Aim:

Cryptorchidism represents the most frequent male genital anomaly in paediatric population and may potentially interfere with fertility and determine neoplastic testicular diseases. We wanted to evaluate the correlation between age at orchiopexy and follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone levels in adulthood, determining the long-term complications of surgical treatment.

Methods:

Fifty-seven patients (mean age 19 years, range 18-27) surgically treated for cryptorchidism in pediatric age were included in a medium and long-term follow-up (10-19 years). We divided this population into four groups: A) monolateral cryptorchidism operated on before 36 months of age (15); B) monolateral cryptorchidism operated on over 36 months (32); C) bilateral cryptorchidism operated on before 36 months (5); and D) bilateral cryptorchidism operated on over 36 months (5). All patients underwent andrological examination, testosterone, FSH and LH dosage, measurement of testicular volume and spermiogram.

Results:

Significant different FSH levels were found between group A and C and between A and D (P<0.01), while groups A and D presented also different mean testicular volume (P<0.01). In addition group D showed an abnormal morphology of spermiogram. The main complications found in follow-up were hydrocele (17,5%), varicocele (8,7%) and epididymal cysts (3.6%).

Conclusion:

Monolateral cryptorchidism is associated with normal fertility when treated early (group A). Subjects in Group D, on the contrary, have a rise of FSH, a reduction of testicular volume and semen abnormalities. The long-term follow-up of these patients can also detect associated.

This study was conducted to investigate the effects of aescin treatment in a rodent model treated with an experimentally induced varicocele. Experimental varicocele was induced by partial ligation of the left renal vein of rats. Aescin administration was performed daily for 4 weeks after the varicocele induction. Seven weeks later, a contrast-enhanced ultrasound was performed of the rats' testis to assess testicular blood flow. The animals were sacrificed, and H&E staining was then used to evaluate testicular pathological changes and polymorphonuclear leucocytes density. Cauda epididymal sperm counts and motility were evaluated. Blood was collected for the measurement of follicle-stimulating hormone, luteinising hormone and testosterone. Contrast-enhanced ultrasound showed that there were significant decreases in testicular blood flow in the aescin-treated groups compared with those in control varicocele group. Testicular oedema was detected in those rats treated with a varicocele but without aescin, while no oedema was found in the experimental group. H&E staining showed dysfunctional spermatogenesis in both cohorts; however, polymorphonuclear leucocytes density was significantly reduced in aescin-treated groups. There was an increase in sperm counts of the aescin-treated groups. Our study demonstrated that aescin could exert therapeutical effects on reversal of testicular lesions in varicocele rats.

OBJECTIVE:

To evaluate the effect of varicocelectomy on sperm retrieval at testicular sperm extraction (TESE) and at spermiograms in patients with nonobstructive azoospermia.

MATERIALS AND METHODS:

An observational study was conducted from April 2008 to December 2011. The study included men with a clinical diagnosis of nonobstructive azoospermia with a history of clinical unilateral varicocele (only grade III). After providing consent, the patients were treated with 2 different strategies according to the timing of varicocelectomy: group 1, varicocelectomy before microsurgical TESE (3 months); and group 2, varicocelectomy during microsurgical TESE. At 6 months after varicocelectomy, we evaluated the semen analysis findings for all patients. All patients underwent subinguinal microsurgical varicocelectomy. We also evaluated the percentage of sperm retrieval during TESE.

RESULTS:

During the study period, 35 patients were enrolled. Group 1 included 19 patients and group 2, 16 patients. The sperm retrieval rate during the spermiograms was significantly greater in group 1 (57.8%) than in group 2 (37.5%). The percentage of sperm retrieval during TESE between the 2 groups was significantly greater in group 1 (57.8%) than in group 2 (27%; P <.05).

CONCLUSION:

Our results have suggested that varicocele repair significantly increases the sperm retrieval rate in patients with clinical varicocele and nonobstructive azoospermia at both TESE and spermiogram.

Varicocele associated with infertility has been recognized for years. Referential literature provides few papers, even meta-analyses which did not confirm the success of surgery related to the increasing of the semen quality.The purpose of the presented paper is referred in arising the quantum of knowledge related to usefulness of surgery in varicocele treatment.The varococele incidence was established in premature age (7-18) in population of 969 boys. In those who suffered from varicocele, we estimated their semen analysis parameters before and three months after the surgery, and followed up the pregnancy rate in surgically treated subjects many years after the treatment.A prevalence of 9.7% in premature age, significantly raising in the group aged 15-18 was showed. After the laparoscopic varicocelectomy, all of the semen parameters (left testicular volume, pH, sperm count, abnormal forms and viability) were improved, since the semen volume and the progressive motility not significantly. Since we observed adolescent varicocele, some of the semen parameters initialy have not been out of reference limits. Following the surgically treated subjects for next 12-17 years, the pregnancy rate is at least 75%, since not all of them have been married yet.We recorded improvement of two out of three parameters of fertility after the operation in a group of 23 surgically treated patients. This fact encourages those who advocate surgical treatment of varicocele in adolescents, since the early therapy would prevent fertility disorders.

This study was designed to evaluate the protective effect of silymarin (SMN) on varicocele-induced damage in testis and its effects on sperm parameters and on antioxidant status. Wistar rats were divided into three groups: control-sham, varicocele-induced, and SMN-treated varicocelized (50mg/kg, orally) rats. The sperm count, DNA integrity, and histone-protamine transition was evaluated after 42 days. The antioxidant status was analyzed by determining testicular malondialdehyde (MDA) and total thiol molecules (TTM). The endocrine status of the testicular tissue was estimated by counting the normal Leydig cell distribution/mm(2) and by determination of serum testosterone. The expression of E2f1 mRNA was analyzed using RT-PCR. Carbohydrate depletion and lipid foci replacement in germinal cells were examined by histochemical analyses. Silymarin rehabilitated the varicocele-induced Leydig cell degeneration and testosterone reduction. In addition, SMN recovered the varicocele-induced reduction of TTM and lowered significantly (P < 0.05) the varicocele-elevated content of MDA. The SMN treatment resulted in a significant (P < 0.05) down-regulation of the VCL-up-regulated E2f1 mRNA. Silymarin-treated animals were protected from varicocele-induced testicular atrophy and these animals showed a significant (P < 0.05) increase in the percentage of seminiferous tubules with positive tubular differentiation, repopulation, and spermiogenesis indices. Furthermore, SMN improved the varicocele-induced carbohydrate reduction in germinal cells. Our data suggest that in addition to oxidative stress, alteration in the testicular endocrine function plays a crucial role in the pathogenesis of varicocele. Moreover, the protective effects of SMN on varicocele-induced damage may reflect its antioxidant property, which may be mediated via the E2f1 transcription factor.

We performed the present study to evaluate the prognostic factors for the surgical outcome of varicocelectomy in the treatment of a painful varicocele.A total of 77 patients undergoing varicocelectomy were enrolled. All the patients were examined for body mass index (BMI), varicocele grade, testosterone, follicle stimulating hormone (FSH), luteinizing hormone (LH), semen analysis, maximal vein diameter, and discrepancy of testicular volume. At a follow-up visit 3~6 months after the surgery, the patient response was graded as a complete response, partial response, or no response. The resolution of pain was defined as a complete or partial response. We used logistic regression analyses to determine the preoperative factors for predicting a complete response and the resolution of pain.Ten subjects were lost to follow-up. The remaining 67 patients were included in this study. The pain was completely resolved in 47.8% of patients, partial resolution was observed in 25.4% of patients, and failure was reported in 26.9% of patients. Among the parameters, only a longer duration of pain (≥3 months) was an independent factor related to the complete response of pain (odds ratio, 7.371; p=0.010) and the resolution of pain (odds ratio, 7.209; p=0.042). The parameters of semen analysis results, testosterone, LH, FSH, BMI, grade, ultrasonography results, and the type of surgical approach did not significantly predict the resolution of pain.The duration of pain (≥3 months) was an independent prognostic factor for the complete response of pain and the resolution of pain.

The most common cause of male infertility is varicocele, and varicocele is the most common correctable cause of male factor infertility. In this article we reviewed the concept of varicocele in terms of its diagnosis, method of treatment, indications for treatment, treatment outcomes, and prognostic factors. Physical examination is an essential diagnostic tool in the evaluation of a patient with a varicocele. However, as it depends on subjective findings, standardization of the physical examination method is needed. Various methods for treatment of varicocele exist, including open surgical, laparoscopic, microscopic surgical, and radiologic treatment such as embolization. Among these treatment approaches, microscopic inguinal or subinguinal varicocelectomy has superior outcomes, with a low complication rate. The influence of the treatment of varicocele on fertility is still a controversial issue and a difficult question to address, because there are limitations to performing a randomized control study, and previous studies had a heterogeneity of subjects and high dropout rate. However, there is robust evidence that varicocelectomy improves semen parameters as a surrogate marker of the potential for fertility. To date, general indications for treatment of varicocele are limited in patients with proven infertility, clinical palpable varicocele, and abnormal semen characteristics. Recently, it was shown that some symptoms other than infertility could be an indication for varicocelectomy because these symptoms are frequently related to deterioration of semen parameters. Varicocele in the adolescent presents a more difficult decision regarding whether to treat. A testicular size discrepancy of more than 20% is helpful for treatment decisions. Various prognostic factors were noted in several studies without, however, a consistent consensus.

OBJECTIVE.

To investigate the impact of subinguinal microsurgical varicocelectomy on semen parameters and pregnancy outcomes in couples with male factor subfertility.

DESIGN.

Case series.

SETTING.

Male Infertility Clinic in an academic institution in Hong Kong.

PATIENTS.

The clinical records of 42 consecutive subfertile male patients who had subinguinal microsurgical varicocelectomy (from January 2000 to December 2009) were retrospectively reviewed. All the patients had a known history of subfertility and abnormalities in one or more semen parameters. Female subfertility factors were not addressed. Only grade 2 or higher clinically palpable varicoceles were operated on. MAIN OUTCOME MEASURES. Preoperative and postoperative semen analyses based on the World Health Organization criteria; the outcome measures included changes in semen parameters and whether a pregnancy ensued.

RESULTS.

The mean age of patients and their spouses were 38 and 33 years, respectively. The mean duration of infertility was 4 years; 37 patients had primary infertility and five had secondary infertility. The mean (+/- standard deviation) sperm concentration improved from 12 +/- 19 million/mL to 23 +/- 29 million/mL following varicocelectomy (P<0.001), the mean sperm motility improved from 26% +/- 16% to 32% +/- 18% (P<0.001), and the mean normal morphology increased from 5% +/- 7% to 6% +/- 6% (P<0.001). Postoperatively, 23 (55%) of the patients achieved pregnancy, 11 (26%) being spontaneous, 1 (2%) by intrauterine insemination, and 11 (26%) by in-vitro fertilisation. Among 20 patients with severe preoperative oligospermia (<5 million/mL), statistically significant improvements occurred in postoperative mean sperm concentration, motility and morphology (all P<0.001), and five (25%) of them achieved a spontaneous pregnancy. There was one intra-operative injury to the testicular artery with immediate repair and no testicular atrophy. Five (12%) of the patients had recurrences. No preoperative factors appeared predictive of a pregnancy ensuing.

CONCLUSIONS.

In couples with male infertility due to varicoceles, subinguinal microsurgical varicocelectomy was shown to improve sperm concentrations, motility and morphology, and the likelihood of a pregnancy. Spontaneous pregnancy was achieved in 25% of the couples in which the man had severe oligospermia.

Abstract Recent reports support the possible role of PI3K in sperm capacitation and acrosome reaction, although studies regarding PI3K identity in human sperm, under certain disease states such as varicocele, are still lacking. The authors, therefore, examined the expression profile and ultrastructural localization of PI3K in human semen samples, comparing healthy donors and patients with varicocele. The results obtained performing western blotting assay showed decreased PI3K expression in varicocele with respect to the "healthy" sperm. Immunogold labeling revealed human sperm cellular compartments containing PI3K, evidencing it in the head at both the membrane and nucleus and the entire tail, from the middle to the end piece of normal sperm. In varicocele PI3K label was confined to the head, with a strong reduction of specific reaction in the neck, middle piece, and tail. In conclusion, the data suggest that PI3K may play a role in the maintenance of male factor infertility associated with varicocele, and it may be further exploited as an additional molecular marker for the diagnosis of male infertility disorders.

To assess the efficacy of transversus abdominis plane (TAP) block as anesthesia method for retroperitoneal varicocele repair and to evaluate its postoperative analgesic effectiveness. Thirty-three consecutive male patients undergoing retroperitoneal varicocele repair (Palomo technique) were enrolled in this study. Patients were randomly allocated to undergo ultrasound-guided TAP block anesthesia (case group), or conventional spinal anesthesia (control group). The primary outcome was the evaluation of the proportion of patients achieving an adequate anaesthesia (as evaluated by prinprick sensation test and by the need of analgosedation). We have also evaluated pain during the intervention and pain on movement, pain at rest, rescue analgesia need, nausea, and satisfaction at different time-points (6, 12, and 24 h after surgery). The proportion of patients achieving adequate anesthesia was not different between the groups (p = 0.1). In the post-operative evaluation, patients enrolled in the case group expressed significantly less pain on VAS score at rest and on movement at 6 (p = 0.001 and p = 0.001) and at 12 h (p = 0.004 and p = 0.01). Moreover, the need of rescue analgesia resulted significantly higher in the control group (p = 0.03). This is the first study showing that TAP block could be employed as an effective and feasible anesthesia method for the retroperitoneal varicocelectomy. Moreover, our results demonstrate that this method is more effective than spinal anesthesia in the pain control after varicocele repair.