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Archivio Italiano Di Urologia,... Sep 2022Varicocele is known to have impacts in infertility cases and sperm quality. This review aimed to evaluate the effects of microsurgical varicocelectomy on sperm DNA... (Meta-Analysis)
Meta-Analysis
Microsurgical varicocelectomy effects on sperm DNA fragmentation and sperm parameters in infertile male patients: A systematic review and meta-analysis of more recent evidence.
BACKGROUND
Varicocele is known to have impacts in infertility cases and sperm quality. This review aimed to evaluate the effects of microsurgical varicocelectomy on sperm DNA fragmentation index (DFI) and sperm parameters.
METHODS
Open full English text articles from January 2017 to October 2021 were searched from online database including PubMed, EMBASE, Scopus, Cochrane Library and Google Scholar.
RESULTS
Systematic search resulted in 277 potential papers. After throughout paper analysis, 5 studies were included in this review. From all five analyzed studies, microsurgical varicocelectomy was statistically proven to reduce DNA fragmentation index by 5.46% (mean difference -5.46; 95% CI: -4.79, -6.13; p < 0.00001). Moreover, the procedure also significantly improved other sperm parameters (sperm concentration +8.23%, sperm motility +7.17%, sperm progressive motility +2.77%, sperm morphology +0.64%).
CONCLUSION
Microsurgical varicocelectomy significantly improves spermatogenesis as reflected by biomarkers of infertile men including semen parameters and sperm DNA fragmentation (SDF).
Topics: Biomarkers; DNA Fragmentation; Humans; Infertility, Male; Male; Microsurgery; Semen; Sperm Count; Sperm Motility; Spermatozoa; Varicocele
PubMed: 36165486
DOI: 10.4081/aiua.2022.3.360 -
European Urology Focus Jan 2023The benefits and harms of varicocele treatment versus observation in adult infertile males are still controversial. (Meta-Analysis)
Meta-Analysis Review
CONTEXT
The benefits and harms of varicocele treatment versus observation in adult infertile males are still controversial.
OBJECTIVE
To systematically pool the evidence on outcomes of varicocele treatment (any surgical or radiological) versus observation in adult infertile men.
EVIDENCE ACQUISITION
A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Only prospective randomized and nonrandomized studies were included until November 2021. The primary outcome was pregnancy rate; the secondary outcomes were improvements in sperm concentration, normal morphology, and progressive sperm motility after treatment compared to baseline. Men ≥18 yr of age with any-grade varicoceles were included.
EVIDENCE SYNTHESIS
Of 557 articles identified, 12 were eligible for inclusion, involving 1357 patients. Varicoceles were treated surgically in ten and radiologically in four studies. Varicocele treatment improved pregnancy rates (odds ratio 1.29; 95% confidence interval [CI] 1.00-1.65; p = 0.048) and sperm concentration (mean difference 12.34 million/ml, 95% CI 3.49-21.18; p = 0.006) compared with observation. Proportions of spermatozoa with normal morphology and progressive motility were not statistically different from those with observation. However, considering treatment arm only, sperm concentration, progressive motility, and normal sperm morphology were improved compared with baseline. A subgroup analysis showed that the benefit of varicocele treatment is evident in men with an abnormal semen analysis. The main limitation is represented by the heterogeneity of the included studies, mostly in terms of study population, fertility of the partner, outcome evaluation, lack of long-term outcomes, and intermediate/high risk of bias.
CONCLUSIONS
Treatment of any-grade varicoceles may improve pregnancy rates and sperm concentration in adult infertile men, while benefits in sperm motility and normal morphology are less clear.
PATIENT SUMMARY
In this systematic review and meta-analysis of all published prospective trials on varicocele treatment, significant evidence emerged on its benefit in terms of improved pregnancy rates and sperm concentration, while benefits in sperm motility and morphology are less clear.
Topics: Pregnancy; Female; Humans; Male; Adult; Varicocele; Prospective Studies; Sperm Motility; Semen; Fertility
PubMed: 36151030
DOI: 10.1016/j.euf.2022.08.014 -
The World Journal of Men's Health Jan 2023Seminal oxidative stress (OS) is a recognized factor potentially associated with male infertility, but the efficacy of antioxidant (AOX) therapy is controversial and...
PURPOSE
Seminal oxidative stress (OS) is a recognized factor potentially associated with male infertility, but the efficacy of antioxidant (AOX) therapy is controversial and there is no consensus on its utility. Primary outcomes of this study were to investigate the effect of AOX on spontaneous clinical pregnancy, live birth and miscarriage rates in male infertile patients. Secondary outcomes were conventional semen parameters, sperm DNA fragmentation (SDF) and seminal OS.
MATERIALS AND METHODS
Literature search was performed using Scopus, PubMed, Ovid, Embase, and Cochrane databases. Only randomized controlled trials (RCTs) were included and the meta-analysis was conducted according to PRISMA guidelines.
RESULTS
We assessed for eligibility 1,307 abstracts, and 45 RCTs were finally included, for a total of 4,332 infertile patients. We found a significantly higher pregnancy rate in patients treated with AOX compared to placebo-treated or untreated controls, without significant inter-study heterogeneity. No effects on live-birth or miscarriage rates were observed in four studies. A significantly higher sperm concentration, sperm progressive motility, sperm total motility, and normal sperm morphology was found in patients compared to controls. We found no effect on SDF in analysis of three eligible studies. Seminal levels of total antioxidant capacity were significantly higher, while seminal malondialdehyde acid was significantly lower in patients than controls. These results did not change after exclusion of studies performed following varicocele repair.
CONCLUSIONS
The present analysis upgrades the level of evidence favoring a recommendation for using AOX in male infertility to improve the spontaneous pregnancy rate and the conventional sperm parameters. The failure to demonstrate an increase in live-birth rate, despite an increase in pregnancy rates, is due to the very few RCTs specifically assessing the impact of AOX on live-birth rate. Therefore, further RCTs assessing the impact of AOX on live-birth rate and miscarriage rate, and SDF will be helpful.
PubMed: 36102104
DOI: 10.5534/wjmh.220067 -
Journal of Vascular Surgery. Venous and... Nov 2022Nutcracker syndrome (NCS) is an increasingly recognized venous compressive disease. Although people with NCS can experience debilitating symptoms, making an accurate... (Review)
Review
OBJECTIVE
Nutcracker syndrome (NCS) is an increasingly recognized venous compressive disease. Although people with NCS can experience debilitating symptoms, making an accurate diagnosis can often be challenging owing to the broad spectrum of clinical presentations and radiologic findings. In the present systematic review, we assessed the most frequent clinical and radiologic criteria used in establishing a diagnosis of NCS and have proposed a comprehensive framework for clinical decision-making.
METHODS
We performed a systematic review to identify all observational studies or case series conducted within the previous 10 years that had studied patients with a clinical and radiologic diagnosis of NCS. The extracted data included details related to the study design, participant demographics, presenting clinical features, and radiologic criteria. These details were compared between studies and synthesized to establish a comprehensive diagnostic framework that would be applicable to clinical practice.
RESULTS
In the present review, we included 14 studies with a total of 384 patients with NCS. The most common clinical features of NCS were hematuria (69.5%), left flank or abdominal pain (48.4%), pelvic pain (23.1%), and varicocele (15.8%). Computed tomography and ultrasound were the most commonly used imaging modalities, with a threshold for left renal vein stenosis of >80% the most frequently used diagnostic parameter. Eight studies had used venography, with the renocaval pressure gradient the most commonly measured parameter. Two studies had reported using intravascular ultrasound. The findings from our review have shown that a thorough clinical workup of NCS should include critical evaluation of the presenting clinical features and exclusion of alternative diagnoses. All patients should undergo duplex ultrasound with or without the addition of computed tomography or magnetic resonance imaging. Any patient considered for therapeutic intervention should also undergo diagnostic venography with measurement of the renocaval pressure gradient and, if available, intravascular ultrasound with measurement of the left renal vein diameters.
CONCLUSIONS
NCS is a challenging condition in terms of the diagnosis and management both. We have proposed a comprehensive diagnostic framework based on the currently available literature to aid in clinical decision-making.
Topics: Algorithms; Constriction, Pathologic; Humans; Male; Renal Nutcracker Syndrome; Renal Veins; Vascular Diseases
PubMed: 36007798
DOI: 10.1016/j.jvsv.2022.08.003 -
Andrologia Nov 2022The aim of this systematic review and meta-analysis was to assess whether oral antioxidant supplementation improves sperm quality in men with infertility and varicocele... (Meta-Analysis)
Meta-Analysis Review
Improvement in sperm quality by oral antioxidant supplementation in infertile men with varicocele who have not undergone surgical repair: Systematic review and meta-analysis.
The aim of this systematic review and meta-analysis was to assess whether oral antioxidant supplementation improves sperm quality in men with infertility and varicocele (VCL) who have not undergone surgical repair. In men with infertility and VCL who had not undergone surgical repair oral antioxidant supplementation significantly increased sperm concentration (WMD +5.86 × 10 /ml 95% CI: +1.47 to +10.24, p < 0.01; random effects model, six studies, 213 patients), total motility (WMD + 3.76%, 95% CI: +0.18 to +7.34, p = 0.04; random effects model, three studies, 93 patients), progressive motility (WMD + 6.38%, 95% CI: +3.04 to +9.71, p < 0.01; random effects model, three studies, 84 patients) and seminal volume (WMD +0.55 ml, 95%CI: +0.06 to +1.04, p = 0.03; random effects model, four studies, 120 patients). On the other hand, no significance difference was observed in sperm morphology (WMD +3.89%, 95% CI: -0.14 to +7.92, p = 0.06; random effects model, five studies, 187 patients). In conclusion, limited evidence suggests that the use of oral antioxidants in men with infertility and VCL, who have not undergone surgical repair improves their seminal volume, sperm concentration, total and progressive motility.
Topics: Antioxidants; Dietary Supplements; Humans; Infertility, Male; Male; Semen; Sperm Count; Sperm Motility; Spermatozoa; Varicocele
PubMed: 35819022
DOI: 10.1111/and.14533 -
Andrologia Sep 2022We aimed to systematically review complications, and recurrence rate of varicocele treatment by comparing the surgical ligature versus sclero-embolization techniques in... (Meta-Analysis)
Meta-Analysis Review
Do sclero-embolization procedures have advantages over surgical ligature in treating varicocele in children, adolescents and adults? Results from a systematic review and meta-analysis.
We aimed to systematically review complications, and recurrence rate of varicocele treatment by comparing the surgical ligature versus sclero-embolization techniques in children, adolescents and adults. The secondary outcomes were the evaluation of semen parameters and spontaneous pregnancy rate in adults. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Continuous variables were pooled using the inverse variance of the mean difference (MD) with a fixed effect, and 95% confidence interval (CI). The incidences of complications were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as Odds Ratio (OR), and 95% CI. Statistical significance was set two-tail p-value < 0.05. Twenty studies were included. Incidence of postoperative hydrocele was significantly higher in the surgical ligation group (OR 3.06 95% CI 1.06-8.88, p = 0.04). Incidence of postoperative orchiepidydimitys was significantly higher in sclero-embolization group (OR 0.26 95% CI 0.08-0.85, p = 0.02). Presence of normal spermatozoa was significantly higher sclero-embolization group compared with the surgical ligature group (MD 2.54% 95% CI 0.43-4.65, p = 0.02). No difference was found in overall complications, wound infection, testis pain, surgical site hematoma, total sperm count, sperm motility, pregnancy and recurrence rate. This review confirms that current data does still not support the superiority of one type of treatment over other ones.
Topics: Adolescent; Adult; Child; Female; Humans; Ligation; Male; Pregnancy; Semen; Sperm Motility; Treatment Outcome; Varicocele
PubMed: 35750057
DOI: 10.1111/and.14510 -
Basic and Clinical Andrology May 2022Infertility related to varicocele, infections, metabolic dysfunctions, oxidative stress and environmental toxicants is also associated with inflammatory processes that... (Review)
Review
BACKGROUND
Infertility related to varicocele, infections, metabolic dysfunctions, oxidative stress and environmental toxicants is also associated with inflammatory processes that ultimately lead to the activation of the inflammasome pathway (IP). IP is classically activated by DAMPs, MAMPs or LAMPs, which stand for Damage-, Microbe- or Lifestyle-Associated Molecular Patterns, respectively. The most important player in IP activation is the NLRP3 (NOD[Nuclear oligomerization domain]-, LRR[Leucine rich repeat]- and pyrin domain-containing protein 3) which functions as an intracellular sensor of D/M/L-AMPs resulting in activation of caspase-1, promotion of apoptosis, pyroptosis and generation of inflammatory cytokines. This review addresses the question of whether IP activation might be associated with male infertility situations.
RESULTS & CONCLUSIONS
We conducted a systematic review of articles published in the Google Scholar, and PubMed databases through October 2021. It turns out that inflammasome activation and its consequences including cytokine storms, apoptosis and pyroptosis could be associated with the reduced sperm count as well as the structural and functional sperm defects recorded in several situations associated with male infertility suggesting that anti-inflammatory therapeutic strategies could be possibly considered to restore male fertility in future research.
PubMed: 35637440
DOI: 10.1186/s12610-022-00157-9 -
Asian Journal of Andrology 2023In this review, we tried to systematize all the evidence (from PubMed [MEDLINE], Scopus, Cochrane Library, EBSCO, Embase, and Google Scholar) from 1993 to 2021 on the... (Review)
Review
In this review, we tried to systematize all the evidence (from PubMed [MEDLINE], Scopus, Cochrane Library, EBSCO, Embase, and Google Scholar) from 1993 to 2021 on the predictors of microsurgical varicocelectomy efficacy in male infertility treatment. Regarding the outcomes of varicocele repair, we considered semen improvement and pregnancy and analyzed them separately. Based on the 2011 Oxford CEBM Levels of Evidence, we assigned a score to each trial that studied the role of the predictor. We systematized the studied predictors based on the total points, which were, in turn, calculated based on the number and quality of studies that confirmed or rejected the studied predictor as significant, into three levels of significance: predictors of high, moderate, and low clinical significance. Preoperative total motile sperm count (TMSC) coupled with sperm concentration can be a significant predictor of semen improvement and pregnancy after varicocelectomy. In addition, for semen improvement alone, scrotal Doppler ultrasound (DUS) parameters, sperm DNA fragmentation index (DFI), and bilateral varicocelectomy are reliable predictors of microsurgical varicocelectomy efficacy.
Topics: Female; Humans; Male; Pregnancy; Infertility, Male; Microsurgery; Semen; Sperm Count; Sperm Motility; Varicocele
PubMed: 35381691
DOI: 10.4103/aja2021125 -
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 -
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