Impact of varicocelectomy on gonadal and erectile functions in men with hypogonadism and infertility.

INTRODUCTION: Previous reports linked varicocele in infertile males with Leydig cell dysfunction and hypogonadism. AIM: The aim of this study was to determine the impact of varicocelectomy on serum total testosterone (TT) level and erectile function in men with infertility and clinical varicocele. METHODS: This study included 141 heterosexual infertile men diagnosed to have clinical varicocele. They were divided into two groups: group 1 (103 men), who had microsurgical varicocelectomy, and group 2 (38 patients), who decided to pursue assisted reproduction procedures. All participants completed the International Index of Erectile Function (IIEF)-5 questionnaire and underwent semen analysis. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and TT were measured both at recruitment time and 6 months later. MAIN OUTCOME MEASURE: Changes in serum TT and IIEF-5 following varicocelectomy. RESULTS: In group 1, the mean TT level increased significantly post-varicocelectomy (379.1 ± 205.8 to 450.1 ± 170.2 ng/dL, P < 0.0001). No similar change was found in group 2. Out of the 49 patients in group 1 with hypogonadism at baseline assessment (TT < 300 ng/dL), 37 (75.5%) exhibited a postoperative normalization of TT. However, only 3/15 hypogonadal men (20%) in group 2 had normal testosterone levels at the second visit. IIEF-5 scores improved significantly postoperatively in patients with hypogonadism (17.1 ± 2.6 to 19.7 ± 1.8, P < 0.001). Neither operating vein diameter 3.6 ± 0.57 mm nor testicular size 10.46 ± 3.3 mL correlated with the mean change in TT (71.1 ± 101.2 ng/dL) (r = 0.162, P = 0.183 and r = -0.077, P = 0.536, respectively). CONCLUSIONS: Varicocele is associated with hypogonadism in some infertile patients. Varicocelectomy significantly improves serum testosterone in infertile men, especially those with hypogonadism. This improvement in TT level may be reflected in the IIEF score.

Reactive oxygen species and antioxidants relationship in the internal spermatic vein blood of infertile men with varicocele.

AIM: To assess the relation of reactive oxygen species (ROS) and antioxidants in the internal spermatic vein blood compared to the peripheral venous blood. METHODS: Sixty-eight infertile oligoasthenozoospemic patients associated with varicocele were investigated. During inguinal varicocelectomy, blood samples of internal spermatic as well as median cubital veins were withdrawn. Three ROS factors (malondialdehyde [MDA], hydrogen peroxide H(2)O(2), nitric oxide [NO]) and four antioxidants (superoxide dismutase [SOD], catalase [Cat], glutathione peroxidase [GPx] and vitamin C) were estimated in these blood samples. RESULTS: Mean levels of tested ROS factors were significantly higher in the internal spermatic venous blood compared to those in the peripheral one (mean+/-SD) (MDA 18.7+/-1.4 nmol/mL vs. 15.4+/-1.4 nmol/mL, H(2)O(2) 43.6+/-8.0 micromol/mL vs. 30.8+/-8.1 micromol/mL, NO 2.3+/-0.5 nmol/L vs. 1.6+/-0.4 nmol/L, P<0.01). Mean levels of tested antioxidants were significantly lower in the internal spermatic venous blood compared to those in the peripheral one (superoxide dismutase 1 690.7+/-130.0 U/mL vs. 1 818.5+/-143.0 U/mL, catalase 38.9+/-6.1 mol/L vs. 47.9+/-10.2 mol/L, GPx 20.4+/-8.1 U/mL vs. 23.0+/-8.4 U/mL, vitamin C 0.3+/-0.1 vs. 0.4+/-0.1 mg/dL, P<0.05). CONCLUSION: Internal spermatic venous blood of infertile male cases associated with varicocele demonstrated elevated levels of ROS and decreased levels of antioxidants compared to peripheral venous circulation.

Beta-endorphin in serum and seminal plasma in infertile men.

AIM: To access beta-endorphin levels in serum as well as seminal plasma in different infertile male groups. METHODS: Beta-endorphin was estimated in the serum and seminal plasma by enzyme-linked immunosorbent assay (ELISA) method in 80 infertile men equally divided into four groups: non-obstructive azoospermia (NOA), obstructive azoospermia (OA), congenital bilateral absent vas deferens (CBVAD) and asthenozoospermia. The results were compared to those of 20 normozoospermic proven fertile men. RESULTS: There was a decrease in the mean levels of beta-endorphin in the seminal plasma of all successive infertile groups (mean +/- SD: NOA 51.30 +/- 27.37, OA 51.88 +/- 9.47, CBAVD 20.36 +/- 13.39, asthenozoospermia 49.26 +/- 12.49 pg/mL, respectively) compared to the normozoospermic fertile control (87.23 +/- 29.55 pg/mL). This relation was not present in mean serum level of beta-endorphin between four infertile groups (51.09 +/- 14.71, 49.76 +/- 12.4, 33.96 +/- 7.2, 69.1 +/- 16.57 pg/mL, respectively) and the fertile control group (49.26 +/- 31.32 pg/mL). The CBVAD group showed the lowest seminal plasma mean level of beta-endorphin. Testicular contribution of seminal beta-endorphin was estimated to be approximately 40%. Seminal beta-endorphin showed significant correlation with the sperm concentration (r = 0.699, P = 0.0188) and nonsignificant correlation with its serum level (r = 0.375, P = 0.185) or with the sperm motility percentage (r = 0.470, P = 0.899). CONCLUSION: The estimation of beta-endorphin alone is not conclusive to evaluate male reproduction as there are many other opiates acting at the hypothalamic pituitary gonadal axis.

Psychosocial impact and effectiveness of tadalafil among treatment-naïve and previously-treated men with erectile dysfunction in Saudi Arabia and other Gulf-region countries.

OBJECTIVE: This observational, comparative study, conducted in Saudi Arabia, Kuwait, and the United Arab Emirates, assessed psychosocial and efficacy outcomes of tadalafil 20 mg on demand, over a period of 20 weeks, in men with erectile dysfunction (ED) who were treatment-naïve versus pretreated with an ED treatment other than tadalafil. METHODS: The short form of the Psychological and Interpersonal Relationship Scales (SF-PAIRS) was used to assess psychosocial outcomes (Time Concerns, Spontaneity, and Sexual Self-Confidence). Change from baseline in the International Index of Erectile Function (IIEF) erectile function (EF) domain score was used to assess effectiveness, and Global Assessment Question (GAQ) was asked to determine improvement in erections. RESULTS: Of 1080 patients analyzed, 557 (51.6%) were treatment-naïve and 523 (48.4%) were pretreated. In all, 500 (89.8%) treatment-naïve men and 473 (90.4%) pretreated men completed the study. Some statistically significant differences were observed in baseline characteristics between treatment-naïve and pretreated groups, including ED etiology, ED severity, duration of ED, and the presence of cormorbid cardiovascular disease, other vascular disease, and neurological disease. Adjusted mean SF-PAIRS Time Concerns domain score was significantly more improved, while the Sexual Self-Confidence domain score was significantly less improved, for the pretreated group compared with the treatment-naive group (both p<0.0001). No significant difference was observed for the Spontaneity domain. The mean change in IIEF-ED domain score for the treatment-naïve group was 13.26 compared with 9.28 for the pretreated group (p<0.0001). Positive responses to GAQ at the last assessment were observed in 97.3% of treatment-naïve men and 94.4% of pretreated men (p<0.0263). CONCLUSION: This large, observational study in the Gulf region demonstrates that ED patients treated with tadalafil in a naturalistic setting, report improvements in both psychosocial outcomes and erectile function, with some differences between the treatment-naïve and pretreated groups. The results of this study may assist physicians in tailoring tadalafil therapy and setting realistic treatment expectations.