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1.
Arch Ital Urol Androl ; 91(2)2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266274

RESUMO

OBJECTIVE: Testicular cancers, which are less common than other cancers, are important in terms of being seen in young people. Physical examination, imaging, laboratory and tumor markers are used for diagnosis. There are some studies of some blood parameters that can be involved in inflammation and tumorogenesis. We retrospectively compared hematological values measured in our patients who were diagnosed with testicular tumor in comparison with patients with similar age group who underwent varicocelectomy repair. MATERIALS AND METHODS: This cross-sectional retrospective study included 120 patients who underwent radical inguinal orchiectomy for testicular tumor between January 2010 and December 2018, and 171 patients who underwent varicocelectomy as a control group. Patients with an active infection and hematological disorders were excluded from the study. We evaulated hematological parameters including neutrophil (NEU), lymphocyte (LYM), platelet (PLT) count, and mean platelet volume. The study was conducted on 291 patients. divided in two groups: tumor (n = 120) and varicocele (n = 171). RESULTS: There was no statistically significant difference between the groups in terms of PLT / lymphocyte ratio and mean platelet volume (MPV) levels (p > 0.05). The neutrophil /lymphocyte ratio (NLR) of the tumor group was significantly higher than the varicocele group (p = 0.001; p < 0.05). There was a statistically significant difference between the tumor stages in terms of PLT / Lymphocyte ratios (p = 0.006; p < 0.05). CONCLUSIONS: There was only a statistically significant increase in NLR values in the testicular tumor group compared to the varicocele group. Larger, randomized controlled studies are needed at this field.


Assuntos
Linfócitos/metabolismo , Neutrófilos/metabolismo , Neoplasias Testiculares/diagnóstico , Varicocele/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/metabolismo , Criança , Pré-Escolar , Estudos Transversais , Humanos , Lactente , Masculino , Volume Plaquetário Médio , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Neoplasias Testiculares/sangue , Varicocele/sangue , Adulto Jovem
3.
Panminerva Med ; 61(2): 118-127, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30990284

RESUMO

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


Assuntos
Dano ao DNA , Infertilidade Masculina/diagnóstico , Espermatozoides/metabolismo , Feminino , Fertilização In Vitro , Humanos , Estilo de Vida , Masculino , Gravidez , Técnicas de Reprodução Assistida , Varicocele/diagnóstico , Varicocele/cirurgia
4.
Urology ; 128: 78-83, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30885542

RESUMO

OBJECTIVE: To examine the implications of varicoceles and nutcracker phenomenon (NcP) in a large cohort of adolescent patients. Varicoceles are common in adolescent males, generating concerns regarding etiology and management. At our institution, Doppler ultrasound (US) of the renal vessels is routinely obtained with the goal of assessing for an associated nutcracker phenomenon. METHODS: Between 1/2000 and 3/2017, 182 patients with clinical varicoceles were evaluated with US. Retrospective assessment provided complete data in 137, including maximum varicose vein diameter, testicular measurements, left renal vein velocities at the hilum and impingement point by the superior mesenteric artery, and procedural interventions. RESULTS: NcP was detected in 77 patients (56.2%), who experienced higher venous velocity ratios (8.33 vs 2.87; P < 0.001) than those without. Overall, 39 patients (28.5%) had a testicular volume discrepancy >20%, without a significant difference based on the presence or absence of NcP (27.3 vs 30.0%, respectively; P = 0.36). Both groups had similar ages at diagnosis, bilateral volume parameters, volume difference, maximum varicose vein sizes, and follow-up duration (P ≥ 0.05 for all). Intervention was more likely in patients with volume difference >20% (P = 0.014). Having NcP was not associated with a higher incidence of initial (P = 0.59) or reoperative surgery (P = 0.73). CONCLUSION: NcP is common in adolescent patients with a varicocele, but it is not associated with differences in testicular parameters or an increased frequency of initial or reoperative surgery. As such, NcP may have few clinical ramifications as an isolated finding in this patient population, calling into question routine assessment for its presence.


Assuntos
Testículo/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Varicocele/diagnóstico , Adolescente , Criança , Seguimentos , Humanos , Masculino , Ontário/epidemiologia , Prevalência , Estudos Retrospectivos , Varicocele/epidemiologia
5.
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
6.
Urology ; 127: 119-123, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30771377

RESUMO

OBJECTIVE: To determine the distribution of semen parameters among adolescent and adult males presenting for fertility preservation. METHODS: A retrospective, cross-sectional cohort study of adolescent males age 11-19 who underwent semen analysis for fertility preservation at 3 centers in 2 countries with a comparison cohort of adult men presenting for fertility preservation. Prevalence of azoospermia and distribution of semen parameters was compared across groups. RESULTS: A total of 197 adolescents and 95 adults underwent semen analysis for fertility preservation. Azoospermia was present in 17 (8.6%) adolescents and 3 (3.2%) adults. There was decline in the prevalence of azoospermia with increasing age. After exclusion of patients with azoospermia, the adolescent and adult cohorts were comprised of 180 and 92 patients, respectively. Median age at presentation among adolescents vs adults was 16.5years (interquartile range [IQR] 15.2-17.6) and 30.8years (IQR 22.7-43.8), respectively. Median semen volume was 1.0mL (IQR 0.5-2.0) vs 2.5mL (IQR 1.5-3.5), P <.001. Median sperm concentration was 30million/mL (IQR 10-57) vs 39million/mL (IQR 14-57), P = .2. Median sperm motility was 39% (IQR 20-55) vs 45% (IQR 35-55), P = .01. Median total motile sperm count was 11million (IQR 1.4-33) for adolescents vs 29million (IQR 13-69) for adults, P <.001. CONCLUSION: Young adolescent males had higher prevalence of azoospermia and lower semen parameters compared to adults. In conjunction with physical examination, Tanner stage, and specific clinical context, these data can help to inform patients and their families about potential for fertility preservation, even in very young adolescent patients.


Assuntos
Azoospermia/epidemiologia , Preservação da Fertilidade/métodos , Análise do Sêmen/métodos , Varicocele/diagnóstico , Adolescente , Adulto , Fatores Etários , Azoospermia/diagnóstico , Estudos de Coortes , Estudos Transversais , Humanos , Incidência , Internacionalidade , Masculino , Estudos Retrospectivos , Medição de Risco , Contagem de Espermatozoides , Motilidade Espermática , Centros de Atenção Terciária , Reino Unido , Estados Unidos , Varicocele/epidemiologia , Adulto Jovem
7.
Aging Male ; 22(3): 207-213, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29683379

RESUMO

Objectives: To investigate the prevalence and severity of varicocele in adult population over the age of 40. We also measured testicular size, consistency, and total testosterone levels with an aim to observe the effect of varicocele on testis as men age. Methods: Two hundred twenty-four patients with varicocele, 241 patients without varicocele who admitted to our clinic were enrolled in the study. We stratified participants by four age groups (40-49, 50-59, 60-69, >70 yr). Patients were grouped according to varicocele grade and laterality. The morning testosterone level was drawn. The subgroups were compared with each other. Results: Overall, varicocele prevalence was 48%. Of the patients, 104 had unilateral, 120 had bilateral varicocele. Of the patients with varicocele, 62 (13.30%) were found as grade 3, 99 (21.10%) were grade 2, and 63 (13.60%) were grade 1. The percentages of smaller testes in grade 1, grade 2, and grade 3 varicocele group were 20.60, 79.80, and 88.70 and a significant association was detected. Age stratification of the data revealed the smaller and soft testis prevalence as well as higher grade varicocele prevalance increased in older age groups. Conclusions: Varicocele presence is associated with lower testicular size, softer testicular consistency, and lower testosterone levels, especially in older patients with bilateral and high-grade varicocele.


Assuntos
Envelhecimento/fisiologia , Testículo/patologia , Testosterona/sangue , Varicocele , Adulto , Fatores Etários , Idoso , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Prevalência , Índice de Gravidade de Doença , Turquia/epidemiologia , Varicocele/sangue , Varicocele/diagnóstico , Varicocele/epidemiologia
8.
World J Urol ; 37(7): 1461-1465, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30324297

RESUMO

OBJECTIVE: Inhere, we compared two of the most common grading systems based on color Doppler ultrasonography (CDU) and physical examination in patients suspected of varicocele. METHODS: This is a cross-sectional study. Overall, 66 patients clinically suspected of varicocele were visited by an attending urologist and a radiologist for physical examination and CDU. Varicocele was then graded according to the WHO criteria and Sarteschi criteria. For comparing the results of the two grading systems, each grading systems was then categorized into four scoring groups. Clinical- and CDU-based scoring, and mean maximum variceal vein diameter (MMVD) were evaluated and compared. RESULTS: The two scoring systems were statistically similar (p < 0.001). CDU scoring of right and left testicles had significant agreement with clinical scoring of varicocele (κ = 0.723 and κ = 0.809, respectively; p < 0.001). MMDV was associated with clinical (right sided: r = 0.681; left sided: r = 0.797; p < 0.001) and ultrasonography scoring (right sided: r = 0.648; left sided: r = 0.821; p < 0.001). CONCLUSION: Grades zero, one and two in ultrasonographic grading are most compatible with grade zero (sub-clinical) in clinical evaluation; so these grades most probably remain undetected in routine physical examination. Furthermore, grade three in ultrasonography and grade one in clinical grading, grade four in ultrasonography and grade two in clinical grading, and finally grade five in ultrasonography and grade three in clinical grading are most compatible. So, by deducting two grades from the ultrasonography grading of varicocele measured by the Sarteschi method, one can obtain a compatible estimate of the clinical grading.


Assuntos
Exame Físico , Ultrassonografia Doppler em Cores , Varicocele/diagnóstico , Adolescente , Adulto , Estudos Transversais , Humanos , Masculino , Índice de Gravidade de Doença , Varicocele/diagnóstico por imagem , Adulto Jovem
9.
Bol. pediatr ; 59(247): 1-10, 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183161

RESUMO

La patología testicular supone una parte principal del día a día del cirujano pediátrico. tanto por su frecuencia como por su morbilidad es muy importante prestar la debida atención a la patología, tanto malformativa como adquirida (aguda y crónica), del testículo en el niño. la criptorquidia o ausencia de teste en el escroto es la malformación genitourinaria más frecuente. Se trata de una malformación asintomática de cuyo adecuado manejo y corrección precoz va a depender el pronóstico del teste, así como el riesgo de malignización en la edad adulta. la torsión testicular es un evento agudo que consiste en el giro sobre sí mismo del órgano, comprimiendo el pedículo y comprometiendo el aporte sanguíneo al teste, que si se mantiene en el tiempo conduce a una necrosis testicular. el pronto reconocimiento de este cuadro dentro del síndrome de escroto agudo será vital para conseguir corregir la torsión e impedir la pérdida de la gónada. El varicocele se define como una dilatación varicosa de las venas del plexo pampiniforme a nivel del cordón espermático. puede ser asintomático o generar molestias. Su efecto sobre la fertilidad no está completamente esclarecido y las indicaciones quirúrgicas, al igual que la técnica idónea son asuntos sujetos a controversia. en el presente texto se repasan los conceptos referentes a estos temas, actualizando las recomendaciones de diagnóstico y manejo


Testicular pathology occupies the main part of the day to day work of the pediatric surgeon. Both because of its frequency as well as its morbidity, it is very important to pay attention to the malformative and acquired (acute and chronic) pathology of the testis in the boy. Cryptorchidism or absence of the testis in the scrotum is the most frequent genitourinary malformation. this is an asymptomatic malformation whose adequate management and early correction will depend on the prognosis of the testis and the risk of malignization in the adult age. testicular torsion is an acute event that consists in the twisting of the organ on itself, with compression of the testicular pedicle, affecting the blood supply to the testis. if this is maintained over time, it leads to a testicular necrosis. early recognition of this picture within the acute scrotum syndrome will be vital to be able to correct the torsion and prevent loss of the gonad. Varicocele is defined as a varicose dilation of the pampiniform plexus on the level of the spermatic cord. it can be asymptomatic or generate discomfort. Its effect on fertility has not been completely clarified and the surgical indications and the best treatment are matters subject to controversy. in the present text, the concepts regarding these subjects are reviewed, updating the recommendations for diagnosis and management


Assuntos
Humanos , Masculino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Criptorquidismo , Escroto/patologia , Varicocele , Criptorquidismo/diagnóstico , Criptorquidismo/epidemiologia , Criptorquidismo/terapia , Doença Aguda , Varicocele/diagnóstico , Varicocele/epidemiologia , Varicocele/terapia , Prognóstico
11.
BMC Urol ; 18(1): 34, 2018 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-29739377

RESUMO

BACKGROUND: Acute scrotal pain has various causes. Testicular torsion, torsion of appendages and Epididymo-orchitis are common causes, while varicocele thromboses are a rare cause. Varicocele thromboses can occur post operatively or spontaneously. Five cases of post-operative and five cases of spontaneous thromboses have been described till date. The traditional advice in the management of thrombosed varicocele has been to manage it conservatively in all patients by drugs and scrotal support with little description of the surgical treatment. Herein, we present an unusual sixth case of spontaneous thromboses of varicocele and discuss its presentation and surgical management. We would also like to highlight the differentiating points between spontaneous thrombosis and post operative in vitro clot formation in the varicoceles, as these two entities can often be confused for each other. CASE PRESENTATION: A 68 year-old man presented with excruciating scrotal pain of one week duration. Doppler study of scrotum revealed left varicocele with no evidence of Epididymo-orchitis. He was treated with intravenous antibiotics, analgesics and scrotal elevation. He had no relief and continued to have severe pain. Clinical examination was normal. Patient underwent exploratory surgery on a semi- emergent basis. Exploration revealed normal testis with thrombosed varicoceles. Patient underwent Varicocelectomy. Postoperatively patient had immediate pain relief. Histopathology revealed prominent thrombosed varicocele. A varicocelectomy specimen (done for primary infertility) was used for comparison. The differentiating points between the two entities were noted. CONCLUSION: Spontaneous thrombosis of varicocele is a rare cause of acute scrotal pain. Pain out of proportion to clinical features is characteristic. Patients not responding to medical therapy may need varicocelectomy. Varicocelectomy may give immediate relief. Histopathology is useful in this disorder.


Assuntos
Dor Aguda/diagnóstico , Escroto/patologia , Trombose/diagnóstico , Varicocele/diagnóstico , Dor Aguda/etiologia , Dor Aguda/cirurgia , Idoso , Humanos , Masculino , Escroto/cirurgia , Trombose/complicações , Trombose/cirurgia , Varicocele/complicações , Varicocele/cirurgia
12.
BJU Int ; 122(4): 654-666, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29461677

RESUMO

OBJECTIVES: To assess the presence of testicular asymmetry and the currently used threshold values in varicocoele management in a healthy adolescent population. SUBJECTS AND METHODS: We conducted an observational cross-sectional study from April 2015 until December 2016 in which we recruited 539 adolescent boys aged 11-16 years. A clinical examination including testicular size measurement by ultrasonography was performed. Testicular volume (TV) was calculated using the Lambert formula (length × width × height × 0.71). The Testicular Atrophy Index (TAI) was calculated using the formula [(TV right - TV left)/largest TV] × 100. The data for all statistical analyses were stratified for Tanner stage for genital development (TSG) and pubic hair (TSP). Non-parametric tests were used to assess the difference between right and left TV, and the prevalence of a smaller left testis for the entire population, and between each TSG and TSP. Parametric tests were used to determine the difference in mean TAI between each TSG and TSP, and to compare the mean TAI to a test value of 0. RESULTS: Of the 539 recruited boys, we excluded 194 due to a current or past pathology, including varicocoeles, influencing normal (testicular) growth or due to incomplete data. Most boys were in the second Tanner stage, followed by the third Tanner stage. The mean (sd) age of the entire population was 13.33 (1.25) years. Of the 345 included participants the mean (sd) left TV was 7.67 (5.63) mL and right TV was 7.97 (5.90) mL. The mean (sd) TAI was 2.85 (17.00)%. In all, 203 (58.84%) boys had a smaller left testis and 142 (41.16%) had a smaller right testis. In all, 51 boys (14.78%) had a TAI >20%, 45 (13.04%) had a TV difference (TVD) of >2 mL with a deficit in left TV, and 69 (20.00)% had a TAI >20% or a TVD of >2 mL with a deficit in left TV. Related-samples Wilcoxon signed-rank test showed a significant difference in mean left and right TV for the entire population, and more specifically for TSG3 (P < 0.001) and TSP3 (P = 0.004). A one-sample t-test showed a significant difference in the mean TAI vs the test value of 0 for the entire population (P = 0.002), and more specifically for TSG3 (P < 0.001) and TSP3 (P = 0.003). CONCLUSION: Testicular asymmetry, with a smaller left testis, was seen in a considerable number of healthy adolescents. One out of five adolescents had a smaller left testis and met one of the threshold values currently used in varicocoele management. Therefore, in left-sided unilateral inguinoscrotal pathology, a smaller ipsilateral testis in combination with a TAI of >20% and/or TVD of >2 mL requires careful interpretation and serial measurements of TV should always be performed. Furthermore, this study provides reference values for TV, TVD and TAI according to TSG and TSP for a healthy adolescent population.


Assuntos
Atrofia/diagnóstico , Tamanho do Órgão/fisiologia , Testículo/anatomia & histologia , Varicocele/diagnóstico , Adolescente , Criança , Estudos Transversais , Humanos , Masculino , Valores de Referência , Estudos Retrospectivos , Testículo/patologia
13.
J Pediatr Urol ; 14(2): 152.e1-152.e6, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29477693

RESUMO

BACKGROUND: Varicocele is a common urologic anomaly in adolescent males; however, evidence-based treatment guidelines do not exist. Hydroceles are known to be a common complication after surgical therapy, with a wide variation in the reported incidence between 1 and 40%. AIM: This study aimed to introduce a standardized indication-to-treat protocol and prove its efficacy by analyzing the outcome of patients. Secondly, it aimed to better define postoperative hydroceles because the wide variation of reported incidence is attributed to a lack of definition. METHODS: Our standardized treatment protocol included an initial assessment with clinical grading of varicoceles, ultrasound evaluation of testicular volume, and calculation of the atrophy index. Indications for surgical treatment were testicular volume asymmetry >20%, discomfort and pain, or bilateral varicocele. The Palomo procedure (laparoscopically since 2005) was the standard procedure. Postoperative hydroceles were graded according to clinical findings and symptoms: Grade I, sonographic chance finding without clinical correlate; Grade II, palpable but clinically insignificant; Grade III, symptomatic. All patients treated according to the defined protocol were prospectively monitored between January 2001 and December 2015. RESULTS: A total of 129 patients with left varicocele were referred to our institution; 70 fulfilled the indication criteria for surgical treatment. Twenty-eight of these patients were treated for volume asymmetry, 26 of these showed catch-up growth. Forty-two patients were treated for discomfort and pain; the symptoms subsided in all of them. Postoperative hydroceles were detected in 36 patients (51%). In 29 patients this was a sonographic chance finding (Grade I). Three patients showed a palpable but clinically insignificant postoperative hydrocele (Grade II) and four patients (5.7%) showed symptomatic hydrocele (Grade III) where treatment was recommended. DISCUSSION: The treatment protocol allowed judicious indication for surgery and postoperative outcomes similar to previous reports. The high rate of catch-up growth in operated cases represents a proxy for successful treatment in cases where more precise parameters, like semen quality or paternity rate, were not yet detectable. The introduced grading system for postoperative hydroceles provs to be a valid and appropriate instrument, and promises to be a standardized method for comparing outcomes in future studies. CONCLUSION: The indication-to-treat protocol proved to be easily applicable, highly efficient, and have outcomes comparable to international literature. The necessity for a standardized grading of postoperative hydroceles was underscored in the data.


Assuntos
Complicações Pós-Operatórias/patologia , Hidrocele Testicular/diagnóstico , Hidrocele Testicular/cirurgia , Varicocele/cirurgia , Adolescente , Atrofia/diagnóstico por imagem , Atrofia/patologia , Biópsia por Agulha , Estudos de Coortes , Humanos , Imuno-Histoquímica , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Ultrassonografia Doppler , Varicocele/diagnóstico
14.
J Med Case Rep ; 12(1): 2, 2018 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-29304872

RESUMO

BACKGROUND: Renal arteriovenous malformation is an aberrant vascular connection between the renal artery and vein. Acquired renal arteriovenous malformation (arteriovenous fistulae) accounts for approximately 70% of renal arteriovenous abnormalities. Congenital renal arteriovenous malformation, relatively rare, can result in significant hematuria which may require arterial embolization or nephrectomy. CASE PRESENTATION: A 64-year-old Asian man presented to the Urology department in our hospital with gradual left scrotal swelling for 2 years. Ultrasound and computed tomography showed an irregular mass in the upper pole of his left kidney. Digital subtraction angiography confirmed cirsoid-type left renal arteriovenous malformation combined with left renal vein ostial stenosis. After digital subtraction angiography and selective segmental renal artery embolization, the varicocele was obviously alleviated. CONCLUSIONS: The etiology diagnosis of varicocele is not always straightforward, and renal arteriovenous malformation should be considered in the differential diagnosis of varicocele and renal mass. Renal arteriovenous malformation is difficult to distinguish from renal tumor according to varicocele and computed tomography presentation, while magnetic resonance imaging and digital subtraction angiography help to make a definite diagnosis and selective renal angiographic embolization is one of the best treatments for renal arteriovenous malformation.


Assuntos
Malformações Arteriovenosas , Embolização Terapêutica/métodos , Neoplasias Renais/diagnóstico , Artéria Renal , Veias Renais , Varicocele , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico , Malformações Arteriovenosas/fisiopatologia , Malformações Arteriovenosas/terapia , Angiografia por Tomografia Computadorizada/métodos , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Renal/anormalidades , Artéria Renal/diagnóstico por imagem , Veias Renais/anormalidades , Veias Renais/diagnóstico por imagem , Ultrassonografia/métodos , Varicocele/diagnóstico , Varicocele/etiologia , Varicocele/fisiopatologia , Varicocele/terapia
15.
J Pediatr Urol ; 14(1): 10.e1-10.e7, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28807743

RESUMO

BACKGROUND: Controversy still exists about the indications and the gold standard approach for varicocele treatment in pediatric population. OBJECTIVE: The authors report their 23 years of experience in laparoscopic varicocele repair in the pediatric population. STUDY DESIGN: We retrospectively evaluated the data of 345 consecutive patients who underwent laparoscopic left varicocelectomy from January 1993 to December 2015. Average patient age was 12.5 years (range 8-17). Seven out of 345 patients (2%) had a recurrent varicocele, and five out of 345 patients (1.4%) had a varicocele on a single testis. In 335/345 patients (97.1%) we performed a Palomo procedure, and in 10/345 patients (2.9%) an artery-sparing Palomo procedure. After 2010, in 105/345 patients (30.4%) we performed a lymphatic sparing procedure using isosulfan blue injection preoperatively. RESULTS: All procedures were completed in laparoscopy (Figure), without conversions or intraoperative complications. The average operative time was 17 min (range 14-45) for the Palomo procedure and 26 min (range 18-50) for artery-sparing Palomo. In 45/345 patients (13%) we performed additional procedures. We recorded 4/345 (1.3%) recurrences/persistences in patients undergoing Palomo, while we recorded 1/10 (10%) recurrence/persistence after artery-sparing Palomo. On 230 Palomo procedures performed in the pre-isosulfan blue era, we recorded 25 cases of hydrocele (10.8%), 13 of these were treated with transcrotal puncture and 12 required surgical operation. The last 105 patients undergoing isosulfan blue injection had no postoperative hydrocele. We also reported 10 other complications (I grade Clavien-Dindo) such as umbilical granuloma or instrumental problems. DISCUSSION: Analyzing the international literature of the last 25 years, most papers focused on the minimally invasive treatment of pediatric varicocele. There are several reasons to perform laparoscopic repair of pediatric varicocele. First of all, it is technically easy to perform, the average operative time is very short, and it has excellent outcome in regard to varicocele persistence/recurrence. In addition it has a very low complication rate, and in particular adopting the intradartoic/intratesticular isosulfan blue injection before surgery we recorded no postoperative hydrocele. CONCLUSION: On the basis of our 23 years of experience with varicocele repair, we clearly believe that laparoscopic Palomo lymphatic sparing varicocelectomy should be considered the standard of care for the treatment of pediatric patients with varicocele. Laparoscopic varicocelectomy is technically easy and quick to perform, painless, and scarless, with a recurrence rate of about 1%. The use of a preoperative injection of isosulfan blue completely eliminates postoperative hydrocele formation.


Assuntos
Laparoscopia/normas , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Corantes de Rosanilina/uso terapêutico , Hidrocele Testicular/prevenção & controle , Varicocele/diagnóstico , Varicocele/cirurgia , Adolescente , Criança , Estudos de Coortes , Seguimentos , Humanos , Laparoscopia/métodos , Masculino , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
16.
Scand J Urol ; 52(5-6): 427-431, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30602328

RESUMO

OBJECTIVE: In 2010 W.H.O. changed the lower reference limit for strict sperm morphology from 15 to 4%. The change was based on 5th percentile cut points from a meta-analysis on a published series of fertile men. This study investigates if patients referred for evaluation with sperm morphologies between 5-14% have identifiable etiologies of male infertility. MATERIALS AND METHODS: I.R.B. approval was obtained to review records for patients referred to the University of Michigan Center of Reproductive Medicine between May 2012-May 2014 whom had a sperm morphology of 5-14%. Semen analysis, hormone levels, and information related to an infertility diagnosis, were recorded into a de-identified database. Patients were placed into the categories 'Varicocele', 'Hypogonadism', 'Intercourse problems', 'Anti-sperm antibodies (A.S.A.)', 'Other' or 'No diagnosis'. RESULTS: A total of 253 patients were included in the study. Of these, 96/253 (38%) had a clinical varicocele; 44/253 (17%) hypogonadism; 4/253 (2%) intercourse problems; 11/253 (4%) evidence of sperm antibodies; and 15/253 (6%) had various other problems deemed potentially contributing causes of infertility. In all, nearly 67% of the subjects were identified to have a potential contributing etiology of male infertility. Similar results were found for the men with isolated low morphology (n = 194). CONCLUSIONS: This study demonstrates that 67% of men in infertile couples, who have strict sperm morphology between 5 and 14%, are found to have a potential contributing male factor infertility diagnosis. This raises the possibility that the new lower reference value for sperm morphology may result in missed opportunities for proper infertility assessment.


Assuntos
Hipogonadismo/diagnóstico , Infertilidade Masculina/diagnóstico , Espermatozoides/patologia , Teratozoospermia/diagnóstico , Varicocele/diagnóstico , Adulto , Humanos , Infertilidade Masculina/patologia , Masculino , Guias de Prática Clínica como Assunto , Valores de Referência , Análise do Sêmen , Teratozoospermia/patologia , Organização Mundial da Saúde
17.
Fertil Steril ; 108(3): 361-363, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28865533

RESUMO

In this Views and Reviews section, four groups of authors address the timely and highly relevant issue of varicoceles across the male life spectrum. Varicoceles are very prevalent among men presenting for an infertility workup. While reduction in bulk semen parameters (including sperm concentration, motility, and morphology) has long been recognized as a deficit caused by varicoceles, in recent years a number of investigators have shown that varicoceles can have broader, multi-faceted effects on male reproductive health. Sperm DNA integrity and other aspects of sperm function appear to be impacted by the presence of varicoceles, and varicocele correction can result in significant improvement in not only semen parameters, but also fertilization and pregnancy rates.


Assuntos
Embolização Terapêutica/métodos , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/prevenção & controle , Varicocele/diagnóstico , Varicocele/terapia , Procedimentos Cirúrgicos Vasculares/métodos , Terapia Combinada/métodos , Medicina Baseada em Evidências , Humanos , Infertilidade Masculina/etiologia , Masculino , Resultado do Tratamento , Procedimentos Cirúrgicos Urogenitais/métodos , Varicocele/complicações
18.
Fertil Steril ; 108(3): 378-384, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28865535

RESUMO

Varicoceles, a dilation of veins within the pampiniform plexus, are present in ∼15% of the general male population. This paper reviews the indications for treatment of varicoceles, post-intervention outcomes following treatment, and the various techniques for treatment of varicoceles. The aim of this review is to describe and compare complications associated with each approach to varicocele treatment.


Assuntos
Embolização Terapêutica/métodos , Infertilidade Masculina/prevenção & controle , Laparoscopia/métodos , Procedimentos Cirúrgicos Urogenitais/métodos , Varicocele/diagnóstico , Varicocele/terapia , Procedimentos Cirúrgicos Vasculares/métodos , Terapia Combinada/métodos , Medicina Baseada em Evidências , Humanos , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/etiologia , Masculino , Resultado do Tratamento , Varicocele/complicações
20.
J Pediatr Urol ; 13(5): 437-445, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28851509

RESUMO

BACKGROUND: The prevalence of varicoceles is as high as 15% in children and adolescents. Optimal management of varicoceles has not been consolidated. Options include observation, radiological intervention, or surgical varicocelectomy. OBJECTIVE: Herein, we aim to assess the outcomes of radiological and surgical interventions for varicocele in children and adolescents evaluated by RCTs. STUDY DESIGN: The study subjects were children and adolescents up to 21 years old, diagnosed with varicocele and allocated to receive either "surgical or radiological intervention" or "no treatment". MATERIALS AND METHODS: We searched MEDLINE and EMBASE (Ovid platform), Web of Science, CINAHL, Cochrane Central Register of Controlled Trials, Google Scholar, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform for RCTs reporting on varicocele treatment in children and adolescents up to June 23, 2016. Only RCTs with patients aged under 21 years were included. Main outcomes of interest included changes in testicular size, semen analysis parameters, surgical adverse events and failures. RESULTS: Nine eligible studies were included in the systematic review. Meta-analysis based on available outcomes data demonstrated an improvement in testicular volume (mean difference 3.18 mL, 95% CI 1.94-4.42) and in sperm count (mean difference 25.54 × 106/mL, 95% CI 12.84-38.25) in patients who underwent radiological or surgical treatment compared with conservative management. CONCLUSIONS: Based on current available randomized controlled trials, there is low to moderate level of evidence that radiological or surgical treatment of adolescent varicocele is associated with improved testicular size/growth and sperm concentration. The ultimate effects on fertility and paternity rates are not known.


Assuntos
Varicocele/terapia , Adolescente , Criança , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Varicocele/diagnóstico , Varicocele/etiologia , Adulto Jovem
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