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1.
Yonsei Med J ; 62(10): 928-935, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34558872

RESUMO

PURPOSE: In young patients with varicocele, preservation of the internal spermatic artery may be advantageous for catch-up growth, but it may also increase the likelihood of treatment failure. Intraoperative venography reduces the likelihood that unsealed veins will remain after varicocelectomy. We analyzed the characteristics of remnant veins visualized through intraoperative venography to investigate the cause of surgical failure in artery-sparing varicocelectomy (ASV). MATERIALS AND METHODS: We retrospectively analyzed clinical characteristics and outcomes of patients aged 18 years or younger who underwent varicocelectomy with intraoperative venography from January 2005 to December 2017. During varicocelectomy, intraoperative venography was performed to distinguish veins from other structures. Any unsealed veins that were discovered were ligated and classified using the Bahren system. RESULTS: One hundred and sixty-two patients underwent intraoperative venography: 153 cases (94.4%) were for primary varicocelectomy, and 9 cases (5.6%) were for repeat varicocelectomy. Open varicocelectomy was performed in 105 cases (64.8%), and laparoscopic varicocelectomy was performed in 57 cases (35.2%). Venography revealed remnant veins after the first ligation in 51 cases (31.2%), 46 (90.2%) and 5 (9.8%) of which were Bähren types 3 and 4, respectively. Five patients (3.1%) experienced varicocele recurrence, classified as persistence in 1 patient (0.6%) and relapse in 4 patients (2.5%). CONCLUSION: Remnant collateral veins of the internal spermatic vein (ISV) (Bahren type 3) are the most common cause of failure in ASV. In a few patients, an external spermatic vein merges with the ISV at a higher level (Bahren type 4) and is unidentifiable without venography.


Assuntos
Cordão Espermático , Varicocele , Humanos , Masculino , Flebografia , Estudos Retrospectivos , Cordão Espermático/diagnóstico por imagem , Cordão Espermático/cirurgia , Testículo , Varicocele/diagnóstico por imagem , Varicocele/cirurgia , Veias/diagnóstico por imagem , Veias/cirurgia
2.
Urologiia ; (4): 73-78, 2021 09.
Artigo em Russo | MEDLINE | ID: mdl-34486278

RESUMO

INTRODUCTION: Varicocelectomy does not always lead to semen improvement and male fertility recovery. OBJECTIVES: Analysis of total progressive motile sperm count (TPMSC) predictive role in fertility recovery of subfertile man after varicocelectomy in combination with other predictors. MATERIALS AND METHODS: This prospective, open, multi-center study comprises 93 men from infertile couples with clinical varicocele who underwent microsurgical (inguinal or subinguinal) varicocelectomy. The changes in the standard semen analysis studied according to WHO 2010 Standards. We also evaluated spontaneous pregnancy rates. A discriminant analysis was carried out with step-by-step selection to identify reliable predictors of pregnancy after varicocelectomy. An increase in TPMSC by at least 12.5 million was considered as a good effect of varicocele repair (reference values for the number and progressive sperm motility according to WHO 2010: 39 million x 0.32 (32%) progressively motile). Patients were divided into 3 groups in regards of direction and degree of semen changes: group I included 48 patients with increase of TPMSC more or equal 12.5 million, group II comprised 20 patients with mild increase in TPMSC (0.1 - 12.5 million) and the III group comprised patients without any effect (TPMSC did not change, or became less than preoperative one) after varicocelectomy. The initial clinical characteristics of patients in the groups were compared. RESULTS: A significant effect was observed in 52% of cases (n=48), a mild favorable effect in 21% (n=20), and no effect in 27% (n=25). Spontaneous pregnancy rates (in 1 year after varicocele repair) were higher in patients of group I than that of groups II and III: 46%, 10% and 12%, respectively (p<0.05). The initial clinical characteristics between groups were comparable (p>0.05). In group I, the initial semen analysis parameters were significantly better than in group II and worse than in group III: the median and 25% -75% of the quartiles for TPMSC were 15 (1-44), 0 (0-8) and 54 (19-100) million, respectively (for all p<0.001). According to discriminant analysis significant predictors of pregnancy after varicocelectomy were an increase of TPMSC, male age and the initial total sperm motility. The predictive accuracy of the prognostic model with these three predictors was 84%, specificity was 87%, and sensitivity was 76%. CONCLUSIONS: The odds of fertility recovery after varicocelectomy has a U-shaped relationship: it is higher in patients with moderate semen quality impairment and it decreases in patients with initially low, and, conversely, high sperm count and motility. An increase in TPMSC by 12.5 million or more is a highly significant indicator of fertility recovery, because in this case the odds of spontaneous pregnancy can reach 50%. Predictors of fertility recovery after varicocelectomy are an increase of TPMSC, male age and the preoperative total motility.


Assuntos
Infertilidade Masculina , Varicocele , Feminino , Fertilidade , Humanos , Infertilidade Masculina/etiologia , Infertilidade Masculina/cirurgia , Masculino , Gravidez , Estudos Prospectivos , Análise do Sêmen , Contagem de Espermatozoides , Motilidade Espermática , Varicocele/cirurgia
3.
Acta Clin Croat ; 60(1): 41-49, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34588720

RESUMO

Several years ago, elastography emerged as a potentially very useful ultrasound technique that is currently used in diagnostic workup of the breast, liver and some other organ systems, whereas for other ones it is still mainly in the phase of research. The aim of the study was to compare elasticity index (EI) of testicles using strain elastography in healthy subjects and those with pathologic changes of testicles/scrotum. A total of 117 patients were included in the study. Measurements were performed on a Logiq E9 ultrasound system using strain elastography. In healthy subjects, the mean EI value was 1.34±0.35 for right testis and 1.49±0.47 for left testis. Increased mean EI values were found in the following six conditions: patients with varicocele, infertile patients, solitary testis after orchidectomy of the other testicle because of tumor, patients with testicular tumors, patients after orchidopexy of undescended testicle, and patients with congenitally smaller testicle. There is a paucity of literature data on the use of elastography in testes, as well as on normal elastography values in testicular tissue. Strain elastography was demonstrated to be a valuable method to acquire additional information in patients with pathologic changes in testicles/scrotum. These data provide reference values for further research in a larger sample of subjects.


Assuntos
Técnicas de Imagem por Elasticidade , Varicocele , Humanos , Masculino , Escroto/diagnóstico por imagem , Testículo/diagnóstico por imagem , Ultrassonografia
5.
Andrologia ; 53(11): e14209, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34378218

RESUMO

Varicocele, phimosis and undescended testes are the most frequent andrological diseases in paediatric age; varicocele and undescended testes are primary causes of male infertility and the interests of research about these conditions have changed in the last years. The aim of the study was to report our experience after 20 years of macro-area school screening between 2000 and 2020. Data about school screening were reviewed and analysed. Subjects aged between 11 and 14 years underwent andrological visit. During the study period, three main andrological screenings were performed into our macro-area. The distribution of cohorts was different among the screenings. Among andrological diseases, varicocele diagnosis increased especially in the last 10 years. Phimosis was diagnosed less respect the first screening (2000-2001), while at present there were no cases of undescended testes. Our experience reported some interesting data, especially for the higher incidence of varicocele detected on two consecutive school screening; our results demonstrate also the importance and the preventive role of andrological check-up also in paediatric age and adolescence, to reduce the incidence of those diseases affecting the fertility potential.


Assuntos
Criptorquidismo , Infertilidade Masculina , Varicocele , Adolescente , Criança , Criptorquidismo/diagnóstico , Criptorquidismo/epidemiologia , Fertilidade , Humanos , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/epidemiologia , Masculino , Instituições Acadêmicas , Testículo , Varicocele/epidemiologia
6.
Semin Pediatr Surg ; 30(4): 151084, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34412881

RESUMO

Varicocele is defined as an abnormal dilation and tortuosity of the internal spermatic veins found within the pampiniform plexus. It is a common finding in adolescents and adult men alike, however its diagnosis in the adolescent population poses different dilemmas in regard to indications for treatment than in adults. Failed Paternity is a clear-cut indication for repair in adult men attempting to father children. In adolescents, the physicians, family and patients must consider potential for future fertility problems which may or may not actually become of concern. Assessing the degree of negative effect of the varicocele on an adolescent's testicular health can also be difficult as teenagers typically are not asked to provide semen for analysis and thus surrogate markers for testicular health such as testicular size differentials must be used. Treatment options for the adolescent varicocele are similar to options in adult populations. While risks and benefits of various techniques can be considered, the gold standard for varicocele repair in adolescents has not been clearly defined. We aim to discuss diagnosis of varicocele, considerations for initiating treatment of varicocele in the adolescent, and techniques for management.


Assuntos
Varicocele , Adolescente , Adulto , Criança , Humanos , Masculino , Testículo , Varicocele/diagnóstico , Varicocele/cirurgia
7.
Arch Ital Urol Androl ; 93(2): 227-232, 2021 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-34286561

RESUMO

BACKGROUND: This study aimed to determine the contribution of color Doppler ultrasonography (CDUS) performed before varicocelectomy to the success of surgical treatment and to evaluate the correlation between CDUS findings and semen parameters. METHODS: A total of 84 patients diagnosed with grade 3 left varicocele in our clinic between 2016 and 2018 were evaluated. The patients in whom the decision for varicocelectomy was based on only physical examination (PE) findings and abnormal semen analysis (SA) were defined as Group 1, while the patients undergoing varicocelectomy based on PE, CDUS and SA findings were defined as Group 2. The patients diagnosed with varicocele based on PE and CDUS findings who were included in a followup protocol due to normal semen parameters were defined as Group 3. RESULTS: In Group 1, there was a total of 28 patients and the mean number of ligated internal spermatic veins was 4.53 (range, 2-10). In Group 2, there was a total of 30 patients and the number of ligated internal spermatic veins was 3.76 (range, 1-8). No statistically significant difference was found between Group 1 and 2 in terms of the number of internal spermatic veins ligated during varicocelectomy. No statistically significant correlation was found between semen parameters and the number of veins ligated during varicocelectomy in Group 1 and 2 and between semen parameters and CDUS findings group 2 and 3. CONCLUSIONS: In patients with primary grade 3 varicocele, diagnosed by physical examination there is no need for additional imaging in primary cases.


Assuntos
Sêmen , Varicocele , Humanos , Masculino , Análise do Sêmen , Ultrassonografia Doppler em Cores , Varicocele/diagnóstico por imagem , Varicocele/cirurgia , Veias/diagnóstico por imagem
8.
Arch Ital Urol Androl ; 93(2): 233-236, 2021 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-34286562

RESUMO

OBJECTIVE: In this study, we compared postoperative outcomes of patients submitted to varicocele correction under general or local anesthesia at a single center. METHODS: All patients underwent varicocele surgical treatment with the Colpi-modified Marmar subinguinal technique. They were managed with either general (Group A) or local with ileo-inguinal and ileo-hypogastric nerves block (Group B) anesthesia. The two groups were compared in terms of timing of discharge and post-operative pain as assessed with the numeric rating scale (NRS) at both rest and movement (NRSm). § Results: Overall, 63 patients were included with a mean (SD) age of 25 years ± 5 yrs. The NRS mean score was significantly lower for Group B during the first 4 days after surgery at both rest and movement (all p < 0.05). Patients receiving local anesthesia showed a faster time to first urination (210 vs. 240 min; p = 0.02), although the time to discharge was comparable between the two groups (250 vs. 250 min). CONCLUSIONS: These results suggest that local anetshesia for varicocele surgical treatment is feasible and provide better pain control and faster recovery after surgery.


Assuntos
Anestesia Local , Varicocele , Adulto , Procedimentos Cirúrgicos Ambulatórios , Estudos de Viabilidade , Humanos , Masculino , Dor Pós-Operatória , Varicocele/cirurgia
9.
J Laparoendosc Adv Surg Tech A ; 31(8): 942-946, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34242515

RESUMO

Objectives: Evaluate clinical outcome, recurrence, morbidity, and cost associated with laparoscopic surgical ligation versus percutaneous embolization of adolescent varicocele. We hypothesize that both approaches are similar in outcomes, complications, and cost. Materials and Methods: A retrospective review of 56 consecutive adolescent males, ≤18 years from 2006 to 2016 with clinical varicocele who underwent laparoscopic surgical ligation or percutaneous embolization. Patient demographics, operative time, postoperative complications, success, varicocele grade, recurrence, and hospital charges were abstracted. Results: Mean age was 14.2 ± 2.1 years; 48 (86%) patients having undergone laparoscopic surgical ligation and 8 (14%) percutaneous embolization. Intervention in 45 (80%) patients was for testicular hypotrophy (mean 27.4% ± 15.6%) and 11 (20%) for pain symptomology. Median follow-up was 17.5 months (range 1-65 months). After ligation, 2 (4%) patients developed hydroceles (1 with subsequent hydrocelectomy) and 6 (12%) varicocele recurrence. There were no cases of hydrocele or varicocele recurrence after percutaneous embolization. Twenty ligation patients had postoperative scrotal ultrasound demonstrating an increase in testicular volume by a reduction in difference in testicular volume from 27.3% ± 14.7% preoperatively to 11.2% ± 13.6% postoperatively (P < .001). There was significant difference in mean operative time between the groups (surgical ligation 41.3 minutes versus percutaneous embolization 117.9 minutes, P < .001) and hospital charges for the procedure (surgical ligation $3983 versus percutaneous embolization $18.165, P < .001). Conclusions: Contrary to our hypothesis, percutaneous embolization has seemingly lower rates of postoperative hydrocele and varicocele recurrence in comparison to surgical ligation but with three times the exposure to general anesthesia and at four times the price.


Assuntos
Laparoscopia , Varicocele , Adolescente , Custos e Análise de Custo , Humanos , Ligadura , Masculino , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Varicocele/cirurgia
10.
Artigo em Inglês | MEDLINE | ID: mdl-34199549

RESUMO

Since varicocele is so common in infertile men, this study intends to analyse the relationships between varicocele and conventional semen characteristics, sperm nuclear DNA dispersion and oxidation-reduction potential (ORP) in semen. Varicocele-positive and varicocele-negative infertile men (study groups) showed significantly lower standard sperm parameters and higher sperm DNA fragmentation (SDF) and ORP in semen than healthy volunteers and subjects with proven fertility (control groups). A lower proportion of low SDF levels (0-15% SDF) and higher incidence of high SDF levels (>30% SDF), as well as a higher prevalence of high ORP values (>1.37 mV/106 sperm/mL), were found in the study groups vs. the control groups. Moreover, infertile men had significantly lower odds ratios (ORs) for low SDF levels and significantly higher ORs for high SDF levels and high ORP. SDF and ORP were negatively correlated with sperm number, morphology, motility and vitality. Furthermore, a significant positive correlation was found between SDF and ORP. The obtained results suggest that disorders of spermatogenesis may occur in varicocele-related infertility. These abnormalities are manifested not only by reduced standard semen parameters but also by decreased sperm DNA integrity and simultaneously increased oxidative stress in semen.


Assuntos
Infertilidade Masculina , Varicocele , DNA/metabolismo , Humanos , Infertilidade Masculina/genética , Masculino , Oxirredução , Sêmen , Análise do Sêmen , Contagem de Espermatozoides , Motilidade Espermática , Espermatozoides/metabolismo , Varicocele/metabolismo
11.
Urologiia ; (3): 122-128, 2021 06.
Artigo em Russo | MEDLINE | ID: mdl-34251112

RESUMO

Varicocele does not always lead to infertility; varicocelectomy does not always improve sperm. THE STUDY OBJECTIVE: to evaluate the quantitative correlation between varicocele and reproductive function with a large sample. DESIGN: a cross-sectional and case control study. MATERIALS AND METHODS: 3632 patients from infertile couples and 276 fertile males. The ejaculate was tested following WHO recommendations (2010), DNA fragmentation was evaluated with chromatin dispersion in agarose gel. RESULTS: we found weak correlation between varicocele degree (VD) and the spermogram parameters: -0.11 for concentration (<0.001), -0.08 for progressively motile sperm count (PMSC) in the ejaculate (<0.001), 0.11 for DNA fragmentation (<0.01), correlation with other parameters was insignificant (p>0.05). The clinical varicocele (V) prevalence in the fertile (F) and the infertile (I) males was the same: 27.2% (75/276) in the F, 31.4% (101/322) in the I1 with oligoasthenotertozoospermia (OAT) syndrome, 34.4% (43/125) in the I2 with OAT (p>0.05). In the general sample of the males from infertile couples V was found insignificantly more frequently in the I2 than in the I1 31.6% (426/1348) and 28.1% (641/2284), respectively (OR=1.13; p<0.05), because of degree 1 varicocele: 23.5% 20.2%, respectively (OR=1.16; p<0.05). Compared to the males without varicocele, median concentration is 8 mln/ml less in degree I,17mln/ml in degree II and 24 mln/ml in degree III (p<0.001); we found parallel increase in oligozoospermia rate: from 14% without varicocele to 27 and 26% in degree II and III (p<0.05-0.01). The PMSC in degree I varicocele is 10 mln less (-16% of the group without varicocele),in degree II 27 mln less (-44%), in degree III 23 mln less (-38%) (<0.001); the difference between the groups with degrees II and III is insignificant (p>0.05). The DNA fragmentation was significantly lower only in degree III (p<0.05). We found no difference in the sperm motility and morphology among the groups (p>0.05). CONCLUSION: In varicocele, the sperm count decreases but in of cases, concentration is within reference values; there is no difference between degree II and III. The sperm motility and morphology do not depend upon varicocele. The DNA fragmentation is increased in degree III varicocele. The relative risk of infertility in varicocele is low (OR is less or equal 1.13).


Assuntos
Infertilidade Masculina , Varicocele , Estudos de Casos e Controles , Estudos Transversais , Fragmentação do DNA , Humanos , Infertilidade Masculina/epidemiologia , Infertilidade Masculina/etiologia , Masculino , Contagem de Espermatozoides , Motilidade Espermática , Espermatozoides , Varicocele/epidemiologia
12.
Arch Razi Inst ; 76(2): 371-384, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34223735

RESUMO

The current study aimed to determine the effect of metformin (MET) on histopathologic evaluation and antioxidant enzyme activity in experimental varicocele-induced rats. A total of 60 rats were randomly divided into six experimental groups. Group 1 (control) received no medication and underwent no surgery. In group 2 (sham), the rats received no medication and the abdominal cavity was opened; however, there was no varicocele induction. In group 3 (varicocele), the abdominal cavity was opened and the rats underwent varicocele induction and received no medication. In group 4, the abdominal cavity was opened and the animals received 25 mg/kg of MET for 42 days and were varicocele-induced. Groups 5 and 6 were similar to group 4 except that the animals received 50 and 100 mg/kg of MET, respectively. At the end of the 21st and 42nd days, the rats were euthanized and the left testis was removed for histological analysis and measurement of superoxide dismutase (SOD), malondialdehyde (MDA), glutathione peroxidase (GPx), and total antioxidant status levels. According to the results, a dose-dependent difference was observed in testis damage grade in the MET treated groups, compared to that reported for the varicocele group (p &lt;0.05). No difference was observed between 25 and 50 mg/kg of MET (P&gt;0.05). Tissue MDA levels significantly increased in varicocele rats (p &lt;0.05); however, MET (25, 50, and 100 mg/kg) in a dose-dependent manner decreased varicocele-induced MDA (p &lt;0.05). Experimental varicocele significantly decreased SOD activity, compared to that reported for the control group (p &lt;0.05). The administration of MET (25, 50, and 100 mg/kg) significantly increased tissue SOD activity in varicocele rats (p &lt;0.05). The MET (25, 50, and 100 mg/kg) in a dose-dependent manner increased GPx activity in varicocele rats (p &lt;0.05). There was no difference in MDA, SOD, and GPx levels between 25 and 50 mg/kg MET groups (P&gt;0.05). The aforementioned findings suggested that MET treatment had beneficial effects on varicocele.


Assuntos
Metformina , Doenças dos Roedores , Varicocele , Animais , Masculino , Malondialdeído , Metformina/uso terapêutico , Ratos , Ratos Wistar , Testículo , Varicocele/veterinária
13.
Andrologia ; 53(10): e14187, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34309875

RESUMO

MUSASHI (MSI) family plays the main role in the spermatogenesis process. The purpose of this study was the assessment of sperm MSI1 and MSI2, and sperm functional tests in infertile men (n = 30) with varicocele and fertile men (n = 30). Furthermore, MSI1 and MSI2 proteins were assessed in testicular tissue of azoospermic men (n = 9) as well as epididymal spermatozoa and testis of mice. Expression of MSI1 and MSI2 was assessed at RNA and protein levels in human spermatozoa. Sperm concentration and motility were significantly lower, while abnormal sperm morphology, lipid peroxidation, DNA fragmentation and protamine deficiency were significantly higher in men with varicocele compared to fertile individuals. Any significant difference was not observed in the expression of MSI1 and MSI2 mRNA between the two groups. Unlike MSI1 protein that was not detectable in humans, the relative expression of MSI2 protein was similar in varicocele and fertile individuals. The expression level of both Msi1 and Msi2 proteins was also observable in mouse spermatozoa. No significant relationship was observed between sperm functional parameters with expression of these genes. The data of this study demonstrated that although MSI1 and MSI2 play important roles during spermatogenesis, their relative expression in spermatozoa was not affected by varicocele.


Assuntos
Infertilidade Masculina , Varicocele , Animais , Humanos , Infertilidade Masculina/genética , Masculino , Camundongos , Proteínas do Tecido Nervoso/metabolismo , Proteínas de Ligação a RNA/genética , Espermatogênese , Espermatozoides/metabolismo , Testículo/metabolismo , Varicocele/genética
15.
Andrologia ; 53(8): e14131, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34117798

RESUMO

We assessed the effect of smoking and/or obesity on semen parameters and testosterone/oestradiol (T/E) ratio among sub-fertile men treated with sub-inguinal varicocelectomy. In this prospective, controlled, clinical study, 80 sub-fertile men with clinical varicocele who were subjected to sub-inguinal varicocelectomy were assigned into four equal groups (n = 20/each), group A: obese and smokers, group B: obese and nonsmokers, group C: smokers and nonobese and group D: nonsmokers and nonobese. Semen parameters, serum testosterone, oestradiol, follicle-stimulating hormone, luteinising hormone, prolactin and calculation of T/E ratio were assessed at baseline and 6 months post-varicocelectomy. The mean age ± SD of the study population was 26.1 ± 4.55. No statistical difference was detected among the study groups regarding age, residence, education, marital status and occupation (p > 0.05 for each). Post-operatively, significant improvements in semen parameters were detected in all groups. There was a significant difference between groups A and B versus C and D (obese versus nonobese groups) and between groups A and C versus B and D (smokers versus nonsmokers; p < 0.05 for each) regarding semen parameters, testosterone level and T/E ratio. Smoking and/or obesity negatively affect(s) the favourable outcome of varicocelectomy, specifically improvement of semen parameters and hormonal pattern in sub-fertile men with varicocele.


Assuntos
Infertilidade Masculina , Varicocele , Humanos , Infertilidade Masculina/etiologia , Masculino , Obesidade/complicações , Obesidade/cirurgia , Estudos Prospectivos , Fumar/efeitos adversos , Testosterona , Varicocele/cirurgia
16.
Andrologia ; 53(8): e14121, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34118088

RESUMO

Our study aimed to assess for predictors of varicocele-associated pain and whether it predicts semen parameters after microsurgical varicocelectomy. We assessed all men diagnosed with a varicocele by two surgeons from 2017 to 2020, excluding those who did not undergo surgical treatment. Patients were stratified based on the presence of pain at clinical assessment, and these groups were compared. Logistic regression models were utilised to assess for predictors of pain. A total of 313 men were included, with relatively similar proportions completed by both surgeons (48.2% and 51.8%). A total of 98 (31.3%) had typical varicocele-associated pain at the time of assessment. The pain group was younger than the no pain group (30.5 versus. 35.0, respectively, p < .01), and those with pain had greater varicocele grades (p = .008). Although not statistically different, there was a greater portion of left-sided only varicoceles in the pain group (p = .09). No significant differences were demonstrated between sperm concentration, motility, volume or morphology pre-operatively, or post-operatively between groups. Younger age and varicocele grade were predictive of varicocele-associated pain. In conclusion, almost 1/3 of men presented with varicocele-associated pain. Pain does not predict response to varicocelectomy, but these men tend to be younger, and have higher grade varicoceles.


Assuntos
Infertilidade Masculina , Varicocele , Humanos , Infertilidade Masculina/etiologia , Infertilidade Masculina/cirurgia , Masculino , Microcirurgia , Dor/etiologia , Sêmen , Contagem de Espermatozoides , Varicocele/cirurgia
17.
J Pediatr Urol ; 17(4): 537.e1-537.e5, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34099399

RESUMO

BACKGROUND: Varicocele affects 15% of adolescents. The main postoperative complications are recurrence and hydrocele; nerve injury is rarely reported. OBJECTIVE: The aims of this study are: to assess the complications after laparoscopic varicocelectomy, namely nerve injury; and to assess if nerve injury is more frequent using "hot" or "cold" ligation. STUDY DESIGN: Retrospective study of varicocele cases submitted to laparoscopic correction in our department from April 2006 to March 2020. Parameters analyzed were: age, clinical findings, surgical indication, operative technique, and outcomes. Comparison was done between the "cold" versus "hot" vessel section technique. RESULTS: 110 patients, with median age 14-years-old, were included. Most cases were on the left side and grade 3. Fifty patients (45%) presented complications: 21% recurrence; 18% hydrocele; and 3% genitofemoral nerve injury. Nerve injury was independent of the technique used. DISCUSSION: Genitofemoral nerve injury is a complication with unknown cause and all cases are related to laparoscopic technique. It was suggested that "hot" methods of ligation of the vessels can lead to higher incidence of the lesion, but that was not corroborated in our analysis. Possible explanations for its occurrence are: a wide peritoneal window opening created with electrocautery near the internal inguinal ring; and additional dissection required to isolate the testicular veins from the artery. Prospective studies are needed to clarify the real incidence of genitofemoral nerve injury and its causes. CONCLUSIONS: Laparoscopic varicocelectomy seems to be safe and effective, although complications remain frequent regardless of the technique used. Genitofemoral nerve injury is a complication rarely described that may require rehabilitation, and so awareness for this problem is of paramount importance.


Assuntos
Laparoscopia , Hidrocele Testicular , Varicocele , Adolescente , Criança , Humanos , Laparoscopia/efeitos adversos , Masculino , Estudos Retrospectivos , Varicocele/cirurgia , Procedimentos Cirúrgicos Vasculares
18.
Andrologia ; 53(7): e14081, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34009669

RESUMO

We aimed to identify proteins that were differentially regulated in spermatozoal samples collected from fertile healthy men (FHM) and infertile patients with varicocele (IFPV) before and after varicocelectomy. Seminal samples were collected from 20 IFPV before and after varicocelectomy and from 14 FHM as controls. Samples underwent seminal examination and proteomic analysis. Extracted spermatozoal proteins were analysed using two-dimensional gel electrophoresis, and differentially regulated spermatozoal proteins (DRSPs) were identified. In particular, attention was placed on those DRSPs in which the concentration changed after varicocelectomy and corrected to approximate levels observed in FHM. Varicocelectomy significantly improved the sperm count and concentration in IFPV (p < 0.05). Proteomic analysis showed that 11 DRSPs were identified when comparisons were made among the three groups. Among these 11 proteins, change in the SERPIN A5 concentrations was notable because it was 100-fold downregulated in pre-operative IFPV samples and nearly resembled to control concentrations following varicocelectomy. Western blot analysis using an anti-SERPIN antibody validated the changes observed in SERPIN A5 levels before and after varicocelectomy operation. Increase in SERPIN A5 after varicocelectomy may be due to improvement in semen quality, suggesting that SERPIN A5 is a potential seminal biomarker for assessment of semen quality in varicocele-related infertility.


Assuntos
Infertilidade Masculina , Varicocele , Biomarcadores , Humanos , Infertilidade Masculina/etiologia , Masculino , Inibidor da Proteína C , Proteômica , Sêmen , Análise do Sêmen , Contagem de Espermatozoides , Varicocele/cirurgia
19.
Andrologia ; 53(8): e14101, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33961713

RESUMO

The objective was to reveal predictors for fertility recovery after varicocelectomy in subfertile men. This retrospective study recruited 93 men with clinical varicocele and pathozoospermia who underwent microsurgical varicocelectomy. Stepwise discriminant analysis was performed to identify predictors of spontaneous pregnancy (SP) after surgery. 'Clinically significant improvement' (CSI) following varicocelectomy was defined as an increase in total progressively motile sperm count (TPMSC) by at least 12.5 million (calculated from WHO-2010 reference values). 52% of patients showed CSI, and 28% reported SP after surgery. Patients who reported SP (group II), compared to that remained infertile (group I), were younger (27.3 ± 2.9 versus 30.2 ± 4.2 years; p < .01), had less infertility period (24.1 ± 14.0 versus 44.4 ± 32.9 months; p < .05) and had initially higher TPMSC (median (25% -75%) = 34 (11-67) versus 9.5 (0-33) mln; p < .05). The stepwise discriminant analysis showed that male age (coefficient value = -0.157), total sperm motility (0.024) and postoperative increase in TPMSC (0.010) were the significant predictors of SP. The predictive ability, sensitivity and specificity of the discriminant function were 84%, 87%, 76% respectively. This algorithm can be recommended after varicocelectomy in decision-making on natural conception or the ART protocols usage.


Assuntos
Infertilidade Masculina , Varicocele , Feminino , Humanos , Infertilidade Masculina/etiologia , Infertilidade Masculina/cirurgia , Laboratórios , Masculino , Microcirurgia , Gravidez , Recuperação de Função Fisiológica , Estudos Retrospectivos , Contagem de Espermatozoides , Motilidade Espermática , Varicocele/cirurgia
20.
Fertil Steril ; 116(3): 696-712, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33985792

RESUMO

OBJECTIVE: To evaluate the effect of varicocelectomy on sperm deoxyribonucleic acid fragmentation (SDF) rates in infertile men with clinical varicocele. DESIGN: Systematic review and meta-analysis. SETTING: Not applicable. PATIENT(S): Infertile men with clinical varicocele subjected to varicocelectomy. INTERVENTION(S): Systematic search using PubMed/Medline, EMBASE, Cochrane's central database, Scielo, and Google Scholar to identify relevant studies published from inception until January 2021. We included studies comparing SDF rates before and after varicocelectomy in infertile men with clinical varicocele. MAIN OUTCOME MEASURE(S): The primary outcome was the difference between the SDF rates before and after varicocelectomy. A meta-analysis of weighted data using random-effects models was performed. Results were reported as weighted mean differences (WMD) with 95% confidence intervals (CIs). Subgroup analyses were performed on the basis of the SDF assay, varicocelectomy technique, preoperative SDF levels, varicocele grade, follow-up time, and study design. RESULT(S): Nineteen studies involving 1,070 patients provided SDF data. Varicocelectomy was associated with reduced postoperative SDF rates (WMD -7.23%; 95% CI: -8.86 to -5.59; I2 = 91%). The treatment effect size was moderate (Cohen's d = 0.68; 95% CI: 0.77 to 0.60). The pooled results were consistent for studies using sperm chromatin structure assay, terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling, sperm chromatin dispersion test, and microsurgical varicocele repair. Subgroup analyses showed that the treatment effect was more pronounced in men with elevated vs. normal preoperative SDF levels, but the impact of varicocele grade remained equivocal. Meta-regression analysis demonstrated that SDF decreased after varicocelectomy as a function of preoperative SDF levels (coefficient: 0.23; 95% CI: 0.07 to 0.39). CONCLUSION(S): We concluded that pooled results from studies including infertile men with clinical varicocele indicated that varicocelectomy reduced the SDF rates. The treatment effect was greater in men with elevated (vs. normal) preoperative SDF levels. Further research is required to determine the full clinical implications of SDF reduction for these men.


Assuntos
Fragmentação do DNA , Fertilidade , Infertilidade Masculina/cirurgia , Espermatozoides/patologia , Procedimentos Cirúrgicos Urológicos Masculinos , Varicocele/cirurgia , Adulto , Humanos , Infertilidade Masculina/etiologia , Infertilidade Masculina/patologia , Infertilidade Masculina/fisiopatologia , Masculino , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Varicocele/complicações , Varicocele/patologia , Varicocele/fisiopatologia
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