No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Etiologic Factors in 1294 Consecutive Cases of Male Infertility*
Abstract
Between January 1965 and December 1970 1294 cases of male subfertility were analyzed. Varicoele which is probably secondary to retrograde flow of blood down the incomopetent internal spermatic vein and to premature sloughing of immature cells in the testes comprised 39% of the cases. Surgical correction where indicated resulted in a 48% pregnancy rate. Subfertility was associated with too low semen volume in 1.8% of the cases and with too high semen volume and poor semen quality in 10% of cases. Ejaculatory disturbances including retrograde ejaculation no ejaculation and congenital anatomic abnormality led to infertility in 2% of cases. Artificial homologous insemination was often sucessful in each of these classes. In this series 7.1% cases were secondary to low levels of pituitary gonadotropin. Treatment with gonadotropins as about 30% successful. Adrenogenital syndrome was diagnosed in .9% of the cases. Treatment with corticosteroids is effective. Thyroid problems were diagnosed in .6% of cases. Sexual problems with normal semen quality occurred in 5.1% of the cases. Epididymal obstruction with an infectious etiology often corrected by epididymovasostomy occurred in 4.4% of cases. Absent vasa deferentia due to an embryological growth were noted in 1.8% of cases. Men requesting repair of vasectomies comprised 1.2%. Success was near 40%. Testicular failure including germinal cell aplasia Klinefelters syndrome infantile testes mumps orchitis maturation arrest testis tumor and surgical injury occurred in 14% of cases. Azoospermia due to untreated nondescent of bilateral crytorchidism surgery after puberty or postsurgical atrophy was observed in 4.4% of cases. Early treatment is advocated. Other causes of subfertility were irreversible necrospermia (1.3%) high sperm density (.2%) sperm autoagglutination (.8%) high seminal viscosity (.1%) and unknown (5.4%).
... Inclusion criteria: According to the registry of men submitted to scleroembolization, men with grade II or grade III bilateral and left-side varicocele on physical evaluation after standing for 5 min [24] were considered potentially eligible for the retrospective study, which was restricted to patients seeking consultation at the included center. In this context, in this retrospective study, the effects of a nutraceutical containing Resveratrol and magnesium dihydroxide (trademark Revifast ® ), vitamin B12, vitamin B6, vitamin D, and folic acid were evaluated on the spermatic function after surgical scleroembolization. ...
... Inclusion criteria: According to the registry of men submitted to scleroembolization, men with grade II or grade III bilateral and left-side varicocele on physical evaluation after standing for 5 min [24] were considered potentially eligible for the retrospective study, which was restricted to patients seeking consultation at the included center. ...
Background: Varicocele still today represents a common cause of infertility in young men. The treatment strategy remains a surgical approach such as scleroembolization; however, the complete restoration of spermatic parameters afterward requires an average of six or more months to fully regain optimal seminal parameters. Recently, many studies have demonstrated the beneficial effects of Resveratrol in male fertility, given its potential anti-inflammatory, antiapoptotic, and mitochondrial effects. Therefore, Resveratrol-based nutraceuticals could be promising as an adjuvant to mitigate subfertility in patients with varicocele. Methods: In the present study, we retrospectively analyzed the effects of the administration of a Resveratrol-based nutraceutical after the scleroembolization procedure. The improvement of sperm quality in terms of number, motility, and morphology were considered to be the study’s main endpoints. A spreadsheet program was used for data analysis, and a p-value of <0.05 was considered significant. Results: We found a statistically significant improvement in the spermatic parameters (sperm count and total motility) and an increase in normal sperm after only 4 months of treatment. The supplementation with a Resveratrol-based nutraceutical associated with the surgical procedure showed encouraging results if compared to data from a control group and the results reported in the literature linked to scleroembolization practice alone. In fact, there was a clear improvement in the seminal parameters at 4 months. Conclusions: This suggests the positive impact of the Resveratrol-based nutraceutical in synergizing with scleroembolization in reducing the time needed to fully recover sperm function.
... Male factor infertility is responsible in about 20% to 40% of infertile couples (1) , the most identifiable cause is the varicocele which found in approximately 40% of infertile men (2) . Azoospermia presents in about 10% to 20% of infertile men, other isolated causes include oligospermia, asthenospermia, teratospermia, low semen volume and ejaculatory problems can cause male infertility as well (3) . ...
... According to our study we suggest the following histopathological categorization and subcategorization depending on the most advanced pattern of spermatogenesis and on the presence or absence of focal area of spermatogenesis and on the type of maturation arrest seen on diagnostic testicular biopsy: [1] normal spermatogenesis(NS); [2] hypospermatogenesis(HS) ; [3] partial spermatogenic maturation arrest(PMA); [4] spermatogenic maturation arrest with focal spermatogenesis(MAFS) ; [5]complete spermatogenic maturation arrest(CMA). This might further subcategorized into late spermatid maturation arrest, intermediate spermatid maturation arrest, early spermatid maturation arrest, secondary spermatocyte maturation arrest, primary spermatocyte maturation arrest., and spermatogoneal maturation arrest(23); [6] Sertoli cell only with focal spermatogenesis (SCOFS); [7] complete Sertoli cell only (CSCO); [8] tubular fibrosis with focal spermatogenesis(TFFS) ; and [9] tubular fibrosis with no focal area of spermatogenesis(TF). ...
Objective: To evaluate the clinical significance of open diagnostic testicular biopsy as prognostic predictor ofsuccessful sperm retrieval among azoospermic infertile patients.Design: Prospective study.Setting: Infertility clinic and assisted reproduction unit at the institute of embryo research and infertilitytreatment, Baghdad University.Patients: Sixty infertile azoospermic patients.Intervention: Pieces of testicular tissue taking during open diagnostic multiple bilateral testicular biopsies wasprepared for histological examination and grouped according to well-defined histopathological patterns.Measurement of testicular size and serum reproductive hormones (FSH, LH, Testosterone, and PRL) were donefor all these sixty azoospermic patients.Main Outcome Measures: Sperm found with a new histopatholigical categorization and sub categorization.Results: Our study showed no significant difference between mean testicular size and mean serum reproductivehormonal (FSH, LH, T and PRL) concentrations of MAFS compared to CMA and that of SCOFS compared toSCO. The sperm found with open diagnostic bilateral biopsy was positive in transverse section of seminiferoustubules of NS, HS, MAFS, and SCOFS, where as it was negative in CMA, CSCO, and TF.Conclusions: It was concluded from the results of the work that the new histological categorization of opentesticular biopsies was found to be practical, informative, and most useful diagnostic and prognostic predictor toselect the patients for TESE-ICSI
... ). Its prevalence in the male population is 10-15%, and this rate rises to 40% in cases of infertility (Dubin and Amelar, 1971). It has been reported that varicocele is seen more frequently in men with secondary infertility, and fertility declines if treatment is not followed (Gorelick and Goldstein, 1993). ...
... If it can be detected without the Valsalva maneuver but is not visible to the naked eye, it is defined as a grade 2 varicocele. If it is understood by direct inspection, it is defined as 3rd degree (Dubin and Amelar, 1971). Apart from these definitions, there is also a subclinical varicocele that is not palpable and invisible, which can only be detected by imaging methods (de Los Reyes et al., 2017). ...
DIABETES MELLITUS AND CYTOKINES
... ). Its prevalence in the male population is 10-15%, and this rate rises to 40% in cases of infertility (Dubin and Amelar, 1971). It has been reported that varicocele is seen more frequently in men with secondary infertility, and fertility declines if treatment is not followed (Gorelick and Goldstein, 1993). ...
... If it can be detected without the Valsalva maneuver but is not visible to the naked eye, it is defined as a grade 2 varicocele. If it is understood by direct inspection, it is defined as 3rd degree (Dubin and Amelar, 1971). Apart from these definitions, there is also a subclinical varicocele that is not palpable and invisible, which can only be detected by imaging methods (de Los Reyes et al., 2017). ...
... The overall response rate to varicocele repair for scrotal pain is approximately 80%. Varicocele has shown a detrimental impact on male reproductive capacity, with proper treatment of clinically significant varicoceles resulting in significant improvements in semen parameters and a chance of successful conception [20][21][22]. Most patients with varicoceles during adolescence, however, do not have fertility problems during adulthood, and surgical correction of varicoceles has shown no benefits in patients with subclinical varicocele or normal semen parameters. ...
... Varicocele (VCL) is the abnormal dilatation, tortuosity of the pampiniform plexus, usually affecting the left testis [1] and it is widely considered the most common correctable cause of male infertility [2], leading to ipo-fertility condition. The incidence of varicocele in men with primary infertility is estimated to be 35-44%. ...
Introduction
Autophagy, a catabolic process enabling cellular organelles and proteins’ reuse for energy, has been observed in varicocele models, but the effect of surgical treatment on this process remains unknown. This study aims to assess autophagy in varicocele models undergoing surgical correction.
Materials and Methods
Twenty-one adolescent male rats were induced with varicocele and divided into three groups: sham, varicocele, and varicocele with varicocelectomy. After 21 days, testicles were examined histologically for spermatogenesis (Jonhsen’s score) and immunohistochemically for autophagy markers (LC3A, Beclin-1, Ambra-1, ULK-1, p62). Positive germ cells were quantitatively evaluated, and data were statistically analyzed (p < 0.05).
Results
Histological examination revealed significantly reduced Jonhsen’s scores in varicocele compared to sham and varicocelectomy groups (p < 0.05). Expression of autophagy markers (LC3A, Beclin-1, Ambra-1, ULK-1, p62) was significantly higher in varicocele than sham and varicocelectomy groups (p < 0.05), and in varicocelectomy than sham (p < 0.05).
Conclusions
Varicocele activates autophagy markers, with p62 potentially modulating autophagy despite being considered an inhibitor. While varicocelectomy improves histology, it doesn’t fully inhibit autophagy, suggesting ongoing germ cell dysfunction despite treatment. This underscores varicocele’s detrimental effects on germ cell functionality.
... Допплерография также позволяет контролировать эффективность терапии, включая оперативные вмешательства, и выявлять возможные рецидивы заболевания [1][2][3][4]. ...
Статья посвящена изучению применения ультразвуковой допплерографии для диагностики варикоцеле у мужчин. Варикоцеле является одной из ведущих причин мужского бесплодия, и ранняя диагностика с использованием ультразвука позволяет своевременно выявлять патологию вен семенного канатика и оценивать их функциональные характеристики. Исследование показало высокую информативность метода в диагностике и мониторинге состояния пациентов после оперативного лечения. Ультразвуковая допплерография зарекомендовала себя как безопасный и доступный метод для неинвазивного обследования.
... Varicocele Varicocele represents a common co-factor of male infertility [79]. It is more prevalent in infertile than fertile men [80] and has been associated with testicular damage and impaired spermatogenesis [81][82][83]. ...
Objectives
The Scrotal and Penile Imaging Working Group (SPIWG) of the European Society of Urogenital Radiology (ESUR) aimed to produce recommendations on the role of the radiologist in the evaluation of male infertility focused on scrotal imaging.
Methods
The authors independently performed an extensive literature Medline search and a review of the clinical practice and consensus opinion of experts in the field.
Results
Scrotal ultrasound (US) is useful in investigating male infertility. US abnormalities related to abnormal sperm parameters (sperm concentration, total count, motility, and morphology) are low testicular volume (TV), testicular inhomogeneity (TI), cryptorchidism, testicular microlithiasis (TML), high-grade varicocele, bilateral absence of vas deferens, bilateral dilation and echotexture abnormalities of the epididymis. The proposed ESUR-SPIWG recommendations for imaging in the evaluation of male infertility are therefore: to measure TV; investigate TI; perform annual (US) follow-ups up to age 55 in men with a history of cryptorchidism/orchidopexy and/or in men with TML plus “additional risk factors” or with “starry sky” TML; perform scrotal/inguinal US in men with nonpalpable testis; perform scrotal US in men with abnormal sperm parameters to investigate lesions suggestive of tumors; evaluate varicocele in a standardized way; evaluate the presence or absence of vas deferens; investigate the epididymis to detect indirect signs suggesting obstruction and/or inflammation.
Conclusions
The ESUR-SPIWG recommends investigating infertile men with scrotal US focusing on TV, inhomogeneity, localization, varicocele, vas deferens, and epididymal abnormalities. Cryptorchidism, TML, and lesions should be detected in relation to the risk of testicular tumors.
Clinical relevance statement
The ESUR-SPIWG recommendations on scrotal imaging in the assessment of male infertility are useful to standardize the US examination, focus on US abnormalities most associated with abnormal semen parameters in an evidence-based manner, and provide a standardized report to patients.
Key Points
So far, ESUR-SPIWG recommendations on scrotal imaging in the assessment of male infertility were not available.
The ESUR-SPIWG recommends investigating infertile men with scrotal US focusing on testicular volume, inhomogeneity, localization, varicocele, vas deferens and epididymal abnormalities, and assessing cryptorchidism, testicular microlithiasis and lesions in relation to the risk of testicular tumors.
The ESUR-SPIWG recommendations on scrotal imaging in the assessment of male infertility are useful to standardize the US examination, focus on US abnormalities most associated with abnormal sperm parameters in an evidence-based manner, and provide a standardized report to patients.
... Varicocele is the pathological dilatation of the venous plexus of testes and it is the most frequently observed correctable cause of male infertility (1). The incidence of varicocele is around 15% in the general population but this rate rises to 35-40% and 69-81% in primary and secondary infertile men, respectively (2,3). ...
... Varicocele is defined as an abnormal venous dilatation and/ or tortuosity of the pampiniform plexus in the scrotum [1]. Clinical varicocele is found in approximately 15% -20 % of the normal adult male population and 35% -44% of men with primary infertility [2][3][4][5][6]. Varicocele is frequently associated with low sperm count, decreased sperm motility and increased sperm abnormal morphology [7][8][9]. ...
The present study compared seminal calbindin 2 (CALB 2) levels and semen parameters in men with and without varicocele. CALB 2 is also known as calretinin and 29 kDa calbindin. The study was a case-control study conducted from April (2021) to March (2022) in the andrology department at Beni-Suef University hospital. The study included four matched groups: group (I) were controls (fertile normozoospermic men without varicocele) (n=24). Group (II) were fertile normozoosper-mic men with varicocele (n=24). Group (III) were infertile oligoasthenoteratozoospermia (OAT) men without varicocele (n=24). Group (IV) were infertile OAT men with varicocele (n=24). The lowest levels of seminal CALB 2 were found in patients with severe oligozoospermia which showed a statistically significant difference when compared to seminal CALB 2 in patients with normal, mildly low, or moderately low sperm counts. There were significant negative correlations between sperm concentration, sperm motility and percentage of normal sperm forms and seminal CALB 2. Seminal plasma CALB 2 may play a role in the negative impact of varicocele on the semen parameters especially sperm concentration, sperm motility and percentage of sperm normal forms. Future studies are needed to verify these findings.
... 5 American epidemiological data indicate a prevalence of isolated male factor of 17.1% and total male infertility of 34.6% 6 although the true extent of male infertility is probably underestimated due to the lack of evaluation of the male partner. 2 Despite a comprehensive diagnostic workup, the diagnosis remains elusive in a quarter of infertile patients who are, therefore, identified as idiopathic. [7][8][9][10][11][12][13] According to a monocentric German study that evaluated the etiology of infertility in over 20 000 male patients who were referred to a fertility center, no diagnosis could be made in about 70% of them. 14 Worryingly, a similar percentage was reported in a Dutch single-center retrospective study on 1737 patients with reduced sperm counts. ...
Context:
Prevalence of obesity in childhood has increased over the past few decades. The impact of obesity and of obesity-related metabolic disorders on testicular growth is unknown.
Objective:
To evaluate the impact of obesity, hyperinsulinemia, and insulin resistance on testicular volume (TV) in pre-pubertal (<9 years), peri-pubertal (9-14 years), and post-pubertal (14-16 years) periods.
Methods:
We collected data on TV, age, standard deviation score (SDS) of the body mass index (BMI), insulin, and fasting glycemia in 268 children and adolescents followed-up for weight control.
Results:
Peri-pubertal boys with normal weight had a significantly higher TV compared to those with overweight or obesity. No difference was found in the other age ranges when data were grouped according to BMI. Pre- and post-pubertal children/adolescents with normal insulin levels had significantly higher TV compared to those with hyperinsulinemia. Peri-pubertal boys with hyperinsulinemia had significantly higher TV compared to those with normal insulin levels. Post-pubertal adolescents with insulin resistance had lower TV and peri-pubertal boys had higher TV compared to those without insulin resistance. No difference was found in pre-puberty.
Conclusions:
Closer control of the body weight and the associated metabolic alterations in childhood and adolescence may maintain testicular function later in life.
... Varicocele is defined as an abnormal venous dilatation and/ or tortuosity of the pampiniform plexus in the scrotum [1]. Clinical varicocele is found in approximately 15% -20 % of the normal adult male population and 35% -44% of men with primary infertility [2][3][4][5][6]. Varicocele is frequently associated with low sperm count, decreased sperm motility and increased sperm abnormal morphology [7][8][9]. ...
The present study compared seminal calbindin 2 (CALB 2) levels and semen parameters in men with and without varicocele. CALB 2 is also known as calretinin and 29 kDa calbindin. The study was a case-control study conducted from April (2021) to March (2022) in the andrology department at Beni-Suef University hospital. The study included four matched groups: group (I) were controls (fertile normozoospermic men without varicocele) (n=24). Group (II) were fertile normozoospermic men with varicocele (n=24). Group (III) were infertile oligoasthenoteratozoospermia (OAT) men without varicocele (n=24). Group (IV) were infertile OAT men with varicocele (n=24). The lowest levels of seminal CALB 2 were found in patients with severe oligozoospermia which showed a statistically significant difference when compared to seminal CALB 2 in patients with normal, mildly low, or moderately low sperm counts. There were significant negative correlations between sperm concentration, sperm motility and percentage of normal sperm forms and seminal CALB 2. Seminal plasma CALB 2 may play a role in the negative impact of varicocele on the semen parameters especially sperm concentration, sperm motility and percentage of sperm normal forms. Future studies are needed to verify these findings.
... Varikosel, en sık görülen ve düzeltilebilen erkek kaynaklı infertilite sebebidir [1]. Değişik çalışmalarda farklı değerler bulunmasına rağmen genel popülasyonda yaklaşık %12-15, infertil popülasyonda ise yaklaşık %30-35 oranında görülmektedir [2]. ...
Amaç: Varikoselektomi operasyonları çoğunlukla 20-35 yaşları arasında uygulanmaktadır. Bu yaş grubu aynı zamanda etkin iş gücü için de oldukça önemlidir. Varikoselektomide iş günü kaybı üzerine literatürde çalışma bulunmamaktadır. Bu çalışmamızla varikoselektomi ameliyatının iş günü kaybına etkisi üzerine farkındalık oluşturmak ve literatüre katkıda bulunmayı amaçladık. Gereç ve Yöntemler: Aksaray Özel İnova Hastanesi’nde 07.03.2019-14.10.2022 tarihleri arasında varikoselektomi yapılan 77 hasta çalışmaya dahil edildi. Varikoselektomi tek cerrah tarafından subinguinal yöntem kullanılarak, Carl-Zeiss operasyon mikroskopu (Carl Zeiss, Thornwood, NY) ile 10’luk büyütme altında uygulandı. Hastaların erken dönem komplikasyonları ve iş günü kaybı ameliyat sonrası 10. gün ve 1. ay kontrollerinde sorgulandı. Araştırma verilerinin istatistiksel analizi için Statistical Package for Social Sciences (SPSS), sürüm 22.0 (SPSS Inc. Chicago, ABD) bilgisayar paket programı kullanıldı. p 0,05). İş türü, medeni durum ve erken dönem komplikasyonların çeşitleri ile iş günü kaybı arasında istatistiksel anlamlı farklılık bulundu (p:0,014, p:0,03 ve p:0,02; sırasıyla). Sonuç: Mavi yakalı çalışanların varikoselektomi operasyonu sonrası beyaz yakalı çalışanlara göre işe dönüş zamanı birkaç gün daha uzun olmaktadır. Yaklaşık olarak varikoselektomi sonrası çalışanlar 15 gün sonra işbaşı yapabilmektedir. Bu konuda prospektif, daha büyük merkezlerin geniş vaka serilerine ihtiyaç olduğu kanaatindeyiz. Anahtar Kelimeler: iş günü kaybı; varikoselektomi; mikrocerrahi
... The principal findings of this study demonstrate that the risk of varicocele increases in patients with left sided IH. An increased prevalence of varicocele was seen in patients with IH (58.3%) compared to the prevalence of varicocele in patients without IH (23.3%) and the prevalence in the general population (15%) reported in the literature (8)(9)(10). Some studies in the literature have investigated diseases that may be associated with varicocele. ...
Objective:The aim of this study was to investigate the relationship between left sided inguinal hernia and varicocele.Method:Between July and October 2022, 60 patients with left inguinal hernia (group 1) and 60 patients without hernia (group 2, control group) were included in our prospective study. Those with a history of right inguinal hernia, left epididymoorchitis, scrotal surgery or inguinal hernia surgery were not included in the study. The patients were evaluated for the presence of left varicocele. Grade of the varicocele, the diameters of the pampiniform plexus veins, and the neck diameter of the hernia were measured.Results:There were 120 male patients in our study (group 1 n=60, group 2 n=60). While the age range of the patients with hernia was 23-60 years (mean age: 36±8.4 years), the age range of the patients without hernia was 20-58 years (mean age: 33±9.5 years). There was no statistically significant difference between the groups in terms of age distribution (p=0.89). While the incidence of varicocele was 58.3% (35/60) in group 1, it was 23.3% (14/60) in group 2 [relative risk 2.5 (95% confidence interval (CI) (1.507, 4.147)] and odds ratio of 4.6 [95% CI (2.091, 10.118)]. While the median grade of varicocele was 1 in group 1, it was 0 in group 2, and a statistically significant difference was found (p
... Varicoceles are the commonly seen and correctable cause of male factor infertility [6]. Based on current evidence, it is the practice guideline of both the American Urological Association and the American Society for Reproductive Medicine (ASRM) that correction of a varicocele should be offered to infertile men with palpable lesions and one or more abnormal semen parameters [7]. ...
Background:
A varicocele can be defined as an abnormal venous dilatation and/or tortuosity of the pampiniform plexus. It is generally reported that varicoceles are present in 15% of the general male population and 35% of men as a cause of primary infertility and in up to 80% of men as a cause of secondary infertility. Differences in venous drainage anatomy between the left and right internal spermatic veins, venous valve incompetence resulting in venous blood reflux, and increased hydrostatic pressure are the most commonly cited theories. Various surgical and non-surgical techniques are in use for treating patients with varicocele. Here we used a modified Palamo procedure to treat the patients and observed the outcome.
Methodology:
A total of 40 patients with varicocele were recruited for the study. A preoperative evaluation, along with serum testosterone levels and semen analysis, was done. A modified Palomo technique was used to treat varicocele. A postoperative follow-up with serum testosterone levels and semen analysis was done to observe improvement.
Results:
The mean (±SD) left testis size, right testis size, testosterone, sperm concentration, sperm vitality and sperm progressive motility were found statistically significantly higher in patients after surgery as compared to patients before surgery (p<0.05). However, there was statistically insignificant mean difference in semen volume between patients before surgery and patients after surgery (p>0.05).
Conclusion:
Modified Palomo procedure can be used to treat varicocele with good improvement in serum testosterone levels and semen parameters.
... Other men present to the physician primarily with ejacula-tory concerns of a medical nature, such as infertility, pain with ejaculation or hematospermia. It has been stated that only 2% of men who presented for treatment of subfertility were diagnosed with ejaculatory dysfunction as the cause of the subfertility (5). ...
... Male infertility affects about half of couples who cannot conceive (1). The main causes of male infertility can be generally divided into three categories: hypogonadism due to hypothalamicpituitary abnormity, seminal outflow disability, and testicular dysfunction, while the last one makes up the most common cause of male infertility (1)(2)(3). Many kinds of stressors impact normal testes functions, including heat, oxidative stress, environmental contamination, and psychological stress (4)(5)(6). ...
Male reproductive function is key to the continuation of species and is under sophisticated regulation, challenged by various stressors including inflammation. In the lipopolysaccharide (LPS) intraperitoneal injection-induced acute systemic inflammation, male fecundity was compromised with decreased testosterone level, damaged spermatogenesis, and downregulations of testicular gene expression levels involved in steroidogenesis regulation and blood–testis barrier. It is also noteworthy that the testis is more sensitive to acute stress caused by LPS-induced systemic inflammation. LPS treatment resulted in lower testicular gene expression levels of steroidogenic acute regulatory protein, cholesterol side-chain cleavage enzyme, and cytochrome P450 family 11 subfamily B member 1 after LPS treatment, while no such decrease was found in the adrenal gland. In parallel to the significant decreases in testicular intercellular adhesion molecule 1, tight junction protein 1, and gap junction alpha-1 protein gene expression with LPS treatment, no decrease was found in the epididymis. In the brain, LPS treatment caused higher medial preoptic area (mPOA) activation in the hypothalamus, which is accompanied by elevated blood follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels, suggesting a disturbed hypothalamic–pituitary–gonad axis function. Besides mPOA, brain c-fos mapping and quantitative analysis demonstrated a broad activation of brain nuclei by LPS, including the anterior cingulate cortex, lateral septum, paraventricular nucleus of the hypothalamus, basolateral amygdala, ventral tegmental area, lateral habenular nucleus, locus coeruleus, Barrington’s nucleus, and the nucleus of the solitary tract, accompanied by abnormal animal behavior. Our data showed that LPS-induced inflammation caused not only local testicular damage but also a systemic disturbance at the brain–testis axis level.
... It is rare for conservative treatment alone to successfully treat pain from varicoceles 23 . Male infertility is most commonly associated with varicoceles, which are easily correctable 24 . Varicoceles have been associated with poor-quality sperm in over half a century of research 25,26 . ...
Many therapies are effective in treating varicoceles, including dilation of the pampiniform plexus in males. The most common method of treatment is varicocelectomy. We aimed to assess an alternative technique (microsurgical spermatic [distal end]-superficial or inferior epigastric vein anastomosis) that preserves the normal blood flow pattern for varicocele treatment. We retrospectively analyzed 27 men with varicocele between October 2019 and July 2020. All patients underwent microsurgical spermatic (distal end)-superficial or inferior epigastric vein anastomosis. The prognosis was reviewed retrospectively with an additional survey conducted 3 months after surgery. The mean ± standard deviation of the age was 26.1 ± 7.3 years in patients with microsurgical spermatic (distal end)-superficial or inferior epigastric vein anastomosis. The maximum diameter of the varicocele vein, perineal pain score, sperm density, and forward movement of sperm improved over 3 months after surgery. Microsurgical spermatic (distal end)-superficial or inferior epigastric vein anastomosis is a safe and efficient surgical treatment for varicoceles.
Background: A varicocele is an unusual enlargement and twisting of veins within the pampiniform plexus, contributing to male infertility. Varicoceles are prevalent in approximately 11 to 15 percent of adult males and can impact testicular function. Varicocelectomy is recommended for non-azoospermic infertile men with abnormal seminal parameters, although uncertainties exist regarding the specific parameters indicating the need for surgery. This study investigates the potential relationship between anogenital distance (AGD) and semen analysis factors before and after varicocelectomy. Methods: The study enrolled 35 males with primary varicocele, excluding those with certain conditions. AGD measurements were taken before surgery, and patients subsequently underwent varicocelectomy. Comprehensive assessments and laboratory examinations were conducted preoperatively, and follow-up semen analyses were performed six months postoperatively. Results: Preoperative and postoperative semen analyses revealed no significant differences in sperm parameters. Statistical analyses indicated no significant correlation between AGD and sperm concentration before or after surgery. Despite these findings, the study contributes valuable information to the ongoing debate on the impact of varicocelectomy on male fertility. Conclusions: This study, while highlighting the limitations and uncertainties, suggests that AGD may not be a significant predictive factor for improvements in semen analysis after varicocelectomy. The nuanced nature of varicocele-associated male infertility underscores the ongoing need for comprehensive research to clarify the true effects of varicocelectomy. Individual patient factors and careful evaluation of available evidence remain crucial in managing varicocele-associated male infertility.
Objective
The aim of this study was to investigate the relationship between left‐sided varicocele and epididymitis or epididymo‐orchitis.
Materials and Methods
The study included 72 patients with left side epididymitis (EP) or epididymo‐orchitis (EPO) (Group 1) and a control group of 72 patients without EP or EPO (Group 2). Those with right EP‐EPO were excluded due to possible other underlying retroperitoneal pathologies causing varicocele. Groups were evaluated for presence of left side varicocele, varicocele grade and pampiniform plexus vein diameter.
Results
The average age was 38 ± 8.4 years (range, 18–50 years) in Group 1, and 36 ± 9.1 years (range, 16–47 years) in Group 2. Varicocele was significantly more common in patients with EP or EPO ( p < .001). The rate of varicocele was 66.7% (48/72) in Group 1, and 22.3% (16/72) in Group 2. The median grade of varicocele was 2 in Group 1, and 0 in Group 2. Pampiniform plexus vein diameters were found to be significantly larger in patients with EP or EPO compare to patients without EP and EPO. The median vein diameter was 3.3 mm with the 25th and 75th percentiles at 2.7 and 3.8 mm, and was 1.9 mm with the 25th and 75th percentiles at 1.7 and 2.3 mm, respectively ( p < .001).
Conclusions
Left‐sided varicocele was significantly more common in patients with EP or EPO and it is an important cause for the development of EP/EPO because of chronic venous stasis.
OBJECTIVE
This study aimed to assess the quality of YouTube videos about microscopic varicocelectomy.
METHODS
On November 20, 2022, a YouTube search for “Microscopic Varicocelectomy” was conducted. Non-English videos uploaded by producers for commercial purposes that lacked audio and subtitles were excluded from the study. A total of 50 videos were evaluated using the Journal of the American Medical Association Benchmark Score and the Global Quality Score, both of which are recognized internationally. Additionally, the researcher developed the Microscopic Varicocelectomy Score to evaluate the videos’ technical content. The upload source, video length, number of views, likes, dislikes, and video power indexes were evaluated.
RESULTS
The Global Quality Score, Journal of the American Medical Association Benchmark Score, and Microscopic Varicocelectomy Score of the academically prepared videos were significantly higher than those of the physician-prepared videos (p<0.05). The Global Quality Score, Journal of the American Medical Association Benchmark Score, and Microscopic Varicocelectomy Score of uploaded videos with audio, audio, and subtitles were significantly higher than those with only subtitles (p<0.05). The video duration was positively correlated with Journal of the American Medical Association Benchmark Score, Global Quality Score, and Microscopic Varicocelectomy Score. The video power index had a strong positive correlation with the number of likes. Moreover, a strong positive correlation was observed, indicating that the Global Quality Score and Journal of the American Medical Association Benchmark Score increased as the Microscopic Varicocelectomy Score increased.
CONCLUSION
YouTube videos regarding microscopic varicocelectomy were of notably low quality. If the video content created by specialist physicians and academic centers is more meticulously organized, more accurate data can be transmitted. Consequently, viewing video content may not be advised based on the available data.
This study investigates the therapeutic effect and the underlying mechanisms of ergothioneine (EGT) on the testicular damage caused by varicocele (VC) in vivo, in vitro, and in silico. This preclinical study combines a series of biological experiments and network pharmacology analyses. A total of 18 Sprague Dawley (SD) male rats were randomly and averagely divided into three groups: the sham‐operated, VC model, and VC model with EGT treatment (VC + EGT) groups. The left renal vein of the VC model and the VC + EGT groups were half‐ligated for 4 weeks. Meanwhile, the VC + EGT group was intragastrically administrated with EGT (10 mg/kg). GC1 and GC2 cells were exposed to H2O2 with or without EGT treatment to re‐verify the conclusion. The structure disorder of seminiferous tubules ameliorated the apoptosis decrease in the VC rats receiving EGT. EGT can also increase the sperm quality of the VC model rats (p < 0.05). The exposure to H2O2 decreased proliferation and increased apoptosis of GC1 and GC2 cells, which was revisable by adding EGT to the plates (p < 0.05). The network pharmacology and molecular docking were conducted to explore the potential targets of EGT in VC, and HSP90AA1 was identified as the pivotal gene, which was validated by western blot, immunohistochemistry, and RT‐qPCR both in vivo and in vitro (p < 0.05). Overall, EGT attenuates the testicular injury in the VC model both in vivo and in vitro by potentially potentiating the expression of HSP90AA1.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The association of clinically apparent varicoceles with male subfertility and infertility has been noted in the urology literature since the late nineteenth century, and surgical ligation of varicoceles has been considered appropriate therapy in an attempt to improve semen quality and increase fertility for the past 40 years. It has been established by several authors cited herein that varicocele size does not predict prognosis after ligation reliably. Because subclinical varicoceles may affect testicular function and histologic characteristics adversely and because age at time of therapy may affect probability of successful enhancement of fertility, the interest of radiologists and urologists has been directed toward diagnosis and treatment of both clinically obvious and clinically occult varicoceles, particularly in young adult men or adolescent boys. Testicular growth after varicocele ligation in adolescent boys also suggests a benefit from early intervention. Sonographic evidence of a varicocele must be correlated with analysis of semen for sperm density, motility, and morphology, as not all patients with varicoceles are infertile. Although surgical therapy is standard for varicocele occlusion, fairly extensive evidence exists to show that percutaneous transvenous occlusion of varicoceles is feasible, safe, and effective, particularly in the setting of varicocele recurrence after conventional surgical treatment.
Varicocele is the most common reversible cause of male infertility, affecting up to 20% of healthy men and 40% of men with primary infertility. The objective of this study was to investigate the prevalence of varicocele in men evaluated for infertility, and to determine rates of subsequent varicocele repair. Since reproductive endocrinologists are the first specialists seen for male infertility care in North America, we hypothesized that varicocele would be underdiagnosed when compared to its reported prevalence among men with infertility. TriNetX, a large, multicenter electronic health record (EHR) database was queried to establish a cohort of all men (above 18 years of age) with a diagnosis of male infertility. This cohort was used to identify those with ensuing varicocele diagnosis. Men who received varicocelectomy or venous embolization after a diagnosis of varicocele were then identified. Out of 101,309 men with a diagnosis of male infertility in the network, only 9768 (9.6%) had a diagnosis of varicocele. Mean age of men with varicocele was 34. Varicocelectomy or venous embolization was performed in 1699 (20.2%) and 69 (0.76%) of men with varicocele, respectively. In this cross‐sectional EHR study, varicocele was underdiagnosed in men evaluated for infertility when compared with prior epidemiological studies.
Infertility, defined as the failure to achieve a clinical pregnancy after 1 year of regular, unprotected sexual intercourse, is a public health issue of global concern. It affects up to 12% of couples worldwide. While traditionally, research and treatment have focused on female causes of infertility, male factors contribute to up to 70% of cases and therefore deserve appropriate recognition. The purpose of this comprehensive review is to detail the diagnostic work-up, investigations and management of male factor infertility. We discuss much-debated pathologies, such as varicocele, and novel investigations, including sperm DNA fragmentation and reactive oxygen species.
Level of evidence: Not applicable
TÓM TẮTMục đích: Xác định mối liên quan giữa các đặc điểm lâm sàng, xét nghiệm tinh dịch đồ với siêu âm Doppler trên bệnh nhân giãn tĩnh mạch tinh ở người trưởng thành dưới 40 tuổiPhương pháp: Tổng số 56 bệnh nhân có chẩn đoán giãn tĩnh mạch tinh trên lâm sàng được phân độ lâm sàng theo Dubinvà Amelar[1], tính chỉ số khối cơ thể BMI, có xét nghiệm tinh dịch đồ và tiến hành siêu âm Doppler bìu, tính điểm theo hệ thốngđiểm của Chiou[2] để xác định giãn tĩnh mạch tinh. Để đánh giá mối liên quan chúng tôi sử dụng test khi bình phương (ChiSquare), hai biến định tính được xác định có liên quan khi giá trị p< 0,05.Kết quả: Có mối liên quan giữa chẩn đoán trên siêu âm Doppler theo Chiou với phân độ lâm sàng giãn tĩnh mạch tinh(p<0,05). Không có mối liên quan giữa chỉ số khối BMI với chẩn đoán siêu âm Doppler giãn tĩnh mạch tinh (p>0,05). Có mốiliên quan giữa xét nghiệm tinh dịch đồ với chẩn đoán giãn tĩnh mạch tinh trên siêu âm Doppler (p<0,05)Kết luận: Nghiên cứu của chúng tôi cho thấy có mối liên quan giữa chẩn đoán siêu âm Doppler dựa theo hệ thống tính điểm của Chiou với phân độ lâm sàng và xét nghiệm tinh dịch đồ ở bệnh nhân giãn tĩnh mạch tinh trưởng thành dưới 40 tuổi.
Objectif : Evaluer l’impact du traitement chirurgical de la varicocèle sur les paramètres du spermogramme. Matériels et Méthodes : Notre étude a porté sur 127 hommes infertiles, ayant une varicocèle associée à des anomalies du spermogramme. Tous les patients ont subi un traitement chirurgical et un spermogramme a été demandé à 3 mois et 6 mois. Les données pré et post opératoires ont été comparées ainsi que le taux de grossesses spontanées évalué. Résultats : Après la chirurgie, nous notons une augmentation très discrète du pourcentage de spermatozoïdes des formes normales de 23,7 % à 27 %, de même que les concentrations moyenne de l’ensemble des patients allant de 10,9 × 10,6 /ml à 27,8 × 10,6/ml ; et de 3,3 × 10,6/ml à 10,7 × 10,6/ml chez les patients dont l’oligospermie avant chirurgie était sévère. La motilité moyenne des spermatozoïdes est passée de 25,1 % à 63,4 %, nous avons également considéré l’index d’anomalies multiples chez nos patients qui est passé de 1,72 à 1,21. La vitalité des spermatozoïdes est passée de 32,4% en moyenne à 71,6 %. Le taux de grossesses spontanées a été de 17 % au cours de la première année. Conclusion : En cas d’infertilité associée à une varicocèle cliniquement palpable, le traitement chirurgical de la varicocèle offre une excellente opportunité d’améliorer la qualité du spermogramme. Le nombre de grossesses spontanées observées après traitement doit inciter à proposer un traitement chirurgical d’une varicocèle, si celle-ci représente le seul élément étiologique de l’infertilité.
To the Editor.—
It is the rule rather than the exception, as stated in the answer, to have a normal testicle associated with a congenital absence of the vas deferens on the same side, and to have bilateral normal testicles if the absence of the vas deferens is bilateral. The embryologic development of the testes is from the genital ridges on the medial aspect of the mesonephros, while the vas deferens has a different origin, from the mesonephric duct. If development is disturbed before the human embryo is at the 60 mm (13 weeks) stage, it is possible to have a fully developed testicle and globus major of the epididymis with an undeveloped vas deferens, seminal vesicle, and ejaculatory duct. If the mesonephric duct ceased development at a very early stage (four weeks) the ureteric bud would not develop and there would be an absence of the ureter and kidney
All candidates for vasectomy should be very carefully screened prior to surgery. The biological effects as well as the permanency of the operation should be carefully explained to husband and wife. During surgery the vas should be interrupted high in the scrotum with the cut ends fulgurized rather than ligated. A fascial barrier should be constructed between the cut ends. There should be no excision of a portion of the vas. Because there is no guarantee that fertility can be restored in all vasectomized males it is suggested that vasectomy should never be done as a temporary procedure.(AUTHORS MODIFIED)
The role of varicocele in subfertility was examined in 200 men with poor semen quality and in 87 additional men with fair to good semen quality despite varicocele. Semen quality was evaluated in terms of sperm count, sperm motility, and sperm morphology. Of the 200 men with poor sperm quality, 65% had a sperm count below 20 million/ml and 42% were in the 0-9 million/ml range. In contrast, most sperm counts in the 87 subjects with fair to good semen quality were above 40 million/ml and none was below 20 million. Ligation was not recommended for the latter group. 106 of the 200 men in the 1st group consented to ligation of the left internal spermatic vein, and the semen quality of 77 men was followed at monthly intervals for an average of 10 months. After ligation, the percentage of those with counts below 20 million/ml fell from 63.5 to 29.7, and 40.7% appeared in the above 40 million/ml category (up from 12.5%). Before ligation, 63.3% of the 77 subjects with adequate follow-up reached an acceptable motility level (120) in contrast to 7.8% in this category before operation. More than 50% of excessively subnormal motility indexes improved to a level approaching or surpassing normal, making motility the single most significant aspect of the effects of ligation on semen quality. In terms of morphology, 91% of the 200 subjects with poor semen quality showed moderate to marked stress pathology (e.g., tapering and amorphous cells and the exfoliation of immature cells of the germinal line into the ejaculate. After ligation, the percentage of men with amorphous cells fell from 78 to 44, and the percentage of those with tapering in conjunction with immature forms dropped from 65 to 28.5. The conception rate among the 68 men for whom information was available was 47.6% (32 cases). 81% and 37% of these conceptions occurred at sperm count levels below 60 and 20 million/ml, respectively. However, 29 of the 32 cases showed passable to excellent motility indexes (120-300), suggesting that motility is a more important factor in conception than sperm count. It is hypothesized that varicocele itself may not be the causative factor in disturbed spermatogenesis. Retrograde flow of blood into the left internal spermatic vein, stasis of blood in the renal vein, and the close proximity of the outflow of hormones from the adrenal cortex may create an abnormal environment around the left testis.
Congenital aplasia of the epididymis and vasa deferentia
- Amelar
Undescended Testes in Pediatric Surgery (Vol. II)
- Snyder
Adrenogenital Syndrome as a Cause of Male Infertility
- Epstein
Traitement chirurgical de la sterilite masculine
- Bayle