Testicular varicocele, which is defined as the dilation of the veins draining the testicle, has long been associated with a detrimental effect on testicular function. Despite a lack of high-quality, prospective data, recent evidence has shed light on potential links between varicocele and male infertility and serum testosterone levels. Similarly, varicocele repair has increasingly been shown to have a beneficial impact on pregnancy rates, semen parameters, and on improving serum testosterone in adult men. Numerous studies have assessed the optimal technique for varicocele repair and the bulk of the evidence has shown the microsurgical inguinal/subinguinal approach to have the highest success rates, the lowest overall complication rates, and the lowest recurrence rates. The management of varicocele in adolescents remains a clinical conundrum, but contemporary evidence suggests early deleterious effects of varicocele on testicular function in some patients. Well-designed prospective trials are critical to delineate the true impact and role of varicocele repair on male infertility and hypogonadism in adult and adolescent men.
- JAMA PATIENT PAGE. Testicular Mass. [Journal Article, Patient Education Handout]
- JAMA 2016 Aug 2; 316(5):557.
- Varicocele in a Young Man: Something We Should Be Worried About? [EDITORIAL]
- Eur Urol 2016 Jul 29.
- First report of a spermatic granuloma and varicocele in a marsupial: A Koala (Phascolarctos cinereus) Case Study. [Journal Article]
- Res Vet Sci 2016 Aug.:30-3.
This study reports the first documented clinical case of a spermatic granuloma and varicocele in a marsupial. Initial clinical presentation included gross morphological changes in the left scrotal cord, epididymis and testis. Ultrasonography of the scrotum and spermatic cord, and gross and histopathological examination after hemicastration, confirmed the condition as a spermatic granuloma affecting the left caput epididymis, with a varicocele in the left proximal spermatic cord, which was causing azoospermia and infertility. Semen quality and serum testosterone secretion following a GnRH challenge was assessed prior to, and following surgery. After hemi-castration, an increase in androgen secretion to within normal reference ranges for the koala was observed with a subsequent increase in semen production and sperm quality resulting in the sire of a pouch young, 12months later.
- Phytochemical and pharmacological aspects of Descurainia sophia Webb ex Prantl: modern and traditional applications. [Journal Article, Review]
- Avicenna J Phytomed 2016 May-Jun; 6(3):266-72.
Seed of Descurainia sophia Webb ex Prantl has been traditionally prescribed as treatment for palpitation, varicose vein, varicocele, constipation, hemorrhoid, skin eruptions, and impotence. To outline a view for further approaches, current work compiled a survey on all relevant clinical properties of this medicament in addition to the traditional reports. To do this, databases as PubMed, Scopus, EMBASE, IranMedex and Science information databases (SID) were searched by keywords, i.e., "Descurainia sophia", "Khaksheer", and "Flixweed" as well as "pharmacology" and "phytochemistry". According to the findings, scant experimental evaluation and clinical assessment have been performed on this medicament. Of those, only anti-inflammatory, analgesic, and antipyretic effects as well as antioxidant and anthelmintic activities were assessed and confirmed in experimental studies. Despite broad administration of this herb in folk and traditional medicine, only two human clinical trials in bowel discomfort and pregnant subjects were conducted. Taken as a whole, more comprehensive clinical evaluations should be conducted on respective applications to support those traditional and folk uses.
- Predictors for successful sperm retrieval of salvage microdissection testicular sperm extraction (TESE) following failed TESE in nonobstructive azoospermia patients. [JOURNAL ARTICLE]
- Andrologia 2016 Jul 21.
The purpose of this study was to observe the clinical utility and the possible determinants in predicting sperm retrieval of salvage microdissection testicular sperm extraction (mTESE) for nonobstructive azoospermia (NOA) patients with failed conventional TESE at their first attempts. A total of 52 NOA males underwent salvage mTESE were recruited in this study. Related data, including age, BMI, the presence of Klinefelter's syndrome and varicocele, cryptorchidism, mean testicular volume, hormonal profile (total testosterone (TT), follicle-stimulating hormone (FSH), luteinising hormone (LH), inhibin B (INHB)), testicular histology and surgical duration, were collected and analysed. A multivariate logistic regression with likelihood ratio test revealed the following predictors of sperm retrieval: TT and testicular histology (chi-square of likelihood ratio = 26.42, df = 4, p < .005). A formula was also established using multivariate regression analysis in predicting sperm retrieval probability. A predicted probability of more than 71% was determined of the formula as the cut-off value in predicting sperm retrieval using receiver operating characteristics (ROC) analysis with a sensitivity and specificity 78.0% and 72.4% respectively. In conclusion, salvage mTESE is of clinical value in NOA males with failed TESE attempts, whereas the established formula could be useful in determining the proper salvage mTESE candidates.
- Anatomical factors affecting the time required for microsurgical subinguinal varicocelectomy. [Journal Article]
- Springerplus 2016; 5(1):1031.
Microsurgical subinguinal varicocelectomy (MSV) is considered an effective and less morbid procedure, but the difficulty in preserving testicular arteries is a limitation of this procedure. We identified the microanatomy encountered during MSV and clarify its significance to the difficulty of the procedure.Three hundred and twenty-six patients who underwent left MSV were evaluated. Detailed intraoperative microanatomy was recorded for each case. A classification system was used to assess the anatomical relationship between the internal spermatic artery and the varicose veins as follows: type I (non-adherent to the veins), type II (adherent to the veins), and type III (surrounded by veins). Type III cases were further divided into types III-a (an arterial pulse) and III-b (a blurred arterial pulse). A linear regression analysis of the factors associated with the length of the operation was used to determine the difficulty of the surgery.A mean number of 8.2 internal spermatic veins were ligated. Internal spermatic arteries were classified as type I in 14 % of patients, type II in 57 %, and type III in 29 % (III-a in 20 % and III-b in 9 %). A large number of internal spermatic veins and higher internal spermatic artery type were observed significantly more often in grade 3 varicoceles (p < 0.05). The types of internal spermatic arteries (ρ = 0.458) and numbers of internal spermatic veins (ρ = 0.431), cremasteric veins (ρ = 0.197), and gubernacular veins (ρ = 0.119) were significantly associated with the length of the operation (p < 0.05).Anatomical factors were associated with the varicocele grade and surgical difficulty. These findings are helpful to perform MSV.
- Venous Blood Gases of Varicocele Veins: Correlation With Testicular Blood Flow and Semen Quality in Varicocele Patients. [JOURNAL ARTICLE]
- Urology 2016 Jul 14.
To investigate venous blood gases (VBG) in varicocele veins and correlation with semen and testicular blood flow.Twenty-seven infertile patients, undergoing left microsurgical varicocelectomy at the Urology/Andrology Department of a teaching hospital, were included. Before surgery semen parameters were recorded and scrotal color Doppler ultrasonography was done to measure peak systolic velocity and resistive index of subcapsular and intraparenchymal branches of testicular artery. During surgery, blood sample was drawn from varicocele veins and a peripheral arm vein. VBGs were estimated and compared with each other.The pH was lower (P < .001) in internal spermatic vein (P < .01) compared to external spermatic and peripheral veins. The partial pressure of oxygen (pO2) and oxygen saturation (sO2) were higher (P < .001) in internal spermatic vein (P < .01) compared with peripheral vein. However, HCO3 was lower (P < .05) in both veins compared to the peripheral vein. The partial pressure of carbon dioxide (pCO2) was similar (P > .05) in 3 veins. The pO2 of internal spermatic vein had negative correlation (r = -0.42; P < .05) with peak systolic velocity of intraparenchymal arteries. No such correlation was observed for external spermatic vein or peripheral vein.Internal spermatic veins had higher oxygen level, lower pH, and bicarbonate levels compared to peripheral veins. External spermatic veins had lower HCO3 but other VBGs were similar to peripheral veins. The shift of internal spermatic vein VBGs toward arterial blood may be due to arteriovenous communications of spermatic cord. It may be a missing link to understand the pathophysiology of varicocele.
- Novel concepts in male factor infertility: clinical and laboratory perspectives. [REVIEW, JOURNAL ARTICLE]
- J Assist Reprod Genet 2016 Jul 16.
In recent years, the management of male factor infertility has undergone important changes with the introduction of novel concepts, advanced testing, and therapeutic interventions. This review highlights some of these changes and discusses their impact to routine clinical practice. First, we discuss the recent changes in the World Health Organization (WHO) laboratory methods and reference values for the examination of human semen. Second, we examine the role of sperm chromatin integrity tests in light of increasing evidence of the detrimental effect of sperm DNA fragmentation on reproductive outcomes. Third, we summarize the main findings of varicocele-related infertility and the outcomes of microsurgical varicocele repair to different case scenarios. Lastly, we critically discuss the current management of men with nonobstructive azoospermia seeking fertility and the new opportunities that emerged to help these men achieve biological fatherhood.
- Varicocele Is Associated with Impaired Semen Quality and Reproductive Hormone Levels: A Study of 7035 Healthy Young Men from Six European Countries. [JOURNAL ARTICLE]
- Eur Urol 2016 Jul 13.
Present knowledge on the impact of varicoceles on testicular function is largely based on studies of subfertile and infertile men, making it difficult to extrapolate the impact of varicocele on the general population.To describe associations between varicocele and testicular function assessed by semen analysis and reproductive hormones in men from the general population.A cross-sectional multicentre study of 7035 young men, median age 19 yr, from the general population in six European countries (Denmark, Finland, Germany, Estonia, Latvia, and Lithuania) were investigated from 1996 to 2010.We analysed results from physical examination, conventional semen variables, and serum reproductive hormones using multivariable regression analyses.A total of 1102 (15.7%) had grade 1-3 varicocele. Increasing varicocele grade was associated with poorer semen quality, even in grade 1 varicocele. In grade 3 varicocele, sperm concentration was less than half of that in men with no varicocele. Presence of varicocele was also associated with higher serum levels of follicle-stimulating hormone, lower inhibin B, and higher levels of luteinising hormone; testosterone and free testosterone were not significantly different between men with and without varicocele. This study cannot draw a conclusion on the progressiveness of varicocele or the effect of treatment.We demonstrated an adverse effect of increasing grade of varicocele on testicular function in men not selected due to fertility status.The presence and increasing grade of varicocele is adversely associated with semen quality and reproductive hormone levels in young men from the general population.