- The clinical findings in young adults with acute scrotal pain. [JOURNAL ARTICLE]
- Am J Emerg Med 2016 Jun 19.
Acute scrotal pain (ASP) is a common symptom of young adults. Testicular torsion is the most important diagnosis in these cases. It is a medical emergency in which the diagnosis must be made rapidly to prevent testicular loss. This requires a high index of clinical suspicion and prompt surgical intervention. This study was conducted to examine the spectrum of diagnoses in young man with ASP in a prehospital setting, the frequency of significant diagnoses, and their outcomes.The medical records of young adults in their obligatory military service presenting with ASP to primary care clinics from 2004 to 2014 were reviewed using the keywords: pain, testis, torsion, and orchialgia. Anamnestic data, physical findings, primary care physician decisions, and final outcomes were analyzed.A total of 9922 medical visits were recorded. Idiopathic scrotal pain, varicocele, scrotal trauma, and genital tract infections were the most common diagnoses. In 3 visits (0.03%), testicular cancer was diagnosed. Testicular torsion was the etiology of ASP in only 12 (0.12%) visits, and 60% the testes were salvaged. The mean duration of symptoms in the salvaged group was 6.33 hours; and in the nonsalvaged group, 44 hours.Testicular torsion is the etiology of ASP in only 0.12% of the visits to the primary care clinic. Patient delay before attending the primary care is responsible for most of the testes lost. Patient education in addition to high index of suspicion of primary care physicians is needed for salvage of more testicles.
- Antegrade Sclerotherapy to Treat All Types of Varicoceles in the Paediatric Population: Experience of a Single Centre. [JOURNAL ARTICLE]
- Urology 2016 Jun 29.
To analyse our experience with antegrade sclerotherapy for the treatment of Coolsaet type I, II and III varicoceles in a paediatric and adolescent population.Between 2005 and 2015, 73 patients who underwent antegrade sclerotherapy were retrospectively evaluated. Patient age, side, clinical and Doppler ultrasound grade and anatomical variations were collected. Varicoceles were grouped following Coolsaet's classification: all types were sclerosed. Follow-up consisted in clinical examination 3 and 6 months following surgery and testicular Doppler ultrasound 6 and 12 months following surgery. Patients were then telephonically interviewed. Success was defined as varicocele resolution or reduction to a grade not requiring surgery.Mean patient age was 14.7 years, mean operating time 50.8 minutes. Based on phlebographic imaging and following Coolsaet's classification, we identified 57 (78.1%) type I, 3 (4.1%) type II and 13 (17.8%) type III varicoceles. No intraoperative complications were observed. 3 patients (4.1%) presented a short-term complication in the form of pampiniform plexus thrombosis; one patient also developed wound dehiscence: all complications occurred in Coolsaet type I varicoceles and during surgeon learning curve. No hydrocele occurred. Out of 59 patients with a satisfactory follow-up (range: 14 months - 10 years), 2 recurrences occurred, success rate thus being 96.6%.Tauber's antegrade sclerotherapy is a simple and feasible technique, effective in treating all kinds of varicocele with low complication, recurrence and persistence rates. Phlebography reveals frequent venous anatomical variations, allows grouping of varicoceles into Coolsaet types and enables to perform sclerosis safely in all three kinds.
- Effects of losartan on experimental varicocele-induced testicular germ cell apoptosis. [JOURNAL ARTICLE]
- Andrologia 2016 Jul 4.
To investigate the potential protective effects of losartan on varicocele-induced germ cell apoptosis, 24 adult male Sprague Dawley rats were divided into three groups: a sham operation was performed in SHAM group, and experimental left varicocele was created in VAR and VAR + LOS groups. Additionally, in VAR + LOS group, losartan was administered for 30 days starting on the day of surgery. At the end of 30 days, all animals were sacrificed and left orchiectomy was performed. Testicular injury and spermatogenesis were evaluated according to Johnsen scoring system. To assess the nitrosative stress, immunohistochemical staining for endothelial nitric oxide synthase was used and evaluated by H-score and apoptotic index (AI) of germ cells was analysed by TUNEL method. A significant decrease in the mean Johnsen score (JS) was observed in VAR group compared with SHAM (p < .001). The mean H-score and AI were significantly higher in VAR group compared with SHAM (p < .001). After losartan administration, mean JS was significantly increased (p < .001) and mean H-score and AI were significantly decreased compared with VAR group (p < .001 and .01, respectively). Findings of this suggest that losartan acts as a potent protective agent against varicocele-induced germ cell apoptosis.
- Varicocele percutaneous embolization outcomes in a pediatric group: 7-year retrospective study. [JOURNAL ARTICLE]
- Int Urol Nephrol 2016 Jun 30.
Percutaneous embolization and surgical repair are the current treatment options for varicocele, but determining method superiority remains controversial. In this retrospective study, we evaluate the technical success, complication and recurrence rates following percutaneous embolization in a pediatric group, which were compared to reported outcomes for surgical repairs.Thirty children treated for percutaneous varicocele embolization were recruited. The side and grade of varicocele, symptoms, testicular asymmetry, mean recurrence time, total radiation dose and complications were evaluated. Recurrence and follow-up complications due to embolization were also reviewed.The venography showed retrograde filling of the internal spermatic vein with the identification of aberrantly fed vessels in 23 % of patients. None of the patients suffered from procedure complications except one who had venous injury which was treated with a sclerosing agent. The technical success rate was 93 % (28 patients) with a recurrence rate of 13 % (4 patients). Interestingly, the mean radiation dose used was 862.5 µGy m(2), 3 times lower than abdominal CT.Considering the intravascular nature of embolization, which aims to avoid testicular artery and spermatic cord damage (difficult to avoid with the surgical method), and consequently a lower complication rate, along with the same success rate and recurrence rate, our study supports that embolization is a superior method to surgical interventions.
- The effect of physical activity on varicocele pain and resolution of this pain by different varicocelectomy techniques. [Journal Article]
- Can J Urol 2016 Jun; 23(3):8285-90.
To evaluate the effect of physical activity on varicocele pain and how different varicocelectomy techniques relieve this pain.Between November 2012 and January 2015, a total of 64 patients with left groin pain and clinical varicocele were enrolled in this study. A visual analogue scale (VAS) classifying the pain in ten scores was used to assess the severity of pain before and after beginning continuous physical activity, and after operations. Patients were randomly divided into three groups. Group 1 had open sub-inguinal varicocelectomy, Group 2 had loupe-assisted sub-inguinal varicocelectomy and Group 3 had microscope-assisted sub-inguinal varicocelectomy.The mean VAS score of patients before and after beginning continuous physical activity was 3.10 +/- 0.9, and 7.65 +/- 0.93, respectively (p = 0.001). These values were 3.36 +/- 0.9, and 7.45 +/- 0.82 in Group 1 (p = 0.001), 2.90 +/- 0.83, and 7.54 +/- 1.29 in Group 2 and 3.06 +/- 1.06, and 7.87 +/- 0.71 in Group 3 (p = 0.001). After the operations, the mean VAS score decreased to 1.90 +/- 1.13 in Group 1 (p = 0.002), 1.63 +/- 1.32 in Group 2 (p = 0.003), and 0.81 +/- 0.71 in Group 3 (p = 0.001). Comparing the postoperative results among the groups, there was no statistical significance between Groups 1 and 2 (p = 0.190), and Groups 2 and 3 (p = 0.378), but a statistically significant difference was determined between Groups 1 and 3 (p = 0.011).Physical activity has a significant worsening effect on varicocele pain. Microscopic sub-inguinal varicocelectomy offers the best results for pain resolution.
- Improvements in Scrotal Thermoregulation in Patients with Varicoceles Treated by Using Traditional Korean Medicine: Two Case Reports. [Journal Article]
- J Acupunct Meridian Stud 2016 Jun; 9(3):156-60.
A varicocele is a dilatation of the pampiniform venous plexus within the spermatic cord. The incidence of varicoceles is 15%, and it occurs in more than 40% of men in infertile couples. Traditional Korean medicine (TKM) has been used to treat male infertility in Korea. We present two cases of men with varicoceles diagnosed via physical examination and scrotal thermography. We treated these men for two months by using TKM techniques, which included acupuncture, pharmacopuncture, and herbal medicine. We used scrotal thermography to evaluate the varicoceles before and after TKM treatment. After TKM treatment, the scrotal thermoregulation of both patients improved. In Patient 1, the temperature difference between the left and the right pampiniform plexus (i.e., ΔTP) was 2.8°C before treatment. It decreased to 1.3°C after treatment. In addition, the temperature difference between the testicles (ΔTT) was 1.5°C before treatment; it decreased to 0.2°C after treatment. In Patient 2, the ΔTP was 1.5°C before treatment; it decreased to 0.2°C after treatment. This report is the first to show that TKM may be an option for treating patients with varicoceles, as determined by using a scrotal thermography evaluation.
- Paradidymis - Fact/Fiction and its Significance. [Journal Article]
- Urol Case Rep 2016 Jul.:26-7.
A 30-year old infertile male was admitted for microsurgical sub inguinal varicocelectomy. Intraoperatively, two tubular structures of the caliber of neighboring veins were noted. They were distinct from the vas, which was carefully preserved. Histopathology revealed varicose veins along with two convoluted tubular structures lined by ciliated pseudo-stratified epithelium. There was an incomplete thin muscle coat. The lumina were irregular and contained no spermatozoa (Fig. 1). These structures were identified as paradidymis based on the location in the cord and microscopic morphology. We have tried to analyze the medico-legal significance of these benign lesions in our every day practice.
- Does the number of veins ligated during varicococele surgery influence post-operative semen and hormone results? [JOURNAL ARTICLE]
- Andrology 2016 Jun 17.
Varicocele is a well-established cause of male subfertility, which is directly proportional to its clinical grade. Although newer ultrasonic grading systems have taken into account the existence of pampiniform venous plexi, little is known about the clinical significance of the number of veins ligated during surgery. Very few undersized studies reported an influence which triggered the need to evaluate such association. This is a retrospective study of 378 patients who underwent left microsurgical subinguinal varicocoelectomy. Semen analyses and blood hormone studies performed pre-operatively were compared to those executed 6 months after surgery. Patients were divided into abnormal semen and normal semen groups based on their initial semen results. They were also subdivided according to the number of veins ligated intraoperatively into three groups: <5, 5-10, and >10 veins. Sperm count, total motility, and progressive motility were significantly increased in 62, 60.3, and 53.3% of patients post-operatively (p = 0.001), respectively. No significant differences in hormone levels were detected overall. Of the 378 patients, 332 had an abnormal semen analysis, while the remaining 46 patients had a normal result. Sperm count, total motility, and progressive motility significantly increased after varicocoelectomy in patients with an abnormal initial semen analysis (p = 0.001). In 48.7% of patients, 5-10 veins were ligated during surgery, whereas 28.3% had >10 and 23% had <5 ligated veins. No statistically significant differences were noted in the initial or the follow-up results among the number of vein subgroups. Varicocele ligation improves patients' fertility potential. This improvement, however, is not influenced by the number of veins ligated intraoperatively. Clinical grading maintains its superiority in the evaluation of varicocele patients.
- The analgesic efficacy of ultrasound-guided transversus abdominis plane block on postoperative pain and morphine consumption in varicocelectomy. [Journal Article]
- Saudi Med J 2016 Jun; 37(6):648-55.
To evaluate the analgesic effect of transversus abdominis plane (TAP) block administered before varicocele surgery.This study was completed at the Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey, between January 2011 and April 2013. In a prospective, double blind, randomized, placebo controlled clinical study, 40 male patients scheduled for elective varicocele operations were randomized to group T (treatment group) or group C (controls). After receiving general anesthesia, group T received a TAP block using 20 mL 0.25% bupivacaine on the operation side, whereas group C received a control block using 20 mL 0.9% Sodium chloride. During the first 24 hours after surgery, the patient pain was evaluated using the visual analogue scale (VAS) at rest and while coughing. Postoperative patient controlled analgesia morphine consumption, VAS scores, and side effects were recorded.Of 34 patients, Group T (n=18) had significantly lower VAS pain scores than Group C (n=16) both at rest and while coughing. The total morphine consumed was lower (7.7 ± 4.0) versus 21.6 ± 12.4 mg, p less than 0.001) in the 24 hours after surgery.As part of a multimodal analgesic regime after varicocelectomy surgery, morphine consumption and VAS pain scores were significantly lower among those receiving 20 mL 0.25% bupivacaine administered for a TAP block than among controls.
- Impact of body mass index, age and varicocele on reproductive hormone profile from elderly men. [Journal Article]
- Int Braz J Urol 2016 Mar-Apr; 42(2):365-72.
To study the impact of obesity, age and varicocele on sexual hormones of adult and elderly men.875 men who were screened for prostate cancer were enrolled in this study. Data recorded comprised age, body mass index (BMI), serum levels of total testosterone (TT), free testosterone (FT), sex hormone-binding globulin (SHBG), luteinizing hormone (LH) and follicular stimulating hormone (FSH). Patients were divided in groups according to their BMI in underweight, normal weight, overweight and obese grades 1, 2 or 3. First, it was studied the association between age, BMI, and hormone profile. Then, clinical varicocele was evaluated in 298 patients to assess its correlation to the others parameters.Obese patients had lower levels of TT, FT and SHBG (p<0.001) compared to underweight or normal weight patients. There were no differences in age (p=0.113), FSH serum levels (p=0.863) and LH serum levels (p=0.218) between obese and non-obese patients. Obese grade 3 had lower levels of TT and FT compared to obese grade 1 and 2 (p<0.05). There was no difference in the SHBG levels (p=0.120) among obese patients. There was no association between varicocele and BMI; and varicocele did not impact on testosterone or SHBG levels.Men with higher BMI have a lower serum level of TT, FT and SHBG. The presence of clinical varicocele as well as its grade has no impact on hormone profile in elderly men.