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BMC Nursing Feb 2024Varicocele is the most prevalent correctable cause of male infertility. Currently, surgical treatment is the primary method to enhance fertility.For many young...
BACKGROUND
Varicocele is the most prevalent correctable cause of male infertility. Currently, surgical treatment is the primary method to enhance fertility.For many young varicocele patients who have postponed surgery due to time constraints, daytime surgery is especially crucial. Thus, this study aims to investigate the clinical and nursing application value of the Plan-Do-Check-Act (PDCA) cycle in daytime varicocelectomy.
METHODS
Retrospective collection of clinical data was conducted on 130 patients undergoing laparoscopic varicocelectomy in the Third Affiliated Hospital of Southern Medical University, Guangzhou,China.Among them, 65 patients who underwent daytime surgery were assigned to the observation group, while 65 patients who underwent routine hospital surgeries were assigned to the control group.The former also implemented PDCA cycle management.A comparison was made between the two groups regarding hospitalization time, hospitalization costs, and patient satisfaction.
RESULTS
The observation group exhibited a shorter hospitalization time and lower hospitalization costs compared to the control group, with higher patient satisfaction and pre-discharge visual analog scale (VAS) scores noted (P < 0.05).No significant difference was observed in the incidence of postoperative complications between the two groups during hospitalization (P > 0.05). The implementation of the PDCA cycle in the observation group has demonstrated its effectiveness, ensuring the smooth conduct of the daytime varicocelectomy.
CONCLUSION
In conclusion,daytime varicocelectomy can reduce hospitalization time,lower hospitalization costs, improve patient satisfaction. The PDCA Cycle enhances the rationality and efficacy of the daytime varicocelectomy procedure and is highly recommended. Furthermore, it offers valuable reference for the application of the PDCA Cycle in various other diseases and nursing management approaches.
TRIAL REGISTRATION
The Trial Registration Number: ChiCTR2300077465;Date of registration: November 9, 2023.
PubMed: 38360590
DOI: 10.1186/s12912-024-01765-8 -
Polski Przeglad Chirurgiczny Oct 2023Testicular and scrotal abnormalities can occur in children, adolescents, and adults. The lesions, often accompanied by pain and swelling/enlargement of the scrotum, can...
Testicular and scrotal abnormalities can occur in children, adolescents, and adults. The lesions, often accompanied by pain and swelling/enlargement of the scrotum, can cause anxiety in patients and their parents. Regardless of age, proper diagnosis is based on adequate anamnesis and physical examination. Color Doppler ultrasound is the first-line test in the differential process of testicular and scrotal diseases. Testicular and scrotal lesions require differentiation for benign and malignant processes as well as therapeutic management, including urgent surgical intervention. The aim of this paper is to present the most common causes of testicular and scrotal abnormalities in pediatric and adult patients and to outline the symptoms and diagnostic and therapeutic management.
Topics: Male; Adolescent; Humans; Child; Genital Diseases, Male; Scrotum; Spermatic Cord Torsion
PubMed: 38348982
DOI: 10.5604/01.3001.0053.9349 -
Clinics (Sao Paulo, Brazil) 2024Varicocele is an abnormal expansion of the pampininias venous plexus in the scrotum, resulting in impaired sperm production and reduced sperm quality. The exact...
BACKGROUND
Varicocele is an abnormal expansion of the pampininias venous plexus in the scrotum, resulting in impaired sperm production and reduced sperm quality. The exact pathophysiological mechanism leading to varicocele-related infertility has not been fully elucidated. Although treatable, varicocele may lead to male infertility.
OBJECTIVE
To investigate the relationship between semen parameters, serum InhB and INSL-3 levels, and the degree of varicocele in male patients.
METHODS
Serum InhB and INSL-3 were detected. To evaluate the relationship between semen parameters and serum InhB and INSL-3 levels. To evaluate the value of semen parameters and serum InhB and INSL-3 levels in distinguishing disease severity in patients with varicocele.
RESULTS
Serum INSL-3 in patients with varicocele decreased with the severity of the disease. Serum INSL-3 was positively correlated with total sperm count and frequency of normal sperm morphology. There was a weak correlation between serum InhB and semen volume, concentration, and total sperm. Patients with different disease severity were similar within the groups, with partial overlap or similarity between varicocele Grade I and Grade II, and significant differences between Grade III and Grade I and II. Semen volume, concentration, total sperm, normal sperm morphology, and serum InhB and INSL-3 levels could distinguish the degree of varicocele.
CONCLUSION
Semen parameters and the combination of serum InhB and INSL-3 levels in patients with varicocele are closely related to the severity of the disease. Serum INSL-3 is expected to be a potential biomarker for early clinical intervention.
Topics: Humans; Male; Semen; Varicocele; Sperm Count; Semen Analysis; Infertility, Male; Spermatozoa
PubMed: 38330789
DOI: 10.1016/j.clinsp.2024.100339 -
Frontiers in Reproductive Health 2023Varicocelectomy is well known to improve the pregnancy outcome of patients with clinical varicoceles in assisted reproductive technologies as well as spontaneous...
INTRODUCTION
Varicocelectomy is well known to improve the pregnancy outcome of patients with clinical varicoceles in assisted reproductive technologies as well as spontaneous conception. Therefore, this study aimed to evaluate the additional effects of oral antioxidant therapy after varicocelectomy on the pregnancy outcome in the assisted reproductive technology setting.
METHODS
This study was a retrospective cohort study. The subjects were couples among whom the male partner had undergone varicocelectomy and was scheduled for subsequent assisted reproductive technology. Pregnancy outcomes were followed retrospectively in 62 couples with male partners who received tocopherol (antioxidant group) and 37 couples who did not (control group). The tocopherol and control groups were assigned dependent on the decision of the physician in charge and the patient's request. The clinical pregnancy rates per couple and embryo transfer, time to pregnancy, and the number of cycles during transfer to pregnancy were evaluated.
RESULTS
No significant differences were observed in the pregnancy rate per couple (antioxidant group 70.9% vs. control group 64.9%, = 0.55) and per embryo transfer (50.4% vs. 39.6%, = 0.22). Regarding the time to event analyzed by adjusted restricted mean survival time, the mean time to pregnancy was significantly shorter in the antioxidant (tocopherol) group (14.2 vs. 17.4 months, = 0.025). No significant difference was observed in the embryo transfer cycle to pregnancy (mean embryo transfer cycles: 2.6 vs. 3.0, = 0.238).
CONCLUSIONS
Additional oral tocopherol nicotinate as antioxidant therapy after varicocelectomy was shown to shorten the time to pregnancy. It is recommended that add-on effects be tested in more well-designed randomized controlled trials to examine whether it improves assisted reproductive outcomes.
PubMed: 38318605
DOI: 10.3389/frph.2023.1325566 -
Asian Journal of Andrology Feb 2024Oxidative stress is one of the main mechanisms responsible for male infertility. Various conditions such as varicocele, obesity, advanced age, and lifestyle can lead to...
Oxidative stress is one of the main mechanisms responsible for male infertility. Various conditions such as varicocele, obesity, advanced age, and lifestyle can lead to an increase in reactive oxygen species, causing an oxidative imbalance in the reproductive environment. Spermatozoa are sensitive to reactive oxygen species and require energy to carry out their main function of fertilizing the egg. Excessive reactive oxygen species can affect sperm metabolism, leading to immobility, impaired acrosome reaction, and cell death, thereby impairing reproductive success. This double-blind randomized study evaluated the effect of supplementation with L-carnitine, acetyl-L-carnitine, vitamins, and other nutrients on semen quality in 104 infertile patients with or without varicocele, while also investigating the impact of factors such as obesity and advanced age on treatment. Sperm concentration significantly increased in the supplemented group compared to the placebo group (P = 0.0186). Total sperm count also significantly increased in the supplemented group (P = 0.0117), as did sperm motility (P = 0.0120). The treatment had a positive effect on patients up to 35 years of age in terms of sperm concentration (P = 0.0352), while a body mass index (BMI) above 25 kg m-2 had a negative effect on sperm concentration (P = 0.0110). Results were not showing a net benefit in stratifying patients in accordance with their BMI since sperm quality increase was not affected by this parameter. In conclusion, antioxidant supplementation may be beneficial for infertile patients and has a more positive effect on younger patients with a normal weight.
PubMed: 38305695
DOI: 10.4103/aja202381 -
Cureus Dec 2023Purpose This article aims to report the first series of men with complete microduplications and their clinical and reproductive characteristics. Methods We sampled...
Purpose This article aims to report the first series of men with complete microduplications and their clinical and reproductive characteristics. Methods We sampled 3000 men who presented for reproductive urology evaluation from 2012-2020, of which 104 men underwent high-resolution Y-chromosome microarray testing, and five men were identified to have complete microduplications. Medical, surgical, and reproductive histories were obtained. Semen and hormonal parameters as well as response to fertility therapies were recorded. Results Five men were identified as having complete microduplications. The mean age was 33.75 years, representing 0.2% (5/3000) of men presenting for fertility investigation, 4.8% (5/104) of men undergoing microarray testing, and 21% (5/24) of men with abnormalities. Two of the men had prior undescended testicles and one had several autoimmune processes. The mean follicle-stimulating hormone (FSH) was 5.5 IU/L, luteinizing hormone (LH) 3.6 IU/L, and testosterone 14.56 nmol/L. One man was azoospermic, one man alternated between severe oligospermia and rare non-motile sperm, one had variable parameters, with one semen analysis demonstrating azoospermia and a second demonstrating a total motile sperm count (TMSC) of 4 ×10, one man was persistently oligospermic with TMSCs ranging 3.96-12.6 ×10, and one man initially had severe oligospermia, with a mean TMSC of 1.5 ×10, which increased to 21.7 ×10 after intervention (varicocele embolization, clomiphene citrate). This last man then fathered a spontaneous pregnancy. Conclusion complete microduplications are a rare cause of spermatogenic failure but not an uncommon form of abnormality. Clinically, they represent a heterogeneous group, having a variable reproductive potential. Cases should be managed on an individual basis.
PubMed: 38283528
DOI: 10.7759/cureus.51140 -
International Journal of Surgery Case... Feb 2024The main types of scrotal vascular lesions are varicocele, hemangioma, lymphangioma and arteriovenous malformation (AVM). AVM consists of network between arteries and...
INTRODUCTION AND IMPORTANCE
The main types of scrotal vascular lesions are varicocele, hemangioma, lymphangioma and arteriovenous malformation (AVM). AVM consists of network between arteries and veins without capillaries. It is the rarest type especially when in scrotum.
CASE PRESENTATION
A 24-year-old male patient presented with a skin deformity and painless swelling in the left scrotum. Physical examination revealed this swelling that extended to the inguinal region. Duplex Ultrasound (DUS) followed by Multi-slice Computed Tomography (MSCT) were performed to establish the diagnosis. Management depended on surgical excision without angioembolization. Preoperative sperm analysis showed oligoasthenozoospermia that improves significantly after treatment and 1 year of follow-up.
CLINICAL DISCUSSION
Surgical resection of scrotal AVM without embolization has been used in very few cases and has resulted in a satisfactory outcome with no signs of recurrence throughout the follow-up period.
CONCLUSION
Based on our experience, surgical excision without embolization is a reasonable alternative approach to treat scrotal AVM in low-income countries alongside avoiding the negative consequences of radiation therapy. Treatment should be considered when fertility is affected.
PubMed: 38280346
DOI: 10.1016/j.ijscr.2024.109303 -
European Urology Open Science Jan 2024Varicocele is a condition that seriously affects male fertility. It can cause pathological changes in the testicles and affect their spermatogenesis and endocrine...
BACKGROUND
Varicocele is a condition that seriously affects male fertility. It can cause pathological changes in the testicles and affect their spermatogenesis and endocrine function.
OBJECTIVE
To formulate nomograms to predict sperm improvements after microscopic varicocelectomy.
DESIGN SETTING AND PARTICIPANTS
A retrospective analysis was conducted on varicocele patients who met the research criteria and were enrolled from March 2020 to June 2022. They were divided into a development and a validation cohort in a 2:1 ratio.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Data on preoperative testicular atrophy index, bilateral testicular elastic modulus, testosterone, pre- and postoperative 6-mo total sperm count, sperm concentration, and sperm vitality were collected. An increase of ≥25% is considered a postoperative improvement in sperm parameters. Predictive nomograms were constructed through forward stepwise LR regression, based on independent risk factors filtered by univariate and multivariate logistic regression analyses. Receiver operating characteristic curve analysis, calibration curve, and decision curve analysis were employed to assess the performance of the models.
RESULTS AND LIMITATIONS
The areas under the curve of nomograms for predicting the postoperative improvement of total sperm count, sperm concentration, and sperm vitality were 0.915, 0.986, and 0.924 respectively. The nomogram models demonstrated good predictive performance. The single-center sample size was a limitation of this study.
CONCLUSIONS
In this study, we developed effective predictive nomogram models for anticipating postoperative improvements in sperm quality among varicocele patients. These models offer a significant value in providing accurate predictions of surgical outcomes. However, it is crucial to conduct further external validation.
PATIENT SUMMARY
In this study, a predictive nomogram model was constructed for assessing the improvement of sperm quality in varicocele patients after surgery. The model offered satisfactory results.
PubMed: 38264086
DOI: 10.1016/j.euros.2023.11.008 -
Arab Journal of Urology 2024Varicocele is a common occurrence, particularly among men with primary and secondary infertility. There has been extensive research into the management of varicocele in...
BACKGROUND
Varicocele is a common occurrence, particularly among men with primary and secondary infertility. There has been extensive research into the management of varicocele in the context of male infertility.
METHODS
This article aims to explore the variations in clinical practice in diagnosing and managing varicoceles in infertile men. A summary of the current recommendations on varicocele management from professional societies is included.
RESULTS
Substantial gaps in knowledge persist regarding varicoceles and male infertility, with significant variation in clinical approaches, despite the wealth of existing data in the medical literature.
CONCLUSION
The existing literature leaves many questions surrounding varicocele management in infertile men unanswered. This lack of clarity contributes to the ongoing controversy among clinicians in the field. New research is essential to address these contentious points and areas of debate.
PubMed: 38205385
DOI: 10.1080/20905998.2023.2291628 -
Archivio Italiano Di Urologia,... Jan 2024The management of infertile patients with unilateral subclinical varicocele (SCV) and contralateral clinical varicocele (CV) remains controversial. We aimed to evaluate...
PURPOSE
The management of infertile patients with unilateral subclinical varicocele (SCV) and contralateral clinical varicocele (CV) remains controversial. We aimed to evaluate the effect of untreating SCV on the outcome of contralateral clinical varicocelectomy in infertile patients with oligoasthenozoospermia (OA).
MATERIALS AND METHODS
Infertile patients with the diagnosis of OA who underwent left varicocelectomy were retrospectively evaluated. While all patients in the study had left clinical varicocele (LCV), some patients had concomitant right SCV. Patients were divided into two groups according to the presence or absence of a right SCV accompanying LCV as group 1; (LCV n = 104) or group 2; (LCV with right SCV, n = 74). Patients were evaluated with spermiogram parameters, pregnancy rates and serum levels of follicle stimulating hormone, luteinizing hormone, total testosterone at the first year of the follow-up.
RESULTS
The mean sperm concentration increased significantly in both groups. However, group 1 showed significantly greater improvement than group 2. The ratio of progressive motile sperm in group 1 was increased significantly whereas no significant change was shown in group 2. Both the spontaneous pregnancy rate and the pregnancy rate with ART were statistically lower in the group of patients with right SCV. No statistically significant difference was detected in serum hormone levels in both groups after varicocelectomy operations.
CONCLUSIONS
Untreated right SCV may have adverse impact on the outcomes of left clinical varicocelectomy. In this context, the right testis can be considered in terms of treatment in patients with right SCV accompanying left CV.
Topics: Female; Pregnancy; Humans; Male; Varicocele; Retrospective Studies; Semen; Scrotum; Luteinizing Hormone
PubMed: 38193220
DOI: 10.4081/aiua.2023.12128