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International Journal of Reproductive... Aug 2023Varicocele is characterized by abnormal dilation of the testicular vein, which results in hypoxia, the accumulation of reactive oxygen species, and the production of...
The time course of nod-like receptor family pyrin domain containing 3 inflammasome complex expressions in the testis tissue of an experimental varicocele rat model: An experimental study.
BACKGROUND
Varicocele is characterized by abnormal dilation of the testicular vein, which results in hypoxia, the accumulation of reactive oxygen species, and the production of proinflammatory cytokines. It seems that a group of cytosolic receptors named nod-like receptor family, pyrin domain containing 3 (NLRP3) inflammasome, is activated and involved in the pathogenesis of varicocele.
OBJECTIVE
We aim to determine the time course of NLRP3 inflammasome expression in the testis tissue following varicocele induction.
MATERIALS AND METHODS
In this experimental study, 36 adult Wistar rats (8 wk, 200-250 gr) were used. For the varicocele induction, the left renal vein was partially ligated. The mRNA levels of NLRP3, apoptosis-associated speck-like protein containing a caspase recruitment domain, and caspase-1 were evaluated by real-time polymerase chain reaction at 1, 2, 4, 8, and 12 wk after varicocele induction.
RESULTS
Results showed that the gene expression of NLRP3 inflammasome component including NLRP3, apoptosis-associated speck-like protein containing a caspase recruitment domain, and caspase-1 did not alter during week 1, 2, 4, and 8 after operation (p = 0.09). 12 wk after varicocele induction, gene expression levels were significantly up-regulated (p = 0.02).
CONCLUSION
Our data provides clear evidence that varicocele stimulates inflammasome activation in the testis tissue 12 wk after the operation, and this time is required for investigating NLRP3 activity in the varicocele rat model.
PubMed: 37727396
DOI: 10.18502/ijrm.v21i7.13895 -
Sexual Medicine Dec 2023The success of telemedicine depends on patient satisfaction with the care that they receive, which is impacted by the ease of use of the technology, quality of the...
BACKGROUND
The success of telemedicine depends on patient satisfaction with the care that they receive, which is impacted by the ease of use of the technology, quality of the connection, and perceived effectiveness of care.
AIM
The study sought to evaluate patient satisfaction with telemedicine services in a high-volume andrology clinic.
METHODS
We included all patients who had a telemedicine appointment between January 1, 2020, and August 22, 2022. Demographic information was gathered, and a satisfaction survey was conducted using REDCap software. Data were grouped into 2 age categories, with ≥50 years as the cutoff (19-50 years; >50 years). The data were analyzed according to age, distance from the patient's home to our center, and survey responses. Pearson's chi-square test and ordinal logistic regression analyses were performed.
OUTCOMES
The main outcome is satisfaction with telemedicine in a men's sexual health context.
RESULTS
A total of 4071 patients were identified based on attending a telemedicine visit. Hypogonadism was the most common diagnosis. Other diagnoses included erectile dysfunction, varicocele, Peyronie's disease, vasectomy, and infertility. In total, 613 patients completed the survey, with a mean age of 56.6 years. Older patients were less likely to prefer telemedicine (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.36-0.80; < .001), less likely to agree to a video visit because of privacy concerns (OR, 0.51; 95% CI, 0.35-0.75; < .001), and less likely to recommend a telemedicine visit compared with their younger counterparts (OR, 0.37; 95% CI, 0.27-0.51; < .001). The median distance was 22.4 (interquartile range, 7.5-57.5) miles. However, there was no significant association between distance and patients' likelihood of preferring telehealth visits, including reviews of outside laboratories and imaging (OR, 1; 95% CI, 0.99-1; = .35), belief in the quality of care provided via video visits (OR, 0.99, CI 0.99-1; = .25), and overall preference for telehealth visits (OR, 0.99; 95% CI, 0.99-1; = .35).
CLINICAL IMPLICATIONS
Healthcare providers should consider the age of patients when deciding to offer telemedicine while addressing privacy concerns to provide adequate reassurance to patients who may have concerns about the quality of care provided through telemedicine.
STRENGTHS AND LIMITATIONS
Our study achieved a substantial sample size that reached statistical significance. Conducted at a single academic center, our study was constrained, possibly introducing biases related to the institution's advanced telemedicine system. Geographic and diagnostic limitations could lead to regional biases, affecting the generalizability of the findings.
CONCLUSION
Older patients exhibited a lower inclination toward preferring telemedicine, along with decreased odds of endorsing in-person visits.
PubMed: 38111635
DOI: 10.1093/sexmed/qfad060 -
Andrology Feb 2024Decision-making regarding varicocele management can be a complex process for patients and families. However, to date, no studies have presented ways to mitigate the...
BACKGROUND
Decision-making regarding varicocele management can be a complex process for patients and families. However, to date, no studies have presented ways to mitigate the decisional conflict surrounding varicoceles.
OBJECTIVE
To facilitate a discussion among physicians in order to develop a framework of the decision-making process regarding adolescent varicocele management, which will inform the development of the first online, interactive decision aid.
MATERIALS AND METHODS
Semi-structured interviews with pediatric urologists and interventional radiologists were conducted to discuss their rationale for varicocele decision-making. Interviews were audio recorded, transcribed, and coded. Key themes were identified, grouped, and then qualitatively analyzed using thematic analysis. Utilizing the common themes identified and the Ottawa Decision Support Framework, a decision aid prototype was developed and transformed into a user-friendly website: varicoceledecisionaid.com.
RESULTS
Pediatric urologists (n = 10) and interventional radiologists (n = 2) were interviewed. Key themes identified included: (1) definition/epidemiology; (2) observation as an appropriate management choice; (3) reasons to recommend repair; (4) types of repair; (5) reasons to recommend one repair over another; (6) shared decision-making; and (7) appropriate counseling. With this insight, a varicocele decision aid prototype was developed that engages patients and parents in the decision-making process.
DISCUSSION AND CONCLUSIONS
This is the first interactive and easily accessible varicocele decision aid prototype developed by inter-disciplinary physicians for patients. This tool aids in decision-making surrounding varicocele surgery. It can be used before or after consultation to help families understand more about varicoceles and their repair, and why intervention may or may not be offered. It also considers a patient and family's personal values. Future studies will incorporate the patient and family perspective into the decision-making aid as well as implement and test the usability of this decision aid prototype in practice and in the wider urologic community.
Topics: Male; Humans; Child; Adolescent; Decision Making; Decision Support Techniques; Varicocele; Physicians; Urology
PubMed: 37417400
DOI: 10.1111/andr.13491 -
Reproductive Sciences (Thousand Oaks,... Aug 2023Varicocele (VCL) has been shown to induce severe oxidative stress in the testicular tissue resulting in 35% of males with primary infertility. To compare the...
Varicocele (VCL) has been shown to induce severe oxidative stress in the testicular tissue resulting in 35% of males with primary infertility. To compare the exacerbating impacts of varicose on oxidative DNA damage and homeostatic antioxidant reactions in the seminiferous tubules (ST), enclosed and far from varicose vessels. Thirty mature Wistar rats were divided into control and VCL-induced groups. To approve VCL, the testicular diameters, volume, and blood circulation were measured using B-mode and Doppler ultrasonography. Next, to confirm oxidative stress (OS), the global homeostatic antioxidant biomarkers were evaluated. Moreover, the OS-induced oxidative DNA damage and homeostatic antioxidant reactions were compared between STs nearby and far from varicose vessels. Finally, to clarify the DNA damage-induced impact on the cell cycle progression, the global and local expressions of Cyclin D1, Cdk4, and p21 were examined. The VCL-induced group exhibited diminished global antioxidant status (marked with TAC, GPX, SOD, and CAT) and UNG and MPG expression levels. Moreover, the cross-sections of the VCL group represented a prominent reduction in the UNG, MPG, Cyclin D1, and cdk4, and upregulation in the p21 expression levels, more prominently in the STs nearby varicose vessels. Concerning severe oxidative DNA damage and intensive molecular changes in the STs nearby the varicose vessels, they can be considered the main cause of oxidative DNA damage in enclosed tubules. Thus, the varicose-mediated oxidative DNA damage negatively impacts the cell cycle progression in the tubules more intensively in the subcapsular area.
Topics: Rats; Male; Humans; Animals; Antioxidants; Varicocele; Cyclin D1; Rats, Wistar; Testis; Oxidative Stress; Seminiferous Tubules; Cell Cycle Checkpoints
PubMed: 36821035
DOI: 10.1007/s43032-023-01200-4 -
Progres En Urologie : Journal de... Nov 2023Following on from the Rapport vers une stratégie nationale de lutte contre l'infertilité (Report on a national strategy to combat infertility) submitted to the French...
BACKGROUND
Following on from the Rapport vers une stratégie nationale de lutte contre l'infertilité (Report on a national strategy to combat infertility) submitted to the French Minister of Health in 2022, whose objective 13 is: to better identify and diagnose male infertility, we wanted to clarify with reproductive specialists what role the urologist should play in the management of the infertile couple.
METHODS
An expert consensus was reached with the Pedagogical Committee and pilots of the Transversal Specialized Training in Reproductive Medicine and Biology - Andrology, and with the presidents, board and scientific council of the French Federation for Reproductive Study (FFER).
RESULTS
In the case of infertility in a couple, the fertility of both partners should be assessed from the outset, and in the event of abnormality or failure of ART, the patient should be referred to a uro-andrologist for expert management. The uro-andrologist will set up medical or surgical treatments to improve the prognosis of the man's fertility, in conjunction with the entire ART team. It is also important for the urologist/andrologist to take charge of the man's health before conception, because of the benefits for the patient himself and for his offspring.
CONCLUSION
This expert consensus has shed light on the role of the uro-andrologist in the ART pathway, on the need for training in Andrology and on the medical demography required.
Topics: Humans; Male; Urologists; Reproductive Techniques, Assisted; Infertility, Male; Prognosis; Consensus
PubMed: 38012913
DOI: 10.1016/j.purol.2023.09.005 -
International Urology and Nephrology May 2024To evaluate the clinical efficacy of microscopic internal spermatic-inferior epigastric vein anastomosis in the treatment of left varicocele and compare it with...
OBJECTIVE
To evaluate the clinical efficacy of microscopic internal spermatic-inferior epigastric vein anastomosis in the treatment of left varicocele and compare it with microscopic spermatic vein ligation for the same condition.
METHODS
A retrospective analysis of 74 patients with left varicocele between July 2020 and July 2022 was performed. The patients were divided into two groups based on the surgical method used. Group A consisted of 37 patients who underwent microscopic internal spermatic-inferior epigastric vein anastomosis, while Group B consisted of 37 patients who underwent microscopic spermatic vein ligation. Comparison of preoperative and postoperative semen quality, reproductive hormone levels, scrotal ultrasound results, duration of surgery, length of hospital stay, postoperative recurrence rate, and occurrence of complications with a follow-up time of 12 mo between two groups.
RESULTS
Both groups showed significant improvements in semen quality and serum reproductive hormone levels. The Group A demonstrated significantly improved sperm forward motility compared to Group B, but had longer operation times and hospital stays (P < 0.05). After 1 year of follow-up, 8 partners in Group A and 6 partners in Group B achieved natural conception, with no significant difference between the two groups. There were no recurrences observed in either group during the follow-up period, and no significant statistical differences were found in other postoperative observation indicators.
CONCLUSIONS
Both microscopic internal spermatic-inferior epigastric vein anastomosis and microscopic spermatic vein ligation are effective surgical methods for treating left varicocele. Anastomosis surgery provides greater improvement in sperm motility, although it is associated with longer operation times and hospital stays.
PubMed: 38782814
DOI: 10.1007/s11255-024-04090-w -
Biology Jan 2024Male-factor infertility is implicated in over half of the millions of cases of infertility worldwide, and varicoceles are the most common correctable cause of... (Review)
Review
Male-factor infertility is implicated in over half of the millions of cases of infertility worldwide, and varicoceles are the most common correctable cause of male-factor infertility. The pathophysiologic mechanism for varicoceles is complex and next-generation technologies offer promising insights into the molecular underpinnings of this condition. In this narrative review, we highlight historical and contemporary paradigms associated with varicoceles, with an emphasis on the biological underpinnings of this disease. Specifically, we review the literature describing the underlying causes of varicoceles, discuss the molecular and cellular mechanisms causing pathological changes in some (but not all) men, and highlight key articles regarding the next-generation analyses (e.g., transcriptome, epigenome, proteome, and microbiome) being applied to better understand the condition and its treatment. These data demonstrate an ongoing evolution of the knowledge of varicoceles and the potential for improved personalized care in the future for men with this condition.
PubMed: 38392299
DOI: 10.3390/biology13020080 -
Health Science Reports Jul 2023Varicocele is one of the most common causes of male infertility in which testicular function is progressively damaged. This study aims to investigate the effect of...
BACKGROUND AND AIMS
Varicocele is one of the most common causes of male infertility in which testicular function is progressively damaged. This study aims to investigate the effect of varicocelectomy and mast cell stabilizers on reducing sperm DNA fragmentation in infertile patients with varicocele.
METHODS
In this randomized clinical trial, after obtaining ethical approval and informed consent, infertile patients with varicocele were randomly assigned to three groups: varicocelectomy, 1 mg ketotifen, and varicocelectomy plus with 1 mg ketotifen for 3-month follow-up. Semen analysis and estimation of DNA fragmentation index (DFI) were obtained from all people in the studied time periods.
RESULTS
In this study, 420 infertile patients with varicocele were included with an average age of 31.6 years. The results showed that sperm morphology, sperm motility, sperm count, and sperm DFI had significant differences after the intervention ( < 0.05). Also, the results of semen analysis for each group showed that there was a significant improvement in sperm morphology, motility, count, and DFI index of infertile people with varicocele after the intervention ( < 0.05). But the difference was statistically higher in the varicocelectomy plus with 1 mg ketotifen group than in the other groups ( < 0.01).
CONCLUSION
The evidence and results of this study showed that the use of varicocelectomy plus ketotifen in infertile people with varicocele was more effective in improving Semen parameters than the use of mast cell stabilizers or varicocelectomy alone.
PubMed: 37455707
DOI: 10.1002/hsr2.1431 -
Andrology Jan 2024Obesity negatively impact on the metabolism of sex hormones, leading to reduced testosterone serum levels. However, how the obesity could negatively impact on the... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Obesity negatively impact on the metabolism of sex hormones, leading to reduced testosterone serum levels. However, how the obesity could negatively impact on the overall gonadal function, particularly on male fertility, remained unclear so far.
OBJECTIVE
To systematically review evidences regarding the influence of body weight excess on the sperm production.
METHODS
A meta-analysis was conducted, searching all prospective and retrospective observational studies reporting male subjects older than 18 years old, with body weight excess from overweight to severe obesity were considered. Only studies using the V edition of the World Health Organization (WHO) manual for semen analysis interpretation were considered. No specific interventions were considered. Search was focused on studies comparing overweight/obese to normal weight subjects.
RESULTS
Twenty-eight studies were considered. Total sperm count and sperm progressive motility were significantly lower in overweight compared to normal weight subjects. Meta-regression analyses demonstrated that patients' age impacted on sperm parameters. Similarly, obese men showed lower sperm concentration, total sperm number, progressive and total motilities, and normal morphology lower than normal weight subjects. Reduced sperm concentration in obese men was influenced by age, smoking habit, varicocele, and total testosterone serum levels at meta-regression analyses.
CONCLUSIONS
The male potential fertility is reduced in subjects with increased body weight, compared to normal weight men. The higher was the increased body weight, the worst was the sperm quantity/quality. This result comprehensively included obesity among non-communicable risk factor for male infertility, shedding new lights on the negative impact of increased body weight on overall gonadal function.
Topics: Male; Humans; Adolescent; Overweight; Retrospective Studies; Prospective Studies; Semen; Body Mass Index; Semen Analysis; Sperm Count; Infertility, Male; Obesity; Spermatozoa; Sperm Motility; Weight Gain; Fertility; Testosterone; World Health Organization
PubMed: 37226894
DOI: 10.1111/andr.13460 -
Cell Journal Oct 2023Varicocele is a common cause of male infertility, affecting a substantial proportion of infertile men. Recent studies have employed transcriptomic analysis to identify...
OBJECTIVE
Varicocele is a common cause of male infertility, affecting a substantial proportion of infertile men. Recent studies have employed transcriptomic analysis to identify candidate genes that may be implicated in the pathogenesis of this condition. Accordingly, this study sought to leverage rat gene expression profiling, along with protein-protein interaction networks, to identify key regulatory genes, related pathways, and potentially effective drugs for the treatment of varicocele.
MATERIALS AND METHODS
In this in-silico study, differentially expressed genes (DEGs) from the testicular tissue of 3 rats were screened using the edgeR package in R software and the results were compared to 3 rats in the control group. Data was obtained from GSE139447. Setting a -1
1 and P<0.05 as cutoff points for statistical significance, up and down-regulated genes were identified. Based on Cytoscape plugins, protein-protein interaction (PPI) networks were drawn, and hub genes were highlighted. ShinyGO was used for pathway enrichment. Finally, effective drugs were identified from the drug database. RESULTS
Among the 1277 DEGs in this study, 677 genes were up-regulated while 600 genes were down-regulated in rats with varicocele compared to the control group. Using protein-protein interaction networks, we identified the top five up-regulated genes and the top five down-regulated genes. Enrichment analysis showed that the up-regulated genes were associated with the cell division cycle pathway, while the down-regulated genes were linked to the ribosome pathway. Notably, our findings suggested that dexamethasone may be a promising therapeutic option for individuals with varicocele.
CONCLUSION
The current investigation indicates that in varicocele the cell division cycle pathway is up-regulated while the ribosome pathway is down-regulated compared to controls. Based on these findings, dexamethasone could be considered a future candidate drug for the treatment of individuals with varicocele.
PubMed: 37865881
DOI: 10.22074/cellj.2023.2004771.1329