ABSTRACT
Abstract This systematic review was conducted in accordance with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, including clinical studies in which one of the outcomes was semen parameter improvement after varicocele embolization using coils only. The objective of the review was to assess the evidence on the role of embolization using coils alone for semen parameter improvement in men with varicocele, since embolization using coils is the most cost-effective method of varicocele repair. Study quality was assessed using the methodological index for non-randomized studies (MINORS). Out of six retrospective and two prospective observational or comparative clinical studies involving 701 patients, semen concentration improved significantly in all five studies that assessed this parameter. Mean semen motility improved significantly in seven studies. The impact of embolization on semen density could not be analyzed.
Resumo Trata-se de uma revisão sistemática conduzida de acordo com o PRISMA 2009 (Principais Itens para Relatar Revisões Sistemáticas e Metanálises) que incluiu estudos em que a melhora dos parâmetros seminais tenha sido um dos desfechos. Esta revisão foi realizada com o objetivo de avaliar as evidências sobre o papel da embolização com uso apenas de molas na melhora de parâmetros seminais em homens com varicocele, uma vez que a embolização apenas com molas é o método com melhor custo-benefício para o reparo de varicoceles. A qualidade dos estudos foi analisada com o índice MINORS. Em seis estudos clínicos retrospectivos e em outros dois prospectivos observacionais ou comparativos, a concentração seminal melhorou significativamente em todos os cinco estudos que avaliaram esse parâmetro. A motilidade seminal melhorou significativamente em sete estudos. Não foi possível analisar o impacto da embolização com molas na densidade seminal.
Subject(s)
Humans , Male , Adult , Young Adult , Varicocele/therapy , Embolization, Therapeutic/instrumentation , Reference Values , Embolization, Therapeutic/methods , Semen AnalysisSubject(s)
Infertility, Male/etiology , Varicocele/complications , Humans , Infertility, Male/metabolism , Infertility, Male/physiopathology , Infertility, Male/surgery , Infertility, Male/therapy , Male , Reproductive Techniques, Assisted , Varicocele/metabolism , Varicocele/physiopathology , Varicocele/surgery , Varicocele/therapyABSTRACT
AIM: Varicocele is characterized by abnormal tortuosity and dilatation of the veins of the pampiniform plexus within the spermatic cord and is one of the causes related to male infertility. This study aimed to investigate the correlation between varicocele and somatometric parameters. We also aimed to determine prevalence and treatment ratio of this disorder among healthy young Turkish men. MATERIALS AND METHODS: A total of 2061 young men aged from 19 to 34 years was enrolled and cross sectionally evaluated for status of varicocele. Body mass index was calculated. Patients were categorized as normal weight, overweight and obese using by National Institutes of Health criteria. Patients underwent physical examinations for the presence and grade of varicocele. If the varicocele was found and previously submitted to different treatment modalities, the age of treatment and outcomes were recorded. RESULTS: Varicocele was present in 498 men (24.2%). The mean age of the participants was 22.7 ± 1.8 years, and the median BMI was 22.8 ± 2.0 kg/m². There were no significant differences in age, height, weight and BMI among the patients with different grades of varicocele (p > 0.05). Although no significant difference was found in varicocele prevalence between normal weight and over-weight participants (p > 0.05), obese participants had significantly lower varicocele prevalence compared with normal or over weight participants (p = 0.006). A total of 49 men had scrotal pain and the treatment ratio was only 2.8%. CONCLUSION: Prevalence of varicocele was found in about 24% of healthy young Turkish population. Participants with varicocele had significantly lower BMI values compared with those without varicocele. Our findings supported the hypothesis that individuals with a greater BMI may have advantages in relieving the varicocele, but further studies are required to clarify this issue. Additionally treatment ratio was low among young men with varicocele.
Subject(s)
Body Mass Index , Obesity/complications , Varicocele/epidemiology , Adult , Humans , Male , Prevalence , Severity of Illness Index , Turkey/epidemiology , Varicocele/etiology , Varicocele/therapy , Young AdultABSTRACT
AIM: Varicocele is characterized by abnormal tortuosity and dilatation of the veins of the pampiniform plexus within the spermatic cord and is one of the causes related to male infertility. This study aimed to investigate the correlation between varicocele and somatometric parameters. We also aimed to determine prevalence and treatment ratio of this disorder among healthy young Turkish men. MATERIALS AND METHODS: A total of 2061 young men aged from 19 to 34 years was enrolled and cross sectionally evaluated for status of varicocele. Body mass index was calculated. Patients were categorized as normal weight, overweight and obese using by National Institutes of Health criteria. Patients underwent physical examinations for the presence and grade of varicocele. If the varicocele was found and previously submitted to different treatment modalities, the age of treatment and outcomes were recorded. RESULTS: Varicocele was present in 498 men (24.2%). The mean age of the participants was 22.7 ± 1.8 years, and the median BMI was 22.8 ± 2.0 kg/m². There were no significant differences in age, height, weight and BMI among the patients with different grades of varicocele (p > 0.05). Although no significant difference was found in varicocele prevalence between normal weight and over-weight participants (p > 0.05), obese participants had significantly lower varicocele prevalence compared with normal or over weight participants (p = 0.006). A total of 49 men had scrotal pain and the treatment ratio was only 2.8%. CONCLUSION: Prevalence of varicocele was found in about 24% of healthy young Turkish population. Participants with varicocele had significantly lower BMI values compared with those without varicocele. Our findings supported the hypothesis that individuals with a greater BMI may have advantages in relieving the varicocele, but further studies are required to clarify this issue. Additionally treatment ratio was low among young men with varicocele.
Subject(s)
Adult , Humans , Male , Young Adult , Body Mass Index , Obesity/complications , Varicocele/epidemiology , Prevalence , Severity of Illness Index , Turkey/epidemiology , Varicocele/etiology , Varicocele/therapyABSTRACT
In 2010, the World Health Organization established new reference values for human semen characteristics that are markedly lower than those previously reported. Despite using controlled studies involving couples with a known time to pregnancy to establish the new limits, the reference studies are limited with regard to the population analyzed and the methods used for semen evaluation. The present review discusses concerns related to the new reference values for semen characteristics, including the effect on patient referral, diagnosis, and treatment of recognized conditions, such as varicocele, and on the indications for assisted reproductive technologies.
Subject(s)
Infertility, Male/diagnosis , Semen Analysis/standards , Semen/cytology , Varicocele/therapy , Adult , Age Factors , Brazil , Female , Humans , Incidence , Infertility, Male/epidemiology , Infertility, Male/etiology , Male , Middle Aged , Pregnancy , Reference Values , Risk Assessment , Sperm Count/standards , Varicocele/complications , Varicocele/diagnosis , World Health Organization , Young AdultABSTRACT
PURPOSE: We evaluated the impact of varicocelectomy on intracytoplasmic sperm injection outcomes in infertile men with clinical varicocele. MATERIALS AND METHODS: We studied 242 infertile men with a history of clinical varicocele who underwent intracytoplasmic sperm injection. Of the men 80 underwent prior subinguinal microsurgical varicocelectomy (treated group 1) and 162 had any grade of clinical varicocele (untreated group 2) at sperm injection. We compared semen analysis results before and after varicocelectomy, and the sperm injection procedure outcomes. Mean time from surgery to sperm injection was 6.2 months. Logistic regression was done to verify whether varicocelectomy influenced the odds of clinical pregnancy, live birth and miscarriage. RESULTS: We noted an improved total number of motile sperm (6.7 × 10(6) vs 15.4 × 10(6), p <0.01) and a decreased sperm defect score (2.2 vs 1.9, p = 0.01) after vs before varicocele repair. The clinical pregnancy (60.0% vs 45.0%, p = 0.04) and live birth (46.2% vs 31.4%, p = 0.03) rates after the sperm injection procedure were higher in the treated than in the untreated group. The chance of achieving clinical pregnancy (OR 1.82; 95% CI 1.06-3.15) and live birth (OR 1.87, 95% CI 1.08-3.25) by the sperm injection procedure were significantly increased while the chance of miscarriage was decreased (OR 0.433, 95% CI 0.22-0.84) after varicocele was treated. CONCLUSIONS: Results suggest that varicocelectomy improves clinical pregnancy and live birth rates by intracytoplasmic sperm injection in infertile couples in which the male partner has clinical varicocele. The chance of miscarriage may be decreased if varicocele is treated before assisted reproduction.
Subject(s)
Infertility, Male , Sperm Injections, Intracytoplasmic , Varicocele , Adult , Female , Humans , Infertility, Male/etiology , Male , Pregnancy/statistics & numerical data , Varicocele/complications , Varicocele/therapyABSTRACT
OBJECTIVE: To determine whether grade of varicocele determines extent of alterations to semen quality in adolescents. DESIGN: Prospective study. SETTING: Patients recruited from a local public school. PATIENT(S): Adolescents (14 to 18 y of age) attending a local public school. INTERVENTION(S): Scrotal palpation in a temperature-controlled room, testicular volume assessment with a Prader orchidometer, and semen analysis according to World Health Organization guidelines, with morphology by Kruger's strict criteria. MAIN OUTCOME MEASURE(S): Presence, and grade, or absence of varicocele; testicular volume (assessed with a Prader orchidometer); semen analysis results; and prevalence of testicular asymmetry. RESULT(S): Among the adolescents, 27.8% (95% confidence interval [CI]: 23.2, 32.4) presented varicocele grades II and III, and 7.8% (95% CI: 5.0, 10.6) presented with a grade III varicocele. There was a high prevalence of testicular asymmetry in adolescents with left grade II (41.7%) and III varicocele (51.9%), whereas adolescents without varicocele showed very low testicular asymmetry (11.0%). Testicular asymetry was significantly less prevalent in adolescents without varicocele. Sperm progressive motility and concentration were lower in the two varicocele groups but were not different according to grade. However, the total number of progressively motile sperm in the ejaculate was lower in the varicocele grade II and III groups, and patients with varicocele grade III presented lower values than those with grade II. CONCLUSION(S): Grades II and III varicocele cause a decrease in testicular volume and in semen quality that is independent of grade, but when assessing the total number of progressively motile sperm in the ejaculate, grade III varicoceles place these adolescents very close to the World Health Organization cutoff rate, and thus, current guidelines for treating the adolescent varicocele may need to be revised.
Subject(s)
Spermatogenesis , Spermatozoa/pathology , Testis/pathology , Varicocele/pathology , Adolescent , Cell Shape , Ejaculation , Humans , Male , Prospective Studies , Severity of Illness Index , Sperm Count , Sperm Motility , Testis/physiopathology , Varicocele/physiopathology , Varicocele/therapyABSTRACT
Las urgencias en pediatría siempre han constituido un problema frecuente y, muchas veces, difícil de resolver, ya sea por la poca historia aportada por los padres -lo que es propio de la preocupación y ansiedad de la situación-, como también por la falta de información en relación a algunas maniobras simples que pueden ser realizadas por cualquier médico. Las lesiones genitourinarias suelen desestimarse en una evaluación de urgencia, a pesar de la trascendencia que éstas pudieran tener a futuro, por lo que suelen pesquisarse en una evaluación secundaria, o luego de la aparición de complicaciones. El presente artículo tiene como objetivo dar a conocer los conceptos que componen el manejo de urgencias genitourinarias en cirugía pediátrica, haciendo énfasis en aquellas que ocurren con mayor frecuencia y que implican un riesgo de complicaciones deletéreas, así como también en las que, por simplicidad de maniobras, pueden ser realizadas en cualquier servicio de atención de urgencia. Los temas expuestos son: torsión testicular, torsión de hidátide testicular, parafimosis, lesiones del tracto urinario y atrapamiento de prepucio en cremallera del pantalón.
Subject(s)
Humans , Male , Child , Genital Diseases, Male/diagnosis , Genital Diseases, Male/therapy , Varicocele/diagnosis , Varicocele/therapy , Emergencies , Paraphimosis/therapy , Pediatrics/methods , Penis/injuries , Testis/injuries , Spermatic Cord Torsion/diagnosis , Spermatic Cord Torsion/therapy , Urinary Tract/injuriesABSTRACT
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).
Subject(s)
Male , Spermatozoa/metabolism , Infertility, Male/etiology , Sperm Injections, Intracytoplasmic/methods , Reproductive Techniques, Assisted , Varicocele/surgery , Varicocele/physiopathology , Varicocele/therapy , Testis/blood supplySubject(s)
Humans , Male , Adolescent , Adult , Varicocele/epidemiology , Chile , Varicocele/complications , Varicocele/etiology , Varicocele/history , Varicocele , Varicocele/therapyABSTRACT
This book is not intended as a text of clinical urology or as a book of operative urology. The main aim is to provide students and surgical urological residents with a practical guide to basic urological examination, procedures and operations. It also provides a framework for preoperative and postoperative care management of complications (Preface)
Subject(s)
Humans , Urologic Diseases/diagnosis , Varicocele/diagnosis , Varicocele/therapy , Urogenital Surgical Procedures/methods , Urogenital Surgical ProceduresABSTRACT
Les infections génito-urinaires sont dominées, en terme de fréquence, par les cystites et les vaginites: ce sont des consultations quotidiennes qui permettent d'affiner progressivement notre connaissance de l'homéopathie à la lumière de l'efficacité des remèdes prescrits. (AU)
Subject(s)
Case Reports , Humans , Female , Adult , Middle Aged , Varicocele/therapy , Homeopathic Therapeutics , Cystitis/therapy , Prostatitis/therapy , Pyelonephritis/therapy , Vaginitis/therapy , Salpingitis/therapy , Endometritis/therapy , Uterine Cervicitis/therapyABSTRACT
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(AU)
Subject(s)
Humans , Male , Varicocele/surgery , Varicocele/diagnosis , Varicocele/physiopathology , Varicocele/therapyABSTRACT
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
Subject(s)
Humans , Male , Varicocele/diagnosis , Varicocele/physiopathology , Varicocele/surgery , Varicocele/therapyABSTRACT
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