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1.
Angiol Sosud Khir ; 26(1): 42-46, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32240135

RESUMO

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


Assuntos
Síndrome de May-Thurner/complicações , Síndrome de May-Thurner/diagnóstico , Síndrome de May-Thurner/cirurgia , Varicocele/diagnóstico , Varicocele/cirurgia , Adolescente , Adulto , Humanos , Veia Ilíaca/diagnóstico por imagem , Masculino , Dor Pélvica/etiologia , Flebografia , Stents , Resultado do Tratamento
2.
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
3.
Rev. clín. med. fam ; 13(1): 76-80, feb. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-193917

RESUMO

Los tumores de células de Leydig son raros y suponen una pequeña proporción de neoplasias testiculares (1-3 %). La forma más frecuente de presentación es una masa indolora testicular o un hallazgo ecográfico incidental acompañado en más del 80 % de los casos de desórdenes hormonales. Los marcadores tumorales séricos son negativos y aproximadamente el 30 % de los casos presentan ginecomastia. El tratamiento de elección es la cirugía (orquiectomía ingui-nal) y el seguimiento postoperatorio será prolongado. El diagnóstico definitivo es histológico y se realizará durante o tras la cirugía. Entre los marcadores inmunohistológicos de tumores de células de Leydig se incluyen alfa inhibina, calretinina y melan A. La presencia de la subunidad alfa de inhibina mediante técnica de inmunohistoquímica, destaca la intensa positividad de las células tumorales en comparación con la del tejido sano circundante. La calretinina es más sensible pero menos específica que la inhibina. Melan A es un marcador moderadamente sensible y específico en la diferenciación de tumores del estroma del cordón sexual y como tal es un valor complementario a otros marcadores inmunohistoquímicos en la valoración de tumores de difícil diagnóstico. El interés de este caso es mostrar la complejidad de alteraciones clínicas asociadas a estos tumores, así como establecer un diagnóstico diferencial con otros tumores histológicos


Leydig cell tumors are rare and account for a small proportion of testicular neoplasms (1-3%). They most frequently present as a painless testicular mass or as an incidental ultrasound finding, accompanied by hormonal disorders in more than 80% of cases. Serum tumor markers are negative and approximately 30% of cases present gynecomastia. The treatment of choice is surgery (inguinal orchiectomy) with a long post-operative follow-up. The definitive diagnosis is histological, which will be carried out during or after surgery. The immunohistochemical markers of Leydig cell tumors include inhibin alpha, calretinin, and melan-A. The presence of the inhibin alpha subunit in immunohistochemical analysis shows intense positivity of tumor cells compared with the surrounding healthy tissue. Calretinin is more sensitive but less specific than inhibin. Melan-A is a moderately sensitive and specific marker of sex cord-stromal tumors, and, as such, complements other immunohistochemical markers in the assessment of tumors which are difficult to diagnose. The interest of this case is to show the complex pattern of clinical presentation of these tumors, and to establish a differential diagnosis with other testicular tumors


Assuntos
Humanos , Masculino , Adulto Jovem , Ginecomastia/diagnóstico , Hipoadrenocorticismo Familiar/diagnóstico , Hipogonadismo/diagnóstico , Neoplasias Testiculares/patologia , Tumor de Células de Leydig/patologia , Diagnóstico Diferencial , Varicocele/diagnóstico , Seminoma/patologia
4.
Andrologia ; 51(10): e13407, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31448444

RESUMO

Although varicoceles are a widely accepted identifiable male factor in infertile couples, the benefit of varicocele repair in improving pregnancy and live birth rates remains uncertain. The Study for Future Families obtained semen and reproductive hormone samples from US men whose partners were currently pregnant. In our analysis cohort of 709 men, a varicocele was detected by clinical examination in 56 (8%) of men. Men with varicocele had smaller left testis, and lower total and total motile sperm counts than men without varicocele. Gonadotropin levels were higher as well in men with varicocele. Interestingly, testosterone levels were also slightly higher in men with varicocele. Despite these differences, there was no difference between the groups in the time to achieve the study pregnancy or percentage of men with a previous pregnancy. We conclude that even in fertile men, varicoceles are associated with some degree of testicular hypofunction. This would support current recommendations to consider varicocele repair in male partners in infertile couples who demonstrate both a varicocele and abnormal semen parameters and after evaluation for treatable female factors.


Assuntos
Fertilidade/fisiologia , Sêmen/fisiologia , Testículo/fisiopatologia , Varicocele/fisiopatologia , Adulto , Estudos de Coortes , Feminino , Gonadotropinas/sangue , Humanos , Masculino , Gravidez , Estudos Prospectivos , Análise do Sêmen/normas , Testosterona/sangue , Varicocele/sangue , Varicocele/diagnóstico
5.
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
6.
Andrologia ; 51(9): e13341, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31195431

RESUMO

This study aimed to assess the possible correlation between mammalian target of rapamycin (mTOR) gene expression and sperm DNA damage among infertile patients with and without varicocele. The study included sixty infertile males and fifty fertile males as controls. The infertile group was subdivided into the following subgroups: thirty males with varicocele and thirty males without varicocele. All subjects underwent medical history collection, clinical examination, semen analysis, sperm DNA integrity assessment, mTOR gene expression assessment and scrotal colour Doppler ultrasound. The mean mTOR gene expression in infertile patients with varicocele (23.52 ± 14.65) was significantly higher than that in infertile patients without varicocele (12.24 ± 12.44) and fertile control subjects (3.92 ± 3.26; p = 0.003 and p < 0.001 respectively). In the infertile varicocele-positive group, mTOR gene expression showed a significant negative correlation with sperm count (p = 0.028, r = -0.400) and progressive sperm motility (p = 0.038, r = -0.381), as well as a significant positive correlation with the sperm DNA fragmentation index (DFI; p = 0.001, r = 0.578). In the infertile varicocele-negative group, mTOR gene expression showed a significant negative correlation with progressive sperm motility (p = 0.018, r = -0.429) and a significant positive correlation with sperm DFI (p < 0.001, r = 0.673). In conclusion, according to these results, there is a significant positive correlation between mTOR gene expression and sperm DFI among infertile patients with and without varicocele.


Assuntos
Fragmentação do DNA , Infertilidade Masculina/patologia , Espermatozoides/patologia , Serina-Treonina Quinases TOR/metabolismo , Varicocele/patologia , Adulto , Estudos de Casos e Controles , Humanos , Infertilidade Masculina/etiologia , Masculino , Escroto/irrigação sanguínea , Escroto/diagnóstico por imagem , Análise do Sêmen , Ultrassonografia Doppler em Cores , Varicocele/complicações , Varicocele/diagnóstico , Adulto Jovem
8.
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
9.
J Endocrinol Invest ; 42(10): 1215-1221, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30955179

RESUMO

PURPOSE: Varicocele repair (VR) is proposed to improve fertility in subfertile couples with a poor semen quality. We explored whether the disappearance of a left continuous spermatic venous reflux (SVR) at scrotal colour-Doppler ultrasound (CDUS), an objective evidence for a VR, is predictive for improved fertility outcome in subfertile couples. METHODS: VR was performed by left internal spermatic vein sclero-embolisation in 88 males seeking a consultation for subfertility. Semen analysis and scrotal CDUS were evaluated before and 6 months after VR. Serum levels of FSH and total testosterone (TT) were obtained at baseline. Telephone interview was used to obtain information about fertility outcome. Significant predictors of pregnancy and live births, selected by univariate analyses, were included into multiple logistic regression models to assess independent associations. RESULTS: At the adjusted model, independent significant predictors of pregnancy after VR were a disappeared SVR at CDUS (OR = 5.5, 97.5% CI 2.01-15.4; p = 0.0009) and an improved sperm total motile count (TMC) (OR = 5.5, 97.5% CI 1.4-27.9; p = 0.02). Even live births were independently associated with both disappeared left SVR at CDUS (OR = 4.3, 97.5% CI = 1.6-11.8; p = 0.003) and improved TMC after VR (OR = 4.8, 97.5% CI 1.3-24.2; p = 0.02). CONCLUSION: The still controversial effect of varicocele repair on fertility in subfertile couples may reside on the undefined objective methods to document a successful VR and its effect on couple fertility. The disappearance of a continuous left SVR at CDUS after VR was the objective best predictor for subsequent improved fertility in subfertile couples.


Assuntos
Infertilidade Masculina/terapia , Nascimento Vivo/epidemiologia , Complicações Pós-Operatórias/diagnóstico , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Varicocele/cirurgia , Doenças Vasculares/diagnóstico , Doenças Vasculares/etiologia , Adulto , Embolização Terapêutica/efeitos adversos , Características da Família , Feminino , Humanos , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/epidemiologia , Infertilidade Masculina/cirurgia , Masculino , Complicações Pós-Operatórias/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Taxa de Gravidez , Prognóstico , Estudos Retrospectivos , Cordão Espermático/irrigação sanguínea , Cordão Espermático/cirurgia , Resultado do Tratamento , Varicocele/diagnóstico , Varicocele/epidemiologia , Doenças Vasculares/epidemiologia , Veias/cirurgia
10.
Fertil Steril ; 111(3): 415-419, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30827515

RESUMO

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


Assuntos
Infertilidade Masculina/cirurgia , Microcirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Varicocele/cirurgia , Fertilidade , Humanos , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/etiologia , Infertilidade Masculina/fisiopatologia , Ligadura , Masculino , Microcirurgia/efeitos adversos , Fatores de Risco , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Varicocele/complicações , Varicocele/diagnóstico , Varicocele/fisiopatologia
11.
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
12.
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
13.
Andrology ; 7(1): 62-68, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30354030

RESUMO

BACKGROUND: The existing classifications of varicocoeles have poor predictive value regarding the effects of surgery on sperm count. OBJECTIVE: To develop a new grading system for varicocoeles, useful as an indication for surgery. MATERIALS AND METHODS: This is a three-center prospective study which examined 173 men having clinically detectable left varicocoeles and oligo ± astheno ± terato-spermia. The patients underwent medical history collection, objective examination, duplex Doppler ultrasound scrotal examination, hormonal profiles, two semen analyses before surgery, and two semen analyses after surgery. Sperm concentration, motility, and morphology (standard semen parameters) were evaluated 6 months after surgery in function of the following preoperative variables: patient age, follicle-stimulating hormone, clinical grade of varicocoele, right and left testicular volume, extension of venous reflux, and semen parameters. The venous reflux was graded in two centers using duplex Doppler ultrasound: reflux visible only with Valsalva and continuous reflux. Spearman's rank semiquantitative analysis was used. All patients had their varicocoeles corrected according to the Colpi technique. RESULTS: The variables capable of determining an improvement in semen parameters after varicocoele correction were in order of decreasing importance: venous reflux extent assessed by scrotal duplex Doppler ultrasound examination, varicocoele clinical grade, basal semen parameters, and follicle-stimulating hormone. Male age did not influence postoperative semen quality. Only patients with continuous reflux had their standard semen parameters improved after surgery. DISCUSSION: Venous reflux extent is the most critical variable capable of predicting semen improvement after varicocoelectomy. CONCLUSIONS: A correct duplex Doppler assessment of venous reflux is mandatory for predicting postoperative improvement of the sperm count.


Assuntos
Contagem de Espermatozoides , Ultrassonografia Doppler/métodos , Varicocele/diagnóstico por imagem , Varicocele/diagnóstico , Adulto , Humanos , Masculino , Avaliação de Resultados da Assistência ao Paciente , Estudos Prospectivos , Análise do Sêmen , Motilidade Espermática/fisiologia , Varicocele/cirurgia , Adulto Jovem
14.
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
15.
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
16.
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
18.
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
19.
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
20.
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
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