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Arab Journal of Urology 2021To investigate the usage and the efficacy of vitamins as primary or adjuvant treatment in infertile men with varicocele.
OBJECTIVE
To investigate the usage and the efficacy of vitamins as primary or adjuvant treatment in infertile men with varicocele.
METHODS
A systematic search in PubMed, the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Cochrane Library with the terms (varicocele) AND (vitamins) was performed. We searched for studies: a) reporting the administration of vitamins (individually or as part of a complex) in men with varicocele and infertility, b) primarily or adjuvant to invasive treatment, and c) reporting the impact on semen parameters and/or pregnancy rates. Exclusion criteria were animal, adolescent and non-English studies, grey literature and trials reporting abstracts only.
RESULTS
Seven studies were identified eligible for qualitative analysis. All studies were randomised except one (case series). Vitamins were administered dominantly as part of antioxidant complex and only two studies used vitamins (C and E, respectively) as sole agent. In two studies, vitamin monotherapy resulted in improvement in semen quality, but the effect on pregnancy rates is unknown. One study reported no efficacy of adjuvant multivitamin treatment after embolisation in terms of both semen quality and pregnancy rates. Finally, four studies reported a positive effect of vitamins on semen parameters after varicocelectomy, but the effect on pregnancy rates is conflicting; one study reported improved pregnancy rates with adjuvant treatment, two studies did not evaluate the pregnancy rates, and in one study the outcome was unclear due to missing data.
CONCLUSIONS
Vitamins have been used mostly as part of an antioxidant panel for the management of infertile men with varicocele. Most studies have found a positive impact on semen parameters in selected men with varicocele and infertility, as primary or adjuvant treatment. However, the clinical benefit of vitamins administration on pregnancy rate is under-evaluated and should be the target of future research.
PubMed: 34552778
DOI: 10.1080/2090598X.2021.1932124 -
Systems Biology in Reproductive Medicine Apr 2017This study reviewed the efficacy and safety of the three surgical approaches for varicocele (microsurgical, laparoscopic, and open varicocelectomy). A systematic review... (Meta-Analysis)
Meta-Analysis Review
This study reviewed the efficacy and safety of the three surgical approaches for varicocele (microsurgical, laparoscopic, and open varicocelectomy). A systematic review of the relevant randomized clinical trials was performed. Trials were identified from specialized trials register of the Cochrane UGDP Group, the Cochrane library, additional electronic searches (mainly MEDLINE, EMBSAE, SCI, CBM), and handsearching. Clinical trials comparing microsurgical, laparoscopic and open varicocelectomies were included. Statistical analysis was managed using Review Manager 5.3. Seven clinical trials of 1,781 patients were included. The meta-analysis indicated that compared with open varicocelectomy, microsurgery had a higher pregnancy rate (p=0.002), while there was nonsignificant difference between microsurgical and laparoscopic varicocelectomies or between laparoscopic and open varicocelectomies. Both microsurgical and laparoscopic varicocelectomies had a greater increase in postoperative sperm concentration than open varicocelectomy (p=0.008 and p=0.001, respectively). Microsurgical varicocelectomy also showed better improvement in postoperative sperm motility (p=0.02). Compared with the other two, microsurgical varicocelectomy had the longest operative time (p=0.01 and p=0.0004 respectively). A nonsignificant difference was found in the hospital stay between the three approaches, whereas microsurgical and laparoscopic varicocelectomies had a shorter time to return to work. Moreover, microsurgical varicocelectomy had a lower incidence of postoperative complications and recurrence compared with the others. Analysis of current evidence shows that microsurgical varicocelectomy has a longer operative time, lower incidence of postoperative complications, and recurrence than laparoscopic and open varicocelectomies, and shows a higher pregnancy rate, with a greater increase in postoperative sperm concentration, better improvement in postoperative sperm motility, and shorter time to return to work than open varicocelectomy.
Topics: Adult; Chi-Square Distribution; Female; Fertility; Humans; Infertility, Male; Laparoscopy; Length of Stay; Male; Microsurgery; Odds Ratio; Postoperative Complications; Pregnancy; Pregnancy Rate; Recovery of Function; Return to Work; Risk Factors; Sperm Count; Sperm Motility; Time Factors; Treatment Outcome; Urogenital Surgical Procedures; Varicocele; Young Adult
PubMed: 28301253
DOI: 10.1080/19396368.2016.1265161 -
European Urology Focus May 2023The outcomes and morbidity following treatment for persistent or varicocele recurrence remain controversial. (Review)
Review
CONTEXT
The outcomes and morbidity following treatment for persistent or varicocele recurrence remain controversial.
OBJECTIVE
To conduct a systematic review relating to the outcomes following treatment (any surgical or radiological) for varicocele persistence/recurrence.
EVIDENCE ACQUISITION
A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Prospective and retrospective observational or interventional studies were included until March 2022. Outcomes were pregnancy rate, improvements in semen parameters after treatment compared with those at baseline, pain control, complication rates, and repeat treatment approach. Men of any age with any-grade persistent/recurrent varicoceles were included.
EVIDENCE SYNTHESIS
Of 913 articles identified, 18 with 1073 patients were eligible for inclusion. The mean time between the first and repeat treatment ranged between 5.3 and 73.3 months. The indication for repeat treatment was infertility in eight and pain control in six out of 18 studies, whereas four did not provide details for the indication. Of the patients with recurrent/persistent varicoceles initially treated using a radiological intervention, 83.8% underwent another radiological procedure, whereas 16.2% underwent a surgical procedure. Of those initially treated with a surgical procedure, 77.8% underwent a further surgical procedure, whereas 22.2% underwent a radiological procedure. The rate of success of repeat treatment was 60-100%. The reported complications were as follows: hydrocele (up to 16%), testicular atrophy (up to 2%), scrotal hematoma (up to 1.6%), wound infection (up to 6.6%), chronic pain (up to 2.9%), injury to other organs (up to 10%), and thrombophlebitis (up to 5.8%). The rate of symptom resolution was >90% for pain control. Pregnancy rates were 17-58% at 12-month follow-up. Semen parameters improved after repeat treatment compared with that at baseline in 87.5% of studies. The main limitations are the high risk of bias according to the Newcastle and Ottawa Scale, heterogeneity of the included studies, and small simple size.
CONCLUSIONS
Treating any grade of persistent/recurrent varicoceles has a good rate of success, pregnancy, and pain control, but there is still a risk of complications. Repeat treatment with the same interventional modality is feasible. The level of evidence is overall low.
PATIENT SUMMARY
In this systematic review on persistent or recurrent varicoceles, we showed that repeat treatment with radiological or surgical procedures was feasible, with good success, pregnancy, and pain control rates at follow-up. However, repeat treatment was associated with a higher risk of complications than reported in the published literature relating to patients having their first intervention.
Topics: Male; Pregnancy; Female; Humans; Varicocele; Retrospective Studies; Prospective Studies; Pregnancy Rate; Chronic Pain
PubMed: 36443199
DOI: 10.1016/j.euf.2022.11.008 -
Journal of Ethnopharmacology Jun 2024Morinda officinalis How is called "Ba-Ji-Tian" in Traditional Chinese Medicine (TCM), which belongs to the genus Rubiaceae and is widely used for medicinal purposes in... (Review)
Review
ETHNOPHARMACOLOGICAL RELEVANCE
Morinda officinalis How is called "Ba-Ji-Tian" in Traditional Chinese Medicine (TCM), which belongs to the genus Rubiaceae and is widely used for medicinal purposes in China and other eastern Asian countries. Morinda officinalis How polysaccharides (MOPs) are one of the key bioactive components, and have a variety of biological activities, such as antioxidation, antifatigue, enhanced immunity, antiosteoporosis, ect.
AIM OF THE REVIEW
This review is aimed at providing comprehensive information of the latest preparation technologies, structural characterization, and pharmacological effects of MOPs. A more in-depth research on the structure and clinical pharmacology of the MOPs was explored. It could lay a foundation for further investigate the pharmacological activities and guide the safe clinical practice of MOPs.
MATERIALS AND METHODS
The Web of Science, PubMed, Scifinder, Google Scholar, CNKI, Wanfang database, and other online database are used to search and collect the literature on extraction and separation methods, structural characterization, and pharmacological activities of MOPs publisher from 2004 to 2023. The key words are "Morinda officinalis polysaccharides", "extraction", "isolation", "purification" and "pharmacological effects".
RESULTS
Morinda officinalis has been widely used in tonifying the kidney yang since ancient times, and is famous for one of the "Four Southern Medicines" in China for the treatment of depression, osteoporosis, rheumatoid arthritis, infertility, fatigue and Alzheimer's disease. The active ingredients of Morinda officinalis that have been researched on the treatment of depression and osteoporosis are mostly polysaccharides and oligosaccharides. The content of polysaccharides varies with different methods of extraction, separation and purification. MOPs have a wide range of pharmacological effects, including antioxidant, antifatigue, immunomodulatory, antiosteoporosis, and regulation of spermatogenesis activities. These pharmacological properties lay a foundation for the treatment of oxidative stress, osteoporosis, spermatogenic dysfunction, immunodeficiency, inflammation and other diseases with MOPs.
CONCLUSIONS
At present, MOPs have been applied in the treatment of skeletal muscle atrophy, varicocele, osteoporosis, because of its effects of enhancing immunity, improving reproduction and antioxidant. However, the structure-activity relationship of these effects are still not clear. The more deeply study could be conducted on the MOPs in the future. The toxicology and clinical pharmacology, as well as mechanism of action of MOPs were also needed to deeply studied and clarified. This paper could lay the foundation for the application and safety of MOPs in multifunctional foods and drugs.
Topics: Male; Humans; Morinda; Antioxidants; Drugs, Chinese Herbal; Oligosaccharides; Osteoporosis; Phytochemicals; Polysaccharides
PubMed: 38521432
DOI: 10.1016/j.jep.2024.118090 -
The World Journal of Men's Health Apr 2021It is widely accepted that oxidative stress plays an important role in the pathophysiology of male infertility and that antioxidants could have a significant role in the... (Review)
Review
It is widely accepted that oxidative stress plays an important role in the pathophysiology of male infertility and that antioxidants could have a significant role in the treatment of male infertility. The main objectives of this study are: 1) to systematically review the current evidence for the utility of antioxidants in the treatment of male infertility; and 2) propose evidence-based clinical guidelines for the use of antioxidants in the treatment of male infertility. A systematic review of the available clinical evidence was performed, with articles published on Scopus being manually screened. Data extracted included the type of antioxidant used, the clinical conditions under investigation, the evaluation of semen parameters and reproductive outcomes. The adherence to the Cambridge Quality Checklist, Cochrane Risk of Bias for randomized controlled trials (RCTs), CONSORT guidelines and JADAD score were analyzed for each included study. Further, we provided a Strength Weakness Opportunity Threat (SWOT) analysis to analyze the current and future value of antioxidants in male infertility. Of the 1,978 articles identified, 97 articles were included in the study. Of these, 52 (53.6%) were uncontrolled (open label), 12 (12.4%) unblinded RCTs, and 33 (34.0%) blinded RCTs, whereas 44 (45.4%) articles tested individual antioxidants, 31 (32.0%) a combination of several products in variable dosages, and 22 (22.6%) registered antioxidant products. Based on the published evidence, we 1) critically examined the necessity of additional double-blind, randomized, placebo-controlled trials, and 2) proposed updated evidence-based clinical guidelines for antioxidant therapy in male infertility. The current systematic review on antioxidants and male infertility clearly shows that antioxidant supplementation improves semen parameters. In addition, it provides the indications for antioxidant treatment in specific clinical conditions, including varicocele, unexplained and idiopathic male infertility, as well as in cases of altered semen quality.
PubMed: 33474843
DOI: 10.5534/wjmh.200196 -
International Angiology : a Journal of... Feb 2016Nutcracker syndrome (NCS) is the name given to entrapment of the left renal vein (LRV) between the aorta and superior mesenteric artery (SMA). The aim of the study was... (Review)
Review
Nutcracker syndrome (NCS) is the name given to entrapment of the left renal vein (LRV) between the aorta and superior mesenteric artery (SMA). The aim of the study was to review current research and clarify the most common clinical image of the syndrome. A systematic review of PubMed and EBSCO databases was performed. Articles included in the study had to meet the following criteria: publication between 1980 and 2014, a detailed report on patient symptoms and laboratory test results, medical imaging confirmation of LRV entrapment diagnosis. Fifty-five publications which met the inclusion criteria provided the final database containing 112 cases. The male-female distribution was equal, the mean age on diagnosis for the whole group was 26.47±13.77years. Diagnosis was made earlier in males (23.59±13.09) than females (29.34±13.93). The following frequency of symptoms was noted: 78.57% for haematuria, 38.39% for left flank pain, 35.71% for varicocele in males, 30.36% for proteinuria and 13.39% for anaemia. NCS diagnosis was made earlier if proteinuria occurred as one of the symptoms (P<0.001). Anemia occurred more often in older patients (P=0.0128). NCS was diagnosed in younger age in patients with varicocele (P=0.037). Although NCS is not a common diagnosis, it should be taken into consideration, particularly in hematuria of unknown origin and varicocele.
Topics: Female; Humans; Male; Renal Nutcracker Syndrome; Young Adult
PubMed: 25972135
DOI: No ID Found -
International Urology and Nephrology Jun 2016We performed this meta-analysis to evaluate the efficacy and safety of artery preserving versus artery non-preserving in laparoscopic varicocelectomy. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
We performed this meta-analysis to evaluate the efficacy and safety of artery preserving versus artery non-preserving in laparoscopic varicocelectomy.
METHODS
All publications up until October 2015 were searched in PubMed, EMBASE, Ovid, Web of Science, and Cochrane library. Randomized controlled trials (RCTs) and cohort studies (CSs) that compared the difference in two operative approaches in laparoscopic varicocelectomy were included. Statistical analysis was performed using Stata version 12.0.
RESULTS
A total of four RCTs and ten CSs involving 503 cases with artery preserving and 911 cases with artery non-preserving met our inclusion criteria. Meta-analysis showed that artery preserving had higher recurrence rate [risk ratio (RR) = 2.91, 95 % confidence interval (CI) 1.83-4.61; P = 0.000], lower incidence of hydrocele formation (RR = 0.18; 95 % CI 0.08-0.42; P = 0.000), and prolonged operating time [standard mean difference (SMD) = 1.27; 95 % CI 0.17-2.37; P = 0.023], compared with artery non-preserving in laparoscopic varicocelectomy. The results were similar in postoperative catch-up growth (RR = 1.00; 95 % CI 0.86-1.17; P = 0.985) and testicular atrophy (RR = 0.36; 95 % CI 0.09-1.54; P = 0.169). Besides, no significant difference was found in sperm concentration, motility, and normal morphology between two groups, as well as on postoperative pregnancy rate (RR = 0.95; 95 % CI 0.65-1.40; P = 0.809).
CONCLUSION
With the advantages of less recurrence, easier operating and less time spending, and comparable results in other respects, artery non-preserving is preferable to artery preserving in laparoscopic varicocelectomy, although there is a relatively high incidence of hydrocele formation. Considering the limitation of included studies, more large-scaled RCTs are required to confirm the present findings.
Topics: Humans; Laparoscopy; Male; Testis; Varicocele
PubMed: 26971102
DOI: 10.1007/s11255-016-1254-7 -
The World Journal of Men's Health Jul 2024Varicocele has been associated with high seminal oxidative stress (OS), impaired semen quality, and reduced male fertility potential. However, the exact mechanism(s)...
PURPOSE
Varicocele has been associated with high seminal oxidative stress (OS), impaired semen quality, and reduced male fertility potential. However, the exact mechanism(s) underlying the development of varicocele-mediated infertility and the cause-effect relationship between varicocele and testicular dysfunction are not fully understood. The aim of this systematic review and meta-analysis (SRMA) is to investigate the impact of varicocele on testicular OS markers and sperm parameters in experimental animals with varicocele as compared to animals without varicocele.
MATERIALS AND METHODS
A literature search was performed using the Scopus and PubMed databases on studies that investigated testicular OS markers and sperm parameters in animals with varicocele. The primary outcomes included malondialdehyde (MDA) (nmol/mg) levels whereas the secondary outcomes included total sperm count (×10), sperm vitality (%), total sperm motility (%), and sperm DNA fragmentation (SDF) (%). Standardized mean difference (SMD) (95% confidence interval [CI]) was chosen to express the effect size. The quality of the included studies was evaluated using the Cambridge Quality Checklist.
RESULTS
Out of 76 identified articles, 6 studies on rats were included in the meta-analysis. The analysis showed a significant increase of MDA (SMD: 15.61 [1.93, 29.29]; p=0.03) in rats with varicocele vs. controls. We also observed a significant decrease in total sperm count (SMD: -17.45 [-28.97, -5.93]; p<0.01), sperm vitality (SMD: -16.41 [-26.30, -6.52]; p<0.01), total sperm motility (SMD: -17.67 [-24.90, -10.44]; p<0.01), and a significant increase of SDF (SMD: 7.41 [1.23, 13.59]; p=0.02), in rats with varicocele vs. controls. The quality of the included studies was ranked as high.
CONCLUSIONS
This SRMA indicates a significant increase in levels of testicular MDA and SDF and a reduction of sperm quality in experimental animals with varicocele. These findings support the potential role of testicular OS in the development of varicocele-induced testicular damage.
PubMed: 38449451
DOI: 10.5534/wjmh.230260 -
Andrologia Nov 2019To evaluate the anthropometric indexes in subjects with varicocele compared to controls and the incidence of varicocele in different body mass index (BMI) groups for the... (Meta-Analysis)
Meta-Analysis
To evaluate the anthropometric indexes in subjects with varicocele compared to controls and the incidence of varicocele in different body mass index (BMI) groups for the purpose of exploring the association between varicocele and anthropometric indexes. A comprehensive literature search was conducted by using PubMed, MEDLINE, EMBASE databases and Cochrane Library up to February 2019. A systematic review and meta-analysis was conducted by STATA, and Newcastle-Ottawa Scale was utilised for assessing risk of bias. Ultimately, 13 articles containing seven case-control studies and six cross-sectional studies with 1,385,630 subjects were involved in our study. Pooled results demonstrated that varicocele patients had a lower BMI (WMD = -0.77, 95% CI = -1.03 to -0.51) and a higher height than nonvaricocele participants, especially in grade 3 varicocele patients. Subgroup analyses showed that normal BMI individuals had a higher risk of varicocele than obese or overweight individuals and a lower risk than underweight individuals. In conclusion, this study indicates that varicocele patients have a lower BMI and a higher height than nonvaricocele participants. Moreover, men with excess bodyweight have a lower incidence of varicocele compared to normal weight or underweight people. That is to say, high BMI and adiposity protect against varicocele and high BMI is associated with a decreased risk of varicocele.
Topics: Adiposity; Body Height; Body Mass Index; Case-Control Studies; Humans; Incidence; Male; Risk Assessment; Risk Factors; Varicocele
PubMed: 31475746
DOI: 10.1111/and.13391 -
Fertility and Sterility Dec 2011To perform a literature search on the association between varicocele and sperm DNA fragmentation. (Review)
Review
OBJECTIVE
To perform a literature search on the association between varicocele and sperm DNA fragmentation.
DESIGN
Systematic review.
PATIENT(S)
Men with a varicocele and infertility.
INTERVENTION(S)
Varicocele repair.
MAIN OUTCOME MEASURE(S)
Does the presence of a varicocele increase seminal oxidative stress and sperm DNA fragmentation?
RESULT(S)
In men with a varicocele increased levels of reactive oxygen species and sperm DNA damage can be found. This is probably related to defective spermatogenesis in these patients. Seminal oxidative stress is believed to be the source of sperm DNA damage. Patients with a varicocele and oligospermia may also have a diminished seminal antioxidant capacity. After varicocele repair sperm DNA fragmentation decreases.
CONCLUSION(S)
Varicocele is associated with sperm DNA damage, and this sperm pathology may be secondary to varicocele-mediated oxidative stress. The beneficial effect of varicocelectomy on sperm DNA damage further supports the premise that varicocele may impair sperm DNA integrity.
Topics: DNA; DNA Damage; DNA Fragmentation; Humans; Infertility, Male; Male; Oxidative Stress; Spermatozoa; Varicocele
PubMed: 22035729
DOI: 10.1016/j.fertnstert.2011.10.016