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Nature Reviews. Urology Sep 2017The link between varicoceles and male infertility has been a matter of debate for more than half a century. Varicocele is considered the most common correctable cause of... (Review)
Review
The link between varicoceles and male infertility has been a matter of debate for more than half a century. Varicocele is considered the most common correctable cause of male infertility, but some men with varicoceles are able to father children, even without intervention. In addition, improvements in semen quality after varicocelectomy do not always result in spontaneous pregnancy. Studies regarding possible pathophysiological mechanisms behind varicocele-induced infertility have tried to address these controversies. Oxidative stress seems to be a central mechanism; however, no single theory is able to explain the differential effect of varicoceles on infertility. As a consequence, careful patient selection for treatment based on couple fertility status, varicocele grade, and semen quality is critical for achieving a chance of a subsequent pregnancy. A substantial amount of data on the effects of varicocelectomy has been gathered, but inadequate study design and considerable heterogeneity of available studies mean that these data are rarely conclusive. Current evidence suggests a beneficial effect of varicocelectomy on semen quality and pregnancy outcomes in couples with documented infertility only if the male partner has a clinically palpable varicocele and affected semen parameters.
Topics: Humans; Infertility, Male; Male; Risk Factors; Treatment Outcome; Varicocele
PubMed: 28675168
DOI: 10.1038/nrurol.2017.98 -
Fertility and Sterility Sep 2017Varicoceles, a dilation of veins within the pampiniform plexus, are present in ∼15% of the general male population. This paper reviews the indications for treatment of... (Review)
Review
Varicoceles, a dilation of veins within the pampiniform plexus, are present in ∼15% of the general male population. This paper reviews the indications for treatment of varicoceles, post-intervention outcomes following treatment, and the various techniques for treatment of varicoceles. The aim of this review is to describe and compare complications associated with each approach to varicocele treatment.
Topics: Combined Modality Therapy; Embolization, Therapeutic; Evidence-Based Medicine; Humans; Infertility, Male; Laparoscopy; Male; Treatment Outcome; Urogenital Surgical Procedures; Varicocele; Vascular Surgical Procedures
PubMed: 28865535
DOI: 10.1016/j.fertnstert.2017.07.020 -
Frontiers in Immunology 2021Varicocele (VC) is present in 35 - 40% of men with infertility. However, current surgical and antioxidant treatments are not completely effective. In addition to... (Review)
Review
BACKGROUND
Varicocele (VC) is present in 35 - 40% of men with infertility. However, current surgical and antioxidant treatments are not completely effective. In addition to oxidative stress, it is likely that other factors such as testicular immune microenvironment disorder contribute to irreversible testicular. Evidence suggests that VC is associated with anti-sperm antibodies (ASAs), spermatogenesis and testosterone secretion abnormalities, and testicular cytokine production. Moreover, inhibition of inflammation can alleviate VC-mediated pathogenesis. The normal function of the testis depends on its immune tolerance mechanism. Testicular immune regulation is complex, and many infectious or non-infectious diseases may damage this precision system.
RESULTS
The testicular immune microenvironment is composed of common immune cells and other cells involved in testicular immunity. The former includes testicular macrophages, T cells, dendritic cells (DCs), and mast cells, whereas the latter include Leydig cells and Sertoli cells (SCs). In animal models and in patients with VC, most studies have revealed an abnormal increase in the levels of ASAs and pro-inflammatory cytokines such as interleukin (IL)-1 and tumor necrosis factor (TNF)-alpha in the seminal plasma, testicular tissue, and even peripheral blood. It is also involved in the activation of potential inflammatory pathways, such as the nucleotide-binding oligomerization domain-like receptor family pyrin domain containing (NLRP)-3 pathway. Finally, the development of VC-mediated infertility (VMI) may be facilitated by abnormal permeability of proteins, such as claudin-11, that constitute the blood-testis barrier (BTB).
CONCLUSIONS
The testicular immune response, including the production of ASAs and inflammatory factors, activation of inflammatory pathways, and destruction of the BTB may be involved in the pathogenesis of VMI it is necessary to further explore how patient outcomes can be improved through immunotherapy.
Topics: Animals; Cellular Microenvironment; Fertility; Humans; Immunotherapy; Infertility, Male; Inflammation Mediators; Male; Orchitis; Signal Transduction; Testis; Varicocele
PubMed: 34531872
DOI: 10.3389/fimmu.2021.729539 -
The efficacy and mechanism of acupuncture in the treatment of male infertility: A literature review.Frontiers in Endocrinology 2022Fertility, a social, cultural, and medical issue, has aroused public attention because of its potential to predict future health. In recent years, the incidence of male... (Review)
Review
Fertility, a social, cultural, and medical issue, has aroused public attention because of its potential to predict future health. In recent years, the incidence of male infertility has increased significantly, and various risk factors, such as congenital factors, acquired factors, and idiopathic factors, have led to this situation. Male infertility causes substantial psychological and social distress in patients. With the implementation of the two-child policy, male infertility has brought enormous psychological and social pressure and huge economic burden to patients and the healthcare system. This has attracted the attention of not only men of childbearing age but also many male experts. The conventional therapeutic approaches for treating male infertility, including drugs, varicocele surgery, intrauterine insemination, fertilization, and intracytoplasmic sperm injection, can restore fertility to a certain extent, but their efficacy is far from satisfactory, not to mention some adverse events. Therefore, acupuncture has been chosen by many men to treat their infertility and produced significant effects. In the present paper, the efficacy and mechanism of acupuncture in the treatment of male infertility were analyzed from different perspectives such as regulating hormone secretion, reducing inflammation, and improving semen parameters. The existing literature shows that acupuncture can effectively treat male infertility.
Topics: Male; Humans; Spermatozoa; Semen; Infertility, Male; Varicocele; Acupuncture Therapy
PubMed: 36329891
DOI: 10.3389/fendo.2022.1009537 -
American Family Physician Aug 2022Scrotal and testicular masses can be broadly categorized into painful conditions, which include testicular torsion, torsion of the testicular appendage, and...
Scrotal and testicular masses can be broadly categorized into painful conditions, which include testicular torsion, torsion of the testicular appendage, and epididymitis, and painless conditions, which include hydrocele, varicocele, and testicular cancer. Testicular torsion is a urologic emergency requiring prompt surgical intervention to save the testicle, ideally within six hours of presentation when the salvage rate is about 90%. The Testicular Workup for Ischemia and Suspected Torsion score can be used to help physicians identify patients at high risk of torsion and those at lower risk who would benefit from imaging first. Torsion of the testicular appendage presents with gradual onset of superior unilateral pain, is diagnosed using ultrasonography, and is treated supportively with analgesics. Epididymitis is usually caused by infection with Chlamydia trachomatis, Neisseria gonorrhoeae, or enteric bacteria and is treated with antibiotics, analgesics, and scrotal support. Hydroceles are generally asymptomatic and are managed supportively. Varicoceles are also generally asymptomatic but may be associated with reduced fertility. It is uncertain if surgical or radiologic treatment of varicoceles in subfertile men improves the rate of live births. Testicular cancer often presents as a unilateral, painless mass discovered incidentally. Ultrasonography is used to evaluate any suspicious masses, and surgical treatment is recommended for suspected cancerous masses.
Topics: Epididymitis; Humans; Male; Neoplasms, Germ Cell and Embryonal; Scrotum; Spermatic Cord Torsion; Testicular Hydrocele; Testicular Neoplasms; Varicocele
PubMed: 35977130
DOI: No ID Found -
Asian Journal of Andrology 2016Varicocele recurrence is one of the most common complications associated with varicocele repair. A systematic review was performed to evaluate varicocele recurrence... (Review)
Review
Varicocele recurrence is one of the most common complications associated with varicocele repair. A systematic review was performed to evaluate varicocele recurrence rates, anatomic causes of recurrence, and methods of management of recurrent varicoceles. The PubMed database was evaluated using keywords "recurrent" and "varicocele" as well as MESH criteria "recurrent" and "varicocele." Articles were not included that were not in English, represented single case reports, focused solely on subclinical varicocele, or focused solely on a pediatric population (age <18). Rates of recurrence vary with the technique of varicocele repair from 0% to 35%. Anatomy of recurrence can be defined by venography. Management of varicocele recurrence can be surgical or via embolization.
Topics: Adolescent; Adult; Age Factors; Child; Humans; Male; Phlebography; Recurrence; Risk Factors; Treatment Failure; Varicocele; Young Adult
PubMed: 26806078
DOI: 10.4103/1008-682X.171578 -
The Urologic Clinics of North America May 2016Varicocele is defined as an excessive dilation of the pampiniform plexus. The association between varicocele and infertility has been well-established as evidenced by... (Review)
Review
Varicocele is defined as an excessive dilation of the pampiniform plexus. The association between varicocele and infertility has been well-established as evidenced by negative effects on spermatogenesis. Accumulating evidence now suggests that varicocele presents a pantesticular insult, with resultant impairment of Leydig cell function. The presence of a varicocele has been linked to lower serum testosterone levels and varicocelectomy may reverse some of the adverse effects on androgen production. In this review, the evidence linking varicoceles to impaired steroidogenesis and which cohorts of men may benefit most from varicocele repair are discussed.
Topics: Disorder of Sex Development, 46,XY; Humans; Hypogonadism; Male; Testis; Testosterone; Varicocele
PubMed: 27132580
DOI: 10.1016/j.ucl.2016.01.009 -
Asian Journal of Andrology 2016This Special Issue of is fully dedicated to the thematic area of Varicocele, which has been one of the most controversial issues in the field of Urology, Andrology, and...
This Special Issue of is fully dedicated to the thematic area of Varicocele, which has been one of the most controversial issues in the field of Urology, Andrology, and Reproductive Medicine. Recognized as a clinical entity for over a century, varicocele from Latin: (dilated vein) and from Greek: (tumor) still elicits heated debate among scientists and clinicians on an arguable negative effect on male fertility and gonadal function and has fueled thousands of scholarly articles since its first report in the 18 century.
Topics: Humans; Infertility, Male; Male; Varicocele
PubMed: 26780875
DOI: 10.4103/1008-682X.172819 -
Progres En Urologie : Journal de... Nov 2023Varicocele is the most common correctable cause of male infertility. It was the subject of recent Association française d'urologie (AFU) Comité d'andrologie... (Review)
Review
BACKGROUND
Varicocele is the most common correctable cause of male infertility. It was the subject of recent Association française d'urologie (AFU) Comité d'andrologie et de médecine sexuelle (CAMS) recommendations. Since then, the literature has provided additional information. This review will comprehensively reassess current indications for the treatment of varicocele, and revisit contemporary issues in the light of current advances.
METHODS
Update of the literature search carried out as part of the CAMS recommendations for the period between 2020 and 2023.
RESULTS
Microsurgical sub-inguinal varicocelectomy remains the surgical treatment of choice for infertile men with clinical varicocele and abnormal sperm parameters. It offers recurrence rates of less than 4%. It significantly improves both natural and in vitro fertilization live birth and pregnancy rates, as well as sperm count, total and progressive motility, morphology and DNA fragmentation rates. All in all, it modifies the MPA strategy in around one in two cases. Varicocele grade and bilaterality are predictive of improved sperm parameters and pregnancy rate. Treatment of subclinical varicocele is not recommended. Complications are rare, notably hydroceles (0.5%), unilateral testicular atrophy due to arterial damage (1/1000), hematomas, delayed healing and postoperative pain. Retrograde embolization is an alternative to surgery.
CONCLUSION
Whenever possible, the urologist should present and discuss treatment options for varicocele with the MPA team and the patient, taking a personalized approach.
Topics: Pregnancy; Female; Male; Humans; Varicocele; Semen; Infertility, Male; Pregnancy Rate; Vascular Surgical Procedures; Sperm Count
PubMed: 38012908
DOI: 10.1016/j.purol.2023.09.003 -
European Radiology Jan 2020Varicoceles are relatively common particularly in asymptomatic men and are even more prevalent in subfertile men, representing the most common potentially correctable...
Ultrasound evaluation of varicoceles: guidelines and recommendations of the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) for detection, classification, and grading.
Varicoceles are relatively common particularly in asymptomatic men and are even more prevalent in subfertile men, representing the most common potentially correctable cause of male infertility. Ultrasound (US) is the imaging modality of choice for varicocele evaluation, but there is no widely accepted consensus on examination technique, diagnostic criteria, or classification. In view of this uncertainty, the guideline writing group (WG) of the European Society of Urogenital Radiology (ESUR) Scrotal and Penile Imaging Working Group (ESUR-SPIWG) undertook a literature review and assessment of the quality of relevant evidence. The group then produced evidence-based recommendations for varicocele US examination, interpretation, and classification by consensus agreement. The results are presented in the form of 15 clinical questions with a brief summary of the relevant evidence and the authorised recommendations from the SPIWG. This paper provides a short summary of the evidence evaluation and the complete recommendations.Key Points• Varicocele is a common clinical problem; it is highly prevalent amongst subfertile men and the most common potentially correctable cause of male infertility. • Ultrasound is the imaging modality of choice for varicocele assessment, but there is no generally agreed consensus on the US examination technique or the criteria that should be used for diagnosis, grading, and classification. • This paper summarises the recommendations of the ESUR-SPIWG for standardising the US assessment of varicoceles. This includes examination technique, image interpretation, classification, and reporting.
Topics: Consensus; Evidence-Based Medicine; Humans; Infertility, Male; Male; Penis; Scrotum; Spermatogenesis; Ultrasonography; Varicocele
PubMed: 31332561
DOI: 10.1007/s00330-019-06280-y