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- [Expressions of hypoxia inducible factor 1 alpha and P53 in the epididymis of varicocele rats]. [English Abstract, Journal Article, Research Support, Non-U.S. Gov't]
- Zhonghua Nan Ke Xue 2014 Jul; 20(7):613-7.
To investigate the mechanism of epididymal hypofunction of rats with varicocele (VC) by observing the changes in the epididymal index, motility of epididymal sperm, expressions of hypoxia-inducible factor 1 alpha (HIF-1alpha) and the tumor suppressor protein p53, and epididymal epithelial cells.Ninety SD rats were equally randomized to a VC model (A), a sham operation (B), and a normal control group (C). At 49 days after surgery, all the rats were executed after weighing. Then the volume of the left epididymis was obtained, the epididymal sperm motility was detected by computer-assisted sperm analysis (CASA), the expressions of HIF-1alpha and p53 in the epididymal tissue were determined by Western-blot, and the epididymal epithelial cells were observed by HE staining.VC models were successfully established in 27 of the rats. One-way ANOVA test showed no statistically significant differences in the epididymis index among groups A ([40.53 +/- 1.76] x 10 (-5)) , B ([43.31 1.58] x 10( -5)) , and C ( [44. 10 +/- 2.62] x 10 -5) (P > 0.05). Sperm motility and the percentage of progressively motile sperm were significantly lower in group A ([71.86 +/- 5.07]% and [42. 26 +/-4.45]%) than in B ([78.51 4.50]% and [49.08 +/-4. 19]% ) and C ( [79.24 +/- 2.70] % and [52. 23+/- 2. 23] % ) (both P <0.05) , while the expressions of HTF-1 a and p53 were remarkably higher in A (1.74 +/- 0. 16and 1.71 +/- 0. 11) than in B (0.32 +/- 0. 08 and 0.56 +/- 0.13) and C (0.12 +/- 0. 03 and 0.25 +/-0.06) (both P < 0.05). The epididymal epithelial cells in group A were obviously decreased in number and arranged in loose and disorderly patterns as compared with those in B and C.Varicocele can cause hypoxia in the epididymal tissue, which in turn may lead to epididymal hypofunction.
- Seminal plasma leptin and spermatozoon apoptosis in patients with varicocele and leucocytospermia. [JOURNAL ARTICLE]
- Andrologia 2014 Aug 1.
Excessive apoptotic spermatozoon death is associated with male infertility. Leptin regulates apoptosis in several cell types. We prospectively investigated if seminal plasma leptin mediates spermatozoon apoptosis in 74 varicocele (VC) patients and 70 leucocytospermia patients. Spermatozoa from 40 normospermic men were used as controls. Routine semen analysis, spermatozoon apoptosis rate, seminal plasma leptin, reactive oxygen species (ROS) and tumour necrosis factor-alpha (TNF-α) levels were measured. In VC and leucocytospermia patients, seminal plasma leptin levels and spermatozoon apoptosis rates were significantly higher compared with controls. In the VC group, seminal plasma ROS levels were significantly higher compared with controls; there were no significant differences in TNF-α levels. In the leucocytospermia group, both ROS and TNF-α levels were significantly higher compared with controls. In both the VC and leucocytospermia groups, there was a significant positive correlation between the spermatozoon apoptosis rate and leptin levels and ROS and leptin levels. There was a significant correlation between leptin and TNF-α levels in the leucocytospermia group. Seminal plasma leptin levels correlate significantly with spermatozoon apoptosis rate, and leptin may be a spermatozoon pro-apoptotic factors. The generation of ROS is a possible mechanism. Leptin may induce apoptosis via TNF-α in leucocytospermia patients.
- Primary treatment of painful varicocoele through percutaneous retrograde embolization with fibred coils. [JOURNAL ARTICLE]
- Andrology 2014 Jul 30.
The literature on the treatment of painful varicocoele is limited, likely because of the short period since it was recognized as a clinical entity and the limitations posed by the subjectivity of pain. Our aim was to systematically analyse the results of percutaneous embolization as the chosen treatment for this condition. We conducted a retrospective study of patients undergoing percutaneous embolization as primary treatment for painful varicocoele from January 2007 to November 2013. Radiologic and ultrasonographic successes were evaluated according to the existence or absence of venous reflux on venography after embolization and on Echo Doppler control at 3-6 months. Clinical success was assessed by Visual Analog Scale pain questionnaires before surgery and at 3-6 months; in addition, at the time of the study, telephone interviews were conducted to update the clinical situation and development. A total of 154 patients received operations. The median pain before surgery, at 3-6 months and at the time of interview was 7, 1 and 0 points respectively (p < 0.001). The ultrasonographic success rate at 3-6 months was 68.6%. With a median follow-up of 39 months, the success and relapse/clinical persistence rates were 86.9 and 13.1% respectively. By studying the degree of agreement between clinical success and ultrasonographic success, a kappa index = 0.443 was obtained. Patients with success recounted greater pre-operative pain scores than those who relapsed or persisted (7.5 vs. 5.0; p = 0.004). In patients with painful varicocoele, the ultrasonographic recurrence of venous reflux does not imply the recurrence of pain; hence, the proper assessment of success in these patients should include a systematic assessment of their pain and grade of reflux. Percutaneous retrograde embolization as a primary treatment for painful varicocoele is a clinically effective option with a high success rate that can be maintained in the long term, especially in patients with high pre-operative pain.
- Abdominal aortic aneurysm rupture into a retro-aortic left renal vein. [Journal Article]
- Acta Chir Belg 2014 Mar-Apr; 114(2):136-8.
We present a case of an abdominal aortic aneurysm ruptured into a retroaortic left renal vein. The patient presented with left flank pain, left-sided varicocoele and haematuria. Imaging showed a juxtarenal AAA associated with a retroaortic left renal vein and simultaneous contrast captation of the aneurysm, the vena cava, the left renal vein and the left vena testicularis. After opening of the aneurysm sac, the defect was controlled by digital pressure and closed by suture. The patient underwent a successful abdominal aorto bi-iliac replacement. We discuss prevalence, clinical features and treatment options of this rare condition.
- Serum oestradiol levels in male partners of infertile couples. [JOURNAL ARTICLE]
- Andrologia 2014 Jul 25.
A prospective clinical study was performed in the reproduction centre of Ichikawa General Hospital (Chiba, Japan) to investigate the relationship between sperm quality and serum oestradiol (E2) level in male partners of infertile couples. The semen parameters and blood samples were assessed in relation to several variables, including body mass index (BMI) and serum oestradiol (E2) levels. Four hundred and nine male partners of infertile couples aged 22-55 years (mean: 36.5 years) were referred to the reproduction centre. In total, 143 patients (35.0%) were included in the low E2 level group (18 pg ml(-1) ≥ E2). Serum E2 levels were slightly correlated with testosterone levels, BMI and serum FSH levels. Total motile sperm count and morphology were decreased in low E2 level group. In multivariate analysis, serum testosterone, E2 levels, existence of varicocele and age were risk factors for decreased semen quality. Serum E2 might be associated with BMI, serum testosterone level and spermatogenesis.
- Antegrade venography identifies parallel venous duplications in the majority of adolescent patients with a varicocele. [JOURNAL ARTICLE]
- J Urol 2014 Jul 21.
To assess the prevalence of internal spermatic venous malformations in adolescent patients with varicocele using intra-operative antegrade venography.Over a 2 year period, adolescent boys with visible or palpable varicocele underwent antegrade venography before varicocele surgery. Antegrade venography was performed through a scrotal incision. A vein within the pampiniform plexus was cannulated and Omnipaque 300mg/ml injected up to 1.75mg/kg to outline the entire length of the internal spermatic vein. The radiographs were reviewed and the Bahren and Murray classifications adopted.Forty-three (74.1%) of our patients demonstrated parallel duplications (Murray's classification type P) of internal spermatic vein. This is higher than the 2 per cent reported by Sigmund and Bahren based on retrograde venography. Among the patients with parallel duplications, 21 patients (48.8%) showed duplications arising superior to the iliac crest (subtype A) and the other 22 patients (51.2%) had a combination of proximal duplications (subtype B and C). Ten patients (17.2%) had single internal spermatic vein, 2 (3.4%) patients had lumbar collaterals and 3 (5.2%) patients had renal collaterals.Parallel duplication of internal spermatic vein is a common finding on antegrade venography. The authors believe that the various levels of duplication need to be identified prior to treatment of varicocele to maximise the chance of success of the procedure.
- Microsurgical intermediate subinguinal varicocelectomy. [Journal Article]
- Int Surg 2014 Jul-Aug; 99(4):398-403.
Abstract This study was conducted to introduce a simple modification that can facilitate microsurgical subinguinal varicocelectomy (MSV) especially for surgeons inexperienced in microsurgical technique. A single surgeon performed microsurgical intermediate subinguinal varicocelectomy (MISV) on 52 patients with 61 cases between September 2010 and August 2012. Patient age, varicocele grade, operation time, intraoperative findings, postoperative complications, and 3-month follow-up results were analyzed. Patient mean age was 28 years (range, 15-69 years), and there were 9 bilateral cases. The mean operative time was 51 minutes (range, 34-109 minutes). We compared the first 31 cases to the second 30 cases, to assess investigator experience on operating times. The mean number of ligated veins was 5 (range, 3-10) in internal spermatic vein, 1 (range, 0-4) in external spermatic vein, and 1 (range, 0-3) in gubernacular vein. In 28 patients, the average postoperative sperm concentration at the 3-month follow-up was significantly higher than the preoperative sperm concentration (28.5 ± 18.2 × 10(6)/mL versus 10.5 ± 23.0 × 10(6)/mL; P = 0.003). Mean motility improved after MSIV (65.7% ± 18.2% versus 47.2% ± 21.7%; P = 0.004). In conclusion, MISV appears comparable with MSV in terms of the high success rate, low complication rate, and low postoperative pain; and it can be easily accomplished by inexperienced surgeons.
- Is the presence of varicocele associated with static and dynamic components of benign prostatic hyperplasia/lower urinary tract symptoms in elderly men? [JOURNAL ARTICLE]
- Int J Urol 2014 Jul 23.
To evaluate the relationship between varicocele and benign prostatic hyperplasia/lower urinary tract symptoms in patients over the age of 40 years.A total of 1040 patients with benign prostatic hyperplasia/lower urinary tract symptoms were evaluated for prostate volume, testicular volume, testicular consistency, total testosterone, total prostate-specific antigen and body mass index. A questionnaire including International Prostate Symptom Score and a uroflow test were also carried out. The presence and grade of varicocele was determined in each patient by physical examination.Varicocele was found bilaterally in 22.3% and unilaterally in 25.7% of the patients. There was no difference in terms of age and body mass index distribution between subgroups. When grouping patients for varicocele laterality, total testosterone (P = 0.04), prostate volume (P = 0.009) and total prostate-specific antigen (P = 0.02) level were significantly different. Similarly, these parameters were significant between patients with grade 1, 2 and 3 varicocele. Total testosterone level (P = 0.02) and prostate volume (P = 0.035) were found to be significantly different when patients were grouped according to testicular size. A positive correlation was found between testosterone level and prostate volume (P = 0.004; r(2) = 0.084).Bilateral and/or higher-grade varicocele is associated with lower prostate volume and testosterone levels, as well as lower prostate-specific antigen levels. However, it is not associated with dynamic components of benign prostatic hyperplasia/lower urinary tract symptoms in patients over the age of 40 years.
- Single-incision laparoscopic surgery and conventional laparoscopic treatment of varicocele in adolescents: Comparison between two techniques. [Journal Article]
- Afr J Paediatr Surg 2014 Jul-Sep; 11(3):201-5.
Background:Single-incision laparoscopic surgery (SILS) has gained great popularity in paediatric surgery due to its minimally invasive approach and improved cosmetic results. Notwithstanding, reports describing its adoption in children are still fragmentary and some perplexities have been raised by some surgeons. We reviewed our experience with the SILS Palomo varicocelectomy procedure (SIL-V) in children and adolescents, comparing this group with a similar series operated using conventional laparoscopic varicocelectomy (CL-V). Patients and
Methods:A total of 69 Palomo laparoscopic varicocelectomies were performed in patients aged 11-17 years from January 2011 to January 2013. Indications for surgery included grades II-III varicocele or ipsilateral testicular hypotrophy. The SIL-V procedure was performed in 44 patients with roticulating and conventional 5 mm instruments. Testicular vessels were isolated "en bloc," clipped and cut. Operating time, visual analogue scale and post-operative results were compared to a similar group of 25 patients operated with CL-V.
Results:No patient of the SIL-V group required conversion to conventional laparoscopy, none to open surgery. Mean operative time was 22 min (range: 19-28) in the SIL-V group, not significantly different compared with CL-V (mean 21 min, range: 18-25). All patients experienced a smooth recovery from surgery without any complications, and were discharged on day 1. No difficulties were found in the SIL-V group. The post-operative pain score was significantly better in SIL-V.
Conclusion:The SIL-V procedure is safe and effective and allows a fast and efficient isolation of the vascular bundle. The use of conventional instruments is technically feasible in SIL-V.
- Platelet volume indices in patients with varicocele. [Journal Article]
- Clin Exp Reprod Med 2014 Jun; 41(2):92-5.
This study sought to evaluate platelet volume indices (mean platelet volume [MPV], platelet distribution width [PDW], and platelet large cell ratio [P-LCR]) in varicocele patients, and compare it with platelet volume parameters in healthy controls.This cross-sectional study involved 2 groups: group 1 included 51 varicocele subjects and group 2 consisted of 50 healthy control subjects of similar ages. Peripheral venous blood samples were collected with ethylenediaminetetraacetic acid-K2 anticoagulant between 8:30 AM and 10 AM following an overnight fast. Platelet volume parameters (MPV, PDW, and P-LCR) were measured in both groups within 2 hours of sampling.The mean PDW, MPV, and P-LCR were 13.9±2.5%, 10.1±1.3 fL, and 27.3±7.8% in varicocele patients, respectively, and were 12.6±2.4%, 9.3±1.1 fL, and 21.9±6.4% in the control group, respectively. The mean PDW, MPV, and P-LCR were significantly higher in the varicocele group than the control group.The results of the present study suggest that vascular components may play an important role in the pathophysiology of varicocele; therefore, there is a great need for prospective studies to confirm this relationship.