-
Fertility and Sterility Sep 2017Determining the effect of varicoceles on future fertility is challenging owing to multiple issues in children/adolescents, including: limitations in obtaining and... (Review)
Review
Determining the effect of varicoceles on future fertility is challenging owing to multiple issues in children/adolescents, including: limitations in obtaining and interpreting semen analyses; potential for unequal differential testicular growth during puberty regardless of varicocele presence; and the potential for a lengthy interval between surgical intervention for varicocele in adolescence and attempts at paternity. This review presents a summary and evaluation of the available evidence relating to future fertility among children and adolescents with varicoceles. Data relating to proxy fertility measures in children/adolescents, including testicular size asymmetry and semen analysis abnormalities, demonstrate that these proxy measures are imperfect predictors of future fertility. Two large, recently published series of adolescents undergoing varicocele treatment showed conflicting paternity outcomes. Pediatric and adolescent varicocele will remain a clinical conundrum, subject to both over- and under-treatment, until more definitive prospective data are available.
Topics: Adolescent; Adolescent Health; Causality; Comorbidity; Evidence-Based Medicine; Humans; Incidence; Infertility, Male; Male; Risk Factors; Treatment Outcome; Varicocele
PubMed: 28803635
DOI: 10.1016/j.fertnstert.2017.07.014 -
Asian Journal of Andrology 2016In the past, the indications for varicocelectomy are primarily for infertility with abnormal semen parameters, testicular hypotrophy/atrophy in adolescents, and/or pain.... (Review)
Review
In the past, the indications for varicocelectomy are primarily for infertility with abnormal semen parameters, testicular hypotrophy/atrophy in adolescents, and/or pain. The surgical treatment of varicocele for hypogonadism is controversial and debated. Recently, multiple reports in the literature have suggested that varicocele is associated with hypogonadism and varicocele repair can increase testosterone levels. Men with hypogonadal symptoms should have at least two serum testosterone levels. Microsurgical varicocelectomy may be beneficial for men with clinically palpable varicoceles with documented hypogonadism. In this review, we summarize the most recent literature linking varicocele to hypogonadism and sexual dysfunction and the impact of repair on serum testosterone levels. We performed a search of the published English literature. The key words used were "varicocele and hypogonadism" and "varicocele surgery and testosterone." We included published studies after 1998. We, also, evaluated the effect of surgery on the changes in the serum testosterone level regardless of the indication for the varicocele repair.
Topics: Erectile Dysfunction; Humans; Hypogonadism; Male; Testosterone; Varicocele
PubMed: 26696437
DOI: 10.4103/1008-682X.169560 -
Journal of Pediatric Urology Jun 2017
Topics: Adolescent; Humans; Male; Varicocele
PubMed: 28645617
DOI: 10.1016/j.jpurol.2017.05.010 -
International Urology and Nephrology Jul 2016To determine the efficacy of different surgical approaches and techniques for resolving varicocele-related pain and factors that predict surgical outcomes. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To determine the efficacy of different surgical approaches and techniques for resolving varicocele-related pain and factors that predict surgical outcomes.
METHODS
The PubMed and Embase databases were searched with the terms "varicocele", "varicocelectomy" and "pain". Manual searches by reviewing the references of included studies were performed. Studies were included when they focused on the influence of varicocele grade, pain quality, different surgical approaches or techniques on pain resolution. A meta-analysis was conducted with RevMan5.3 software.
RESULTS
Twelve studies were identified in the analysis. No significant correlation was found between varicocele grade and pain resolution (P > 0.05). The resolution rate for dull pain was significantly higher than sharp pain [RR = 1.11, 95 % CI (1.02, 1.22), P = 0.02], and there were no other significant differences between the qualities of pain and pain resolution. The pain resolution rate was significantly higher after subinguinal varicocelectomy than after high or inguinal varicocelectomy [RR = 0.83, 95 % CI (0.76, 0.90), P < 0.00001 and RR = 0.92, 95 % CI (0.86, 0.99), P = 0.02]. The pain resolution rate was significantly higher after microsurgery than after laparoscopic varicocelectomy [RR = 0.77, 95 % CI (0.60, 0.99), P = 0.04].
CONCLUSION
Subinguinal varicocelectomy and microsurgical varicocelectomy are efficacious for resolving varicocele-related pain compared to other approaches and techniques. Pain quality is a factor that predicts surgical outcomes while varicocele grade is not. Additional controlled studies are warranted to clearly define this clinical problem.
Topics: Adult; Humans; Male; Microsurgery; Pain; Pain Measurement; Prognosis; Risk Assessment; Severity of Illness Index; Treatment Outcome; Varicocele; Vascular Surgical Procedures
PubMed: 27074742
DOI: 10.1007/s11255-016-1246-7 -
Pediatric Surgery International Jul 2015Adolescent varicocele is associated with ipsilateral testicular hypotrophy and the concern for future infertility. A testicular size discrepancy greater than 15-20 %... (Review)
Review
Adolescent varicocele is associated with ipsilateral testicular hypotrophy and the concern for future infertility. A testicular size discrepancy greater than 15-20 % between left and right testicle is an indication for treatment to allow catch-up growth in the hope of preventing a future decline in fertility. Some authors advocate for a period of watchful waiting, as normal testicular growth may occur asymmetrically. We review the current literature to highlight some controversies and challenges in management.
Topics: Adolescent; Humans; Male; Organ Size; Scrotum; Testis; Varicocele
PubMed: 25895069
DOI: 10.1007/s00383-015-3698-8 -
Sexual Medicine Reviews Apr 2022Optimal male reproductive health is dependent upon critical mediators of cell-cell communication: exosomes or extracellular vesicles. These vesicles are nano-sized... (Review)
Review
INTRODUCTION
Optimal male reproductive health is dependent upon critical mediators of cell-cell communication: exosomes or extracellular vesicles. These vesicles are nano-sized particles released into a variety of bodily fluids, such as blood and semen. Exosomes are highly stable and can carry genetic and other molecules, including DNA, RNA, and proteins, which provide information about their origin cells.
OBJECTIVE
To identify exosomes as potential biomarkers or therapeutic mediators in male sexual and reproductive disorders like erectile dysfunction (ED), varicocele, and testicular injury.
METHODS
A PubMed search was performed to highlight all articles available relating to exosomes and extracellular vesicles in the pathogenesis of different male sexual and reproductive disorders, and their importance in clinical use as both diagnostic markers and potential therapeutic mediators.
RESULTS
Various male reproductive system disorders, such as ED, varicocele, and testicular injury, are linked to increased or decreased levels of exosomes. Exosomes have a higher number of molecules such as DNA, RNA, and proteins, which can give a more precise and comprehensive result when compared to other biomarkers. Exosomes can be considered as plausible diagnostic biomarkers for male sexual and reproductive diseases, with considerable advantages over other diagnostic procedures such as invasive tissue biopsy. Exosomes can carry cargo such certain drugs and therapeutic molecules making them a promising therapeutic approach. Several studies have begun to test treating various male sexual reproductive disorders with exosomes.
CONCLUSION
Exosomes deliver many components that can regulate gene expression and target signaling pathways. Understanding how extracellular vesicles can be utilized as biomarkers in diagnosing men, particularly those with idiopathic erectile dysfunction, will not only aid in diagnosis but also help with making therapeutic targets. Khodamoradi K, Golan R, Dullea A, et al. Exosomes as Potential Biomarkers for Erectile Dysfunction, Varicocele, and Testicular Injury. Sex Med Rev 2022;10:311-322.
Topics: Biomarkers; Erectile Dysfunction; Exosomes; Humans; Male; RNA; Varicocele
PubMed: 34838504
DOI: 10.1016/j.sxmr.2021.10.001 -
Current Urology Reports Sep 2017Varicocele may play a significant role in a subset of patients presenting with male factor infertility. Despite its relatively high prevalence amongst subfertile men,... (Review)
Review
PURPOSE OF REVIEW
Varicocele may play a significant role in a subset of patients presenting with male factor infertility. Despite its relatively high prevalence amongst subfertile men, there has been controversy over the effectiveness of surgical treatments, patient selection, and when to administer treatment, particularly in the era of assisted reproductive technology.
RECENT FINDINGS
In line with earlier finding, recent evidence strongly suggests that varicocelectomy improves pregnancy rates and semen parameters. The currently available literature still does not clearly elucidate the answer to this question, due to flaws in retrospective study design. Patients undergoing subinguinal microsurgical varicocelectomy appear to have the highest pregnancy rates, and lowest complication rates, compared to other surgical approaches. Current research has given us a better understanding of the relationship between varicocele and infertility. Amongst men presenting with semen analysis abnormalities and varicoceles, including those patients presenting with non-obstructive azoospermia or couples with a significant male factor component failing previous attempts at in vitro fertilization, varicocelectomy may improve take home baby rates. More robust, prospective, controlled studies are needed to further clarify the population of subfertile men with varicocele most likely to benefit from varicocelectomy.
Topics: Humans; Infertility, Male; Male; Patient Selection; Varicocele
PubMed: 28718159
DOI: 10.1007/s11934-017-0713-8 -
Human Fertility (Cambridge, England) Apr 2021Male infertility is a major health burden worldwide. In the United Kingdom, the diagnostic and treatment pathway for male factor fertility is fragmented with wide... (Review)
Review
Male infertility is a major health burden worldwide. In the United Kingdom, the diagnostic and treatment pathway for male factor fertility is fragmented with wide variance in management and funding protocols. There is now a focus on potential overtreatment of couples with IVF and failure to treat male factors before considering assisted reproductive technology (ART). Despite this, contemporary Urological guidelines are not definitive in the indications for varicocele treatment, whilst the current National Institute for Health and Care Excellence (NICE) guidelines do not advocate surgical intervention. While controversy exists concerning the effects of varicocele treatment on natural pregnancy rates, there is growing evidence that varicocele treatment can have additional positive effects on fertility by reducing their impact on sperm DNA fragmentation and improving ART outcomes. Studies have demonstrated that azoospermic men may become oligospermic following varicocele intervention, obviating the need for surgical sperm retrieval. Sperm retrieval rates also increase following varicocele treatment in men with non-obstructive azoospermia. The contemporary literature demonstrates a clear clinical benefit for treating varicoceles in infertile men, which may be more cost-effective than proceeding to immediate ART. This review comprehensively evaluates the current indications for varicocele treatment, and it is proposed that these should be redefined in contemporary guidelines to reflect current advances in male fertility research.
Topics: Azoospermia; Female; Humans; Infertility, Male; Male; Overtreatment; Pregnancy; Reproductive Techniques, Assisted; Varicocele
PubMed: 30905210
DOI: 10.1080/14647273.2019.1582807 -
Journal of Ultrasound in Medicine :... Nov 2017An intratesticular varicocele is an uncommon entity, and its clinical importance remains unclear. The diagnosis can be made in the case of an intratesticular tortuous... (Review)
Review
An intratesticular varicocele is an uncommon entity, and its clinical importance remains unclear. The diagnosis can be made in the case of an intratesticular tortuous vein that shows retrograde flow on color Doppler sonography. The anatomic location and course of the intratesticular varicocele within the testicular parenchyma and its association with the existence of an ipsilateral extratesticular varicocele may vary among patients. The pathophysiologic mechanisms remain unclear; however, it may be questioned whether there is an association between testicular atrophy and intratesticular varicocele development. Although the diagnosis is usually made incidentally, patients may rarely present with acute scrotal pain due to acute thrombosis of an intratesticular varicocele.
Topics: Humans; Male; Testis; Thrombosis; Ultrasonography, Doppler, Color; Varicocele
PubMed: 28593638
DOI: 10.1002/jum.14281 -
The Journal of Urology Mar 2023
Topics: Male; Humans; Varicocele; Sclerotherapy; Scrotum; Follow-Up Studies; Laparoscopy
PubMed: 36622708
DOI: 10.1097/JU.0000000000003148