Adolescent varicocele: improved sperm function after varicocelectomy.

OBJECTIVE: To assess the effect of varicocelectomy on sperm function (DNA integrity and mitochondrial activity) and levels of lipid peroxidation in seminal plasma of adolescents. DESIGN: Prospective study. SETTING: Patients recruited from a local public school. PATIENT(S): Adolescents (14-19 years old), Tanner stages IV or V with varicocele grades II or III, attending a local public school. INTERVENTION(S): Two semen collections with a one week interval between collections before bilateral varicocele repair using subinguinal microsurgical varicocelectomy, and two semen collections with a one week interval between collections three months after the surgery. MAIN OUTCOME MEASURE(S): Rate of sperm DNA fragmentation as assessed by the Comet assay and categorized as classes I (no DNA fragmentation) to IV (high DNA fragmentation). Rate of mitochondrial activity as assessed by the diaminobenzidine assay and categorized as grades I (all mitochondria active) to IV (all mitochondria inactive). Levels of lipid peroxidation in seminal plasma by a colorimetric method that quantifies a lipid peroxidation subproduct (malondialdehyde). RESULT(S): Concerning DNA integrity, the samples after varicocelectomy showed more spermatozoa with intact nuclear DNA (grade I) and less spermatozoa with Comet grades II, III, and IV. Regarding mitochondrial activity, the samples after varicocelectomy showed less cells with inactive mitochondria (class III). No differences were observed in classes I, II, and IV. Concerning lipid peroxidation, no significant differences were observed. CONCLUSION(S): This study was able to demonstrate that varicocelectomy in adolescents is associated with increased sperm DNA integrity and mitochondrial activity. However, levels of seminal products of lipid degradation (malondialdehyde) are not different.

Transurethral resection of the ejaculatory duct in a fertile man.

OBJECTIVE: To report a case of transurethral resection of the ejaculatory duct in a fertile man with normozoospermia. DESIGN: Case report. SETTING: Large federal hospital in Sao Paulo, Brazil. PATIENT(S): A 29-year-old man with normal semen analysis values who had recently fathered a healthy child, seen with complaint of scrotal pain and reduced ejaculate volume. INTERVENTION(S): Transurethral resection of the ejaculatory duct. MAIN OUTCOME MEASURE(S): Relief of the symptoms. RESULT(S): Successful relief of the scrotal pain and increase in ejaculate volume after correction of the partial ejaculatory duct obstruction. CONCLUSION(S): Fertile men with scrotal pain and reduced ejaculate volume may be seen with partial ejaculatory duct obstruction, and surgical transurethral resection of the ejaculatory duct may provide resolution of symptoms.