may confound the effects of the disease and its treatment on the developing testes.
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Affiliation(s)
- Thomas de Los Reyes
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Locke
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Kourosh Afshar
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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Majzoub A, Elbardisi H, Arafa M, Agarwal A, Al Said S, Al Rumaihi K. Does the number of veins ligated during varicococele surgery influence post-operative semen and hormone results? Andrology 2016; 4:939-43. [PMID: 27317389 DOI: 10.1111/andr.12226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/21/2016] [Accepted: 04/26/2016] [Indexed: 12/01/2022]
Abstract
Varicocele is a well-established cause of male subfertility, which is directly proportional to its clinical grade. Although newer ultrasonic grading systems have taken into account the existence of pampiniform venous plexi, little is known about the clinical significance of the number of veins ligated during surgery. Very few undersized studies reported an influence which triggered the need to evaluate such association. This is a retrospective study of 378 patients who underwent left microsurgical subinguinal varicocoelectomy. Semen analyses and blood hormone studies performed pre-operatively were compared to those executed 6 months after surgery. Patients were divided into abnormal semen and normal semen groups based on their initial semen results. They were also subdivided according to the number of veins ligated intraoperatively into three groups: <5, 5-10, and >10 veins. Sperm count, total motility, and progressive motility were significantly increased in 62, 60.3, and 53.3% of patients post-operatively (p = 0.001), respectively. No significant differences in hormone levels were detected overall. Of the 378 patients, 332 had an abnormal semen analysis, while the remaining 46 patients had a normal result. Sperm count, total motility, and progressive motility significantly increased after varicocoelectomy in patients with an abnormal initial semen analysis (p = 0.001). In 48.7% of patients, 5-10 veins were ligated during surgery, whereas 28.3% had >10 and 23% had <5 ligated veins. No statistically significant differences were noted in the initial or the follow-up results among the number of vein subgroups. Varicocele ligation improves patients' fertility potential. This improvement, however, is not influenced by the number of veins ligated intraoperatively. Clinical grading maintains its superiority in the evaluation of varicocele patients.
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Affiliation(s)
- A Majzoub
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - H Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - M Arafa
- Department of Andrology, Cairo University, Cairo, Egypt
| | - A Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - S Al Said
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - K Al Rumaihi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
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13
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Eid AA, Younan DN. Seminal Tumour necrosis factor-related apoptosis-inducing ligand and its relationship to infertility in Egyptian patients with varicocele. Andrologia 2014; 47:1028-33. [DOI: 10.1111/and.12373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- A. A. Eid
- Department of Dermatology, Venereology and Andrology; Faculty of Medicine; Alexandria University; Alexandria Egypt
| | - D. N. Younan
- Department of Clinical Pathology; Faculty of Medicine; Alexandria University; Alexandria Egypt
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14
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Gökhan-Köse M, Erdem ŞR, Peşkircioğlu ÇL, Çaylak B. Angiogenesis inhibition impairs testicular morphology in experimental left varicocele rat model. Actas Urol Esp 2014; 38:459-64. [PMID: 24702910 DOI: 10.1016/j.acuro.2013.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 12/01/2013] [Indexed: 01/25/2023]
Abstract
INTRODUCTION It has been reported that varicocele might promote angiogenesis. However, it is not clearly identified how angiogenesis affect testicular morphology or spermatogenic activity. The objective of the study is to investigate the effect of spironolactone, as an angiogenesis inhibitor, on the ipsilateral testis morphology in left varicocele-induced rats. MATERIALS AND METHODS Twenty four adult (12-14 mo), male Wistar albino rats were randomly assigned to four groups (n=6, for each): 1. Control group, 2. Sham-operated group, 3. Experimental left varicocele group and, 4. Spironolactone (20mg/kg/day)-treated experimental left varicocele group. Histopathological findings in rat testis were investigated. RESULTS Microvessel density increased in varicocele group and spironolactone inhibited angiogenesis neither by antimineralocorticoid, nor by antiandrogenic effect. However, spermatogenesis impaired in spironolactone treated varicocele group. CONCLUSION Angiogenesis seems to be a protective process in varicocele. Spironolactone treatment, probably by inhibiting angiogenesis, impairs testicular morphology.
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Affiliation(s)
- M Gökhan-Köse
- Baskent University School of Medicine, Department of Urology, Ankara, Turquía.
| | - Ş R Erdem
- Baskent University School of Medicine, Department of Pharmacology, Ankara, Turquía
| | - Ç L Peşkircioğlu
- Baskent University School of Medicine, Department of Urology, Ankara, Turquía
| | - B Çaylak
- Baskent University School of Medicine, Department of Pathology, Ankara, Turquía
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15
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Serefoglu EC, Saitz TR, La Nasa JA, Hellstrom WJ. Adolescent varicocoele management controversies. Andrology 2013; 1:109-15. [PMID: 23258638 DOI: 10.1111/j.2047-2927.2012.00004.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/18/2012] [Accepted: 07/05/2012] [Indexed: 11/28/2022]
Abstract
Varicocoele is defined as excessive dilatation of the pampiniform venous plexus of the spermatic cord. Varicocoele frequently appears during early puberty and is recognized to be the most common surgically correctable cause of male infertility. However, the actual incidence in adolescents, pathophysiology and the association with male factor infertility all remain somewhat controversial. The most accurate diagnostic technique for identifying young men who will benefit from surgical treatment has yet to be established. Observations of testicular asymmetry and deteriorating semen quality helped establish current guidelines and recommendations for surgical treatment. Further studies, comparing observation with surgical intervention, are needed to refine the current indications for varicocoele repair in the adolescent male.
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Affiliation(s)
- E C Serefoglu
- Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, USA
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Köse MG, Erdem ȘR, Peșkircioğlu ÇL, Çaylak B. Effects of Angiogenesis Inhibition by Spironolactone on Isolated Vas Deferens Contractility in an Experimental Varicocele Model in Rats. Urology 2012; 80:816-21. [DOI: 10.1016/j.urology.2012.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 07/02/2012] [Accepted: 07/10/2012] [Indexed: 10/27/2022]
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Expression of E-cadherin and α-catenin in a varicocele-induced infertility rat model. Asian J Androl 2011; 13:470-5. [PMID: 21399649 DOI: 10.1038/aja.2010.94] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The roles of E-cadherin and α-catenin were evaluated in the development of varicocele-induced infertility. Analysis of the association between the expression of E-cadherin/α-catenin and clinical/pathological parameters was performed. Thirty 10-week-old male rats (experimental group) were used for the experiments; the left renal vein was ligated to form a varicocele. The abdomen was incised in 30 rats (control group) and no procedure was performed on 10 rats (baseline group). The weights of the left testis, serum reactive oxygen species (ROS), testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and degenerative changes in the seminiferous tubules after 4 and 8 weeks were recorded. The expression of E-cadherin and α-catenin was evaluated by immunohistochemical (IHC) staining and Western blot analysis. The ROS increased in the 8-week experimental group, compared with the baseline and control groups (P < 0.001 for both). Additionally, FSH significantly increased in the 4- and 8-week experimental group compared with the control groups (P = 0.013 and P = 0.032, respectively). The ratio of degenerative changes in the seminiferous tubules of the experimental groups increased. The IHC staining showed that the expression of E-cadherin and α-catenin decreased in the 4- and 8-week experimental groups. Similar to the IHC staining, the experimental group had decreased reactivity on Western blot analysis. The expression of E-cadherin and α-catenin was significantly associated with the ROS and degenerative changes in the seminiferous tubules. The results of this study suggest that damage to the blood-testis barrier (BTB) is associated with varicocele-induced male infertility, and that ROS may cause damage to the BTB.
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Sathya Srini V, Belur Veerachari S. Does varicocelectomy improve gonadal function in men with hypogonadism and infertility? Analysis of a prospective study. Int J Endocrinol 2011; 2011:916380. [PMID: 22190930 PMCID: PMC3235454 DOI: 10.1155/2011/916380] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 10/04/2011] [Indexed: 12/23/2022] Open
Abstract
Varicocele in infertile males is associated with Leydig cell dysfunction and hypogonadism. The effect of varicocelectomy on serum testosterone level is not yet established. We analysed 200 heterosexual infertile men diagnosed to have clinical varicocele they were divided into two groups: group 1 (100 men) had microsurgical varicocelectomy, and group 2 (100 patients) underwent assisted reproduction procedures. All participants had semen analysis, serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and total testosterone (TT), measured both at recruitment time and 6 months later. In group 1, the mean TT level increased significantly after varicocelectomy (1.644 ± 0.029 to 2.461 ± 0.0198 ng/dL, P < 0.0001) and testicular size correlated with the mean change in TT (P = 0.001). No similar change was found in group 2. Out of the 100 patients in group 1, 78 had postoperative normalization of TT unlike only 16 men in group 2.
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Affiliation(s)
- Vasan Sathya Srini
- Department of Andrology, Ankur Health Care Private Limited, No. 55, 20th Main, 1st Block, Rajajinagar, Bengaluru 560010, India
| | - Srinivas Belur Veerachari
- Department of Andrology, Ankur Health Care Private Limited, No. 55, 20th Main, 1st Block, Rajajinagar, Bengaluru 560010, India
- *Srinivas Belur Veerachari:
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Zohdy W, Ghazi S, Arafa M. Impact of varicocelectomy on gonadal and erectile functions in men with hypogonadism and infertility. J Sex Med 2010; 8:885-93. [PMID: 20722780 DOI: 10.1111/j.1743-6109.2010.01974.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Previous reports linked varicocele in infertile males with Leydig cell dysfunction and hypogonadism. AIM The aim of this study was to determine the impact of varicocelectomy on serum total testosterone (TT) level and erectile function in men with infertility and clinical varicocele. METHODS This study included 141 heterosexual infertile men diagnosed to have clinical varicocele. They were divided into two groups: group 1 (103 men), who had microsurgical varicocelectomy, and group 2 (38 patients), who decided to pursue assisted reproduction procedures. All participants completed the International Index of Erectile Function (IIEF)-5 questionnaire and underwent semen analysis. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and TT were measured both at recruitment time and 6 months later. MAIN OUTCOME MEASURE Changes in serum TT and IIEF-5 following varicocelectomy. RESULTS In group 1, the mean TT level increased significantly post-varicocelectomy (379.1 ± 205.8 to 450.1 ± 170.2 ng/dL, P < 0.0001). No similar change was found in group 2. Out of the 49 patients in group 1 with hypogonadism at baseline assessment (TT < 300 ng/dL), 37 (75.5%) exhibited a postoperative normalization of TT. However, only 3/15 hypogonadal men (20%) in group 2 had normal testosterone levels at the second visit. IIEF-5 scores improved significantly postoperatively in patients with hypogonadism (17.1 ± 2.6 to 19.7 ± 1.8, P < 0.001). Neither operating vein diameter 3.6 ± 0.57 mm nor testicular size 10.46 ± 3.3 mL correlated with the mean change in TT (71.1 ± 101.2 ng/dL) (r = 0.162, P = 0.183 and r = -0.077, P = 0.536, respectively). CONCLUSIONS Varicocele is associated with hypogonadism in some infertile patients. Varicocelectomy significantly improves serum testosterone in infertile men, especially those with hypogonadism. This improvement in TT level may be reflected in the IIEF score.
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Affiliation(s)
- Wael Zohdy
- Department of Andrology, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Abstract
A varicocele is a dilatation of the testicular vein and the pampiniform venous plexus within the spermatic cord. Although rare in pediatric populations, the prevalence of varicoceles markedly increases with pubertal development. Varicoceles are progressive lesions that may hinder testicular growth and function over time and are the most common and correctable cause of male infertility. Approximately 40% of men with primary infertility have a varicocele, and more than half of them experience improvements in semen parameters after varicocelectomy. The decision to treat adolescents with varicocele is a controversial one. The task for pediatricians and urologists is to identify those adolescents who are at greatest risk for infertility in adulthood, in an effort to offer early surgical intervention to those most likely to benefit.
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Affiliation(s)
- Samuel P Robinson
- Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA 23298-0118, USA
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Zhang Y, Gao X, Liu X, Wang K, Pang J, Zhou J. A new experimental inbred Wistar rat varicocele model: anatomy of the left spermatic vein and the effect on histology. Andrologia 2008; 40:13-7. [DOI: 10.1111/j.1439-0272.2008.00802.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Zampieri N, Corroppolo M, Zuin V, Cervellione RM, Ottolenghi A, Camoglio FS. Longitudinal Study of Semen Quality in Adolescents with Varicocele: To Treat or Not? Urology 2007; 70:989-93. [DOI: 10.1016/j.urology.2007.07.061] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Revised: 06/21/2007] [Accepted: 07/18/2007] [Indexed: 10/22/2022]
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