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Belkovsky M, Passerotti CC, Maximiano LF, Otoch JP, Cruz JASDA. The learning curve of bilateral laparoscopic varicocelectomy: a prospective study. Rev Col Bras Cir 2023; 50:e20233456. [PMID: 37075467 PMCID: PMC10508658 DOI: 10.1590/0100-6991e-20233456-en] [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: 08/23/2022] [Accepted: 09/20/2022] [Indexed: 04/21/2023] Open
Abstract
Varicocele occurs in 15% of general male population and in 35% of infertile men. Since 1992, surgical correction with laparoscopic varicocelectomy is the gold standard for treatment of symptomatic patients or patients with abnormal seminal analysis. The learning curve for this frequently performed procedure has not yet been described. In the present study, we investigated the learning curve of a single urologist in training performing his first 21 laparoscopic varicocelectomies using qualitative and quantitative tools to evaluate his performance during the process. Our results show that 14 bilateral laparoscopic varicocelectomies are enough to achieve the plateau of the learning curve.
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Affiliation(s)
- Mikhael Belkovsky
- - Faculdade de Medicina da USP, Técnica Cirúrgica e Cirurgia Experimental - São Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Centro de Cirurgia Robótica - São Paulo - SP - Brasil
| | | | - Linda Ferreira Maximiano
- - Faculdade de Medicina da USP, Técnica Cirúrgica e Cirurgia Experimental - São Paulo - SP - Brasil
| | - José Pinhata Otoch
- - Faculdade de Medicina da USP, Técnica Cirúrgica e Cirurgia Experimental - São Paulo - SP - Brasil
| | - Jose Arnaldo Shiomi DA Cruz
- - Faculdade de Medicina da USP, Técnica Cirúrgica e Cirurgia Experimental - São Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Centro de Cirurgia Robótica - São Paulo - SP - Brasil
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Relationship between Varicocele and Male Hypogonadism: A Review with Meta-Analysis. ENDOCRINES 2022. [DOI: 10.3390/endocrines3010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The relationship between varicocele and hypogonadism becomes clearer everyday thanks to the most recent literature, particularly with regards to the impact of varicocele repair on serum testosterone level improvement in hypogonadal patients. We selected English articles published from 1964 to September 2021. The search terms “varicocele” and “hypogonadism” were used as filters. A total of 102 studies have been obtained. For the meta-analysis, the pooled mean differences (MDs) for continuous variables and the ln(OR) were used for data pooling observational studies. A total of 15 articles have been finally included: nine retrospective and six observational. Testosterone levels pre- and after surgery were reported in four studies. There was statistically significant heterogeneity in these studies (chi2 = 267.09, I2 = 72%; p = 0.01). Mean differences of total testosterone was statistically different in men pre- and after-surgery (mean difference = 106.76; p < 0.0001). It is indeed established that altered environments caused by varicocele cause pantesticular insult, but it has not been unequivocally determined whether men with varicocele are at increased risk for the development of clinical hypogonadal symptoms.
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Ory J, Tradewell MB, Blankstein U, Lima TF, Nackeeran S, Gonzalez DC, Nwefo E, Moryousef J, Madhusoodanan V, Lau S, Jarvi K, Ramasamy R. Artificial Intelligence Based Machine Learning Models Predict Sperm parameter Upgrading after Varicocele Repair: A Multi-Institutional Analysis. World J Mens Health 2022; 40:618-626. [PMID: 35021305 PMCID: PMC9482858 DOI: 10.5534/wjmh.210159] [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: 08/18/2021] [Revised: 09/17/2021] [Accepted: 09/28/2021] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Varicocele repair is recommended in the presence of a clinical varicocele together with at least one abnormal semen parameter, and male infertility. Unfortunately, up to 50% of men who meet criteria for repair will not see meaningful benefit in outcomes despite successful treatment. We developed an artificial intelligence (AI) model to predict which men with varicocele will benefit from treatment. MATERIALS AND METHODS We identified men with infertility, clinical varicocele, and at least one abnormal semen parameter from two large urology centers in North America (Miami and Toronto) between 2006 and 2020. We collected pre and post-operative clinical and hormonal data following treatment. Clinical upgrading was defined as an increase in sperm concentration that would allow a couple to access previously unavailable reproductive options. The tiers used for upgrading were: 1-5 million/mL (ICSI/IVF), 5-15 million/mL (IUI) and >15 million/mL (natural conception). Thus moving from ICSI/IVF to IUI, or from IUI to natural conception, would be considered an upgrade. AI models were trained and tested using R to predict which patients were likely to upgrade after surgery. The model sorted men into categories that defined how likely they were to upgrade after surgery (likely, equivocal, and unlikely). RESULTS Data from 240 men were included from both centers. A total of 45.6% of men experienced an upgrade in sperm concentration following surgery, 48.1% did not change, and 6.3% downgraded. The data from Miami were used to create a random forest model for predicting upgrade in sperm concentration. On external validation using Toronto data, the model accurately predicted upgrade in 87% of men deemed likely to improve, and in 49% and 36% of men who were equivocal and unlikely to improve, respectively. Overall, the personalized prediction for patients in the validation cohort was accurate (AUC 0.72). CONCLUSIONS A machine learning model performed well in predicting clinically meaningful post-varicocelectomy sperm parameters using pre-operative hormonal, clinical, and semen analysis data. To our knowledge, this is the first prediction model to show the utility of hormonal data, as well as the first to use machine learning models to predict clinically meaningful upgrading. This model will be published online as a clinical calculator that can be used in the preoperative counseling of patients.
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Affiliation(s)
- Jesse Ory
- Department of Urology, University of Miami, Coral Gables, FL, USA.,Department of Urology, Dalhousie University, Halifax, NS, Canada
| | | | - Udi Blankstein
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Thiago F Lima
- Department of Urology, University of Miami, Coral Gables, FL, USA
| | - Sirpi Nackeeran
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Elie Nwefo
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | | | - Susan Lau
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Keith Jarvi
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Ranjith Ramasamy
- Department of Urology, University of Miami, Coral Gables, FL, USA.
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Panach-Navarrete J, Morales-Giraldo A, Ferrandis-Cortés C, García-Morata F, Pastor-Lence JC, Martínez-Jabaloyas JM. Is there a relationship between varicocele and testosterone levels? Aging Male 2020; 23:592-598. [PMID: 31070084 DOI: 10.1080/13685538.2018.1550745] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES The goal of this work was to study the relationship between presence of varicocele and testosterone serum levels in adulthood. METHODS A comparative, cross-sectional study of 387 men who consulted for erectile dysfunction. Age, body mass index (BMI), diabetes (DM), and presence of varicocele were related to testosterone levels through uni- and multi-variate analysis. RESULTS A total of 248 cases (70.8%) had no varicocele, 46 (13.1%) had grade I varicocele, 36 (10.3%) grade II, and 20 (5.7%) grade III. The mean total testosterone levels were 4.77 ng/mL in the non-varicocele group and 4.34 ng/mL in the varicocele group (p = .91), while free testosterone levels were 69.81 and 73.24 pg/mL (p = .18), respectively. In the multivariate analysis, BMI> = 30 was related to low total testosterone levels (OR: 2.94, p < .001) and low free testosterone (OR: 2.01, p = .01), while advanced age associated with low levels of free testosterone (OR: 1.04, p < .001). CONCLUSIONS We were not able to establish a relationship between the presence of varicocele and decreased serum testosterone levels. Other factors already described, such as obesity and age, were related to low levels of total and free testosterone.
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Affiliation(s)
- Jorge Panach-Navarrete
- Department of Urology, University Clinic Hospital of Valencia, Valencia, Spain
- Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
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Lipshultz LI, Ramasamy R, Sandlow JI, Hotaling J, Eisenberg M, Niederberger C, Brannigan RE. Microsurgical varicocelectomy: novel applications to optimize patient outcomes. Fertil Steril 2019; 112:632-639. [DOI: 10.1016/j.fertnstert.2019.08.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 11/30/2022]
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Dobronski P, Dobronska K, Kupis L, Radziszewski P. Subinguinal microsurgical varicocelectomy is safe and effective in a solitary testicle. Asian J Androl 2019; 22:120-121. [PMID: 31210150 PMCID: PMC6958977 DOI: 10.4103/aja.aja_37_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Piotr Dobronski
- Department of Urology, Medical University of Warsaw, Warsaw 02-005, Poland
| | - Karolina Dobronska
- First Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw 02-005, Poland
| | - Lukasz Kupis
- Department of Urology, Medical University of Warsaw, Warsaw 02-005, Poland
| | - Piotr Radziszewski
- Department of Urology, Medical University of Warsaw, Warsaw 02-005, Poland
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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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