Prospective evaluation of the association between varicocele and benign prostatic hyperplasia in men over 40 years of age.

We investigated the association between varicocele and benign prostatic hyperplasia in men over the age of 40 years. A total of 296 outpatients were evaluated. Prostate volume was measured with transrectal ultrasound. Varicocele was diagnosed by physical examination and ultrasound. Prostatic hyperplasia was defined as prostate volume greater than or equal to 40 ml. Two groups were compared: patients with prostate volume less than 40 ml and patients with prostate volume greater than or equal to 40 ml. There was a statistically significant difference between the groups in terms of mean age, post-void residual, International Prostate Symptom Score and PSA. The percentage of patients with clinical varicocele in the group with a volume less than 40 ml and the group with a volume equal to or greater than 40 ml was 38.2% and 47.7% respectively (p = .12). There were no differences between the two groups in the percentage of patients with clinical or subclinical varicocele (43.2% vs. 52.2%, respectively, p = .12). No differences were found in the percentage of patients with varicocele when comparing men with prostates smaller than 40 ml and greater than or equal to 40 ml.

Diagnostic accuracy of physical examination compared with color Doppler ultrasound in the determination of varicocele diagnosis and grading: Impact of urologists' experience.

BACKGROUND: Treatment of palpable varicocele in infertile men with abnormal semen parameters is widely accepted, and physical examination (PE) remains a cornerstone for recommending varicocele repair. However, identification of clinical varicocele during PE can be challenging for both urology residents and consultants. OBJECTIVE: To compare the diagnostic accuracy of PE to color Doppler ultrasonography (CDU) for the diagnosis of varicocele in experienced and non-experienced examiners. MATERIALS AND METHODS: Diagnostic accuracy study involving 78 patients attending a university-based infertility unit. Patients underwent scrotal PE by both experienced (over 10 years experience in male infertility) and non-experienced urologists (senior residents), and were subjected to CDU. varicocele diagnosis and varicocele grading were compared between examiner groups and to CDU. Accuracy measures were evaluated, and interobserver agreement was estimated using unweighted kappa statistics. A subgroup analysis for normal and high body mass index (BMI) was also performed for the same variables. RESULTS: Accuracy of PE for varicocele diagnosis was 63.5% with a positive predictive value (PPV) of 75.5%. The specificity and PPV of PE were higher among experienced than non-experienced urologists (82.0% CI: 74.27-88.26 and 81.1% CI: 74.39-86.44% vs 67.2% CI: 58.33-75.22 and 70.6% CI: 64.52-76.08, respectively). Agreements on varicocele diagnosis (k: 0.625 vs 0.517) and grading (k: 0.548 vs 0.418) by PE were higher among experienced than non-experienced urologists. Differences between eutrophic and overweight/obese patients were also suggested. DISCUSSION AND CONCLUSIONS: PE performed by infertility specialists identify patients with varicocele more precisely than non-specialists. However, PE alone has suboptimal accuracy for varicocele diagnosis. Our results indicate that PE should be followed by CDU to decrease the number of false positives and increase the diagnostic accuracy of varicocele diagnosis.

Use of indocyanine green angiography in microsurgical subinguinal varicocelectomy - lessons learned from our initial experience

ABSTRACT Microsurgical subinguinal varicocelectomy (MSV) is generally considered the gold standard nowadays in view of the lower risk of complications and recurrence. To achieve complete ligation of veins while preserving testicular artery (TA) during the procedure remains challenging despite the application of high power optical magnification and micro-Doppler ultrasonography. The use of intraoperative indocyanine green angiography (ICGA) with infrared fluorescence operative micro-scope in MSV potentially lowers the incidence of TA injury and shortens the learning curve of novice surgeons. We present our initial experience in the application of the technique in nine patients and explore the potential of the new adjunct.

Use of indocyanine green angiography in microsurgical subinguinal varicocelectomy - lessons learned from our initial experience.

Microsurgical subinguinal varicocelectomy (MSV) is generally considered the gold standard nowadays in view of the lower risk of complications and recurrence. To achieve complete ligation of veins while preserving testicular artery (TA) during the procedure remains challenging despite the application of high power optical magnification and micro-Doppler ultrasonography. The use of intraoperative indocyanine green angiography (ICGA) with infrared fluorescence operative micro-scope in MSV potentially lowers the incidence of TA injury and shortens the learning curve of nov-ice surgeons. We present our initial experience in the application of the technique in nine patients and explore the potential of the new adjunct.

Computer-aided sperm analysis: a useful tool to evaluate patient's response to varicocelectomy.

Preoperative and postoperative sperm parameter values from infertile men with varicocele were analyzed by computer-aided sperm analysis (CASA) to assess if sperm characteristics improved after varicocelectomy. Semen samples of men with proven fertility (n = 38) and men with varicocele-related infertility (n = 61) were also analyzed. Conventional semen analysis was performed according to WHO (2010) criteria and a CASA system was employed to assess kinetic parameters and sperm concentration. Seminal parameters values in the fertile group were very far above from those of the patients, either before or after surgery. No significant improvement in the percentage normal sperm morphology (P = 0.10), sperm concentration (P = 0.52), total sperm count (P = 0.76), subjective motility (%) (P = 0.97) nor kinematics (P = 0.30) was observed after varicocelectomy when all groups were compared. Neither was significant improvement found in percentage normal sperm morphology (P = 0.91), sperm concentration (P = 0.10), total sperm count (P = 0.89) or percentage motility (P = 0.77) after varicocelectomy in paired comparisons of preoperative and postoperative data. Analysis of paired samples revealed that the total sperm count (P = 0.01) and most sperm kinetic parameters: curvilinear velocity (P = 0.002), straight-line velocity (P = 0.0004), average path velocity (P = 0.0005), linearity (P = 0.02), and wobble (P = 0.006) improved after surgery. CASA offers the potential for accurate quantitative assessment of each patient's response to varicocelectomy.

Gonadal function in male patients with ankylosing spondylitis.

OBJECTIVE: To assess reproductive function in male ankylosing spondylitis (AS) patients in comparison to healthy controls. METHODS: Twenty AS patients were compared to 24 healthy male subjects with regard to demographic data, urological examination, testicular ultrasound (US), semen analysis, anti-sperm antibodies, and hormone profile. Exclusion criteria were present use of sulfasalazine or methotrexate, and ever use of biological/cytotoxic agents. Disease activity of AS was evaluated by clinical and laboratory assessments. RESULTS: Demographic data were similar in AS and controls (p = 0.175). Varicocele was found significantly more frequently in AS patients than in controls (40% vs. 8%, p = 0.027). Semen analysis revealed no significant differences in sperm quality between AS patients and controls (p > 0.05). By contrast, the median of normal sperm forms was significantly lower in AS patients with vs. those without varicocele [13.5 (range 2-27) vs. 22 (range 10-32.5)%, p = 0.049] whereas no difference in sperm morphology was observed comparing AS patients and controls without varicocele (p = 0.670). Comparison of AS patients with and without varicocele showed that anti-sperm antibodies, hormones, inflammatory markers, and disease activity scores did not contribute to the impaired sperm morphology observed in AS patients with varicocele. CONCLUSIONS: An increased frequency of varicocele was found in AS patients associated with sperm abnormalities but independent of therapy, anti-sperm antibodies, hormonal alterations, or disease parameters. Investigation for varicocele should be routine in AS patients with fertility problems.

Effect of varicocele grade and age on seminal parameters.

AIM: To evaluate the effect of presence, grade and anatomical side of varicocele on semen parameters and to identify age-related modifications in semen quality in men with varicocele. METHODS: A prospective clinical study was performed in 363 men with varicocele and 155 normozoospermic men without varicocele. We determined the presence, grade and anatomical localization of varicocele: left (grades I-III), right or bilateral. Additionally, evaluation of semen was done and the hypoosmotic swelling test (HOST) percentage determined. RESULTS: The percentage of spermatozoa with normal morphology, motility, vitality, and HOST was reduced in patients with varicocele. Comparison of semen parameters between the different degrees of left varicocele (I, II or III) shows that the percentage of normal sperm morphology is reduced in men with varicocele grade III, while other parameters are not affected. The percentage of patient normozoospermic was 50 and 24% in men with left varicocele grades I and III, respectively. A negative correlation between increase of age in men and sperm motility was observed only in the varicocele group. CONCLUSIONS: This study suggests that both the varicocele grade and an increase of age in men with varicocele could determine the extent of alteration to semen quality.

Predictors of improved seminal parameters and fertility after varicocele repair in young adults.

The aim of our study was to determine hormonal or biochemical markers in patients with clinically palpable left varicocele but without a history of infertility, with especial emphasis on nitric oxide, related with improved seminal parameters after varicocelectomy. Semen samples were obtained from 202 patients with left varicocele grade II or III. Nitric oxide levels in seminal plasma were determined by the Griess technique. Testicular volume was determined ultrasonographically in both testes and hormonal profile was measured. The post-operative sperm concentration increased significantly in patients with normal sperm count or moderate oligozoospermia, but we did not find an increment in sperm count in patients with mild and severe oligozoospermia after surgery. The mean percentage of normal motility significantly increased after surgery, but we did not observe a significant increment in morphologically normal sperm count and testicular volume after varicocele repair. Moreover, we did not find any correlation between nitric oxide concentrations and severity of oligozoospermia, asthenozoospermia or abnormal sperm morphology in this population. It is concluded that in the general male population, varicocele repair is not associated with an improved semen profile in all cases. We did not observe a significant correlation between nitric oxide concentrations and semen profile.

Infrared digital telethermography: a new method for early detection of varicocele.

Besides physical examination, various traditional methods of examination are believed to have an important role in diagnosing varicocele. Infrared digital telethermography is presented as a new diagnostic tool for early presentation of varicocele.

Utilidad ultrasonido en la evaluación de la patología escrotal benigna / Sonographic findings in benign scrotal diseases

La utilización de la ecografía tanto en escala de grises como Doppler color resulta una práctica de mucha utilidad en la caracterización de diversas entidades a nivel del escroto y su contenido. Para su realización se utilizaron transductores lineales con frecuencia entre 7,5-10 MHz en cortes transversales y sagitales de testículo y epidídimo, incluyendo imágenes comparativas del tamaño y ecogenicidad de ambos testículos. Este ensayo iconográfico intenta revisar el aporte del ultrasonido en la patología escrotal benigna más frecuente (AU)

[Renal cell carcinoma and simultaneous left varicocele]. / Carcinoma de células renales y varicocele izquierdo de forma simultánea.

OBJECTIVES: To report a rare case of left renal cell carcinoma causing simultaneous acute left varicocele. We also performed a bibliographic review. METHODS: We present the case of a male adult who was diagnosed as having a left varicocele during a medical exam at his work center and referred to the urology clinic. On physical examination a left flank and hypochondrium mass was found. We analyze the diagnostic tests performed and possible therapies. RESULTS: With the diagnosis of left hypernephroma the patient underwent surgery. A big lower pole and medial portion kidney tumor displacing neighbor structures was found, and left radical nephrectomy was performed. CONCLUSIONS: Although it was easy to diagnose a hypernephroma with the diagnostic tests performed, the clinical presentation is not frequent, neither is the sudden onset of left varicocele. Currently, after 8 years of follow-up, the patient has normal blood-ultrasound tests.

Varicocele en adolecentes y jóvenes, su correlación clínica y su incidencia en los parámetros seminales / Varicocele in adolescent and young, clinical correlation and its incidence in alteration of seminal parameters

Se estudian 294 pacientes entre 18 y 24 años con varicocele clínico de los cuales 164 tienen espermograma físico y químico en un período de 5 años previo a cualquier tratamiento. Se obtuvo una correlación altamente significativa entre los parámetros clínicos de los diferentes grados de varicocele. Comparando los parámetros clínicos con los del espermograma, concentración, motilidad y morfología, se obtienen correlaciones estadísticamente significativas en los varicoceles grado 3 izquierdos, lo que confirma que en éstos hay una mayor incidencia de alteración de los parámetros seminales. Esto justificaría tratar al grado 3 sólo con los parámetrso clínicos: grado, doppler y orquidometría, sin la estricta necesidad de un espermograma previo. Encontramos en estos jóvenes con varicocele, parámetros seminales alterados estadísticamente respecto de los valores de la O.M.S.(AU)

[The assessment of varicocele by ultrasound]. / Evaluación del varicocele por ultrasonido.

OBJECTIVE: Evaluating the utility that has the scrotal ultrasound in the patient with varicocele. METHODS: 34 patients with varicocele, 28 unilateral, y 6 bilateral, 9 right and 31 left, was evaluated by means of scrotal ultrasound in high-resolution real-time united, we utilized an ATL with transducers 7-12 Mhz. The age oscillates between 13-36 years. Five patient adolescent went for pain, 23 infertile patients, and 6 adults for pain/or discomfort scrotal. RESULTS: For ultrasound we observed 10/40 testicular atrophy, the texture was homogeneous 35/40. Five testicles had decrease of the echogenicity. The ultrasound confirms varicocele in the clinical cases 31/31, we detect 3/9 subclinical. The images that were gotten being the of a group of 2 or 3 tubular structures, or liquid cords dilated of a diameter between 1.5 and 2 mm in the subclinical, and superior to 2 mm in the clinical, or one greater of 3 mm, located in the cord or in the groin canal, up and behind of the head of the epididymis, in the voluminous cases could be observed behind and below the testicle. CONCLUSIONS: The scrotal ultrasound is an adequate method, rapid, easy not obnoxious, useful in the evaluation preoperative and postoperative of the varicocele.

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 classified 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.