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1.
J Urol ; 205(1): 44-51, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33295258

RESUMO

PURPOSE: The summary presented herein represents Part II of the two-part series dedicated to the Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline. Part II outlines the appropriate management of the male in an infertile couple. Medical therapies, surgical techniques, as well as use of intrauterine insemination (IUI)/in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) are covered to allow for optimal patient management. Please refer to Part I for discussion on evaluation of the infertile male and discussion of relevant health conditions that are associated with male infertility. MATERIALS/METHODS: The Emergency Care Research Institute Evidence-based Practice Center team searched PubMed®, Embase®, and Medline from January 2000 through May 2019. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions (table[Table: see text]). This summary is being simultaneously published in Fertility and Sterility and The Journal of Urology. RESULTS: This Guideline provides updated, evidence-based recommendations regarding management of male infertility. Such recommendations are summarized in the associated algorithm (figure[Figure: see text]). CONCLUSION: Male contributions to infertility are prevalent, and specific treatment as well as assisted reproductive techniques are effective at managing male infertility. This document will undergo additional literature reviews and updating as the knowledge regarding current treatments and future treatment options continues to expand.


Assuntos
Infertilidade Masculina/terapia , Medicina Reprodutiva/normas , Urologia/normas , Varicocele/terapia , Aconselhamento/normas , Suplementos Nutricionais , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Fertilização In Vitro/métodos , Fertilização In Vitro/normas , Humanos , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/etiologia , Masculino , Medicina Reprodutiva/métodos , Escroto/diagnóstico por imagem , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Análise do Sêmen , Sociedades Médicas/normas , Recuperação Espermática/normas , Resultado do Tratamento , Estados Unidos , Urologia/métodos , Varicocele/complicações , Varicocele/diagnóstico
2.
Zhonghua Nan Ke Xue ; 26(4): 341-345, 2020 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-33351302

RESUMO

Objective: To observe the clinical effect of Yishen Tongluo Recipe (YTR) combined with minimally invasive surgery (MIS) in the treatment of varicocele-associated asthenospermia (of the kidney-deficiency and collateral-obstruction type). METHODS: We randomly divided 116 patients with varicocele-associated asthenospermia and up to the inclusion criteria into three groups and treated them by YTR combined with MIS (low spermatic vein ligation at the external inguinal ring orifice under the microscope) (the YTR+MIS group, n = 39), YTR alone (the YTR group, n = 38), or MIS alone (the MIS group, n = 39). At 12 weeks after treatment, we compared the total effectiveness rate, the percentage of progressively motile sperm (PMS), sperm straight line velocity (VSL), sperm DNA fragmentation index (DFI) and symptoms among the three groups of patients. RESULTS: After treatment, the total effectiveness rate was significantly higher in the YTR+MIS than in the YTR and the MIS group (89.74% vs 63.16% and 64.10%, P < 0.05), and so were the percentage of PMS (31.67 ± 3.93 vs 24.48 ± 3.15 and 25.57 ± 3.37, P < 0.05) and VSL (ï¼»30.19 ± 5.32ï¼½ vs ï¼»27.19 ± 5.48ï¼½ and ï¼»27.55 ± 5.24ï¼½ µm/s, P < 0.05), but the DFI was remarkably lower in the former than in the latter two groups (11.25 ± 8.27 vs 15.87 ± 5.45 and 15.26 ± 4.36, P < 0.05). The symptoms were improved more significantly in the YTR+MIS than in the YTR and MIS groups (P < 0.05). CONCLUSIONS: Yishen Tongluo Recipe combined with minimally invasive surgery, as an effective and safe strategy, can significantly improve sperm quality and sperm DNA integrity in patients with varicocele-associated asthenospermia.


Assuntos
Astenozoospermia/terapia , Medicamentos de Ervas Chinesas , Procedimentos Cirúrgicos Minimamente Invasivos , Varicocele , Astenozoospermia/etiologia , Medicamentos de Ervas Chinesas/uso terapêutico , Humanos , Masculino , Varicocele/complicações
3.
Zhonghua Nan Ke Xue ; 26(10): 922-925, 2020 Nov.
Artigo em Chinês | MEDLINE | ID: mdl-33382225

RESUMO

Objective: To explore the distribution of Traditional Chinese Medicine (TCM) syndrome types and their relationship with semen parameters in infertility male patients with varicocele (VC). METHODS: Using Questionnaire on Clinical Symptoms of Varicocele-Caused Male Infertility, we made an investigation among 147 infertility male patients with VC, determined the types of their TCM syndromes, obtained their semen parameters, and analyzed the distribution of the TCM syndrome types and their correlation with semen parameters. RESULTS: Of the TCM syndrome types identified, kidney deficiency and stagnated heat constituted the largest proportion (34.7%), and the mixed type accounted for a significantly higher percentage than the simple type (P < 0.05). The patients with kidney deficiency and stagnated heat, compared with those with other syndrome types, had a dramatically lower sperm concentration (ï¼»21.62 ± 9.25ï¼½ vs ï¼»28.88 ± 12.92ï¼½ ×106/ml, P < 0.01), but a higher percentage of morphologically abnormal sperm (ï¼»98.33 ± 0.15ï¼½% vs ï¼»96.27 ± 0.18ï¼½%, P < 0.05) and DNA fragmentation index (ï¼»19.72 ± 3.17ï¼½% vs ï¼»10.96 ± 3.82ï¼½%, P < 0.01). No statistically significant differences were observed in the percentage of progressively motile sperm among different TCM syndrome types. CONCLUSIONS: Kidney deficiency and stagnated heat is a main TCM syndrome type in infertility male patients with varicocele and correlated with sperm concentration, the percentage of morphologically abnormal sperm and DNA fragmentation index.


Assuntos
Infertilidade Masculina , Medicina Tradicional Chinesa , Varicocele , Fragmentação do DNA , Humanos , Infertilidade Masculina/complicações , Infertilidade Masculina/diagnóstico , Masculino , Sêmen , Análise do Sêmen , Contagem de Espermatozoides , Motilidade Espermática , Espermatozoides , Síndrome , Varicocele/complicações , Varicocele/diagnóstico
4.
Zhonghua Nan Ke Xue ; 26(6): 547-552, 2020 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-33356045

RESUMO

Objective: To investigate the effect of varicocelectomy (VCE) combined with medication of Qilin Pills (QLP) in the treatment of varicocele (VC)-associated male infertility. METHODS: We retrospectively analyzed the clinical data on 180 cases of VC-associated male infertility treated in our hospitals between October 2017 and March 2019, 67 by VCE ( the control group) and 113 by VCE in combination with 6-month medication of QLP after operation (the VCE+QLP group). We obtained the semen parameters from the patients before and at 1, 2, 3 and 6 months after surgery, measured their sperm DNA fragmentation index (DFI) before and at 6 months after operation, and recorded the rate of pregnancy at months postoperatively. RESULTS: There were no severe complications in any of the cases after surgery or during the whole course of medication. Compared with the baseline, the patients in control group showed significant increases at 6 months postoperatively in sperm concentration (ï¼»17.1 ± 12.4ï¼½ vs ï¼»29.5 ± 14.4ï¼½ ×106/ml, P < 0.01), sperm motility (ï¼»33.6±13.5ï¼½% vs ï¼»54.5±12.0ï¼½% , P <) and the percentage of progressively motile sperm (PMS) (ï¼»22.8 ± 10.9ï¼½% vs ï¼»43.7 ± 11.7ï¼½%, P <) but a remarkable decrease in sperm DFI (16.5 ± 7.6ï¼½% vs ï¼»13.3 ± 4.4ï¼½% , P <), and so did those in the VCE+QLP group in sperm concentration (ï¼»16.8 ± 10.7ï¼½ vs ï¼»38.9 ± 24.1)×106/ml, P < 0.01), sperm motility (ï¼»32.8 ± 14.0ï¼½% vs ï¼»50.1 ± 15.0)%, P <), PMS (ï¼»21.8 ± 11.3ï¼½% vs ï¼»39.6 ± 13.3ï¼½% , P <) and sperm DFI (ï¼»17.8 ± 9.0ï¼½% vs ï¼»11.8 ± 4.8ï¼½%, P <). There were even more statistically significant differences between the control and VCE+QLP groups at 6 months in the above semen parameters (P < 0.01) and in the rate of natural pregnancy (32.8% ï¼»22/67ï¼½ vs 48.7% ï¼»55/113ï¼½, P < 0.05). CONCLUSIONS: Varicocelectomy combined with medication of Qilin Pills can effectively improve semen quality and increase the rate of natural pregnancy in the treatment of VC-associated male infertility.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Infertilidade Masculina , Varicocele , Feminino , Humanos , Infertilidade Masculina/tratamento farmacológico , Infertilidade Masculina/etiologia , Masculino , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Análise do Sêmen , Contagem de Espermatozoides , Motilidade Espermática , Espermatozoides , Varicocele/complicações , Varicocele/cirurgia
5.
PLoS One ; 15(4): e0232357, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32353040

RESUMO

One of the main molecular causes that contributes to varicocele-related male infertility is excess production of reactive oxygen species (ROS). It is believed that hypoxia is an important stimulator of ROS in this condition. Recently, the significant roles of long non-coding RNAs (lncRNAs) in hypoxia response have emerged. Despite the investigation of hypoxia, there is scant information about the role of hypoxia-responding lncRNAs in varicocele-related male infertility. In the present study, we deduced eight hypoxia-responding lncRNAs based on high-throughput RNA sequencing data from two Gene Expression Omnibus (GEO) datasets. We used qRT-PCR to assess the expression levels of some of these lncRNAs in 42 ejaculated spermatozoa samples from 25 infertile men with varicocele and 17 fertile men as controls. We identified significant increases in expression levels of hypoxia-related lncRNAs, MIR210HG and MLLT4-AS1 in ejaculated spermatozoa of infertile men with varicocele. These lncRNAs also showed significant positive correlations with ROS levels and meaningful negative correlations with sperm parameters (count and motility). Besides, in silico studies identified several hypoxia response elements (HREs) within selected lncRNAs promoters. Delineation of hypoxia-related lncRNAs in varicocele-related infertility provides a valuable insight into male infertility.


Assuntos
Infertilidade Masculina/genética , RNA Longo não Codificante/genética , Varicocele/complicações , Adulto , Hipóxia Celular , Humanos , Infertilidade Masculina/etiologia , Infertilidade Masculina/patologia , Masculino , RNA Longo não Codificante/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Elementos de Resposta , Motilidade Espermática , Espermatozoides/metabolismo , Espermatozoides/fisiologia
6.
Rev. int. androl. (Internet) ; 18(1): 7-13, ene.-mar. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-193832

RESUMO

OBJECTIVES: The aim of this study was to evaluate polymorphisms of sperm protamine genes and their effects on the result of CMA3 staining in varicocele men. MATERIAL AND METHODS: In a case control study, 128 patients with male infertility due to varicocele and 128 controls were recruited. Polymorphisms of PRM1 and PRM2 genes in extracted DNA samples were assessed by PCR-SSCP and sequencing. Protamine deficiency was also indirectly estimated by CMA3 staining. RESULT: Nine different variants including six variants in PRM1 gene and three variants in PRM2 gene were found among varicocele patients. The results showed that sperm count, motility and morphology were significantly different between control group without gene variations and varicocele group who had several variations in their protamine genes (P<0.05). CONCLUSION: Therefore, PRM1 and PRM2 variations in varicocele patients are associated with the production of spermatozoa with more protamine deficiency and this is one of the possible causes of infertility due to varicocele


OBJETIVOS: El objetivo de este estudio fue evaluar los polimorfismos de los genes de la protamina espermática y sus efectos sobre el resultado de la tinción CMA3 en varones con varicocele. MATERIAL Y MÉTODOS: En un estudio de casos y controles, se reclutó a 128 varones con infertilidad por varicocele y 128 controles. Los polimorfismos de los genes PRM1 y PRM2 en muestras de ADN extraídas se evaluaron mediante PCR-SSCP y se realizó su secuenciación. La deficiencia de protamina también se estimó indirectamente mediante tinción CMA3. RESULTADO: Se encontraron 9 variantes diferentes, incluidas 6 variantes en el gen PRM1 y 3 variantes en el gen PRM2 entre los pacientes con varicocele. Los resultados mostraron que el recuento de espermatozoides, la movilidad y la morfología eran considerablemente diferentes entre el grupo de control sin variaciones genéticas y el grupo de varicocele que presentaba algunas variaciones en sus genes de protamina (p < 0,05). CONCLUSIÓN: Por tanto, las variaciones de PRM1 y PRM2 en los pacientes con varicocele están asociadas con la producción de espermatozoides con más deficiencia de protamina y esta es una de las posibles causas de infertilidad debida al varicocele


Assuntos
Humanos , Masculino , Adulto , Varicocele/complicações , Varicocele/genética , Polimorfismo Genético , Infertilidade Masculina/etiologia , Infertilidade Masculina/genética , Protaminas/genética , Estudos de Casos e Controles , Polimorfismo Conformacional de Fita Simples , Coloração e Rotulagem
7.
Andrologia ; 52(3): e13523, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32017167

RESUMO

Spermatozoa are vulnerable to lack of energy and oxidative stress as a result of elevated levels of reactive oxygen species. Therefore, it is essential that appropriate nutrients are available during maturation. This randomised, double-blind, placebo-controlled trial investigated the effect of 6-month supplementation with carnitines and other micronutrients on sperm quality in 104 subjects with oligo- and/or astheno- and/or teratozoospermia with or without varicocele. Semen analyses were done at the beginning and end of the treatment. In addition to main analyses, post hoc analyses for age and body mass index (BMI) were carried out. Results were interpreted by dividing the population into two age and BMI classes. In 94 patients who completed the study, all sperm parameters increased in supplemented patients compared to the placebo group. A significant (p = .0272) difference in supplementation efficacy was observed for total motility on patients with varicocele and BMI < 25. In the same group, also the progressive motility was significantly superior (p = .0159). For Responder analysis, total motility results were confirmed in both the cited group (p = .0066) and in the varicocele group with BMI < 25 and age < 35 (p = .0078). This study suggests that supplementation is more effective in subjects with varicocele younger than 35 years with BMI < 25.


Assuntos
Antioxidantes/administração & dosagem , Índice de Massa Corporal , Suplementos Nutricionais , Infertilidade Masculina/dietoterapia , Micronutrientes/administração & dosagem , Varicocele/dietoterapia , Adolescente , Adulto , Fatores Etários , Método Duplo-Cego , Humanos , Infertilidade Masculina/etiologia , Infertilidade Masculina/patologia , Masculino , Pessoa de Meia-Idade , Estresse Oxidativo/efeitos dos fármacos , Placebos/administração & dosagem , Espécies Reativas de Oxigênio/metabolismo , Contagem de Espermatozoides , Motilidade Espermática/efeitos dos fármacos , Motilidade Espermática/fisiologia , Resultado do Tratamento , Varicocele/complicações , Varicocele/patologia , Adulto Jovem
8.
Urologe A ; 59(3): 284-288, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32047954

RESUMO

The prevalence of varicocele in children is less than 1% and in 11- to 19-year-old boys 8-14%. Up to 15% of patients with varicocele have impaired fertility. The indication for therapy of varicocele is still controversially discussed. In clinical trials testicular volume, volume difference, semen quality, fertility, hormones and pain have been investigated. The results are very heterogeneous for all parameters, so that the evidence level of recommendations for therapy of varicocele is very low. Nevertheless, the EAU guidelines recommend therapy of varicocele in children and young adults in case of small testis (volume difference >2 ml or 20%), additional cryptorchism, bilateral palpable varicoceles, symptomatic varicoceles and in case of pathological semen (in older boys). Microsurgical inguinal and laparoscopic procedures with preservation of lymph vessels have the best success and lowest complication rates.


Assuntos
Infertilidade Masculina/etiologia , Microcirurgia/métodos , Testículo/patologia , Varicocele/complicações , Varicocele/terapia , Adolescente , Adulto , Idoso , Criança , Criptorquidismo , Fertilidade , Humanos , Laparoscopia , Masculino , Análise do Sêmen , Resultado do Tratamento , Varicocele/diagnóstico , Adulto Jovem
9.
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
10.
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
11.
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
12.
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
13.
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
15.
Eur Radiol ; 30(1): 11-25, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31332561

RESUMO

Varicoceles are relatively common particularly in asymptomatic men and are even more prevalent in subfertile men, representing the most common potentially correctable cause of male infertility. Ultrasound (US) is the imaging modality of choice for varicocele evaluation, but there is no widely accepted consensus on examination technique, diagnostic criteria, or classification. In view of this uncertainty, the guideline writing group (WG) of the European Society of Urogenital Radiology (ESUR) Scrotal and Penile Imaging Working Group (ESUR-SPIWG) undertook a literature review and assessment of the quality of relevant evidence. The group then produced evidence-based recommendations for varicocele US examination, interpretation, and classification by consensus agreement. The results are presented in the form of 15 clinical questions with a brief summary of the relevant evidence and the authorised recommendations from the SPIWG. This paper provides a short summary of the evidence evaluation and the complete recommendations.Key Points• Varicocele is a common clinical problem; it is highly prevalent amongst subfertile men and the most common potentially correctable cause of male infertility. • Ultrasound is the imaging modality of choice for varicocele assessment, but there is no generally agreed consensus on the US examination technique or the criteria that should be used for diagnosis, grading, and classification. • This paper summarises the recommendations of the ESUR-SPIWG for standardising the US assessment of varicoceles. This includes examination technique, image interpretation, classification, and reporting.


Assuntos
Infertilidade Masculina/diagnóstico por imagem , Escroto/diagnóstico por imagem , Varicocele/diagnóstico por imagem , Consenso , Medicina Baseada em Evidências , Humanos , Infertilidade Masculina/etiologia , Masculino , Pênis/diagnóstico por imagem , Espermatogênese/fisiologia , Ultrassonografia , Varicocele/complicações
16.
Urologiia ; (5): 94-97, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808639

RESUMO

INTRODUCTION: Feasibility of prophylactic varicocelectomy in adolescents is under discussion, which determines the importance of studying the frequency of paternity among men who were actively monitored. AIM: to evaluate a paternity rate in a group of adult men who have not undergone varicocelectomy in childhood or adolescence. MATERIALS AND METHODS: The paternity rate was evaluated using a questionnaire-based survey carried out in 2018 among men who were actively monitored for unilateral varicocele with ipsilateral testicular hypotrophy during adolescence in 1999-2004. A total of 202 questionnaires were sent out checking whether the recipients were willing to have children. Median age at the time of the varicocele diagnosis was 15 years [Q1; Q3] (13-17). At the time of diagnosis, varicocele of grade III was found in 114 (93.4%) boys, and in 8 (6.6%) children, varicocele of grade II was seen. RESULTS: A total of 142 respondents were enrolled. Median age of the participants was 31 (29; 34). 20 men were excluded from the survey, due to prophylactic varicocelectomy (n=8, 5.6%), other reproductive diseases (n=4, 2.8%), previous radiotherapy or chemotherapy (n=2, 1.4%) and reproductive pathologies in the spouses (n=6, 4.2%). 16 (13.1%) participants were not planning to have children. Among the remaining, 9 respondents (6.6%) had no children. Varicocelectomy was carried out in 17 (16.3%) patients due to infertility, and 14 (82.3%) subsequently became fathers. 83 (78.3%) patients had one or more children as a result of spontaneous pregnancy. Paternity frequency in the surveyed group was 91.5%. CONCLUSION: Our results demonstrate high paternity frequency among men with asymptomatic left-sided varicocele accompanied by ipsilateral testicular hypotrophy during childhood and adolescence who were actively monitored without surgical treatment.


Assuntos
Infertilidade Masculina/etiologia , Paternidade , Testículo/patologia , Varicocele/complicações , Adulto , Feminino , Humanos , Masculino , Gravidez , Varicocele/patologia
17.
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
18.
Andrologia ; 51(10): e13396, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31423629

RESUMO

Antioxidants were proved to be efficient to improve the quality of spermatozoa after varicocelectomy. We carried out a systematic review and performed a meta-analysis to evaluate the efficacy of antioxidant therapy in sperm parameters' quality after varicocelectomy during 3 or 6 months' treatment cycle. During research, randomised controlled trials were searched by MEDLINE, EMBASE and the Cochrane Controlled Trials Register, and necessary parameters were compared between two groups after varicocelectomy. Finally, six studies including 576 patients were included in our meta-analysis. As for sperm parameters, significant improvements of sperm concentration (p < .0001), sperm motility (p = .03), progressive sperm motility (p < .00001) and sperm morphology (p < .00001) were existed in antioxidant group 3 months after varicocelectomy. With regard to the 6 months' outcomes, sperm parameters were improved as well except sperm motility (p = .72) and progressive sperm motility (p = .57). Referring to pregnancy rate, no significant difference was existed between two groups (p = .36), and the FSH level of antioxidant group was lower than placebo group 3 or 6 months after varicocelectomy (3 months, p = .02; 6 months, p = .03). In conclusion, compared with the placebo, the antioxidant therapy after varicocelectomy can improve the quality of sperm parameters and construct a favourable living condition for spermatozoa by reducing FSH level.


Assuntos
Antioxidantes/administração & dosagem , Infertilidade Masculina/prevenção & controle , Espermatozoides/efeitos dos fármacos , Varicocele/cirurgia , Procedimentos Cirúrgicos Vasculares , Feminino , Humanos , Infertilidade Masculina/etiologia , Masculino , Gravidez , Taxa de Gravidez , Contagem de Espermatozoides , Motilidade Espermática/efeitos dos fármacos , Testículo/irrigação sanguínea , Testículo/cirurgia , Resultado do Tratamento , Varicocele/complicações
19.
Andrologia ; 51(10): e13398, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31468556

RESUMO

Dopamine is an important regulator of male sexual function and behaviour. Decreased levels of this substance have been observed in blood and seminal plasma of infertile men. Hence, this study was carried out to determine the impact of varicocelectomy on 24-hr urine dopamine values in patients with both premature ejaculation (PE) and varicocele. In this prospective study, 55 consecutive patients with premature ejaculation and grade 2 or 3 varicocele were enrolled. The urine dopamine level was measured in a 24-hr sample by HPLC method in a single laboratory centre. Two samples were gathered from each patient, one before and the other 1 month after varicocelectomy. The mean initial and final 24-hr urine dopamine levels were 259.6 ± 86.3 and 602.9 ± 88.4 micrograms, respectively, showing statistically significant increase (p = .0001), while there was no statistically significant difference between urine volume and creatinine. However, the change in intravaginal ejaculation latency time value was not statistically significant at this short time visit. According to our findings, varicocelectomy results in a significant increase in 24-hr urine dopamine levels in patients with premature ejaculation and varicocele. However, the effect of this change on premature ejaculation in the long term has yet to be determined.


Assuntos
Dopamina/urina , Ejaculação/fisiologia , Ejaculação Precoce/urina , Varicocele/cirurgia , Procedimentos Cirúrgicos Vasculares , Adulto , Dopamina/fisiologia , Humanos , Masculino , Ejaculação Precoce/etiologia , Ejaculação Precoce/fisiopatologia , Estudos Prospectivos , Testículo/irrigação sanguínea , Testículo/cirurgia , Fatores de Tempo , Resultado do Tratamento , Varicocele/complicações , Varicocele/fisiopatologia , Adulto Jovem
20.
Arch Ital Urol Androl ; 91(2)2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266282

RESUMO

OBJECTIVE: This exploratory retrospective study aimed to compare the level of Sperm DNA Fragmentation (SDF) and investigate its association with bulk semen parameters, for the first time in Bulgarian patients with varicocele, using a distinct methodology. MATERIAL AND METHODS: Standard semen analysis was performed according to the 2010 criteria of the European Society of Human Reproduction and Embryology - Nordic Association for Andrology (ESHRE-NAFA-2010) and DNA fragmentation was assessed using the Halosperm® kit. The total sample included 28 males: the control group consisted of men with normal genital examination and unknown fertility (n = 10), group one consisted of men with varicocele, normozoospermia and DNA fragmentation > 15% (n = 9) and group two consisted of men with varicocele, abnormal sperm parameters and DNA fragmentation > 15% (n = 9). RESULTS: DNA fragmentation was found to be higher in patients with abnormal sperm parameters (43.78 ± 30.78) compared to the normozoospermic group (21.22 ± 3.93) (p = 0.008). In normozoospermic patients, no statistically significant correlations were observed between SDF and bulk semen parameters. In patients with abnormal sperm parameters, DNA fragmentation exhibited significant very strong negative association with motility (a+b), vitality and typical morphology (p < 0.001). CONCLUSIONS: DNA integrity assays could be used for a better evaluation and management of male infertility, particularly in normozoospermic varicocele patients.


Assuntos
Fragmentação do DNA , Sêmen/metabolismo , Espermatozoides/metabolismo , Varicocele/complicações , Adulto , Bulgária , Humanos , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/etiologia , Masculino , Estudos Retrospectivos , Análise do Sêmen , Motilidade Espermática , Espermatozoides/patologia , Adulto Jovem
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