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Asian Journal of Andrology 2021Subclinical varicocele represents an abnormality of veins of the pampiniform plexus on scrotal ultrasound (US) without a clinically palpable varicocele. Its significance... (Review)
Review
Subclinical varicocele represents an abnormality of veins of the pampiniform plexus on scrotal ultrasound (US) without a clinically palpable varicocele. Its significance remains unclear. While guidelines do not recommend surgical intervention, clinical management is variable. As there is limited information on long-term outcome of subclinical varicoceles due to challenges in diagnosis and management, we performed a single-institution, retrospective review of patients from October 1999 to October 2014 with subclinical varicocele and with available US studies reviewed by a single radiologist. Subclinical varicocele was defined as dilation of the pampiniform venous plexus on US involving ≥2 vessels with diameter >2.5 mm, without clinical varicocele on physical examination or prior inguinal surgery. Thirty-six of 98 patients identified were confirmed as having a subclinical varicocele and analyzed. The mean age at initial visit was 15.5 years, with a mean follow-up of 26.5 months. The majority were right-sided (69.4%, n = 25), usually with a contralateral clinical varicocele. Testicular asymmetry (>20% volume difference of the affected side by testicular atrophy index formula) was assessed in 9 patients with unilateral subclinical varicocele without contralateral clinical or subclinical varicocele and observed in 1 patient. Of 17 patients with follow-up, 3 (17.6%) progressed to clinical varicocele without asymmetric testicular volume, as most remained subclinical or resolved without surgery. In our experience, subclinical varicoceles appeared unlikely to progress to clinical varicoceles, to affect testicular volume, or to lead to surgery. Although our study is limited in numbers and follow-up, this information may aid clinical management strategies and guide future prospective studies.
Topics: Adolescent; Boston; Child; Humans; Male; Physical Examination; Prospective Studies; Retrospective Studies; Treatment Outcome; Varicocele; Young Adult
PubMed: 33885004
DOI: 10.4103/aja.aja_22_21 -
The Aging Male : the Official Journal... Dec 2020The goal of this work was to study the relationship between presence of varicocele and testosterone serum levels in adulthood.
OBJECTIVES
The goal of this work was to study the relationship between presence of varicocele and testosterone serum levels in adulthood.
METHODS
A comparative, cross-sectional study of 387 men who consulted for erectile dysfunction. Age, body mass index (BMI), diabetes (DM), and presence of varicocele were related to testosterone levels through uni- and multi-variate analysis.
RESULTS
A total of 248 cases (70.8%) had no varicocele, 46 (13.1%) had grade I varicocele, 36 (10.3%) grade II, and 20 (5.7%) grade III. The mean total testosterone levels were 4.77 ng/mL in the non-varicocele group and 4.34 ng/mL in the varicocele group ( = .91), while free testosterone levels were 69.81 and 73.24 pg/mL ( = .18), respectively. In the multivariate analysis, BMI> = 30 was related to low total testosterone levels (OR: 2.94, < .001) and low free testosterone (OR: 2.01, = .01), while advanced age associated with low levels of free testosterone (OR: 1.04, < .001).
CONCLUSIONS
We were not able to establish a relationship between the presence of varicocele and decreased serum testosterone levels. Other factors already described, such as obesity and age, were related to low levels of total and free testosterone.
Topics: Adult; Body Mass Index; Cross-Sectional Studies; Erectile Dysfunction; Humans; Male; Testosterone; Varicocele
PubMed: 31070084
DOI: 10.1080/13685538.2018.1550745 -
DNA and Cell Biology Oct 2022Varicoceles (VCs) have received widespread attention as a primary factor affecting male fertility and a pathological condition that may lead to decreased sperm count and...
Varicoceles (VCs) have received widespread attention as a primary factor affecting male fertility and a pathological condition that may lead to decreased sperm count and motility in patients. Many studies have shown that an imbalance of local antioxidant balance exists in patients with VC, leading to an obvious increase in the content of reactive oxygen species (ROS) and may cause reductive stress. Excessive ROS may aggravate spermatogenesis dysfunction and affect male fertility. Poly(ADP-ribose) polymerase (PARP) is an enzyme associated with DNA repair in eukaryotic cells, can be activated by DNA fragments with structural damage, and has been considered a DNA damage receptor in DNA damage repair and apoptosis. We built a rat model of VC and an oxidative damage model of a spermatocyte-derived cell line (GC-2 cells) induced by hydrogen peroxide to study the role of PARP1 in VC. Differentially expressed genes (DEGs) were obtained by RNA sequencing in the testes of VC rats. Analysis of DEGs revealed some genes with significantly altered expression, which were validated in rat and cell models. Immunofluorescence, real-time quantitative PCR analysis, Western blot, and flow cytometry were used to analyze the changes between the control group and the VC or hydrogen peroxide group. Overall, we found that PARP1 protein expression increased in VC rats and in the hydrogen peroxide-induced oxidative stress model of GC-2 cells. Parthanatos may be one of the factors leading to reduced reproductive capacity in VC patients. Our study provides novel insights into the mechanisms of male infertility induced by oxidative stress and provides a new therapeutic target for VC.
Topics: Humans; Male; Rats; Animals; Varicocele; Poly (ADP-Ribose) Polymerase-1; Parthanatos; Reactive Oxygen Species; Antioxidants; Hydrogen Peroxide; Poly(ADP-ribose) Polymerase Inhibitors; Semen; Oxidative Stress; Poly(ADP-ribose) Polymerases
PubMed: 36067068
DOI: 10.1089/dna.2022.0289 -
American Journal of Men's Health 2023Varicocele surgical repair can improve the function of the testis for patients with varicocele. We carried out a systematic review and meta-analysis to assess the... (Meta-Analysis)
Meta-Analysis Review
Varicocele surgical repair can improve the function of the testis for patients with varicocele. We carried out a systematic review and meta-analysis to assess the effects of varicocele surgical repair on serum hormones and inhibin B levels in patients with varicocele. A literature search was performed in August 2022, and no language or geographic region restrictions were applied. The search included the following databases: PubMed, Embase, and Medline. A literature review was performed to identify all published clinical trials assessing serum hormone and inhibin B levels before and after varicocele surgical repair. The reference lists of retrieved studies were also investigated. A systematic review and meta-analysis were conducted. Eight articles were selected from 162 articles, including 452 patients. The combined analysis showed that after surgical treatment, mean serum testosterone, inhibin B, and sperm concentration levels increased compared with preoperative levels ( .05). After surgical treatment, mean serum follicle-stimulating hormon (FSH), and Luteinizing hormone (LH) levels decreased compared with preoperative levels ( .05). This meta-analysis demonstrates that varicocele surgical repair can improve testicular function, increase serum testosterone, and inhibin B levels and decrease serum FSH and LH levels in patients with varicocele. This might be related to the improvement of infertility. A large-scale multicenter randomized controlled study is needed for further confirmation.
Topics: Humans; Male; Follicle Stimulating Hormone; Luteinizing Hormone; Varicocele; Testosterone; Semen; Multicenter Studies as Topic
PubMed: 37694823
DOI: 10.1177/15579883231199400 -
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 -
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 -
The Journal of Urology Mar 2023
Topics: Male; Humans; Varicocele; Sclerotherapy; Scrotum; Follow-Up Studies; Laparoscopy
PubMed: 36622708
DOI: 10.1097/JU.0000000000003148 -
Reproductive Biomedicine Online Dec 2022Varicocele is one of the most common, yet treatable, causes of male infertility. Varicoceles are present in more than 40% of infertile men with primary infertility, a...
Varicocele is one of the most common, yet treatable, causes of male infertility. Varicoceles are present in more than 40% of infertile men with primary infertility, a figure that increases with age. Varicoceles impair semen parameters and sperm DNA and are linked with lower pregnancy and live birth rates. Until recently, men had seldom been examined in male fertility workups. This is changing as urologists have become recognized as team members in infertility. Hence identification and treatment are available as never before. Furthermore, as men become aware that they are as likely as their female partners to be infertile, they want equal 'couple care', requesting urological referrals as they realize that they can improve their semen quality and chances of fatherhood without or before fertility treatment. There is now a greater understanding of the mechanisms of varicocele-induced damage by oxidative stress, using sperm DNA as a sensitive biomarker of sperm quality. There is a current consensus that varicocele is linked to poor semen and repair improves semen and sperm DNA quality. Evidence is strengthening to indicate that varicocele repair increases pregnancy and live birth rates in natural conception and following fertility treatment.
Topics: Pregnancy; Male; Female; Humans; Varicocele; Semen Analysis; Semen; Infertility, Male; DNA; Sperm Count; Sperm Motility
PubMed: 36207252
DOI: 10.1016/j.rbmo.2022.07.004 -
Oxidative Medicine and Cellular... 2020Since autophagy was suspected to occur in the pathological situation of varicocele (VCL), we have attempted to confirm it here using a surgical model of...
Since autophagy was suspected to occur in the pathological situation of varicocele (VCL), we have attempted to confirm it here using a surgical model of varicocele-induced rats. Thirty Wistar rats were divided into three groups (varicocele/sham/control) and analyzed two months after the induction of varicocele. Testicular tissue sections and epididymal mature sperm were then monitored for classic features of varicocele, including disturbance of spermatogenesis, impaired testicular carbohydrate and lipid homeostasis, decreased sperm count, increased sperm nuclear immaturity and DNA damage, oxidative stress, and lipid peroxidation. At the same time, we evaluated the Atg7 protein content and LC3-II/LC3-1 protein ratio in testis and mature sperm cells, two typical markers of early and late cellular autophagy, respectively. We report here that testis and mature sperm show higher signs of autophagy in the varicocele group than in the control and sham groups, probably to try to mitigate the consequences of VCL on the testis and germ cells.
Topics: Animals; Autophagy; Disease Models, Animal; Male; Rats; Rats, Wistar; Reactive Oxygen Species; Spermatozoa; Testis; Varicocele
PubMed: 32351674
DOI: 10.1155/2020/5140383 -
Aktuelle Urologie Apr 2020The treatment of a varicocele in childhood and adolescence is considered very controversial. In the past varicocele was often diagnosed during the medical examination... (Review)
Review
The treatment of a varicocele in childhood and adolescence is considered very controversial. In the past varicocele was often diagnosed during the medical examination for military purposes, but today varicocele is common in the J1 exam and is found rather frequently. However, we are still lacking evidence-based recommendations. This means that urologists and paediatric urologists are increasingly confronted with the question of whether intervention is necessary or not.The literature on this is very contradictory. Systematic reviews and meta-analyses have recently shown that there are only modest benefits of intervention in terms of testicular size and spermiogram quality. Solid data on the impact on paternity rates are still lacking. However, it has been shown that if an intervention is to be made, the lymphatic sparing techniques have a distinct advantage.Possible indications for intervention may be the persistent difference in size of the testes (> 20 % for at least 6 months), a symptomatic varicocele (very subjective criterion), a pathological spermiogram (better 2), and possibly the presence of additional fertility-limiting factors.
Topics: Child; Humans; Male; Testis; Varicocele
PubMed: 31830770
DOI: 10.1055/a-1075-1665