- Best practice in the diagnosis and treatment of varicocele in children and adolescents. [Review]
- TATher Adv Urol 2018; 10(9):273-282
- A varicocele is an abnormal dilation of the pampiniform plexus of veins in the scrotum which begins at puberty in approximately 15% of males. Although common in the general population and often asymp...
A varicocele is an abnormal dilation of the pampiniform plexus of veins in the scrotum which begins at puberty in approximately 15% of males. Although common in the general population and often asymptomatic, varicoceles are associated with gonadal dysfunction including testicular atrophy, infertility, and hypogonadism in a subset of men diagnosed later in life. Because of the high prevalence and uncertain pathogenesis, definitive management guidelines for varicoceles diagnosed in the pediatric and adolescent population remain poorly defined. The varicocele is the most common etiology of male factor infertility, and treatment in the pediatric and adolescent population may improve semen quality and improve fecundity in adulthood. Evaluation of the pediatric and adolescent varicocele should include history, physical exam, and measurement of testicular volume with orchidometer or ultrasound. Testicular volume differentials and peak retrograde flow on Doppler ultrasonography are important factors in risk stratification of the pediatric varicocele population. Semen analysis and reproductive endocrine assessment should also be considered as part of the workup for adolescent patients. A variety of treatment approaches exist for varicocele, and while the microsurgical subinguinal approach is the gold standard for the adult population, it has yet to be confirmed as superior for the adolescent population. Referral to an andrologist for the adolescent patient with varicocele should be considered in equivocal cases. While active treatment of varicocele in the pediatric and adolescent population is controversial, it is clear that some untreated patients will suffer symptoms later in life, while overtreatment remains a concern for this large, vulnerable population. Therefore, surveillance strategies and improved accuracy in diagnosis of clinically important pediatric varicoceles prompting treatment are needed in the future.
- Should A Couple with Failed In Vitro Fertilization/Intracytoplasmic Sperm Injection and Increased Sperm DNA Fragmentation Use Testicular Sperm for the Next Cycle? [Journal Article]
- EUEur Urol Focus 2018 Aug 10
- Limited observational data purporting a benefit of testicular sperm for intracytoplasmic sperm injection failure do not provide sufficient evidence. The first step is to reduce sperm DNA fragmentatio...
Limited observational data purporting a benefit of testicular sperm for intracytoplasmic sperm injection failure do not provide sufficient evidence. The first step is to reduce sperm DNA fragmentation in ejaculated sperm through lifestyle modifications, antioxidant therapy, or treatment of underlying abnormalities such as infection or varicocele.
- Complications of 411 laparoscopic urological procedures: A single surgeon experience. [Journal Article]
- UAUrol Ann 2018 Jul-Sep; 10(3):308-312
- CONCLUSIONS: Even though the complications rate in this series was comparable to those of other studies in the literature, yet it remains higher than that of open surgery. The continuing advances in laparoscopic techniques will reduce the complication rate and will pave the way for laparoscopy to replace most currently practiced open surgical urological procedures.
- Abnormal Human Sperm Parameters Contribute to Sperm DNA Fragmentation in Men with Varicocele. [Journal Article]
- WJWorld J Mens Health 2018 Jul 30
- CONCLUSIONS: In this study, a correlation between SDF and sperm parameters was confirmed in men with varicocele. SDF may be contributing factors to sperm motility, viability, and morphology. Abnormal sperm count, motility, and viability showed high sperm DFI. Therefore, lower sperm parameters were indicative of increasing SDF in men with varicocele.
- Wilm's tumor presenting with scrotal varicocele in an 11-month-old boy. [Journal Article]
- IJIndian J Radiol Imaging 2018 Apr-Jun; 28(2):247-249
- This is a case report of Wilms' tumor which presented with varicocele in an 11-month old infant. The age of the patient and the uncommon mode of presentation are the unique features of this case. Thi...
This is a case report of Wilms' tumor which presented with varicocele in an 11-month old infant. The age of the patient and the uncommon mode of presentation are the unique features of this case. This case emphasizes the need to exclude a renal tumor in children with scrotal varicoceles.
- Does total testicular volume predict testicular volume difference in adolescent males with varicocele? [Journal Article]
- IBInt Braz J Urol 2018 Jun 20; 44
- CONCLUSIONS: Adolescent varicoceles continue to pose a challenge to pediatric urologists. The dilemma of over-aggressive treatment has proven difficult to balance with the risk of infertility. We hoped that elucidating the relationship between TTV and TVD could be useful in identifying patients who are at greater risk for infertility while decreasing the need for more intrusive testing, such as semen analysis, in an adolescent population. We looked at the direct relationship between low TTV and high TVD. In our population, there was a non-significant relationship between TTV < 30 cc and TVD ≥ 20% (p > 0.05) indicating that in adolescents with varicocele, TTV and TVD are independent variables. Our study limitations include the inherent user dependent bias of ultrasound measurements and data collection at a single institution with high ethnic diversity, possibly not comparable to all patient populations.Low TTV (< 30 cc) itself is not predictive of high TVD (≥ 20%) in adolescent boys with varicocele, despite their reported independent associations with impaired fertility in other studies.
- Reproductive hormones and sperm parameters after varicocele repair: An observational study. [Journal Article]
- AAndrologia 2018 Jul 25; :e13118
- Varicocele repair (VR) is associated with improved sperm parameters in subfertile patients. We examined the association of the levels of reproductive hormones, scrotal colour Doppler ultrasound (CDU)...
Varicocele repair (VR) is associated with improved sperm parameters in subfertile patients. We examined the association of the levels of reproductive hormones, scrotal colour Doppler ultrasound (CDU) and seminal parameters in subfertile men, before and after VR. Fifty subfertile males, with left-side varicocele, were enrolled in this retrospective study. The serum levels of FSH, LH and total testosterone (TT), along with continuous left spermatic venous reflux (SVR) and testicular volumes at CDU were evaluated, before and six months after VR by a left-side retrograde internal spermatic vein sclero-embolisation (SVE). Left-side SVR was either no longer present or significantly reduced in all patients after VR (p < 0.0001). Sperm parameters, in particular, the total sperm motile count (TMC), were found significantly improved after VR (p < 0.0001). Post-VR, no differences were observed in the baseline values of the reproductive hormones. Only SVR change was seen to predict TMC change (p = 0.026) in the univariate analysis, while reproductive hormones change had no effect on TMC change (FSH:p = 0.85;LH:p = 0.44;TT:p = 0.76). In conclusion, the improved sperm parameters were associated with the disappearance or reduction in SVR and not with changes in the levels of reproductive hormones after SVE. Thus, SVR change at CDU was the only predictor of improved sperm quality after VR in subfertile males.
- Outcomes of microsurgical subinguinal varicocelectomy to treat painful recurrent varicocele. [Journal Article]
- AAndrologia 2018 Jul 23; :e13105
- In this study, was evaluated the outcomes of patients undergoing microsurgical varicocelectomy to treat scrotal pain due to recurrent varicocele were evaluated. A total of 27 patients who underwent m...
In this study, was evaluated the outcomes of patients undergoing microsurgical varicocelectomy to treat scrotal pain due to recurrent varicocele were evaluated. A total of 27 patients who underwent microsurgical varicocele ligation for recurrent varicocele and scrotal and/or testicular pain were included in this retrospective study. Recurrent varicocele in all patients was diagnosed with by physical examination and coloured Doppler ultrasonography (CDUSG). All patients underwent pre-operative follow-up and post-operative follow-up at 3 and 6 months by physical examination, assessment of using the Visual Analog Scale (VAS) score, and CDUSG. The rRecurrent varicocele was grade 3 in 24 patients (88.9%) and grade 2 in 3 patients (11.1%). In all cases, the varicocele was on the left side. The mean VAS score was 6.5 (range 5-8) pre-operatively, 0.7 (range 0-5) at 3 months post-operatively, and 0.3 (range 0-4) at 6 months post-operatively (p < 0.001). Post-operative complete responseresolution, partial resolutionponse, and non-responsiveness rates were 85.2%, 11.1%, and 3.7% at the 3rd month post-operatively, respectively, and 88.8%, 7.5%, and 3.7% at the 6th month post-operatively, respectively. During follow-up, there was recurrence in 1 patient (3.7%) and hydrocele in 1 patient (3.7%). Microsurgical subinguinal varicocelectomy is an effective treatment for patients with scrotal pain caused by recurrent varicocele.
- Alpha-Lipoic Acid improves the testicular dysfunction in rats induced by varicocele. [Journal Article]
- AAndrologia 2018 Jul 23; :e13085
- Alpha-lipoic acid (ALA) is a disulphide compound with multifunctional antioxidant properties and is soluble in both water and lipid. Several recent studies evaluated efficacy of ALA in various diseas...
Alpha-lipoic acid (ALA) is a disulphide compound with multifunctional antioxidant properties and is soluble in both water and lipid. Several recent studies evaluated efficacy of ALA in various diseases related to oxidative damage such as diabetes, multiple sclerosis and Alzheimer and concluded that ALA can reduce oxidative stress by quenching reactive oxygen and nitrogen species, restoring antioxidants such as glutathione, vitamins C and E, and/or improving activity of antioxidant enzymes. Varicocele, an enlargement of the veins in scrotum, is considered as the most common repairable cause of male infertility and is associated with high levels of oxidative stress. In this study, surgical varicocele was induced in 30 adult male Wistar rats with other 20 rats serving as sham-operated and nonoperated control. Varicocele caused significant worsening of sperm parameters, DNA damage and lipid peroxidation 2 and 4 months after surgery. A 2-month ALA administration after surgery was able to revert these effects. These results clearly showed that ALA can reduce the negative side effects of elevated testicular temperature and increased oxidative stress in varicocelised rats. This study warrants future clinical research to assess whether ALA is of help in the treatment of infertile men with varicocele.
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- Contribution to the Pathophysiology and Treatment of Varicoceles. [Journal Article]
- JBJ Belg Soc Radiol 2018 Feb 09; 102(1):22
- Anatomical differences between adults and adolescents and between left and right varicoceles were shown in this work. We designed a standardized and reproducible method for pressure measurement in th...
Anatomical differences between adults and adolescents and between left and right varicoceles were shown in this work. We designed a standardized and reproducible method for pressure measurement in the inguinal internal spermatic vein (ISV). We demonstrated that the mean absolute pressure in the ISV in the upright position is higher than the veno-capillary pressure in the testicle, and hence could impair spermatogenesis prompting the need for treatment in varicoceles. Histoacryl transparent and Glubran2, the current commercially available adhesives for the treatment of varicoceles, do not differ with regard to efficiency, safety and tolerance during and after embolization. Both adhesives cause a mild pain in 30% of the patients in the week after embolization. The radiation exposure is low during embolizations of varicoceles with highly viscous liquid products. Therefore, the endovascular treatment with glue is an efficient, safe and tolerable method of treatment for varicoceles when applicable.