Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.264
Filtrar
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.
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
3.
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
4.
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
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.
Andrologia ; 51(7): e13286, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30983022

RESUMO

Varicocele is a rather common andrological condition in adolescents, which can adversely affect testicular growth and seminal parameters, leading to infertility in about 20% of adults. The aim of this study was to investigate if treating varicocele before the age of 18 is a beneficial option to improve testicular hypotrophy and seminal parameters and if minimally invasive techniques could be an appropriate treatment choice for adolescent varicocele associated with spermatic vein reflux. A percutaneous scleroembolization was performed in sixty-four consecutive young patients (13-19 years old) with left varicocele, preceded by a fluoroscopy. In thirty-four of them, semen samples were also collected. We examined semen samples and testicles dimensions before and after percutaneous varicocelectomy, compared to a nonoperated control group, with a six-month follow-up. Total sperm count and sperm morphology were significantly increased in the intervention group. Left testicular volume significantly increased in both groups, while only correction of varicocele improved spermatozoa release per unit of testis volume. We conclude that early varicocelectomy by percutaneous scleroembolization significantly ameliorates seminiferous tubules activity in the critical adolescent phase of testicular growth. It is suggested that adolescents should be; offered varicocele repair as soon as possible in order to improve reproductive potential.


Assuntos
Embolização Terapêutica/métodos , Escleroterapia/métodos , Túbulos Seminíferos/metabolismo , Espermatozoides/metabolismo , Varicocele/terapia , Adolescente , Humanos , Infertilidade Masculina/etiologia , Infertilidade Masculina/prevenção & controle , Masculino , Túbulos Seminíferos/citologia , Contagem de Espermatozoides , Fatores de Tempo , Tempo para o Tratamento , Resultado do Tratamento , Varicocele/complicações , Adulto Jovem
7.
Urology ; 129: 71-73, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30922974

RESUMO

Varicocele is a common cause of impaired semen parameters in men with infertility. Here, we investigated genetic variants as possible causes of varicocele with impaired semen parameters using whole exome sequencing in a family with 2 brothers with severe oligospermia, 1 unaffected brother, father, and the mother. Results showed a premature stop codon alteration on Chromosome X (37028866 CT) in the gene FAM47C. The affected brothers were found to be hemizygous for the variant, while the mother was a heterozygous carrier. In conclusion, identifying men with varicocele that would have impaired spermatogenesis, using approaches like whole-exome sequencing, can be paradigm shifting.


Assuntos
Códon sem Sentido/genética , Mutação , Oligospermia/genética , Sequenciamento Completo do Exoma , Adolescente , Adulto , Humanos , Masculino , Oligospermia/complicações , Linhagem , Índice de Gravidade de Doença , Varicocele/complicações , Varicocele/genética
8.
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
9.
Andrologia ; 51(5): e13258, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30809834

RESUMO

Seminal oxidative stress (OS) is a major cause of male factor infertility and can be measured as oxidation-reduction potential (ORP). Studies showed significant negative relationships of ORP with sperm count, motility or DNA integrity. Since these parameters are also positively or negatively associated with reproductive hormones follicle-stimulating hormone (FSH), luteinising hormone (LH), testosterone, testicular volume and the occurrence of varicocele, it is important to understand the mechanistic relationship between ORP and hormonal and/or testicular parameters. Therefore, we studied the relationship between ORP levels, standard hormone profiles and testicular volume in infertile men with and without varicocele. Results show a highly significant negative relationship of ORP with testicular volume and significantly positive correlations with FSH and LH. Yet, when adding varicocele as covariate, the relationship with FSH/LH became nonsignificant. Contrary, the presence of varicocele had only a contributing influence on the association of ORP with the testis volume. No association was found with estradiol. We propose that since OS causes degeneration of Sertoli cell with testicular shrinkage, such negative effect would result in a negative feedback on the hypothalamus with less inhibin secretion. This may result in increased secretion of LH and FSH. Thus, systemic and/or local OS may be responsible for smaller testis volumes.


Assuntos
Infertilidade Masculina/diagnóstico , Estresse Oxidativo/fisiologia , Testículo/patologia , Varicocele/patologia , Adulto , Idoso , Estradiol/sangue , Hormônio Foliculoestimulante/sangue , Hormônio Foliculoestimulante/metabolismo , Humanos , Hipotálamo/fisiologia , Infertilidade Masculina/sangue , Infertilidade Masculina/etiologia , Infertilidade Masculina/patologia , Inibinas/metabolismo , Hormônio Luteinizante/sangue , Hormônio Luteinizante/metabolismo , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Oxirredução , Estudos Retrospectivos , Sêmen , Contagem de Espermatozoides , Testosterona/sangue , Testosterona/metabolismo , Varicocele/complicações , Adulto Jovem
10.
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
11.
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
12.
Andrologia ; 51(2): e13189, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30474123

RESUMO

This study aimed to compare main molecular markers of hypoxia (HIF1-α and P53) and inflammation (TLR-2, TLR-4 and TNF-α) pathways between infertile men with varicocele and fertile individuals. Sperm parameters such as sperm concentration, motility and morphology were assessed according to World Health Organization (Laboratory manual for the examination and processing of human semen. Geneva, Switzerland, 2010) guideline in 20 infertile men with grade II or III varicocele, and 20 fertile men candidate of family balancing. In addition, sperm DNA fragmentation and molecular markers involved in hypoxia and inflammation pathways were evaluated by terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) assay and real-time PCR respectively. Mean of sperm parameters (concentration, motility and morphology) and DNA integrity were significantly lower in infertile men with varicocele compared to fertile individuals. Unlike markers involved in inflammation pathway, mean expression of markers of hypoxia pathway (HIF1-α and P53) was significantly higher in infertile men with varicocele compared to fertile individuals (p < 0.05), and also a significant correlation was observed between expression of HIF1-α and P53 (r = 0.461; p = 0.003). Overall, the result of this study suggests higher likelihood of involvement of hypoxia pathway, in comparison with inflammation pathway, in pathogenesis varicocele associated with male infertility.


Assuntos
Hipóxia/metabolismo , Infertilidade Masculina/etiologia , Inflamação/metabolismo , Espermatozoides/metabolismo , Varicocele/complicações , Apoptose/fisiologia , Biomarcadores/metabolismo , Forma Celular/fisiologia , Fragmentação do DNA , Humanos , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Infertilidade Masculina/metabolismo , Masculino , Análise do Sêmen , Contagem de Espermatozoides , Motilidade Espermática/fisiologia , Espermatozoides/citologia , Receptor 2 Toll-Like/metabolismo , Receptor 4 Toll-Like/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Varicocele/metabolismo
13.
Andrologia ; 51(2): e13184, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30370543

RESUMO

The aim of this study was to investigate the effect of varicocele on DNA fragmentation index (DFI), zinc concentration and seminal parameters in infertile patients. In this prospective study, 179 men with at least 1-year history of infertility and varicocele were examined for semen quality at Hanoi Medical University Hospital (HMUH), Hanoi, Vietnam. In addition, an inverse correlation between zinc concentration and the degree of sperm DNA fragmentation in patients with clinical varicocele was found. The difference in mean values of sperm DNA fragmentation index in patients with various grades of varicoceles can be neglected, whereas most patients with varicocele of grades II and III had DFI >30%. Varicocele is associated with high levels of DNA damage in spermatozoa and reduced zinc levels that correlate with different grades of disease. Therefore, DNA fragmentation index and zinc concentration can be used as essential additional diagnostic test for patients with clinical varicocele. A study should be conducted to evaluate the benefits of zinc supplementation to improve seminal parameters in patients with varicocele.


Assuntos
Fragmentação do DNA , Infertilidade Masculina/metabolismo , Sêmen/metabolismo , Espermatozoides , Varicocele/metabolismo , Zinco/metabolismo , Adulto , Humanos , Infertilidade Masculina/etiologia , Infertilidade Masculina/genética , Masculino , Análise do Sêmen , Contagem de Espermatozoides , Motilidade Espermática/genética , Varicocele/complicações , Varicocele/genética
14.
Andrologia ; 51(2): e13187, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30357879

RESUMO

We investigated the clinical characteristics of patients with varicocele according to the presence or absence of scrotal pain. We retrospectively reviewed the records of patients who underwent varicocelectomy. The age, body mass index, grade, laterality of varicocele, testicular volume difference, time to hospital visit, serum testosterone level and semen parameters were evaluated. A total of 954 patients were included. The painful group had lower mean age, lower BMI, higher grade of varicocele, smaller testicular volume difference and shorter time to hospital visit than the painless group. In addition, the median serum total testosterone level and total sperm count, concentration and motility were higher in the painful group than in the painless group. In multivariate analysis, there were significant differences between the two groups in age, grade of varicocele, testis volume difference, time to hospital visit, total sperm count and concentration. Patients with painful varicocele visited hospital earlier because of the pain and tended to start treatment sooner. They were also younger, had smaller testis atrophy and had higher sperm concentration, even though they had a higher grade of varicocele than patients without pain. Although scrotal pain in varicocele patients is difficult to treat, it leads to early diagnosis and treatment.


Assuntos
Dor Pélvica/diagnóstico , Motilidade Espermática/fisiologia , Testosterona/sangue , Varicocele/complicações , Adolescente , Adulto , Índice de Massa Corporal , Humanos , Masculino , Medição da Dor , Dor Pélvica/sangue , Dor Pélvica/etiologia , Estudos Retrospectivos , Análise do Sêmen , Contagem de Espermatozoides , Avaliação de Sintomas , Varicocele/sangue , Adulto Jovem
15.
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
16.
Andrologia ; 51(2): e13185, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30375021

RESUMO

PURPOSE: This study sought to evaluate the impact of varicocele repair on intracytoplasmic sperm injection outcomes. PATIENTS AND METHODS: A prospective comparative study was conducted at the Assisted Reproduction Unit, International Islamic Center for Population Studies and Researches, Al-Azhar University. This study included 100 non-azoospermic infertile men with a history of varicocele who were scheduled for intracytoplasmic sperm injection, half of them had already undergone prior subinguinal varicocelectomy at least 12 months prior to ICSI without clinically evident recurrence (treated group 1), and the other half has any grade of an unrepaired clinical varicocele (untreated group 2) at sperm injection. All cases were clinically evaluated and eligible for analysis by using inclusion and exclusion criteria. ICSI outcomes compared between the two groups, including fertilisation rate, embryo development rate and pregnancy outcome. RESULTS: Our study did not show any significant difference between treated and untreated groups regarding the mean values of fertilisation (0.7759 ± 0.2708 vs. 0.7119 ± 0.3057, p = 0.2708), embryo development (0.7759 ± 0.2708 vs. 0.6991 ± 0.3211, p = 0.1990) or different embryo grades. There was no statistically significant difference between groups regarding pregnancy occurrence rates (p = 0.0928). CONCLUSION: Infertile men scheduled for ICSI do not seem to benefit from varicocele repair as regard to the outcomes of ICSI.


Assuntos
Infertilidade Masculina/cirurgia , Varicocele/cirurgia , Adulto , Feminino , Humanos , Infertilidade Masculina/etiologia , Masculino , Gravidez , Resultado da Gravidez , Taxa de Gravidez , Estudos Prospectivos , Contagem de Espermatozoides , Injeções de Esperma Intracitoplásmicas , Resultado do Tratamento , Varicocele/complicações , Adulto Jovem
17.
J Endocrinol Invest ; 41(12): 1365-1375, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30284221

RESUMO

PURPOSE: Varicocele is defined as a state of varicosity and tortuosity of the pampiniform plexus around the testis caused by retrograde blood flow through the internal spermatic vein. The prevalence of clinically relevant varicocele ranges from 5 to 20% in the male population and is often associated with infertility and reduction of sperm quality. In this review, the pathophysiology and clinical aspects of varicocele are reviewed along with therapeutic options and treatment effects on sperm parameters and fertility both in adult and in pediatric/adolescent subjects. METHODS: We conducted a Medline and a PubMed search from 1965 to 2018 to identify publications related to varicocele clinical aspects, treatment procedures and treatment outcomes. Keywords used for the search were: "varicocele", "varicocelectomy", "sclerotherapy", "male infertility", "subfertility", and "semen abnormalities". RESULTS: Data from a large number of studies in adolescent and adult males indicate that varicocele correction improves semen parameters in the majority of patients, reducing oxidative stress and improving sperm nuclear DNA integrity either with surgical or percutaneous approach. CONCLUSIONS: Varicocele repair seems to represent a cost-effective therapeutic option for all males (both adolescent and adults) with a clinical varicocele in the presence of testicular hypotrophy, worsening sperm alterations or infertility. On the other hand, some investigators questioned the role of varicocelectomy in the era of assisted reproduction. Thus, a better understanding of the pathophysiology of varicocele-associated male subfertility is of paramount importance to elucidating the deleterious effects of varicocele on spermatogenesis and possibly formulating new treatment strategies.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Infertilidade Masculina/etiologia , Varicocele/cirurgia , Humanos , Masculino , Resultado do Tratamento , Varicocele/complicações
18.
Eur Urol Focus ; 4(3): 338-347, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-30327281

RESUMO

Imaging can benefit clinicians in evaluating men with infertility or sexual dysfunction by giving an overview of a patient's overall clinical condition before undertaking an invasive procedure. An understanding of the limitations and advantages of image modalities used in clinical practice will ensure that clinicians can optimize patient care with imaging when necessary. PATIENT SUMMARY: The objective of this article was to review the current literature on imaging modalities used for the diagnosis and management of male infertility and sexual dysfunction. An understanding of the advantages and limitations of these imaging modalities will ensure that clinicians can optimize patient care with imaging when necessary.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Disfunção Erétil/diagnóstico por imagem , Infertilidade Masculina/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Ultrassonografia/métodos , Ultrassom Focalizado Transretal de Alta Intensidade/métodos , Criptorquidismo/complicações , Criptorquidismo/diagnóstico por imagem , Ductos Ejaculatórios/anormalidades , Ductos Ejaculatórios/diagnóstico por imagem , Disfunção Erétil/epidemiologia , Humanos , Hiperprolactinemia/complicações , Hiperprolactinemia/diagnóstico por imagem , Hiperprolactinemia/patologia , Sistema Hipotálamo-Hipofisário/anormalidades , Sistema Hipotálamo-Hipofisário/diagnóstico por imagem , Infertilidade Masculina/epidemiologia , Infertilidade Masculina/etiologia , Síndrome de Kallmann/complicações , Síndrome de Kallmann/diagnóstico por imagem , Masculino , Doenças Urogenitais Masculinas/complicações , Doenças Urogenitais Masculinas/diagnóstico por imagem , Induração Peniana/complicações , Induração Peniana/diagnóstico por imagem , Doenças da Hipófise/complicações , Doenças da Hipófise/diagnóstico por imagem , Escroto/anormalidades , Escroto/diagnóstico por imagem , Varicocele/complicações , Varicocele/diagnóstico por imagem , Ducto Deferente/anormalidades , Ducto Deferente/diagnóstico por imagem
19.
Eur Urol Focus ; 4(3): 299-300, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-30104168

RESUMO

Limited observational data purporting a benefit of testicular sperm for intracytoplasmic sperm injection failure do not provide sufficient evidence. The first step is to reduce sperm DNA fragmentation in ejaculated sperm through lifestyle modifications, antioxidant therapy, or treatment of underlying abnormalities such as infection or varicocele.


Assuntos
Ejaculação/fisiologia , Fertilização In Vitro/estatística & dados numéricos , Injeções de Esperma Intracitoplásmicas/métodos , Espermatozoides/citologia , Testículo/citologia , Fragmentação do DNA , Feminino , Humanos , Masculino , Metanálise como Assunto , Gravidez , Taxa de Gravidez , Comportamento de Redução do Risco , Falha de Tratamento , Varicocele/complicações
20.
Zhonghua Nan Ke Xue ; 24(3): 195-198, 2018 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-30161302

RESUMO

The therapeutic decision for male infertility with varicocele is difficult and controversial, which requires the consideration of the patient's purpose of seeking medical help. The treatment of this condition involves not only surgery, but also medication and assisted reproductive technique (ART), and synergetic effects can be achieved by combination of the three options. In making a therapeutic decision, all related factors should be taken into full consideration.


Assuntos
Tomada de Decisão Clínica , Infertilidade Masculina/terapia , Varicocele/terapia , Humanos , Infertilidade Masculina/complicações , Masculino , Técnicas de Reprodução Assistida , Varicocele/complicações
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA