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1.
J Urol ; 203(1): 48-56, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31042452

RESUMO

PURPOSE: We evaluated the impact of varicocele grade on the response to varicocelectomy or spermatic vein embolization. MATERIALS AND METHODS: We systematically reviewed the published English language literature to identify studies on changes in semen quality and pregnancy outcomes after varicocele treatment, stratified by varicocele grade. Descriptive statistics and continuous random effects models were used to study the impact of varicocele grade and the surgical approach on the response to treatment. Result heterogeneity among studies was analyzed using the I2 statistic. Quality assessment of nonrandomized studies was done with the Newcastle-Ottawa Scale. Publication bias was analyzed using funnel plots and the Egger test. RESULTS: We identified 20 studies describing the outcome of varicocele treatment stratified by varicocele grade in a total of 2,001 infertile men with varicocele. A microsurgical approach (inguinal, subinguinal and/or Palomo) was used in 11 of the 20 studies (55%). Varicocele treatment was associated with improvements in sperm concentration and overall motility in patients with all grades of varicocele. Semen quality improvements were directly related to varicocele grade. The mean sperm concentration improvement in men with grades 1, 2, 2-3 and 3 varicoceles were 5.5, 8.9, 12.7 and 16.0 million sperm per ml, respectively. The mean improvement in the percent of overall motility in men with grades 1, 2, 2-3 and 3 varicoceles was 9.6%, 10.6%, 10.8% and 17.7%, respectively. Pregnancy outcomes were assessed but could not be analyzed systematically due to the lack of adequate published data. CONCLUSIONS: Mean improvements in the sperm concentration and the percent of overall motility after treatment of grade 1 varicocele were statistically significant but small in magnitude. In contrast, mean improvements in the sperm concentration and the percent of overall motility after treatment of grade 2-3 varicoceles were greater and highly likely to be clinically significant. Incorporating varicocele grade into shared decision making discussions with affected couples may improve the ability to select patients who are the best candidates for treatment.


Assuntos
Varicocele/cirurgia , Adulto , Feminino , Humanos , Infertilidade Masculina/etiologia , Masculino , Microcirurgia , Gravidez , Taxa de Gravidez , Análise do Sêmen , Varicocele/complicações
2.
Cir. pediátr ; 32(3): 141-144, jul. 2019.
Artigo em Espanhol | IBECS | ID: ibc-183733

RESUMO

Objetivos: El varicocele constituye la principal causa de infertilidad masculina tratable. Su fisiopatología no es todavía bien conocida y existen varios estudios que sugieren que esta patología se desarrolla con menos frecuencia en pacientes obesos. Sin embargo, la relación entre el varicocele y el índice de masa corporal (IMC) continúa siendo controvertida. Nuestro objetivo es estudiar los pacientes pediátricos con varicocele y establecer una relación entre el IMC de estos pacientes y esta patología. Material y métodos: Para estudiar la relación entre el varicocele y el índice de masa corporal en la población infantil, revisamos a los pacientes intervenidos de varicocele en nuestro centro. Se estudiaron 79 pacientes en los últimos 10 años. Todos los pacientes fueron tratados con técnica de Palomo. Analizamos: edad, localización y grado de varicocele, peso y talla, técnica quirúrgica, aparición de hidrocele reactivo u otras complicaciones, recurrencia de varicocele y reintervención. Resultados: Observamos en nuestra serie una mayor frecuencia de varicocele en pacientes más altos y delgados (menor IMC) comparándolos con los pacientes con mayor masa corporal en relación a la altura. Conclusiones: Concluimos que según nuestra serie y en concordancia con literatura, el varicocele podría darse con más frecuencia en pacientes altos y delgados. Son necesarios más estudios para confirmar este hecho y aclarar la fisiopatología de esta entidad, pero dado que se trata de una patología que podría tener repercusión en la fertilidad creemos que debemos estar alerta en este grupo de pacientes para detectar esta patología y valorar la necesidad de corrección


Objectives: Varicocele is a dilatation of the venous pampiniform plexus considered the leading cause of correctible male infertility. Varicocele ethology remains controversial and there have been several studies which inform that varicoceles are found less frequently in obese adolescents but relationship between varicocele and body mass index (BMI) remains controversial yet. Subjects and methods: To study the relationship between varicocele and body mass index in children population we review the patients treated for varicocele in our institution. We analyzed patients with varicocele surgical correction in our centre in the last 10 years. At our institution all patients were treated by Palomo technique. We analyzed: age, location and degree of varicocele, weight and height, surgical technique, appearance of reactive hydrocele or others complications, varicocele recurrence and reoperation. Our objective is to study the relationship between BMI and varicocele in adolescent boys. Results: We observed that varicocele in our series was found more frequently in taller patients and less frequently in obese patients (higher BMI). Conclusions: Future studies will be needed to confirm that theory and to understand varicocele ethology but we consider that this fact is very useful because we are talking about a pathology with repercussion in fertility so we must be alert about it in adolescent population to correct it


Assuntos
Humanos , Adolescente , Varicocele/complicações , Índice de Massa Corporal , Antropometria , Recidiva , Varicocele/cirurgia , Complicações Pós-Operatórias , Infertilidade/complicações , Infertilidade/terapia
3.
Panminerva Med ; 61(2): 118-127, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30990284

RESUMO

Sperm DNA fragmentation (SDF) is an advanced test of sperm function that is utilized during male fertility evaluation. Recently, a guideline was published highlighting the detrimental impact of SDF on sperm function identifying practice-based clinical indications for SDF testing. This review illustrates the commonly utilized SDF measurement techniques and explores the current evidence behind their utility in clinical practice. Patients diagnosed with varicocele, unexplained infertility, recurrent pregnancy loss, recurrent failure of assisted reproductive techniques (ART) and those at risk of lifestyle/environmental exposures are recognized candidates for SDF testing. On a therapeutic level, SDF can help in selecting patients for varicocelectomy, choosing the ART modality and intervention associated with highest pregnancy and live birth outcomes and monitoring treatment response in patients with lifestyle risk factors.


Assuntos
Dano ao DNA , Infertilidade Masculina/diagnóstico , Espermatozoides/metabolismo , Feminino , Fertilização In Vitro , Humanos , Estilo de Vida , Masculino , Gravidez , Técnicas de Reprodução Assistida , Varicocele/diagnóstico , Varicocele/cirurgia
4.
Panminerva Med ; 61(2): 152-163, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30990285

RESUMO

Varicoceles exert deleterious effect on testicular function. The condition has been associated with male infertility, testicular hypotrophy and pain. These comprises the common indications for varicocele repair currently. Significant improvement in semen parameters and pregnancy outcomes had been suggested by reports decades ago. However, selection of the best candidates remains an issue since not all patients respond positively to treatment. Consensus has been reached in recent decade after the publication of a series of meta-analyses. Significant improvement in pregnancy outcomes were reported in patients with clinical varicocele and abnormal semen parameters. Varicocelectomy in adolescents with testicular hypotrophy was supported by the positive implication on catch-up growth and semen parameters. However, little is known about the treatment effect of adolescence varicocelectomy on long term fertility and paternity rate. Recent studies on outcome of varicocele repair for pain consistently demonstrated a resolution rate of approximately 90% and support varicocele-associated pain as an indication for surgery. Alternate indications for varicocele repair have been proposed in recent decade. Despite the encouraging preliminary data, most studies were uncontrolled retrospective series. Although varicocelectomy may not obviate the need for assisted reproductive techniques in patients with non-obstructive azoospermia, it potentially increases sperm retrieval rate. The significant increase in serum testosterone after varicocelectomy in patients with androgen deficiency may open an alternative treatment for hypogonadism. The adjunctive role of varicocelectomy before assisted reproduction and the significant decrease in sperm DNA fragmentation after varicocele repair deserve further well-designed controlled studies.


Assuntos
Varicocele/cirurgia , Adolescente , Androgênios/deficiência , Azoospermia/complicações , Fragmentação do DNA , Humanos , Infertilidade Masculina/etiologia , Infertilidade Masculina/cirurgia , Masculino , Estresse Oxidativo , Técnicas de Reprodução Assistida , Testículo/patologia , Procedimentos Cirúrgicos Urogenitais , Varicocele/fisiopatologia
5.
Andrologia ; 51(7): e13293, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30995701

RESUMO

In the present study, we compared the retroperitoneal high ligation with subinguinal varicocelectomy on the treatment of painful varicocele. A total of 90 patients who underwent retroperitoneal high ligation (n = 45) and subinguinal varicocelectomy (n = 45) for painful varicocele were included in this prospective study. Varicocele in all patients was diagnosed with by physical examination and coloured Doppler ultrasonography. All the patients underwent a conservative treatment for pain for 4 weeks. Patient ages, varicocele grades, preoperative pain scores, postoperative pain scores at 6 months, duration of surgeries, complications and recurrences were recorded. Complete success rate for chronic scrotal pain was found to be 80% in retroperitoneal varicocelectomy group and 71% in subinguinal varicocelectomy group. Partial success rate was 11% for retroperitoneal varicocelectomy group and 18% for subinguinal ligation group. There was no significant difference between two groups in terms of pain and complications. However, the operation time was significantly lower in the Palomo group. Although microsurgical subinguinal varicocelectomy is the current approach for the treatment of varicocele, retroperitoneal high ligation can achieve the same pain resolution with shorter operative duration compared to loupe-assisted subinguinal varicocelectomy.


Assuntos
Dor Crônica/terapia , Microcirurgia/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Varicocele/cirurgia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Adolescente , Adulto , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Humanos , Ligadura/efeitos adversos , Ligadura/métodos , Masculino , Microcirurgia/métodos , Duração da Cirurgia , Medição da Dor , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Recidiva , Espaço Retroperitoneal , Estudos Retrospectivos , Escroto/irrigação sanguínea , Escroto/diagnóstico por imagem , Escroto/cirurgia , Resultado do Tratamento , Ultrassonografia Doppler , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Varicocele/complicações , Varicocele/diagnóstico por imagem , Procedimentos Cirúrgicos Vasculares/métodos , Adulto Jovem
6.
Biomed Res Int ; 2019: 7934328, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30984784

RESUMO

Varicocele, a vascular event, is associated with infertility due to testicular damage that causes abnormal spermatogenesis in males. The goal of this study is to ascertain the diagnostic significance of scrotal color Doppler ultrasonography (CDUS) by measuring peak systolic value (PSV) and resistive index (RI) of the arteries supplying blood to the testis and their association with semen quality attributes. Sixty prospective patients (age: 20-50 years) undergoing microsurgical varicocelectomy at a teaching hospital were included in the study. Semen parameters and CDUS were recorded and testicular blood flow was determined as PSV and RI of subcapsular artery and intraparenchymal artery of the testes. Nonparametric statistics was applied to test the correlation/association of the semen quality with the PSV, RI, and other variables. Results revealed a significant negative correlation (r = -0.28; p < 0.05) between progressive motility of spermatozoa and resistive index of the intraparenchymal arterial blood flow. Furthermore, it was noticed that the progressive motility of spermatozoa was tended to be negatively correlated (r = -0.236) with resistive index of subcapsular arterial blood flow. In conclusion, this study has revealed that progressive motility of sperms has correlation with the intraparenchymal blood flow of testes. The progressive motility of sperms could be correlated with RI of testicular blood flow. The apparent lack of association between diameter of varicocele vein and semen quality signifies the need of investigating some other factors that may be involved in pathogenicity of varicocele. The diagnostic value of CDUS may be carefully interpreted and clinically correlated in assessment of severity of varicocele.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Infertilidade Masculina/sangue , Testículo/irrigação sanguínea , Varicocele/sangue , Adulto , Hemodinâmica , Humanos , Infertilidade Masculina/patologia , Infertilidade Masculina/cirurgia , Masculino , Microcirurgia , Pessoa de Meia-Idade , Paquistão , Sêmen/metabolismo , Análise do Sêmen , Motilidade Espermática/fisiologia , Espermatogênese/fisiologia , Testículo/patologia , Testículo/cirurgia , Varicocele/patologia , Varicocele/cirurgia , Veias/patologia , Veias/cirurgia , Adulto Jovem
7.
J Chin Med Assoc ; 82(2): 115-119, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30839501

RESUMO

BACKGROUND: Varicocele is believed to be a dilated vein of the pampiniform plexus along the spermatic cord. Surgical treatment should be considered in men with a symptomatic varicocele. To date, microsurgical varicocelectomy is the most effective method among various varicocelectomy techniques, according to the current evidence. This study aimed to evaluate the effectiveness of subinguinal varicocelectomy with intraoperative vascular Doppler for symptomatic varicocele and map the distributional trend of spermatic content simultaneously. METHODS: A total of 24 male patients underwent subinguinal varicocelectomy with intraoperative vascular Doppler ultrasound between March 2016 and October 2017, because of symptomatic varicocele or infertility. The numbers, sizes, and location of spermatic vessels in each site were recorded during operation. The visual analogue scale (VAS) score of scrotal pain was also obtained before and after surgery. RESULTS: The mean number of spermatic veins that were ligated in each spermatic unit was 4.70 (±2.06). The predominant distributional zone of spermatic veins was the medial upper zone on an axial view of the spermatic cord. Fifty-six (44.1%) spermatic veins were found in this zone. Normally, each spermatic cord has 1.33 (±0.61) spermatic arteries. The average VAS score prior to surgery was 1.95 (±0.89) and it decreased to 0.05 (±0.21) after the surgery. Complete resolution of pain was observed in almost all symptomatic patients (95.23%). A significant positive relationship between the number of veins ligated and improvement of VAS score was also noted (p < 0.05). CONCLUSION: Subinguinal varicocelectomy with intraoperative vascular Doppler ultrasound is an effective treatment for symptomatic varicocele. The more the internal spermatic veins are ligated, the more the VAS scores are improved. Determining the distributional trend of spermatic content is of great importance in the prevention of iatrogenic injury to the spermatic vessels and vas deferens.


Assuntos
Cordão Espermático/irrigação sanguínea , Ultrassonografia Doppler/métodos , Varicocele/cirurgia , Veias/diagnóstico por imagem , Adulto , Humanos , Masculino , Monitorização Intraoperatória , Varicocele/diagnóstico por imagem , Veias/anatomia & histologia , Escala Visual Analógica
9.
Urologia ; 86(1): 23-26, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30890103

RESUMO

OBJECTIVE:: Varicocele is the most commonly curable cause of infertility in men. Varicocele is found in 15% of the total male population, 35% of men with primary infertility, and 75%-81% of men with secondary infertility. Generally, patients seek microscopic surgery via surfing the Internet, which is not an available option in all medical centers. The purpose of this study was to determine the success rate and complications of conventional varicocelectomy and to compare it with that of the microscopic method. METHODS:: In this descriptive cross-sectional study, 88 patients with varicocele who underwent non-microscopic varicocele surgery in the 15th Khordad Hospital during 2013-2015 were evaluated by the census method. RESULTS:: The mean age of patients with varicocele was 27.30 years; 52 patients underwent bilateral varicocelectomy and 36 left varicocelectomy. Surgical complications of non-microscopic varicocelectomy in the studied patients included bleeding and hydrocele formation both in 0.7% and recurrence in 2.8%. Testicular atrophy was not observed in any case. CONCLUSION:: The incidence of recurrence, hydrocele formation, atrophy, and bleeding in non-microscopic varicocelectomy, if done in accordance with its principles, is not more than the microscopic approach and therefore it could be recommended as a safe surgical treatment in centers where microscopic surgery is not available.


Assuntos
Microcirurgia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Varicocele/cirurgia , Adolescente , Adulto , Criança , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Adulto Jovem
10.
Fertil Steril ; 111(3): 415-419, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30827515

RESUMO

The impact of clinical varicoceles on semen parameters and male infertility has long been established. In the era of assisted reproduction, clinical discussion has questioned the role of varicocelectomy, offering the potential to bypass, rather than treat, varicocele-associated male infertility. However, current literature supports improved semen parameters and reproductive outcomes following repair. This article presents the stepwise operative approaches to microsurgical varicocelectomy and discusses the recent publications on outcomes.


Assuntos
Infertilidade Masculina/cirurgia , Microcirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Varicocele/cirurgia , Fertilidade , Humanos , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/etiologia , Infertilidade Masculina/fisiopatologia , Ligadura , Masculino , Microcirurgia/efeitos adversos , Fatores de Risco , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Varicocele/complicações , Varicocele/diagnóstico , Varicocele/fisiopatologia
11.
Andrologia ; 51(5): e13256, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30820998

RESUMO

After varicocelectomy, complications such as hydrocele, testicular atrophy and recurrence can be seen. Our case was a 29-year-old male patient who had a fistula mouth laterally on the left scrotum. In the examination and scrotal ultrasonography (USG), a foreign body was detected under the skin. The patient had a history of varicocelectomy, suggesting suture reaction. Our case is interesting because it is the first reported suture granuloma case after varicocelectomy.


Assuntos
Granuloma de Corpo Estranho/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Suturas/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Adulto , Granuloma de Corpo Estranho/etiologia , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Escroto/irrigação sanguínea , Escroto/diagnóstico por imagem , Escroto/cirurgia , Ultrassonografia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Varicocele/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos
12.
BMC Urol ; 19(1): 14, 2019 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-30704438

RESUMO

BACKGROUND: An acute scrotal hematoma, secondary to a spontaneous rupture of a varicocele is still a rare presentation in daily practice. However, multiple case reports have been reported. Sudden increase in abdominal pressure, resulting to an increased venous pressure can lead to a rupture of the varicocele. Literature search shows that due to uncertainty of the diagnosis, explorative surgery is often performed, sometimes resulting in unnecessary orchiectomies. The objective of this study was to determine classical clinical presentation of patients with a spontaneous rupture of a varicocele, determine the diagnostic procedure, and give an insight in the follow-up. CASE PRESENTATION: We present a case of a 24-year old male with acute scrotal swelling after sneezing. Subsequently, we carried out a systematic literature search to identify all eligible studies to determine classic clinical presentation of spontaneous ruptures of a varicocele. CONCLUSION: The literature search shows that clinical presentation of idiopathic spontaneous scrotal hematomas is similar to testicular torsion, epididymo-orchitis, malignancy, or (incarcerated) inguinal hernia making differential diagnosis difficult. Especially when there has been increased abdominal pressure or strenuous activity preceding the symptoms, and the swelling is left sided, it should be included in the differential diagnosis for patient with acute inguinoscrotal swelling. Colour Doppler-Ultrasonography is recommended to distinguish between other causes of acute scrotum. The hematoma is usual self-limiting, justifying conservative treatment. Early surgical intervention is indicated with signs of ischaemia due to obstruction, infection of the hematoma, or uncertain diagnosis (i.e. malignancy). However, physicians should be cautious with direct exploration, as it led to unnecessary orchiectomy in 25% of patients. The hematoma can increase in size up to 3 months post-event, and it can take up to 15 months to completely resolve.


Assuntos
Hematoma/diagnóstico por imagem , Ruptura/diagnóstico por imagem , Escroto/diagnóstico por imagem , Espirro , Varicocele/diagnóstico por imagem , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Masculino , Ruptura/etiologia , Ruptura/cirurgia , Escroto/cirurgia , Espirro/fisiologia , Varicocele/etiologia , Varicocele/cirurgia , Adulto Jovem
13.
Int Urol Nephrol ; 51(3): 401-408, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30701399

RESUMO

PURPOSE: We studied prospectively the role of FSH, testis volume, age, duration of infertility, hormonal therapy, varicocelectomy and testicular histopathology in determining the sperm retrieval rate (SRR) in fresh versus salvage micro-TESE. METHODS: Our study analysed retrospectively the prospectively maintained database of 330 NOA patients who underwent micro-TESE either 1st or 2nd or 3rd timers from January 2017 to August 2018 from the Andrology Clinic of a specialized IVF centre. They were divided equally into 3 groups, group (1) were 1st timers, group (2) were 2nd timers and group (3) were 3rd timers, respectively. RESULTS: Interestingly, our study demonstrated a positive correlation between high FSH level and favourable micro-TESE outcome in 1st timers who underwent micro-TESE (p 0.015). Additionally, our study revealed a positive correlation between age and favourable micro-TESE outcome in 2nd timers who underwent micro-TESE (p 0.031). Further, our study revealed a positive correlation between right testicular volume and favourable micro-TESE outcome in 1st timers who underwent micro-TESE (p 0.023). Eventually, there was a significant positive correlation between histopathology which was mainly sertoli cell only syndrome and favourable micro-TESE outcome in 1st timers micro-TESE (p 0.001). CONCLUSION: Our study demonstrates that sperms can be retrieved despite high FSH level, and preoperative histopathology is not essential in predicting SRR in NOA patients. Further, age can be considered a good prognostic factor in patients who undergo salvage micro-TESE for the 2nd time.


Assuntos
Hormônio Foliculoestimulante/sangue , Infertilidade Masculina/terapia , Recuperação Espermática , Testículo/patologia , Adulto , Fatores Etários , Azoospermia/sangue , Azoospermia/complicações , Hormônios/uso terapêutico , Humanos , Infertilidade Masculina/sangue , Infertilidade Masculina/etiologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Retrospectivos , Terapia de Salvação , Varicocele/cirurgia
14.
Andrologia ; 51(5): e13244, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30714182

RESUMO

To evaluate the value of seminal plasma miR-210-3p as a novel and non-invasive biomarker for screening dyszoospermia caused by varicocele. Semen samples from patients with varicocele and healthy males were collected for semen analysis and quantitative real-time polymerase chain reaction. Cox univariate and multivariate analysis and receiver operating characteristic curve analysis were used to assess the relationship between the level of seminal plasma miR-210-3p and impaired spermatogenic function. Our results showed that the level of seminal plasma miR-210-3p in the varicocele patients was 2.18 times that of the control group (p < 0.001), and its expression increased significantly with the severity of varicocele. Compared with preoperative, the expression of seminal plasma miR-210-3p declined significantly at 3 months after surgery. Cox univariate and multivariate analysis showed that seminal plasma miR-210-3p (p = 0.02), bilateral varicocele (p = 0.04) and the grade 3 varicocele (p = 0.03) were significantly and independently associated with dyszoospermia caused by varicocele. Our results suggest that seminal plasma miR-210-3p is a useful clinical biomarker for screening dyszoospermia caused by varicocele, and this is the key to deciding early effective treatment and protecting the fertility of the patients.


Assuntos
Infertilidade Masculina/diagnóstico , Programas de Rastreamento/métodos , MicroRNAs/análise , Análise do Sêmen/métodos , Varicocele/complicações , Adulto , Biomarcadores/análise , Biomarcadores/metabolismo , Humanos , Infertilidade Masculina/etiologia , Infertilidade Masculina/prevenção & controle , Masculino , MicroRNAs/metabolismo , Curva ROC , Sêmen/metabolismo , Índice de Gravidade de Doença , Varicocele/cirurgia , Adulto Jovem
15.
J Laparoendosc Adv Surg Tech A ; 29(4): 564-567, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30676243

RESUMO

BACKGROUND: Laparoscopic Palomo varicocelectomy is one the most common approaches adopted to treat pediatric varicocele, but postoperative hydrocele still remains a potential problem with this procedure. This study aimed to evaluate the outcome of a new technique of lymphography using indocyanine green (ICG)-enhanced fluorescence to perform lymphatic sparing laparoscopic Palomo varicocelectomy. PATIENTS AND METHODS: The records of 25 patients who underwent laparoscopic left varicocelectomy in our unit from March 2017 to March 2018 were retrospectively evaluated. The average patients' age was 13.7 years (range 12-16). All patients had a high degree varicocele associated with left testicular hypotrophy and symptoms. All procedures were performed in laparoscopy using three trocars. After trocars' positioning, 2 mL of ICG solution was directly injected into the left testicle. Using ICG fluorescence, the lymphatic vessels were clearly identified and spared, and then the entire spermatic bundle was clipped and divided according to Palomo's principle. RESULTS: The average operative time was 18 minutes (range 10-25). No conversions to open surgery and no allergy or other adverse reactions induced by ICG were reported. At a maximum follow-up of 18 months, no recurrence of varicocele or postoperative hydrocele was recorded. CONCLUSIONS: Our preliminary experience showed that ICG fluorescence lymphography is a safe and effective option to perform lymphatic sparing laparoscopic Palomo varicocelectomy in children and adolescents with high degree varicocele. The intratesticular injection of ICG and use of fluorescence vision allowed identification of lymphatic vessels in 100% of cases. No allergy to ICG or postoperative hydrocele was reported in our experience.


Assuntos
Verde de Indocianina/administração & dosagem , Laparoscopia/métodos , Linfografia/métodos , Tratamentos com Preservação do Órgão/métodos , Varicocele/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Adolescente , Criança , Conversão para Cirurgia Aberta/estatística & dados numéricos , Corantes Fluorescentes/administração & dosagem , Humanos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/prevenção & controle , Recidiva , Estudos Retrospectivos , Hidrocele Testicular/prevenção & controle , Testículo/cirurgia
16.
Andrologia ; 51(4): e13234, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30689241

RESUMO

Impacts of a subinguinal microsurgical varicocelectomy on the sperm parameters and fertility rates were investigated in three different ages according to their age at the time of the varicocelectomy: Group 1 was ≤20 years old, Group 2 was 21-30 years old, and Group 3 was ≥31 years old. The patients were also classified both preoperatively and post-operatively according to the total motile sperm count (TMSC) into the following categories: invitro fertilisation, intrauterine insemination and naturally fertile. The proportion of patients who upgraded to a higher TMSC category level was calculated, and natural fertility rates were recorded. The mean infertility duration was statistically longer in Group 3, compared to Group 1 and 2. The mean TMSCs and normal sperm morphology rates increased in all groups. The mean post-operative natural fertility rates were similar. The highest rate of TMSC upgrade was observed in Grade 3 varicocele patients under 20 years of age, compared to other grades of varicocele in patients older than 20 years. A microsurgical subinguinal varicocele repair, which is an effective treatment modality reduces the need for any type of ART, has an important impact on the TMSC increase in patients, particularly in the younger population.


Assuntos
Fertilidade/fisiologia , Infertilidade Masculina/prevenção & controle , Microcirurgia/métodos , Varicocele/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Fatores Etários , Humanos , Infertilidade Masculina/etiologia , Masculino , Período Pós-Operatório , Estudos Prospectivos , Estudos Retrospectivos , Contagem de Espermatozoides , Motilidade Espermática/fisiologia , Fatores de Tempo , Resultado do Tratamento , Varicocele/complicações , Adulto Jovem
18.
J Pediatr Surg ; 54(1): 177-183, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30482540

RESUMO

BACKGROUND/PURPOSE: Inguinal hernia repair and orchidopexy are among the most common operations in boys. The impact on future fertility has not been conclusively defined. This study evaluates sperm quality after previous inguinal surgery. METHODS: Spermiograms of men with a desire to conceive children were analyzed. History of previous inguinal surgery (hernia repair, orchidopexy, varicocele ligation) was correlated with sperm quality. Other influential factors (age, BMI, chronic medication, tobacco use) were also tested. RESULTS: A total of 333 patients were included. Overall, 12.6% of the subjects had undergone previous inguinal surgery. Of these, 17 (43%) were inguinal hernia repairs, 8 (20%) orchidopexies, and 6 (15%) varicocele ligations, while 9 (22%) could not give an exact history. Abnormal spermiograms were found in 60% (n = 24) of those with previous inguinal surgery versus 48% in controls (p = 0.16). On multivariate analysis, pathologic spermiogram parameters were associated with previous inguinal surgery, orchidopexy, use of chronic medication, and smoking, but NOT with inguinal hernia or varicocele repair alone. CONCLUSIONS: Previous inguinal hernia or varicocele repair does not seem to impact negatively on quality of sperm later in life. Orchidopexy, smoking, and use of chronic medication, however, were all associated with pathologic sperm quality parameters. TYPE OF STUDY: Prospective comparative study. LEVEL OF EVIDENCE: Level II.


Assuntos
Fertilidade , Herniorrafia/efeitos adversos , Canal Inguinal/cirurgia , Orquidopexia/efeitos adversos , Análise do Sêmen/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos de Coortes , Hérnia Inguinal/cirurgia , Humanos , Ligadura/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Varicocele/cirurgia , Adulto Jovem
19.
Andrologia ; 51(2): e13188, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30397905

RESUMO

Various studies have been reported to predict the success of varicocelectomy. Neutrophil-lymphocyte ratio (NLR) is a frequently used indicator of systemic inflammation. We aimed to evaluate the effect of inflammation on the success of varicocelectomy using the NLR. The data of 86 patients who underwent varicocelectomy for infertility were evaluated retrospectively. Pre-operative demographic characteristics of patients, laboratory results such as haemogram, and semen analysis and clinical data were recorded. The semen analysis with the highest total motile sperm count was accepted as pre-operative value. Control was performed with semen analysis at post-operative 6th month. As described in previous studies, in our study, more than 50% increase in total motile sperm count in post-operative semen analysis was defined as a significant improvement. However, at least a 100% increase was required for patients with a total motile sperm count <5 million in the definition of recovery. Patients were divided into two groups as those with improvement in the semen parameters (Group 1) and those without (Group 2). NLR was statistically significantly higher in Group 2 compared with Group 1. The area under the curve (AUC) in the ROC curve for NLR was 0.89. According to the Youden index, the best cut-off value of NLR for varicocelectomy success was 1.98 (sensitivity: 94.7%, specificity: 75.9%, p < 0.001). Logistic regression analysis showed that NLR (odds ratio: 3.6, 95% confidence interval: 1.69-8.38, p < 0.001) is independent predictor factors in predicting the success of varicocelectomy. The results of this study show that systemic inflammation adversely affects the likelihood of improvement in sperm parameters by varicocelectomy. Additionally, NLR has been shown to be an independent factor in the prediction of varicocelectomy success.


Assuntos
Infertilidade Masculina/cirurgia , Canal Inguinal/cirurgia , Linfócitos , Microcirurgia/métodos , Neutrófilos , Varicocele/cirurgia , Adulto , Humanos , Infertilidade Masculina/sangue , Contagem de Leucócitos , Masculino , Prognóstico , Varicocele/sangue , Adulto Jovem
20.
Urology ; 124: 131-135, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30359710

RESUMO

OBJECTIVE: To characterize the pathways to care that infertile couples requiring varicocele repair (VR) pursue prior to presenting to a male fertility clinic. METHODS: An IRB-approved single center retrospective review of patients undergoing VR after presentation to an academic male fertility clinic was performed. Patients whose charts included partner histories were assessed for duration of attempting conception, prior workup, and assisted reproductive technology (ART) use. RESULTS: A total of 405 couples were included. At presentation, mean age was 34.4 (SD ± 6.5) years for men and 31.1 (SD ± 4.3) years for women (P < .0001). A couple's first visit to a physician was a gynecologist in 59% (198/334) of couples, a reproductive endocrinologist (REI) in 25% (83/334) of cases, with 14% (47/334) presenting without a previous female workup and were self-referred, and 2% (6/334) seeing both a gynecologist and REI prior to presentation. On average, couples attempted pregnancy for 22.3 (SD ± 21.1, range 0-120) months prior to presentation. Eighteen percent of couples underwent ART prior to presentation. Couples who had undergone ART had lower pre-VR total motile sperm counts compared to couples not pursuing ART prior to presentation (P = 0.031). The majority (70.4%) of females had no abnormality in their workup, making varicocele the only correctable factor for infertility in the couple. CONCLUSIONS: Our findings show a significant delay in referral of infertile men requiring VR. Eighteen percent of couples underwent costly ART prior to an inexpensive male workup. In an era of medical cost containment, early referral to a male infertility specialist is imperative.


Assuntos
Procedimentos Clínicos/economia , Infertilidade Masculina/cirurgia , Encaminhamento e Consulta/estatística & dados numéricos , Tempo para o Tratamento/economia , Tempo para o Tratamento/estatística & dados numéricos , Varicocele/cirurgia , Adolescente , Adulto , Feminino , Humanos , Infertilidade Masculina/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Cirúrgicos Urológicos Masculinos/economia , Varicocele/complicações , Adulto Jovem
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