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1.
Urol Clin North Am ; 48(1): 127-135, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218587

RESUMO

The robotic platform offers theoretical and practical advantages to microsurgical male infertility surgery. These include reduction or elimination of tremor, 3-dimensional visualization, and decreased need for skilled surgical assistance. This article reviews the application of robotic surgery to each of the 4 primary male infertility procedures: vasectomy reversal, varicocelectomy, testicular sperm extraction, and spermatic cord denervation. Historical perspective is presented alongside the available outcomes data, which are limited in most cases. Before the robotic approach can be widely adopted, further clinical trials are needed to compare outcomes and costs with those of other validated surgical techniques.


Assuntos
Infertilidade Masculina/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Vasovasostomia/métodos , Azoospermia/cirurgia , Denervação/métodos , Previsões , Humanos , Infertilidade Masculina/etiologia , Masculino , Microcirurgia/métodos , Microcirurgia/tendências , Procedimentos Cirúrgicos Robóticos/tendências , Cordão Espermático/inervação , Cordão Espermático/cirurgia , Testículo/cirurgia , Varicocele/cirurgia , Vasovasostomia/tendências
2.
Niger J Clin Pract ; 23(12): 1744-1747, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33355829

RESUMO

Background: Varicocele is the most common correctable cause of male infertility. But, it is still controversial in patients with severe oligospermia. Aim: The aim of this study is to evaluate how varicocelectomy impacts pregnancy rates (natural or assisted reproductive techniques) in infertile couples when the male partner has severe oligospermia and history of varicocele. Materials and Methods: A retrospective examination was made of males with total motile sperm count <5 million/mL with varicocele in the period April 2013 to October 2019. Pregnancy rates were compared at the end of 1-year follow-up of 52 patients (Group 1) who underwent varicocelectomy and 36 patients (Group 2) who applied for assisted reproductive techniques without surgery. The postoperative third-month sperm parameters were compared for Group 1. Spontaneous pregnancy and conception rates with assisted reproductive techniques for Groups 1 and 2 were also investigated after 1 year. Results: In the semen analysis performed in the 3rd month, a statistically significant increase was observed in sperm number, motility, and morphology of the patients in Group 1. Spontaneous pregnancy was obtained in 7 (13.4%) of the 56 Group 1 patients who underwent varicocelectomy, in 7 (13.4%) patients with intrauterine insemination, and in 6 (11.5%) patients with intracytoplasmic injection (ICSI). In Group 2, pregnancy occurred with the help of ICSI in 4 of 32 patients (11.1%). Conclusions: Varicocele surgery before assisted reproductive techniques will be more beneficial in terms of both cost-effectiveness and pregnancy rates.


Assuntos
Infertilidade Masculina , Oligospermia , Varicocele , Feminino , Humanos , Infertilidade Masculina/epidemiologia , Infertilidade Masculina/etiologia , Masculino , Oligospermia/epidemiologia , Oligospermia/cirurgia , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Contagem de Espermatozoides , Varicocele/cirurgia
3.
Urologiia ; (6): 148-154, 2020 Dec.
Artigo em Russo | MEDLINE | ID: mdl-33377695

RESUMO

Varicocele is one of the most common correctable cause of male subfertility. According to recent meta-analyzes of RCTs varicocelectomy, in general, leads to significant improvement in semen quality and thereby male fertility. However, varicocelectomy success rate is 55-70%, it means that 30-40% of infertile men does not experience fertility improvement after varicocelectomy. The aim of our review was to search and analyze literature data on clinical-anamnestic and laboratory-instrumental predictors that positively or negatively affect varicocelectomy efficacy. As a result of analysis, we systematized the studied predictors based on the total points calculated on the basis of number and quality of studies that confirm or reject the studied predictor as a significant, into three levels of evidence: predictors of high, moderate and low evidence levels. Predictors of high level of evidence included: initial semen parameters, sperm DNA fragmentation index, and Doppler ultrasound imaging of testicular vessels. The initial serum level of FSH and testicular volume were included in the group of predictors of moderate evidence level. At the same time, such factors as the male age and his female partner age, varicocele grade and infertility duration entered the group of predictors of low evidence level. In this way, we performed "gradation" of predictors of varicocelectomy efficacy in subfertile men based on the analysis of the evidence level of each predictor.


Assuntos
Infertilidade Masculina , Varicocele , Feminino , Humanos , Infertilidade Masculina/diagnóstico por imagem , Infertilidade Masculina/etiologia , Infertilidade Masculina/cirurgia , Masculino , Recuperação de Função Fisiológica , Análise do Sêmen , Espermatozoides , Varicocele/diagnóstico por imagem , Varicocele/cirurgia
4.
Urologiia ; (4): 111-118, 2020 Sep.
Artigo em Russo | MEDLINE | ID: mdl-32897024

RESUMO

Varicocele is the most common and treatable cause of male infertility. Therefore, surgical treatment of varicocele should be recommended for motivated patients and infertile couples who do not have other identified causes of infertility. Varicocelectomy has been proved to improve sperm parameters and improve chances of successful conception in most patients. However, surgical treatment is associated with certain risks, and therefore, the choice of the optimal treatment is under discussion. A total of 78 articles using a search in MEDLINE database (PubMed) were found and included in the review, dedicated to current concepts of functional anatomy of testicular arteries and veins. The current recommendations of professional communities regarding the selection of patients for varicocelectomy are described. The efficiency and safety of various surgical procedures for varicocele is analyzed. This review suggests high inconsistences in the literature. The available information on the indications for surgical treatment, as well as comparative data on the efficiency and safety of the inguinal, laparoscopic and microsurgical sub-inguinal approaches are presented. When urologist faces with a diagnosis of varicocele, individual approach should be applied, with a discussion of both benefits and possible complications of surgical treatment. Of the many existing techniques, microsurgical ligation of dilated veins is the most preferred.


Assuntos
Infertilidade Masculina/cirurgia , Varicocele/cirurgia , Humanos , Masculino , Microcirurgia , Resultado do Tratamento , Veias
5.
Medicine (Baltimore) ; 99(38): e21960, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957313

RESUMO

INTRODUCTION: Sperm DNA integrity has been considered as one of the important determinants of normal fertilization and embryonic development in natural and assisted pregnancy. It is difficult for men with high levels of sperm DNA fragmentation (SDF) in semen to conceive their partners naturally and assist in conception. The studies have found that the level of SDF in the semen of patients with varicocele (VC) was on the high side. In recent years, the effect of VC surgery on DNA fragmentation index has attracted the attention of researchers. In this study, we will evaluate the effectiveness of VC repair as a way to alleviate SDF and improve male fertility. METHODS AND ANALYSIS: Electronic databases including English databases (PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Library) and Chinese databases (China National Knowledge Infrastructure, China Biology Medicine Database, Wanfang Database, VIP Database) will be searched from their inception to December 2020 to recognize related studies. All the randomized controlled trials of microsurgical varicocelectomy for the management of VC patients will be included. The potential outcome will include improvement in SDF, oxidative stress markers (reactive oxygen species, nitric oxide, and lipid peroxidation products), sperm chromatin compaction, other advanced sperm function characteristics, follow-up of fertility results. We will conduct this study strictly according to the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: The study is a protocol for systematic review and meta-analysis without results, and data analysis will be carried out after the protocol. We will share our findings on April 5th of 2021. CONCLUSION: This systematic review will provide more evidence to assess whether varicocelectomy is an effective intervention for patients with SDF. The results will be published in a public issue journal and offer the urologists help to make clinical decisions. ETHICS AND DISSEMINATION: Formal ethical approval is not required in this protocol. We will collect and analyze data based on published research. Since this research does not involve patients, personal privacy will not be affected. The results of this review will be distributed to peer-reviewed journals or submitted to relevant conferences. PROTOCOL REGISTRATION NUMBER: INPLASY202070119.


Assuntos
Fragmentação do DNA , Espermatozoides/patologia , Varicocele/cirurgia , Cromatina/metabolismo , Humanos , Masculino , Estresse Oxidativo/fisiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
6.
Medicine (Baltimore) ; 99(31): e21308, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756113

RESUMO

INTRODUCTION: Premature ejaculation (PE) is the most common type of sexual disorder among men which comprises a great of problems. Varicocele is defined as the dilation of the pampiniform venous plexus draining the testicle. At present, selective serotonin reuptake inhibitors antidepressants, topical anesthetics, tramadol, phosphodiesterase type 5 inhibitors are the common alternative strategy to improve PE. However, these therapeutic measures have several shortcomings and side effects. Recently, the correlation between varicocele and PE has attracted the attention of some researchers. A few studies consider microsurgical varicocelectomy can be a new remedy for PE. But it is still absent enough a great deal of convincing evidence. The study will assess the effectiveness and safety of the microsurgical varicocelectomy treatment in PE patients. METHODS AND ANALYSIS: Electronic databases including English databases (PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Library) and Chinese databases (China National Knowledge Infrastructure, China Biology Medicine Database, Wanfang Database, VIP Database) will be searched from their inception to December 2020 to recognize related studies. All the randomized controlled trials of microsurgical varicocelectomy for the management of PE patients will be included. The potential outcome will include intravaginal ejaculation latency time, Chinese index of sexual function for premature ejaculation-5, visual analogue score, premature ejaculation diagnostic tool, success treatment rate, serum testosterone levels. We will conduct this study strictly according to the Cochrane Handbook for systematic reviews of interventions. RESULTS: The current study is a protocol for systematic review and meta-analysis without results, and data analysis will be carried out after the protocol. We will share our findings in the February 28, 2021. CONCLUSION: This systematic review will provide more evidence to assess whether microsurgical varicocelectomy is an effective intervention for patients with PE. The results will be published in a public issue journal and offer the urologists and andrologists help to make clinical decisions. ETHICS AND DISSEMINATION: Formal ethical approval is not required in this protocol. We will collect and analyze data based on published studies, and since there are no patients involved in this study, individual privacy will not be under concerns. The results of this review will be disseminated to peer-reviewed journals or submit to related conferences. PROTOCOL REGISTRATION NUMBER: INPLASY202060058.


Assuntos
Ejaculação Precoce/cirurgia , Procedimentos Cirúrgicos Vasculares , Humanos , Masculino , Metanálise como Assunto , Revisões Sistemáticas como Assunto , Varicocele/cirurgia
8.
Angiol Sosud Khir ; 26(1): 42-46, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32240135

RESUMO

Described in the article is a clinical case report regarding diagnosis and treatment of pelvic varicose veins in a 34-year-old male patient presenting with compressive stenosis of the left common iliac vein (May-Thurner syndrome). The man had developed clinical symptoms of the disease as varicocele when he was 17 years old. Multiple surgical interventions on the veins of the spermatic cord failed to result in significant success. The diagnosis was verified by means of ultrasound examination and contrast X-ray phlebography. The patient was subjected to balloon angioplasty and stenting of the compressive stenosis of the left common iliac vein. The endovascular treatment performed was followed by the patient's improved condition, confirmed by methods of instrumental diagnosis, as well as by regression of clinical symptomatology.


Assuntos
Síndrome de May-Thurner/complicações , Síndrome de May-Thurner/diagnóstico , Síndrome de May-Thurner/cirurgia , Varicocele/diagnóstico , Varicocele/cirurgia , Adolescente , Adulto , Humanos , Veia Ilíaca/diagnóstico por imagem , Masculino , Dor Pélvica/etiologia , Flebografia , Stents , Resultado do Tratamento
9.
Andrologia ; 52(3): e13525, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32022285

RESUMO

The pathophysiology of varicocele remains to be unknown. Several genetic factors have been implicated in varicocele etiopathogenesis. We studied the relationship between NOS3 c.894G>T, c.786T>C and 4b/a polymorphisms to varicocele risk and their prognostic value as regards improvement of the post-operative seminal parameters &/or seminal malonaldehyde levels. The three NOS3 polymorphisms were evaluated in 100 patients with varicocele and 100 healthy subjects by RT-PCR. Seminal plasma MDA level was measured pre-operatively and 3 months after varicocelectomy by the thiobarbituric acid method. The GT, TT, TC and bb genotypes of NOS3 polymorphism were more commonly observed in varicocele patients (30%, 9%, 28% and 70% respectively) compared to normal controls (12%, 0%, 10% and 50% respectively). The mean percentage of post-varicocelectomy seminal MDA reduction was highest with the GT genotype (p < .001). Genotypes GT+TT, TC and bb were associated with varicocele occurrence in our patients. The T (c.894G>T), C (c.786T>C) and b (NOS3 intron 4 VNTR) alleles were significantly associated with varicocele occurrence in our cohort of patients. We also report a better response regarding the reduction of seminal MDA after varicocelectomy with the GT and ba genotypes.


Assuntos
Infertilidade Masculina/prevenção & controle , Óxido Nítrico Sintase Tipo III/genética , Procedimentos Cirúrgicos Urológicos Masculinos , Varicocele/genética , Procedimentos Cirúrgicos Vasculares , Adulto , Estudos de Casos e Controles , Predisposição Genética para Doença , Humanos , Incidência , Infertilidade Masculina/genética , Infertilidade Masculina/patologia , Masculino , Malondialdeído/análise , Malondialdeído/metabolismo , Pessoa de Meia-Idade , Estresse Oxidativo/genética , Polimorfismo de Nucleotídeo Único , Prognóstico , Sêmen/metabolismo , Cordão Espermático/irrigação sanguínea , Cordão Espermático/cirurgia , Resultado do Tratamento , Varicocele/epidemiologia , Varicocele/cirurgia
10.
Andrologia ; 52(3): e13515, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31957921

RESUMO

One of the most important causes of varicocele-related infertility is oxidative stress (OS). One of the markers considered as an indicator of OS is thiol-disulphide homeostasis (TDH). Based on the hypothesis that OS should decrease after varicocelectomy in the light of this information, in our current study, we investigated the relationship between TDH levels and sperm parameters. The data of 56 infertile varicocele men were prospectively analysed. The post-operative total and native thiol levels were significantly higher than those pre-operative total and native thiol levels (477.7 & 436.7 nmol/L, 417.6 & 372.1 nmol/L). Positive correlation was found between total thiol change and change in semen volume (ρ: .277, p: .039), ratio of spermatozoa with normal morphology (ρ: .342, p: .01), progressive (ρ: .334, p: .012) and nonprogressive motility (ρ: .385, p: .003). Positive correlation was also found between native thiol change and semen volume (ρ: .349, p: .008), ratio of spermatozoa with normal morphology (ρ: .362, p: .006), progressive (ρ: .297, p: .026) and nonprogressive motility (ρ: .368, p: .005). Change in the level of TDH was found as positively correlated with progressive and nonprogressive motility change. According to these results, OS decreases with varicocelectomy in infertile patients and TDH can be used as a useful method for measuring OS.


Assuntos
Dissulfetos/análise , Infertilidade Masculina/cirurgia , Compostos de Sulfidrila/análise , Varicocele/cirurgia , Procedimentos Cirúrgicos Vasculares , Adolescente , Adulto , Biomarcadores/análise , Biomarcadores/metabolismo , Dissulfetos/metabolismo , Humanos , Infertilidade Masculina/etiologia , Infertilidade Masculina/patologia , Masculino , Estresse Oxidativo , Período Pós-Operatório , Período Pré-Operatório , Análise do Sêmen , Cordão Espermático/irrigação sanguínea , Cordão Espermático/cirurgia , Espermatozoides/metabolismo , Espermatozoides/patologia , Compostos de Sulfidrila/metabolismo , Resultado do Tratamento , Varicocele/complicações , Varicocele/patologia , Adulto Jovem
11.
Andrologia ; 52(3): e13513, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31989676

RESUMO

Several theories were proposed to explain the pathophysiology of varicocele-related infertility seen in some patients. Our aim was to study the levels of angiotensin II in semen and angiotensin II type 2 receptor expression on spermatozoa in varicocele patients in relation to their fertility status and to evaluate the influence of varicocelectomy on their levels in infertile varicocele patients. Thirty fertile and 30 infertile varicocele patients and 30 healthy controls were subjected to measurement of reproductive hormones, semen analysis, measurement of seminal angiotensin II and evaluation of angiotensin II type 2 receptor expression on spermatozoa. Infertile varicocele patients underwent varicocelectomy and were re-evaluated for the same parameters after the operation. Sperm concentration, morphology, progressive motility, seminal angiotensin II and angiotensin II type 2 receptor expression were significantly lower in infertile varicocele patients compared with the other groups. Post-operative values showed significant increase in the studied parameters compared with the pre-operative values but not to other two groups. A significant positive correlation between angiotensin II type 2 receptor expression and progressive motility was detected in all studied groups. In conclusion, dysregulation of angiotensin II and angiotensin II type 2 receptor in varicocele patients may be involved in varicocele-related infertility.


Assuntos
Angiotensina II/análise , Infertilidade Masculina/patologia , Receptor Tipo 2 de Angiotensina/análise , Varicocele/complicações , Adulto , Angiotensina II/metabolismo , Estudos de Casos e Controles , Humanos , Infertilidade Masculina/etiologia , Masculino , Receptor Tipo 2 de Angiotensina/metabolismo , Sêmen/química , Motilidade Espermática , Espermatozoides/química , Procedimentos Cirúrgicos Urológicos Masculinos , Varicocele/patologia , Varicocele/cirurgia , Procedimentos Cirúrgicos Vasculares
12.
Andrologia ; 52(2): e13500, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31840291

RESUMO

While ligation of clinical varicoceles has been clearly shown to improve semen parameters in subfertile men, evidence describing when to expect improvement and the potential effects on fertility following surgery are sparse. A chart review was undertaken to identify men who had undergone a microscopic subinguinal varicocelectomy from January 1, 2006, to June 30, 2018. Semen analyses were reviewed to determine if a significant improvement occurred post-operatively and when the improvement was seen. Pregnancy data were reviewed to determine if fecundity rates were affected by semen parameter improvement or the interval at which improvement occurred. A total of 170 men met criteria for inclusion, including pregnancy data on 140. 69.4% of patients experienced a significant improvement in total progressive sperm count (TPSC), 78.8% of which occurred after 3 months. The overall pregnancy rate was 40.7%. When comparing men whose TPSC improved to those who did not, there was an odds ratio (OR) of 5.89 (2.28-15.28, 0.0003) for achieving pregnancy, while an OR of 2.05 (0.80-5.28, 0.13) was found when comparing pregnancy rates between early and late improvement in semen parameters. Pregnancy rates were not affected by time to improvement, but were higher in men who had a significant improvement in TPSC after surgery.


Assuntos
Sêmen/fisiologia , Varicocele/cirurgia , Adulto , Fertilidade , Humanos , Masculino , Pessoa de Meia-Idade , Análise do Sêmen , Contagem de Espermatozoides , Cordão Espermático/cirurgia , Fatores de Tempo , Adulto Jovem
13.
Andrologia ; 52(2): e13486, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31825116

RESUMO

The effectiveness of varicocelectomy in nonobstructive azoospermia is controversial. The current study assessed the efficacy of microsurgical subinguinal varicocelectomy in nonobstructive azoospermic men with palpable varicocele and to evaluate predictive parameters of outcome. We reviewed the records of 723 patients who had microsurgical varicocelectomy and diagnostic testicular biopsy between 2012 and 2016 at a tertiary medical centre. Data pertaining to the physical, laboratory (semen analysis and hormonal profile) and histopathology features were examined, exploring the predictors of improvement in semen analysis post-varicocelectomy. In total, 42 patients with mean age 35.71 ± 6.35 years were included. After a mean varicocelectomy follow-up of 6.7 months, motile spermatozoa in the ejaculate could be observed in 11 patients (26.2). Out of all the factors examined, only testicular histopathology significantly predicted post-varicocelectomy outcome, where 8/11 patients exhibited hypospermatogenesis, and 3/11 Sertoli cell-only regained spermatozoa in semen. Microsurgical varicocelectomy in nonobstructive azoospermic men with clinically palpable varicocele can result in sperm appearance in the ejaculate with the highest success expected in hypospermatogenesis.


Assuntos
Azoospermia/cirurgia , Análise do Sêmen , Procedimentos Cirúrgicos Urológicos Masculinos , Varicocele/cirurgia , Adulto , Humanos , Masculino , Estudos Retrospectivos
14.
J Invest Surg ; 33(1): 40-48, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30339469

RESUMO

Background: The goal of this meta-analysis and systematic review is to evaluate the overall effect and safety of microsurgery versus laparoscopic surgery in the treatment of varicocele according to qualified randomized controlled trials (RCTs). Methods: The following electronic databases were searched including PubMed, Cochrane, Embase to identify the qualified studies and publications that were associated with this meta-analysis updated to February 2018 based on index words. The qualified studies only included RCTs. We analyzed the main outcomes through mean difference (MD) and relative risk (RR) along with 95% confidence interval (95% CI). Results: Totally, the current meta-analysis included 23 studies with 1178 patients in the group with microsurgery and 1069 patients in the group with laparoscopic surgery. The results indicated that compared with the laparoscopic surgery group, the microsurgery group could significantly decrease the complication rate (RR: 0.40, 95% CI: 0.21-0.75), as well as the hospital stay (WMD: -0.53, 95% CI: -0.85 to -0.21), increase the sperm concentration after the surgery (WMD: 3.00, 95% CI: 1.23-4.76), and decrease the recurrence rate (RR: 0.35, 95% CI: 0.22-0.55). Besides, there was no significant difference of operation time (SMD: 1.61, 95% CI: 0.71-2.51) and sperm motility (WMD: 2.38, 95% CI: 0.39-4.37) between the two groups. Conclusion: The results demonstrated microsurgery would significantly decrease the complication, hospital stay, and recurrence rate and increase the sperm concentration when compared with laparoscopic surgery. In conclusion, microsurgery is prone to be a better alternative therapy for the treatment of varicocele than laparoscopic surgery.


Assuntos
Infertilidade Masculina/cirurgia , Laparoscopia/efeitos adversos , Microcirurgia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Varicocele/cirurgia , Humanos , Infertilidade Masculina/etiologia , Laparoscopia/métodos , Tempo de Internação , Masculino , Microcirurgia/métodos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Contagem de Espermatozoides , Motilidade Espermática , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Varicocele/complicações
16.
Altern Ther Health Med ; 26(3): 24-31, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31221940

RESUMO

Context: Not all men presenting varicocele-associated infertility exhibit improved sperm quality or achieve pregnancy following varicocelectomy. Some combinations of specific natural herbs have been shown empirically to reduce oxidative stress and improve sperm quality. Objective: We conducted a study to determine the effects of an herbal combination on sperm quality in varicocele-induced rats following varicocelectomy, hoping to find a new treatment approach to restore sperm quality following varicocelectomy. Design: The research team designed an animal study. Setting: The study took place in the Department of Urology at Seoul St. Mary's Hospital (Seoul, Republic of Korea). Animals: Fifty white, male, Sprague-Dawley rats weighing 250 to 300 g each were used in the study. Intervention: The rats were randomly assigned to 5 groups: (1) a control group (n = 10), (2) varicocele group (n = 10), (3) rats with varicocele and receiving varicocelectomy only (varicocelectomy group, n = 10), (4) rats with varicocele received varicocelectomy and oral administration with 200 mg/kg of an herbal combination for 4 wk (varicocelectomy + 200 mg/kg group, n = 10), and (5) rats with varicocele received varicocelectomy and oral administration with 400 mg/kg of an herbal com for 4 wk (varicocelectomy + 400 mg/kg group, n = 10). Outcome Measures: The study measured (1) sperm concentration and motility, (2) levels of reactive oxygen species (ROS), (3) concentrations of interleukin 6, interleukin 1ß, and tumor necrosis factor alpha (TNF-α), (4) apoptotic change, and (5) levels of heat shock protein (HSP). Results: The sperm concentrations and motilities recovered after treatment in the varicocelectomy, varicocelectomy + 200 mg/kg, and varicocelectomy + 400 mg/kg groups. Significantly increased SOD and decreased ROS and cytokine levels were also observed. The apoptosis in the testes also was significantly decreased compared with the varicocele group. HSP70 in groups received varicocelectomy and administered with herbal combination was significantly decreased compared with the varicocelectomy group. Conclusions: The herbal combination was found to improve the sperm qualities, oxidative stress, and inflammation after varicocelectomy. Therefore, the herbal combination may provide a new and additional treatment for varicocele-associated infertility. For clinical application, further studies are needed to identify active ingredients in each herb and the mechanism by which each ingredient works, to standardize the herbal combination.


Assuntos
Medicina Herbária , Infertilidade Masculina/cirurgia , Espermatozoides/fisiologia , Varicocele/cirurgia , Animais , Feminino , Humanos , Infertilidade Masculina/etiologia , Masculino , Estresse Oxidativo , Gravidez , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Contagem de Espermatozoides , Resultado do Tratamento
17.
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
18.
Andrologia ; 52(1): e13456, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31696601

RESUMO

This work assessed seminal SIRT1-oxidative stress (OS) relationship in infertile oligoasthenoteratozoospermic (OAT) men after varicocele repair. Overall, thirty OAT men with varicocele were investigated. Inclusion criteria were infertile males (males who were unable to initiate a pregnancy within 1 year of regular unprotected intercourse), confirmed OAT and normal female factor. These cases were subjected to history taking, clinical checkup and semen analysis. In their semen, seminal SIRT1, malondialdehyde (MDA) and glutathione peroxidase (GPx) levels were assessed. These men were subjected to varicocele surgical repair and were followed up for 3 months. Post-operatively, the mean seminal SIRT1, GPx levels showed significant increases and the mean MDA level showed significant decrease compared to the pre-operative levels linked to improved sperm parameters. The mean seminal SIRT1, GPx, MDA levels showed more significant improvement in grade III varicocele cases compared to grade II cases after surgical repair. Seminal SIRT1 levels showed significant positive correlations with sperm concentration, sperm motility, sperm normal morphology, seminal GPx levels and a significant negative correlation with seminal MDA levels. It could be concluded that seminal SIRT1 is significantly decreased in infertile OAT men with varicocele after its surgical repair linked to improved sperm parameters as well as seminal OS.


Assuntos
Oligospermia/cirurgia , Sêmen/metabolismo , Sirtuína 1/metabolismo , Procedimentos Cirúrgicos Urológicos Masculinos , Varicocele/cirurgia , Adulto , Estudos de Casos e Controles , Humanos , Masculino , Oligospermia/etiologia , Oligospermia/patologia , Estresse Oxidativo , Análise do Sêmen , Resultado do Tratamento , Varicocele/complicações
19.
Andrologia ; 51(11): e13462, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31646672

RESUMO

To investigate whether bilateral surgery can bring more benefits to infertile patients with bilateral varicocele than unilateral surgery. A search of PubMed, Web of Science, EMBASE and the Cochrane Library on 13 January 2019 was conducted to identify studies published in English that used varicocelectomy. The protocol of the present meta-analysis was pre-published on PROSPERO (registration number CRD42019093894). Primary outcomes were spontaneous pregnancy rates. A total of eleven articles were finally enrolled in, with a total of 1,743 patients. Spontaneous pregnancy rate was higher in patient with bilateral varicocelectomy than unilateral varicocelectomy with an odds ratio (OR) of 1.89 (95% CI 1.52-2.35; I2  = 0%; p < .00001). The results indicated bilateral is superior than unilateral varicocelectomy concerning sperm concentration (SMD: 2.88 × 106 /ml; 95% CI: 1.06, 4.70; I2  = 93%), sperm motility (SMD: 5.08; 95% CI: 2.65, 7.50; I2  = 0%), progression of sperm motility (SMD: 6.48; 95% CI: 5.16, 7.81; I2  = 0%) and sperm morphology (SMD: 2.38%; 95% CI: 0.72, 4.03; I2  = 94%) between bilateral and unilateral varicocelectomy. Bilateral varicocelectomy may be superior to unilateral in regard to spontaneous pregnancy rate and sperm motility for infertile male with bilateral varicocele (both left clinical and right subclinical varicocele and bilateral clinical varicocele).


Assuntos
Procedimentos Cirúrgicos Urológicos Masculinos/estatística & dados numéricos , Varicocele/cirurgia , Feminino , Humanos , Masculino , Gravidez , Taxa de Gravidez , Contagem de Espermatozoides , Motilidade Espermática , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
20.
J Pak Med Assoc ; 69(Suppl 3)(8): S73-S77, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31603882

RESUMO

Objective: To compare the post-operative outcomes of open inguinal versus laparoscopic varicocelectomy. Methods: The comparative prospective study was conducted from January 2016 to January 2018 at the Al-Yarmouk Teaching Hospital and a private hospital in Baghdad, Iraq, and comprised patients diagnosed with varicocele. Group A patients underwent laparoscopic varicocelectomy and Group B patients were treated with open inguinal varicocelectomy. All patients were followed up for a minimum of six months and parameters compared included operative time, post-operative need for analgesia, hospital stay, post-operative changes in seminal fluid parameters, complications of surgery, recurrence rate and patient satisfaction. SPSS 25 was used for data analysis. Results: Of the 60 patients, 20(33.3%) were in Group A and 40(66.6%) in Group B. Operative time was shorter in Group B (p=0.066), but it was shorter in Group A in cases of bilateral varicocele (p=0.005).Mean duration of analgesia need was significantly lower in Group A compared to Group B (p= 0.001). Significant post-operative improvement in sperm count and motility was detected in both groups (p<0.05). Conclusions: Both techniques were found to be effective in treating varicocele with a reasonable safety profile.


Assuntos
Laparoscopia , Varicocele/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Humanos , Infertilidade Masculina/etiologia , Iraque , Laparoscopia/efeitos adversos , Masculino , Duração da Cirurgia , Satisfação do Paciente , Complicações Pós-Operatórias , Estudos Prospectivos , Análise do Sêmen , Resultado do Tratamento , Varicocele/complicações , Procedimentos Cirúrgicos Vasculares/efeitos adversos
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