Does total testicular volume predict testicular volume difference in adolescent males with varicocele?

ABSTRACT Introduction: We evaluated the relationship between total testicular volume (TTV) and testicular volume differential (TVD) in adolescent males with varicocele. Both low TTV and high TVD have been independently associated with higher incidences of infertility later in life, but a predictive relationship between TTV and TVD directly has yet to be described. Materials and Methods: We retrospectively analyzed a database of Tanner 5 boys ages 16-21 who presented with varicocele at a single institution between 2009 and 2017. All patients had a scrotal sonogram prior to surgical intervention. TTV and TVD were calculated for each individual and four non-exclusive groupings of patients were created for statistical analysis. We chose 30 cc as a cut off value for low TTV based on prior studies. Results: 209 patients met our inclusion criteria. Mean age was 18.3 years (16-21, SD 1.7) with a mean total testicular volume of 36 cc (13.5-78.2, SD 11.1). Cut off points of TVD of 20% and TTV of 30 cc were used to separate patients. There were 65 boys (31%) with TTV < 30 cc and 58 boys (28%) with TVD ≥ 20%. Among males with TTV < 30 cc, 23 (35%) had a TVD ≥ 20%. Among males with TTV ≥ 30 cc, 35 (24%) had a TVD ≥ 20%. The relationship between TVD and TTV was found to be non-significant (p > 0.05). Discussion: Adolescent varicoceles continue to pose a challenge to pediatric urologists. The dilemma of over-aggressive treatment has proven difficult to balance with the risk of infertility. We hoped that elucidating the relationship between TTV and TVD could be useful in identifying patients who are at greater risk for infertility while decreasing the need for more intrusive testing, such as semen analysis, in an adolescent population. We looked at the direct relationship between low TTV and high TVD. In our population, there was a non-significant relationship between TTV < 30 cc and TVD ≥ 20% (p > 0.05) indicating that in adolescents with varicocele, TTV and TVD are independent variables. Our study limitations include the inherent user dependent bias of ultrasound measurements and data collection at a single institution with high ethnic diversity, possibly not comparable to all patient populations. Conclusions: Low TTV (< 30 cc) itself is not predictive of high TVD (≥ 20%) in adolescent boys with varicocele, despite their reported independent associations with impaired fertility in other studies.

Should azoospermic patients with varicocele disease undergo surgery to recover fertility? / Pacientes com azoospermia e varicocele devem ser submetidos à cirurgia para recuperar a fertilidade?

Summary Introduction: Varicocele disease is well-known cause of infertility in men. The presence of spermatic varices veins create a hostile environment to spermatogenesis. It results in reduced quality of the sperm production and in some cases can determine a total absence of sperm. The varicocelectomy procedure in patients with non-obstructive azoospermia (NOA) can raise the rates of sperm in the semen analysis. A positive rate for sperm, even if very low, may be sufficient to enable the capture of sperm intended for in-vitro fertilization without the use of donor sperm. Objetive: To evaluate the raise of sperm in NOA patients with varicocele disease who were submitted to a bilateral procedure to recovery sperm production. Method: We analized the sperm results of 25 NOA patients who undergone to a bilateral varicocelectomy procedure. Results: From a total of 25 patients, three (12%) recovered sperm count four months after procedure. One year after the procedure, five (20%) patients recovered sperm production. Conclusion: Patients with varicocele disease and azoospermia, without genetic changes or obstruction of the spermatic tract, should undergo surgical procedure to recover sperm.

Resumo Introdução: A varicocele é sabidamente uma das causas de infertilidade nos homens. A presença de veias espermáticas dilatadas pode criar um ambiente hostil para a espermatogênese. Isso é causa de baixa qualidade e quantidade da produção do esperma; em alguns casos, pode determinar uma ausência total de espermatozoides. O procedimento de varicocelectomia em pacientes com azoospermia não obstrutiva pode aumentar as taxas de espermatozoides na análise do sêmen. Uma taxa positiva para o esperma, mesmo se muito baixa, pode ser suficiente para permitir a coleta e destinar-se ao processo de fertilização in vitro. Isso sem a necessidade de usar esperma de doador. Objetivo: Avaliar o aumento de espermatozoides em pacientes com varicocele associada à azoospermia não obstrutiva. Método: Foram analisados os espermas de 25 pacientes azoospêrmicos não obstrutivos submetidos a procedimento de varicocelectomia bilateral com magnificação microcirúrgica. Resultados: De um total de 25 pacientes, em três (12%) ocorreu recuperação da contagem de espermatozoides quatro meses após o procedimento. Após um ano de procedimento, em cinco (20%) ocorreu a recuperação. Conclusão: Pacientes com ausência de espermatozoides e varicocele, sem alterações genéticas, devem ser submetidos a tratamento cirúrgico a fim de recuperar a produção de espermatozoides.

Impact of body mass index, age and varicocele on reproductive hormone profile from elderly men

ABSTRACT Objectives: To study the impact of obesity, age and varicocele on sexual hormones fof 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.

Simultaneous Administration of Dexamethasone and Vitamin E Reversed Experimental Varicocele-induced Impact in testicular tissue in Rats; Correlation with Hsp70-2 Chaperone Expression

ABSTRACTPurpose:This study aimed to investigate the protective effects of isolated and co-administration of vitamin E (VitE) and dexamethasone (DEX) on varicocele (VCL)-induced damages in testicular tissue.Materials and Methods:Wistar rats were divided into five groups (n=6), including; control-sham, non-treated VCL-induced, VitE-treated VCL-induced (VitE, 150 mg/kg, orally), DEX-administrated VCL-induced (DEX, 0.125 mg/kg, i.p.), VitE+DEX-received VCL-induced animals. The antioxidant status analyses, histopathological examinations, hormonal assay and tissue levels of alkaline phosphatase (ALP) were analyzed. The germinal epithelium RNA damage and Leydig cells steroidogenesis were analyzed. Moreover, the Hsp70-2 protein expression was examined based on immunohistochemical and western blot analyses. The sperm parameters, DNA integrity and chromatin condensation were investigated.Results:VitE and DEX in simultaneous form of administration significantly (P<0.05) down-regulated the tissue ALP level and attenuated the VCL-decreased GSH-px, SOD and TAC levels and remarkably (P<0.05) down-regulated the testicular malondialdehyde (MDA) and nitric oxide (NO) contents. The VCL-induced histopathological alterations significantly (P<0.05) improved in VitE and DEX-administrated animals. The VitE and DEX co-administration reduced the VCL-increased RNA damage and elevated the Leydig cells steroidogenic activity. The Hsp70-2 protein level completely (P<0.05) increased in VitE and DEX alone–and-simultaneous-administrated animals. Finally, the VitE and DEX could significantly (P<0.05) improve the VCL-decreased semen quality and improved the sperm DNA integrity and chromatin condensation.Conclusion:Our data suggest that Vit E by up-regulating the antioxidant status and DEX by reducing inflammation-dependent oxidative and nitrosative stresses could improve the VCL-reduced Hsp70-2 chaperone expression and ultimately protected the testicular endocrine activities and promoted the spermatogenesis process.

Does the duration of infertility affect semen parameters and pregnancy rate after varicocelectomy?: a retrospective study

OBJECTIVES: The most common indication for treatment of varicocele is still male subfertility. The aim of this study was to explore the effect of infertility duration on semen parameters and spontaneous pregnancy rate after varicocelectomy. MATERIALS AND METHODS: The medical records of 183 infertile patients with clinical varicocele were retrospectively reviewed. The patients were divided into three groups according to the duration of infertility (group I, 1-3 years, group II, 3-6 years and group III, > 6 years). Total sperm motility counts (TMCs) before and after varicocelectomy and spontaneous pregnancy rate among these groups were statistically compared. RESULTS: The greatest changes, regarding preoperative and postoperative TMCs and spontaneous pregnancy rate were noticed between group I and III. Preoperative TMCs in group I and III was 15.2 ± 1.2, 7.8 ± 1.4, respectively (p < 0.05). Postoperative TMCs in group I and III was 33.7 ± 2.5, 25.2 ± 1.9, respectively (p < 0.05). An overall spontaneous pregnancy rate of 34.4 percent was achieved after inguinal varicocelectomy. The greatest spontaneous pregnancy rate was achieved in Group I (37.3 percent), and the lowest pregnancy rate in Group III (26.3 percent) (P < 0.05). CONCLUSIONS: Surgical varicocelectomy improves the total sperm motility counts especially in patients who have a TMCS more than 5 million and improves the spontaneous pregnancy rates. The improvement in the spontaneous pregnancy rates after varicocelectomy correlates negatively with the duration of infertility. Therefore, duration of infertility should be considered in treating a patient with a varicocele as a cause of infertility.

The role of varicocele repair in the new era of assisted reproductive technology: [review]

Infertility affects 10-15 percent of couples who are trying to conceive, and half of the cases are due to male infertility. Intracytoplasmic sperm injection is increasingly being used to overcome multiple sperm deficiencies. Due to its effectiveness, some have proposed ICSI as a solution for all cases of male infertility, regardless of the cause. Hence, even men with potentially treatable causes of infertility have sought the aid of assisted reproductive technology, rather than undergo specific therapies to treat their infertility. Varicoceles are the most frequent physical finding in infertile men; indeed, they may be responsible for nearly one-third of cases of male infertility. Varicocele management, however, has always been a controversial issue because very few randomized, controlled studies have been performed to examine varicocelectomy as an infertility treatment. Significant evidence suggests that varicoceles have a harmful effect on the testis and that varicocelectomy can not only prevent progressive decline in testicular function but also reverse the damage. However, the degree to which varicocele repair improves pregnancy rates and the success of assisted reproductive technology remains controversial.

Varicocele en adolescentes: revisión bibliográfica / Adolescent varicocele: bibliographic review

La dilatación de las venas del plexo pampiniforme es un problema médico que ya fue identificado hacia fines del siglo XIX. A pesar de esto, sus consecuencias en el tamaño testicular, parámetros seminales y el impacto en la fertilidad siguen siendo temas debatidos en forma activa en la literatura actual, apoyado principalmente en el desarrollo de nuevas técnicas de laboratorio, exámenes diagnósticos y procedimientos quirúrgicos mínimamente invasivos. Como resultado de esto, hay una serie de interrogantes acerca del varicocele adolescente que no han sido respondidas, principalmente en lo que respecta a la utilidad de realizar una corrección quirúrgica precoz para prevenir una eventual infertilidad futura.

Novidades na fisiopatologia e tratamento do homem infértil com varicocele e sua relação com reprodução assistida / News in pathophysiology and treatment of the infertile man with varicocele and its relationship with assisted reproduction

Varicocele é considerada a causa mais freqüente de infertilidade masculina. Embora esteja presente em 8 a 23 porcento da população em geral, ele acomete 19 a 41 porcento dos homens que procuram o serviço de medicina reprodutiva. Apesar das excelentes taxas de sucesso com o tratamento cirúrgico da varicecele, muitos profissionais ainda questionam a validade de realizar a varicocelectomia e indicam tratamento com reprodução assistida. O objetivo deste estudo é avaliar os trabalhos publicados na literatura em relação à patofisiologia da varicocelectomia, à varicocelectomia e seu resultado. Além disso, pretendíamos avaliar as indicações de varicocelectomia (ou reprodução assistida)nos casos mais comuns observados em serviços de reprodução humana (ou no consultório do urologista).

Varicocele, un tema polémico: revisión y apreciaciones personales / Varicocele, a controversial topic: a revision and personal commentary

El varicocele es la dilatatación de la venas del plexo pampiniforme en el cordón espermático y constituye un hallasgo frecuente entre los varones infértiles. Esta patología ha generado un enorme interés en las últimas décadas, por cuanto su tratamiento quirúrgico permite restaurar la fertilidad en un importante número de casos. A pesar de la voluminosa literatura publicada sobre esta afección, aún hay muchas preguntas sin respuesta. Sería muy extenso emprender una revisiòn exhaustiva de las publicaciones más importantes; sin embargo, en esa presentación trataremos de recordar algunos aspectos importantes de su anatomía, fisiopatología, metodología diagnóstica, los resultados del tratamiento quirúrgico y, finalmente, una breve descripción de las técnicas quirúrgicas habituales y de sus posibles complicaciones. En el desarrollo de algunos temas, comentaremos nuestra opinión personal y eventuales resultdos, producto de la experiencia recogida en el diagnósticoy tratamiento del varicocele, en los últimos 15 años

Varicocele in prepubertal boys: evaluation of clinical, doppler and hormonal findings

Hormonal, clinical and scrotal Doppler findings were assessed in 16 prepubertal patients having unilateral varicocele. As already described in pubertal patients, Doppler studies made it possible to detect patterns of prolonged, intermittent or permanent reflux. An LH-RH test and an hCG test measuring LH, FSH and testosterone (T) were performed in all cases. patients with varicocele showed (median and range): LH B (mlU/ml): 0.40 (0.40-2.1); LH Mx.: 3.7 (1.1-15); FSH B (mlU/ml); 1.95 (0.40-4.5); FSH Mx.: 4.9 (3.1-10); T B (ng/ml): 0.2 (0.1-1.5): T Post.: 2.25 (0.82-11.5). The control group showed: LH B (mlU/ml): 0.40 (0.4-0.85); LH Mx.: 2.15 (0.63-12) FSH B (mlU/ml): 1.45 (0.4-3); FSH Mx.: 4.25 (2.6-5.9); T B (ng/ml): 0.1 (0.1-0.3); T Post.: 3.26 (1.0-5.6). No significant differences were found between the hormonal results of the different groups classifed according to the scrotal findings. Basal LH and FSH in grade 3 varicoceles were found to be significantly higher (p < 0.05) than those of the control group. Basal T, as well as the maximal response of both gonadotropins to LH-RH, and T response to hCG showed no significant differences with reference to the control group. Our findings provide indirect support to the notion that the gonadal damage would become detectable from puberty onwards.

Sertoli cell function in varicocele-induced subfertility

The aim of this study is to find a correlation between the grade of varicocele, the total seminal transferrin level and the altered seminal parameters in 40 infertile patients with varicocele. Although no correlation had been found between both the grade of varicocele and intrascrotal temperature and both the total seminal transferrin concentration and the altered seminal parameters studied, a positive direct correlation was detected between the decreased seminal transferrin concentration and both the sperm density and% of motile sperms. The possible role of both Sertoli cell dysfunction and increased intrascrotal temperature in inducing subfertility in patients with varicocele has been discussed in details, and the relation between Sertoli cell dysfunction and altered spermatogenesis was explained in details on the basis of the testicular cell interaction

Uroflujometría con instrumentación y sin ella en pacientes con crecimiento prostático benigno / Uroflowmetry with and without instrumentation in patients with benign prostatic growth

A pesar de la amplia aceptación de la uroflujometría existen aspectos sin resolver, como la influencia de la instrumentación. Se estudiaron 119 pacientes con crecimiento prostático benigno y promedio de edad de 65.3 años, y se comparó la uroflujometría espontánea con la instrumentada. Los promedios de la tasa de flujo máximo (TFmás) y la tasa de flujo medio (TFmed) disminuyeron con la instrumentación de 15.9 a 10.9 ml/seg y de 6.6 a 4.7 ml/seg, respectivamente (p < 0.0001). El volumen de vaciado (Vvac) aumentó de 259.8 a 389.3 ml y el volumen residual (Vres) disminuyó de 129.3 a 64.6 ml (p < 0.0001) en la uroflujometría instrumentada. La uroflujometría en pacientes con crecimiento prostático benigno debe realizarse en forma espontánea, dado que la instrumentación influye de manera significativa y disminuye las tasas de flujo, lo que podría sobreestimar el grado de obstrucción prostática con mayor probabilidad de error en la decisión terapéutica

Varicocele em adolescentes: atualizaçäo de conduta / Varicocele in adolescent

É feita uma revisäo atualizada da etiopatogenia e fisiopatologia da varicocele. Com base nestes conhecimento, säo discutidos os critérios para a indicaçäo do tratamento da varicocele, que pode ser conservador ou curúrgico, cujas técnicas cirúrgicas säo comenradas. As indicaçöes säo apresntadas na forma de algoritmo, através das quais säo especificadas as correlaçöes clínicas e laboratoriais. Como conclusäo da experiência de um serviço, apresenta-se a proposta para avalaçäo de adolescentes portadores de varicocele, elaborada por uma equipe multiprofissional e por alguns especialistas, na qual é salientada, inclusive, a importância da abordagem dos aspectos psicossociais

Hormonal profiles in blood and seminal plasma of infertile men with and without varicocele

Follicle stimulating hormone [FSH], lutenizing hormone [LH], prolactin, testosterone and estradiol were determined in blood seminal plasma of 60 infertile males, 30 had varicocele and 30 without varicocele, together with 10 fertile men who served as controls. FSH was significantly higher in both blood and seminal plasma of infertile men with varicocele compared to the other two groups. LH and prolactin levels in seminal plasmae were insignificantly higher in infertile men with and without varicocele compared with controls. Testosterone and estradiol levels in blood and seminal plasma were significantly lower in the infertile group with varicocele compared to the group without varicocele and the control group. The decreased levels of both steroids in infertile men with varicocele could account for the disturbed function of spermatozoa observed in category of infertile men