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Journal of Endocrinological... Sep 2022Adolescence represents an important window for gonadal development. The aim of this review is to carry out a critical excursus of the most recent literature on... (Review)
Review
PURPOSE
Adolescence represents an important window for gonadal development. The aim of this review is to carry out a critical excursus of the most recent literature on endogenous and exogenous risk factors related to testicular function, focusing the research on adolescence period.
METHODS
A comprehensive literature search within PubMed was performed to provide a summary of currently available evidence regarding the impact on adolescence of varicocele, cryptorchidism, cancer, diabetes, lifestyle factors, endocrine disruptors, obesity and sexually transmitted diseases. We focused on human studies that evaluated a possible impact of these factors on puberty timing and their effects on andrological health.
RESULTS
Evidence collected seems to suggest that andrological health in adolescence may be impaired by several factors, as varicocele, cryptorchidism, and childhood cancer. Despite an early diagnosis and treatment, many adolescents might still have symptoms and sign of a testicular dysfunction in their adult life and at the current time it is not possible to predict which of them will experience andrological problems. Lifestyle factors might have a role in these discrepancies. Most studies point out towards a correlation between obesity, insulin resistance, alcohol, smoking, use of illegal drugs and testicular function in pubertal boys. Also, endocrine disruptors and sexually transmitted diseases might contribute to impair reproductive health, but more studies in adolescents are needed.
CONCLUSION
According to currently available evidence, there is an emerging global adverse trend of high-risk and unhealthy behaviors in male adolescents. A significant proportion of young men with unsuspected and undiagnosed andrological disorders engage in behaviors that could impair testicular development and function, with an increased risk for later male infertility and/or hypogonadism during the adult life. Therefore, adolescence should be considered a key time for intervention and prevention of later andrological diseases.
Topics: Adolescent; Adult; Child; Cryptorchidism; Endocrine Disruptors; Humans; Male; Obesity; Risk Factors; Testis; Varicocele
PubMed: 35286610
DOI: 10.1007/s40618-022-01769-8 -
Advances in Experimental Medicine and... 2022Despite being regarded as one of the most common causes of male subfertility, the pathophysiology of varicocele remains largely unknown. Recently, oxidative stress (OS)...
Despite being regarded as one of the most common causes of male subfertility, the pathophysiology of varicocele remains largely unknown. Recently, oxidative stress (OS) is proposed to be the mediator in how varicocele may negatively impact fertility. The imbalance of reactive oxygen species (ROS) and seminal antioxidants results in damage to sperm DNA and lipid membrane. There is evidence demonstrating higher OS level in men with varicocele which is also positively correlated with clinical grading of varicocele. Moreover, a number of studies have revealed the negative correlation between OS and conventional semen parameters. Furthermore, various interventions have shown their potential in alleviating OS in men with varicocele-associated infertility. Although direct evidence on improving pregnancy rate is not available at the moment, varicocelectomy has demonstrated promising results in relieving OS. Oral antioxidants represent another option with a favourable safety profile. The supplement can be used alone or as adjunct to varicocelectomy. However, most of the studies are hampered by heterogenous dose regime and high-level evidence is lacking.
Topics: Antioxidants; Humans; Infertility, Male; Male; Oxidative Stress; Spermatozoa; Varicocele
PubMed: 35641872
DOI: 10.1007/978-3-030-89340-8_10 -
The Journal of Urology Mar 2021
Topics: Adolescent; Biomarkers; Humans; Inhibins; Male; Sperm Count; Testis; Varicocele
PubMed: 33332153
DOI: 10.1097/JU.0000000000001580 -
Journal of Vascular and Interventional... Jul 2022To conduct a systematic review and meta-analysis to assess the relative efficacy of endovascular and surgical treatments for varicocele. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To conduct a systematic review and meta-analysis to assess the relative efficacy of endovascular and surgical treatments for varicocele.
MATERIALS AND METHODS
PubMed and Embase databases were systematically searched to identify studies reporting on the outcomes associated with surgical or endovascular treatments of varicoceles. The studies that assessed the relative efficacy of surgical and endovascular treatments for patients with clinical varicocele were eligible for inclusion. Pooled data analyses were performed.
RESULTS
A total of 16 studies incorporating 2,138 patients were included in the present meta-analysis. The pooled risk ratio (RR) values suggested that rates of adverse events were lower among patients who underwent endovascular treatment than those who underwent surgical treatment (RR, 0.63; 95% confidence interval (CI), 0.42-0.93; P = .02). Both treatments were associated with similar rates of recurrence (RR, 1.03; 95% CI, 0.78-1.36; P = .82) and pregnancy (RR, 1.03; 95% CI, 0.85-1.25; P = .82).
CONCLUSIONS
These data demonstrate that endovascular treatment for varicocele is associated with similar rates of recurrence and subsequent pregnancy outcomes compared with surgical treatment but with lower rates of adverse events.
Topics: Female; Humans; Male; Pregnancy; Varicocele
PubMed: 35314371
DOI: 10.1016/j.jvir.2022.03.013 -
Seminars in Pediatric Surgery Aug 2021Varicocele is defined as an abnormal dilation and tortuosity of the internal spermatic veins found within the pampiniform plexus. It is a common finding in adolescents...
Varicocele is defined as an abnormal dilation and tortuosity of the internal spermatic veins found within the pampiniform plexus. It is a common finding in adolescents and adult men alike, however its diagnosis in the adolescent population poses different dilemmas in regard to indications for treatment than in adults. Failed Paternity is a clear-cut indication for repair in adult men attempting to father children. In adolescents, the physicians, family and patients must consider potential for future fertility problems which may or may not actually become of concern. Assessing the degree of negative effect of the varicocele on an adolescent's testicular health can also be difficult as teenagers typically are not asked to provide semen for analysis and thus surrogate markers for testicular health such as testicular size differentials must be used. Treatment options for the adolescent varicocele are similar to options in adult populations. While risks and benefits of various techniques can be considered, the gold standard for varicocele repair in adolescents has not been clearly defined. We aim to discuss diagnosis of varicocele, considerations for initiating treatment of varicocele in the adolescent, and techniques for management.
Topics: Adolescent; Adult; Child; Humans; Male; Testis; Varicocele
PubMed: 34412881
DOI: 10.1016/j.sempedsurg.2021.151084 -
American Journal of Reproductive... Nov 2023Varicocele is one of the main causes of male infertility. Although the pathophysiology mechanism of varicocele is very well described and understood, there are some... (Review)
Review
BACKGROUND
Varicocele is one of the main causes of male infertility. Although the pathophysiology mechanism of varicocele is very well described and understood, there are some unanswered questions that remains unknown. Some studies have previously described the state of testicular inflammation and sperm in animal models, especially the mouse model, and the seminal plasma of men with varicocele, with or without changes in semen parameters.
METHODS OF STUDY
This review intended to verify the role of inflammatory mechanism in varicocele, using clinical studies as well as animal model studies on the effect of inflammation caused by varicocele on the function of testicular somatic and germ cells.
RESULTS
In-vivo studies confirmed whether anti-inflammatory molecules could treat the semen of men with varicocele and rats with varicocele. The use of different anti-inflammatory agents in mouse model studies provided a new perspective for future clinical studies to investigate the effect of concurrent treatment with surgery to improve surgical outcomes.
CONCLUSION
Similar to animal model studies, previously conducted clinical trials have demonstrated the effectiveness of anti-inflammatory therapy in varicocele patients. However, clinical trials using anti-inflammatory are needed to be conducted agents to evaluate different aspects of this therapeutical approach in varicocele patients.
Topics: Humans; Mice; Male; Animals; Rats; Semen; Varicocele; Spermatozoa; Infertility, Male; Inflammation; Anti-Inflammatory Agents; Sperm Motility
PubMed: 37881120
DOI: 10.1111/aji.13786 -
Phlebology May 2022This study is aimed to evaluate the association between varicocele and other vascular diseases through a systematic reviews and meta-analyses. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This study is aimed to evaluate the association between varicocele and other vascular diseases through a systematic reviews and meta-analyses.
MATERIAL AND METHODS
We searched Cochrane Central Register of Controlled Trials, Embase, PubMed, and Web of Science for studies that reported varicocele and other vascular diseases published before 30 June 2021. The meta-analysis was performed by Revman V.5.2 to calculate the pooled odds ratios and corresponding 95% confidence intervals. Subsequently, the impact of publication bias was evaluated, and sensitivity analysis as performed to assess our results' robustness.
RESULTS
In total, seven case-control studies, including 803 varicocele cases and 727 controls, were included. Our meta-analysis results showed that the varicocele patients had a higher risk of saphenofemoral insufficiency when compared with the control group (odds ratio [OR]: 2.80; 95% confidence intervals [CIs]: 2.03, 3.84; < 0.00001). Additionally, varicocele patients also had a higher risk of lower extremity venous insufficiency when compared with the control group (OR: 2.34; 95% CI: 1.58, 3.47; < 0.0001). However, there was no statistical difference in hemorrhoid risk between both groups (OR: 1.13; 95% CI: 0.28, 4.59; = 0.87).
CONCLUSION
Our study demonstrated that varicocele patients have higher risk of saphenofemoral and lower extremity venous insufficiencies but not the risk of hemorrhoids.
Topics: Hemorrhoids; Humans; Lower Extremity; Male; Varicocele; Vascular Diseases; Veins
PubMed: 35199618
DOI: 10.1177/02683555211069247 -
International Journal of Urology :... Jan 2024Approximately 1% of the general male population has azoospermia, and nonobstructive azoospermia accounts for the majority of cases. The causes vary widely, including... (Review)
Review
Approximately 1% of the general male population has azoospermia, and nonobstructive azoospermia accounts for the majority of cases. The causes vary widely, including chromosomal and genetic abnormalities, varicocele, drug-induced causes, and gonadotropin deficiency; however, the cause is often unknown. In azoospermia caused by hypogonadotropic hypogonadism, gonadotropin replacement therapy can be expected to produce sperm in the ejaculate. In some cases, upfront varicocelectomy for nonobstructive azoospermia with varicocele may result in the appearance of ejaculated spermatozoa; however, the appropriate indication should be selected. Each guideline recommends microdissection testicular sperm extraction for nonobstructive azoospermia in terms of successful sperm retrieval and avoidance of complications. Sperm retrieval rates generally ranged from 20% to 70% but vary depending on the causative disease. Various attempts have been made to predict sperm retrieval and improve sperm retrieval rates; however, the evidence is insufficient. Further evidence accumulation is needed for salvage treatment in cases of failed sperm retrieval. In Japan, there is inadequate provision on the right to know the origin of children born from artificial insemination of donated sperm and the rights of sperm donors, as well as information on unrelated family members, and the development of these systems is challenging. In the future, it is hoped that the pathogenesis of nonobstructive azoospermia with an unknown cause will be elucidated and that technology for omics technologies, human spermatogenesis using pluripotent cells, and organ culture methods will be developed.
Topics: Child; Humans; Male; Azoospermia; Varicocele; Microdissection; Semen; Retrospective Studies; Gonadotropins; Testis
PubMed: 37737473
DOI: 10.1111/iju.15301 -
Andrologia Feb 2021Varicocele is the most common correctable cause for male infertility, but not all men with varicocele are affected equally by this condition. The pathophysiology of... (Review)
Review
Varicocele is the most common correctable cause for male infertility, but not all men with varicocele are affected equally by this condition. The pathophysiology of varicocele-induced fertility remains ill-defined. While evidence suggests that oxidative stress remains a central factor, other mechanisms likely include scrotal hyperthermia, reflux of metabolites, hypoxia and cadmium accumulation. Microsurgical varicocelectomy remains the gold standard treatment option for infertile men with a clinically palpable varicocele and abnormal semen parameters. Newer evidence suggests a potential role for antioxidant supplementation and a meaningful role of varicocelectomy for patients destined for ART to improve pregnancy outcomes.
Topics: Female; Fertility; Humans; Infertility, Male; Male; Microsurgery; Oxidative Stress; Pregnancy; Pregnancy Outcome; Varicocele
PubMed: 32271477
DOI: 10.1111/and.13576 -
Andrologia Feb 2022The updated meta-analysis was conducted to further verify the effect of varicocele on sperm DNA damage, supplying clinicians and researchers with high-grade evidence.... (Meta-Analysis)
Meta-Analysis Review
The updated meta-analysis was conducted to further verify the effect of varicocele on sperm DNA damage, supplying clinicians and researchers with high-grade evidence. The sperm DNA damage was evaluated by DNA fragmentation index (DFI), associated with the male fertility capability tightly. PubMed, Web of Science and Cochrane Library were searched extensively for eligible studies with the search terms: varicocele, sperm DNA and sperm DNA damage. Finally, a total of 12 studies were included in our meta-analysis with a total of 845 patients diagnosed with varicocele and 2,377 healthy controls. A statistical difference of DFI between varicocele patients and healthy controls was found after pooling the data ((Standardised mean difference) SMD: 1.40, 95%CI: 0.83-1.98, p < .0001), using the random effect model. We conducted subgroup analysis according to study region (Brazil and Other countries), detection methods of DFI (TUNEL, Comet, and SCSA), sample size (<50 and >50) and age (<30 and >30 years), based on substantial heterogeneity among eligible studies. The stability of pooled results was verified by sensitivity analysis. All these statistical analyses were conducted using Stata version 16.0. In conclusion, patients diagnosed with clinical varicocele had higher DFI than healthy controls, which means varicocele could impair sperm DNA, consequently the fertility potential of affected men.
Topics: Adult; DNA Damage; DNA Fragmentation; Humans; Infertility, Male; Male; Spermatozoa; Varicocele
PubMed: 34658054
DOI: 10.1111/and.14275