Application of a topical anesthetic reduces pain-associated parameters during spermatic cord transection in piglet castration using a minimal anesthesia model.

OBJECTIVE: This study assessed the use of a topical anesthetic as a feasible approach to reduce pain during piglet castration using a minimal anesthesia protocol. ANIMALS: 18 male piglets, aged 3-6 days, were included in this study. METHODS: A minimal anesthetic state was induced with isoflurane administered by facemask, with anesthetic depth individually adjusted based on responses to interdigital pinch. To desensitize the scrotal skin, a vapocoolant was applied 3 times. Scrotal incisions were made subsequently and Tri-Solfen (TS) or Placebo (P) was administered in both incisional gaps. After 30 seconds, the spermatic cords were severed followed by a further application of TS/P to both incision edges. Nociception-related variables, such as mean arterial blood pressure (MAP), heart rate (HR), and nocifensive movements, were assessed. RESULTS: Significant differences in MAP changes were assessed between the TS (14 ± 4 mmHg) and the P group (36 ± 8 mmHg) for cutting the spermatic cords. Furthermore, significantly fewer nocifensive movement score points appeared in the TS than in the P group (0; IQR = 0 vs 5; IQR = 6). CLINICAL RELEVANCE: In this anesthesia model, the application of TS after skin incision significantly reduced MAP responses and nocifensive movements with spermatic cord transection compared with the application of P. However, the waiting period between TS-application and spermatic cord transection might limit the benefit of the method in conscious piglets, as pain during castration is reduced but additional stress is caused by the prolonged handling. Furthermore, using a vapocoolant did not provide anesthesia for skin incisions.

Chronic Scrotal Content Pain: a Review of the Literature and Management Schemes.

PURPOSE OF REVIEW: Chronic scrotal content pain (CSCP) is a complex condition with multiple etiologies that requires a thorough understanding of its pathophysiology, workup, and treatment options. We performed a comprehensive and contemporary review to augment our current understanding of CSCP. RECENT FINDINGS: We discuss new advances in CSCP-specific pain questionnaires, modern studies of microscopic spermatic cord denervation and its variations, and novel techniques including electric nerve stimulation and cryoablation in addition to randomized control trials with significant negative findings. We also present literature focusing on the prevention of CSCP secondary to surgical iatrogenic causes. The constantly evolving literature of CSCP has led to the significant evolution in its diagnosis and treatment, from oral medications to salvage options after microscopic spermatic cord denervation. With each advance, we come closer to developing a more thorough, evidence-based algorithm to guide urologists in treatment of CSCP.

Trombosis de la vena espermática derecha. Revisión de la literatura a propósito de un caso / Right spermatic vein thrombosis. Revision of literature regarding a specific case

La tromboflebitis aguda de la vena espermática es una dolencia de muy baja frecuencia, con afectación mayoritaria del lado izquierdo, y de etiología desconocida en la mayoría de las ocasiones. Suele ser un hallazgo inesperado en el diagnóstico diferencial del dolor testicular agudo. Se trata de un varón de 29 años con un consumo abusivo de cocaína que acude con dolor testicular agudo. Se confirma la afectación de la vena espermática derecha mediante ecografía-doppler. Se optó por manejo conservador con anticoagulación y antiinflamatorios. La eco-doppler es la técnica con mayor especificidad y sensibilidad para diagnosticarlo, mientras que la TC puede completar su diagnóstico etiológico. El tratamiento de elección es conservador basado en la anticoagulación del paciente. Es imperativo un estudio hematológico en búsqueda de alteraciones de la coagulación (AU)

Acute thrombophlebitis of spermatic vein is an unusual pathology involving, in most of the cases, the left side, and whose etiology remains uncertain. Most of them are found during a a differential diagnosis in acute testicular pain. We introduce the case of a 29 years old male with abusive cocaine consumption, admitted to hospital due to severe testicular pain. Doppler-ultrasound examination was undertaken, showing right spermatic vein flux alteration. Conservative management was decided and anticoagulant and non-esteroidal anti-inflammatory drugs were started. Eco-doppler is the most specific and sensible technique for diagnosis of these cases, while TC can always confirm etiologic diagnosis. Treatment was initially conservative based on anticoagulation. Hematological study is necessary in order to determine coagulation alterations (AU)

Modified Inguinal Microscope-Assisted Varicocelectomy under Local Anesthesia: A Non-randomised Controlled Study of 3565 Cases.

Varicocele is a common abnormality, but the conventional microsurgical subinguinal varicocelectomy (CMSV) has some disadvantages. We invented Modified Inguinal Microscope-Assisted Varicocelectomy (MIMV) under local anesthesia. This study aims to evaluate MIMV by comparing it to CMSV in operating duration, time to return to normal activity, postoperative complications, achievement of natural pregnancy and improvement of semen quality for patients with infertility, pain score for those with scrotal pain, and so on. We enrolled 3089 patients who underwent MIMV and 476 who underwent CMSV in our hospital. Both the operating duration and the time to return to normal activity of MIMV was shorter than that of CMSV (P < 0.001). The recurrence rate (P < 0.001) and injury rate of vas deferens (P = 0.011) after MIMV were lower than that after CMSV. Moreover, patients with MIMV showed higher degree of satisfaction with the surgery experience and outcome than those with CMSV (P < 0.001). However, no statistical difference was found between the two groups in scores of pain due to surgery, postoperative varicose veins diameters, reflux duration, and the postoperative complications of wound infection, hydrocele, atrophy of testis, epididymitis, and scrotal hematoma. In summary, MIMV is a promising varicocelectomy and could be applied more in clinical practice.

Efficacy of the traditional Japanese medicine goreisan for the resolution of spermatic cord hydrocele in children.

PURPOSE: Goreisan, a traditional Japanese medicine, has previously been used for hydrostatic modulation. This retrospective study investigated the efficacy of goreisan for spermatic cord hydrocele resolution in children. METHODS: Seventy-two boys treated for spermatic cord hydrocele between 2012 and 2015 were included; Goreisan was administered to 16 [group G, median age 3 (1-8) years], and 56 were followed without medication [group C, median age 1 (0-8) years]. An age-matched comparison was conducted between 14/16 group G patients (group g) and 14/56 group C patients (group c). RESULTS: Incidences of resolution were higher in groups G and g than in groups C and c, respectively, both during the study period and within the first 6-month observation period; groups G and g also had a significantly lower incidence of surgery for hydrocele than in groups C and c, respectively. The interval from the commencement of observation until hydrocele resolution was significantly shorter in group G than in group C, but not in group g than in group c. CONCLUSION: Goreisan can effectively promote the resolution of spermatic cord hydrocele in children and may be a valid treatment choice for this condition.

Twisting of the spermatic cord: ischemia and reperfusion, toxicogenetic evaluation, and the effects of phosphatidylcholine in pre-clinical trials.

Phosphatidylcholine is the main phospholipid present in cell membranes and in lipoproteins, and can interfere with various biological processes. This lipid also has antioxidant activity, and protects against damage caused by free radicals under conditions of ischemia/reperfusion. Therefore, the present study was designed to evaluate toxicogenetic damage caused by twisting of the spermatic cord in ischemia/reperfusion, and whether phosphatidylcholine plays a role in conditions of ischemia/reperfusion in preclinical trials. The results indicate that spermatic cord torsion does not cause genotoxic damage or mutagenesis. A dose of 300 mg/kg of phosphatidylcholine is toxic and is thus not recommended. However, a dose of 150 mg/kg does not promote toxicogenetic damage, and though it does not statistically prevent tissue damage occurring from lack of oxygenation and nutrition of testicular cells, it has a tendency to reduce this damage. Therefore, this research suggests that further studies should be conducted to clarify this tendency and to provide a better explanation of the possible therapeutic effects of phosphatidylcholine in cytoprotection of germ cells affected by ischemia/reperfusion.

[Modified Jujing No.2 Decoction for varicocele-induced male infertility].

Objective: To investigate the clinical effect of Jujing No.2 Decoction on male infertility induced by varicocele. METHODS: We equally randomized 70 male patients with varicocele-induced infertility into a treatment group and a control group, the former treated with modified Jujing No.2 Decoction (1 dose a day, bid) and the latter given Danshen Tablets (4 tablets once, tid) plus Liu Wei Di Huang Wan (8 pills once, tid), both for 3 months. We examined the spermatic veins of the patients by ultrasonography and performed seminal analysis before and after medication. RESULTS: Compared with the controls, the patients in the treatment group showed significant improvement after medication in sperm concentration (ï¼»12.35±2.12ï¼½ vs ï¼»18.56±4.16ï¼½ ×106/ml, P<0.05), progressively motile sperm (ï¼»16.18±6.34ï¼½ vs ï¼»24.63±8.51ï¼½ %, P<0.05), and morphologically normal sperm (ï¼»11.59±5.31ï¼½ vs ï¼»14.17±6.02ï¼½ %, P<0.05). In the control group, sperm concentration was increased from (12.29±2.07) ×106/ml at the baseline to (13.13±3.13) ×106/ml after medication, progressively motile sperm from (16.13±6.45) % to (20.55±7.30) % (P<0.05), and morphologically normal sperm from (11.62±5.35) % to (12.69±5.77) %. The total effectiveness rate was significantly higher in the treatment than in the control group (71.88% vs 46.67%, P<0.05). The inner diameter of the left spermatic vein was decreased from (0.32±0.05) mm at the baseline to ï¼»0.26±0.05ï¼½ mm after medication in the treatment group (P<0.05) and from (0.32±0.03) mm to (0.29±0.04) mm in the control (P<0.05), with statistically significant difference between the two groups after medication (P<0.05). CONCLUSIONS: Jujing No.2 Decoction is effective in the treatment of varicocele-induced male infertility.

[Testicular artery-sparing microscopic varicocelectomy combined with Qilin Pills for bilateral varicocele-induced oligoasthenospermia].

OBJECTIVE: To explore the clinical effect of testicular artery-sparing microscopic varicocelectomy (MV) in combination with Qilin Pills (QL) in the treatment of bilateral varicocele-induced oligoasthenospermia. METHODS: Sixty patients with bilateral varicocele-induced oligoasthenospermia were randomly assigned to receive MV (n=30) or MV+QL (n=30), those in the latter group treated with oral QL for 12 weeks postoperatively. At 4, 8, and 12 weeks after operation, we compared the semen volume, sperm concentration, sperm motility, the levels of serum Inh B, luteinizing hormone (LH) and total testosterone (TT), and the testosterone secretion index (TSI) between the two groups. RESULTS: After surgery, all the patients showed disappearance of varicocele symptoms, remarkably improved semen volume, sperm concentration, sperm motility, serum Inh B and TT levels, TSI, decreased LH and FSH (P<0.01). At 12 weeks after treatment, statistically significant differences were found between the MV and MV+QL groups in Inh B (138.96±22.26 vs 129.54±22.23) ng/L, LH (3.17±0.12 vs 3.59±0.11) IU/L, TT (13.98±3.02 vs 12.68±3.12) nmol/L, and TSI (4.41±0.53 vs 3.53±0.51) nmol/ IU (P<0.05). The pregnancy rate was significantly higher in the MV+QL than in the MV group (73.4% vs 36.6%, P<0.05). CONCLUSIONS: Testicular artery-sparing microscopic varicocelectomy combined with Qilin Pills is an effective strategy for the treatment of bilateral varicocele-induced oligoasthenospermia by significantly improving the semen quality of the patient.

Modified Jujing No.2 Decoction for varicocele-induced male infertility / 中华男科学杂志

<p><b>Objective</b>To investigate the clinical effect of Jujing No.2 Decoction on male infertility induced by varicocele.</p><p><b>METHODS</b>We equally randomized 70 male patients with varicocele-induced infertility into a treatment group and a control group, the former treated with modified Jujing No.2 Decoction (1 dose a day, bid) and the latter given Danshen Tablets (4 tablets once, tid) plus Liu Wei Di Huang Wan (8 pills once, tid), both for 3 months. We examined the spermatic veins of the patients by ultrasonography and performed seminal analysis before and after medication.</p><p><b>RESULTS</b>Compared with the controls, the patients in the treatment group showed significant improvement after medication in sperm concentration (［12.35±2.12］ vs ［18.56±4.16］ ×10⁶/ml, P<0.05), progressively motile sperm (［16.18±6.34］ vs ［24.63±8.51］ %, P<0.05), and morphologically normal sperm (［11.59±5.31］ vs ［14.17±6.02］ %, P<0.05). In the control group, sperm concentration was increased from (12.29±2.07) ×10⁶/ml at the baseline to (13.13±3.13) ×10⁶/ml after medication, progressively motile sperm from (16.13±6.45) % to (20.55±7.30) % (P<0.05), and morphologically normal sperm from (11.62±5.35) % to (12.69±5.77) %. The total effectiveness rate was significantly higher in the treatment than in the control group (71.88% vs 46.67%, P<0.05). The inner diameter of the left spermatic vein was decreased from (0.32±0.05) mm at the baseline to ［0.26±0.05］ mm after medication in the treatment group (P<0.05) and from (0.32±0.03) mm to (0.29±0.04) mm in the control (P<0.05), with statistically significant difference between the two groups after medication (P<0.05).</p><p><b>CONCLUSIONS</b>Jujing No.2 Decoction is effective in the treatment of varicocele-induced male infertility.</p>

Expression and Subcellular Localization of Retinoic Acid Receptor-α (RARα) in Healthy and Varicocele Human Spermatozoa: Its Possible Regulatory Role in Capacitation and Survival.

Varicocele, an abnormal tortuosity and dilation of veins of the pampiniform plexus, is the most common identifiable and correctable cause of male infertility. It is now becoming apparent that signaling through vitamin A metabolites, such as all-trans retinoic acid (ATRA), is indispensable for spermatogenesis and disruption of retinoic acid receptor-α (RARα) function may result in male sterility and aberrant spermatogenesis. Herein, we investigated by Western blot and immunogold electron microscopy the expression profiles and subcellular localization of RARα in healthy and varicocele human sperm; in addition, we analyzed the effects of ATRA on cholesterol efflux and sperm survival utilizing enzymatic colorimetric CHOD-PAP method and Eosin Y technique, respectively. In varicocele samples, a strong reduction of RARα expression was observed. Immunogold labeling evidenced cellular location of RARα also confirming its reduced expression in "varicocele" samples. Sperm responsiveness to ATRA treatment was reduced in varicocele sperm. Our study showed that RARα is expressed in human sperm probably with a dual role in promoting both cholesterol efflux and survival. RARα might be involved in the pathogenesis of varicocele as its expression is reduced in pathologic samples. Thus, ATRA administration in procedures for artificial insemination or dietary vitamin A supplementation might represent a promising therapeutic approach for the management of male infertility.

Epididymal sparing bilateral simple orchiectomy with epididymoplasty: preservation of esthetics and body image.

PURPOSE: We report the surgical technique and results of epididymal sparing bilateral simple orchiectomy as an esthetic alternative to standard bilateral simple orchiectomy and luteinizing hormone releasing hormone (LH-RH) agonist injection therapy in patients with prostate cancer. MATERIALS AND METHODS: The study included 91 consecutive epididymal sparing bilateral simple orchiectomy (BSO) procedures that were performed at the Atlanta Veterans Affairs Medical Center during a 25-month period. All patients had pathologically confirmed prostate cancer. A total of 52 patients (57.1%) were receiving LH-RH agonist therapy prior to the procedure and the remaining 39 (42.9%) were not. All procedures were performed in an outpatient clinic setting using spermatic cord anesthesia block as the only method of anesthesia. In the 52 patients who were on LH-RH agonist therapy prior to the procedure the overall impression/satisfaction with the procedure was evaluated using a questionnaire. RESULTS: All 91 procedures were performed at the urology outpatient clinic using local anesthesia. Mean patient age was 74.2 years (range 44 to 86). Mean serum prostate specific antigen was 58.9 ng/ml. The mean time required to perform the spermatic cord anesthesia block was 3.9 minutes (range 2 to 6) and the volume of anesthetic solution was 18.9 ml per case (range 10 to 32). Despite significant difference in testicular size between patients receiving and not receiving LH/RH agonists there were no differences in anesthesia time or anesthetic volume (3.9 and 3.9 minutes, p = 0.97, and 18.6 and 19.4 ml, respectively, p = 0.47). Mean operative time for BSO excluding anesthesia time was 36.9 minutes (range 18 to 70). Mean operative time was similar in patients receiving and not receiving LH-RH agonists (36.2 and 37.8 minutes, respectively, p = 0.39). The procedure was well tolerated, as judged by the mean intraoperative pain score during BSO of 0.2 (range 0 to 3). The majority of patients (76 or 83.5%) were pain-free during the procedure. Pain scores were similar in patients who were and were not receiving LH-RH agonists during BSO (p = 0.97). There were no adverse events. Followup data were available on 26 of the 52 patients who were receiving LH-RH agonist therapy prior to the procedure. Of them 96.2% were satisfied with the results and 84.6% preferred the procedure over medical castration therapy with LH-RH agonist therapy. CONCLUSIONS: Epididymal sparing bilateral simple orchiectomy is a simple and safe procedure that can be conveniently performed in an outpatient clinic setting using pure local anesthesia. Preservation of the epididymis and subsequent epididymoplasty is effective for maintaining the esthetic appearance of the scrotum and patient satisfaction. The procedure offers patients the convenience of 1-time surgical therapy over lifelong medical injection therapy at a significantly lower cost and without significantly compromising the esthetic appearance of the scrotum.

Spermatic cord anesthesia block for scrotal procedures in outpatient clinic setting.

PURPOSE: We evaluated the safety and effectiveness of spermatic cord anesthetic block (SCAB) as the only method of anesthesia for bilateral simple orchiectomy in an outpatient clinic setting. MATERIALS AND METHODS: The study included 141 consecutive bilateral simple orchiectomy (BSO) procedures performed at Atlanta Veterans Affairs Medical Center during a 33-month period. All procedures were performed in an outpatient clinic setting using SCAB as the only method of anesthesia. The anesthetic solution consisted of an equal mixture of 1% lidocaine with epinephrine at 1:100,000 and 0.25% bupivacaine. A 10-point visual analog pain scale was used to assess pain/discomfort at baseline, during SCAB instillation and during BSO. Postoperatively overall patient impression/satisfaction with SCAB as a method of anesthesia was determined. RESULTS: Nine of the 141 available cases (6.4%) were excluded from study. The remaining 132 cases were included in data analysis. Mean patient age was 75.4 years (range 44 to 86). A total of 76 patients (57.6%) were receiving luteinizing hormone releasing hormone agonist therapy at the time of the procedure. The mean time needed to perform SCAB and BSO was 3.9 (range 2 to 6) and 33.0 minutes (range 12 to 70), respectively. The average volume of anesthetic solution was 20.1 ml per case (range 10 to 32). The mean pain score was 0.36 (range 0 to 8), 1.96 (range 0 to 8) and 0.33 (range 0 to 5) at baseline, and during SCAB and BSO, respectively. Of the patients 102 (77.3%) underwent a painless procedure (pain score = 0), 29 (21.9%) experienced transient pain that was mild in nature (pain score 4 or less) and only 1 (0.7%) had a pain score of 5. Pain scores were similar in patients who were and were not receiving luteinizing hormone releasing hormone agonists at baseline (p = 0.36), during SCAB instillation (p = 0.89) and during BSO (p = 0.36). The overall impression/satisfaction with SCAB as a method of anesthesia was rated as highly satisfactory by 91.7% of patients and satisfactory by 8.3%. There were no intraoperative adverse events related to SCAB. CONCLUSIONS: SCAB is a simple, safe and highly effective method of anesthesia for scrotal procedures. It allows such procedures to be performed in an outpatient clinic setting, offering convenience and the potential for cost savings.

Ascorbic acid supplementation restores defective leukocyte-endothelial interaction in alloxan-diabetic rats.

BACKGROUND: Defective leukocyte-endothelial interactions are observed in experimental diabetes and may reduce the capacity to mount an adequate inflammatory response. The present study investigated the effect of ascorbic acid, an inhibitor of free radical and glycated protein formation as well as an aldose reductase inhibitor, on leukocyte-endothelial interaction in alloxan-diabetic rats. METHODS: Rats were rendered diabetic by alloxan injection (40 mg/kg; iv). After 30 days, diabetic and nondiabetic controls were supplemented for 12 days with ascorbic acid (50 or 200 mg/kg/day) or received saline by gavage. The number of rollers, stickers after zymosan-activated plasma (10%) or leukotriene B(4) (1 microM) applied topically, and migrated cells after local injection of carrageenan (100 microg) were determined in the venules of the internal spermatic fascia by intravital microscopy. Erythrocyte velocity and wall shear rate were determined as well. Reactive oxygen species formation by endothelial cells was measured in vivo by the same technique. Immunocytochemistry for ICAM-1 detection on the endothelium of the venules of the internal spermatic fascia was carried out in cross sections of the whole testis of the animals. RESULTS: The reduced number of rollers, stickers and migrated cells, as well as the higher production of reactive oxygen species by endothelial cells in diabetic rats was corrected by ascorbic acid supplementation. The low immunoreactivity for ICAM-1 in the venules of diabetic rats was improved by ascorbic acid supplementation. Ascorbic acid supplementation did not interfere with erythrocyte velocity or wall shear stress. Ascorbic acid administered to control rats did not alter the parameters studied above. CONCLUSION: We conclude that ascorbic acid improves leukocyte-endothelial interaction in diabetic rats at least in part by restoring the expression of ICAM-1 in the venules of diabetic rats.

Spermatic cord block: a safe technique for intrascrotal surgery.

In a prospective study, 103 patients underwent operative procedures on the testis, epidydimis or spermatic cord using the technique of spermatic cord block anaesthesia. The procedures were tolerated well and all patients were treated on a day case basis. There were no complications attributable to the technique. We consider cord block anaesthesia to be a safe and cost-effective technique suitable for intrascrotal surgery.

Laparoscopic management of testicular pain after embolotherapy of varicocele.

We report a patient who underwent embolization of a varicocele for chronic testicular pain with Gianturco coils and developed increased bilateral pain. Complete pain relief was achieved by laparoscopic resection of both spermatic cords. The case provides insights into the pathophysiology of testicular pain and may suggest alternative therapies for chronic orchialgia.

[Local anesthesia in the surgical management of hydrocele and cysts of the spermatic cord]. / La anestesia local en el tratamiento quirúrgico del hidrocele y quiste de cordón espermático.

Traditional management of vaginal fluid collections has always been surgery. The benignancy of this disease does not correspond with the morbidity caused by the anaesthetic techniques used. Over the last few years, sclerotherapy has become increasingly attractive as an alternative to hydrocelectomy. Indications are, nonetheless, restricted, presenting a relapse rate which varies according to the substance used and the operating team. The study proposes the use of local anaesthetics for the surgery of vaginal fluid collections so as to minimize the immediate postoperative period and thus the hospital stay. Between May and October 1991, 55 patients, 49 with hydrocele (4 bilateral) and 6 with sperm cord cyst, were treated in our Unit. Patients were monitored in the theatre (EKG, blood pressure and oximeter) to supervise their life constants, and 2% Mepivacaine (10-20 cc) was infiltrated into the sperm cord and the area of scrotal wall to be cut. Surgical techniques range from dissection to scission of the bag until partial eversion, requiring the use of reabsorbable suture and a careful haemostasis to avoid drainage. Anaesthetics tolerance has been highly satisfactory in 52 patients (94%), good in one patient (2%) and unsatisfactory in two cases (4%). Recorded complications include: severe bradycardia and hypotension in one case (2%), persistent right renoureteral pain in one case (2%), scrotal haematoma in 5 cases (9%) and suture dehiscence in another patient (2%). It is concluded that surgical management of vaginal collection with local anaesthetics is feasible, and reduces the immediate postoperative period also avoiding morbidity derived from a more aggressive anaesthetic technique.

Morphological and physiological factors involved in the contractility of the spermatic cord and ductus deferens of the opossum (Didelphis albiventris).

The opossum spermatic cord is characterized by a thick skeletal muscle coat, provided by the great development of the cremasteric muscle. Acetylcholine induced a powerful contraction of the spermatic cord placed in an organ bath containing Heller's solution. This contraction was blocked by curare but not completely by atropine as is usual for skeletal muscle. However, the ductus deferens did not respond to acetylcholine or catecholamines under the same conditions. Specific histochemical methods for both catecholamines and acetylcholinesterases revealed that the ductus deferens musculature, composed mainly of circular fibres, is richly innervated by adrenergic and presumed cholinergic nerve fibres. The lack of responsiveness to the neurotransmitters could be explained by the absence of longitudinally arranged muscle. It is suggested that in the opossum the cremaster could participate in the mechanism of sperm transport.