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PubMed1999

Sequential scrotal scintigraphy for the study of varicocele.

Scrotal scintigraphy is a non-invasive procedure for evaluating spermatic vein reflux. This technique was used in 43 infertile patients with varicocele. None of them had infections, traumatic, or chromosomal abnormalities that could be associated with their infertility. Twelve patients showed type 1 time activity curve, including 3 with grade II, and 9 with grade III varicocele. A total of 12 patients showed a type 2 pattern and consisted of 2 patients with grade I, 6 with grade II, and 4 with grade III varicocele. Nineteen showed type 3 pattern consisting of 6 with grade I, 6 with grade II, and 7 with grade III. The patients with grade III varicocele showed type 1 pattern more frequently than those with grade I or II (p<0.05). Preoperative sperm concentration in patients with grade I varicocele was significantly lower than that in patients with grade II or III disease (p<0.05, each). Sperm motility of patients with grade I varicocele was also significantly lower than that of those with grade II or III varicocele (p<0.01, each). Patients with grade II or III varicocele showed an increase in sperm concentration postoperatively, and those with grade I varicocele showed a postoperative increase in sperm motility, but the differences between pre- and postoperative values were not significant. While seminal findings in patients with type 2 or 3 pattern did not change after surgery, patients with type 1 pattern showed significant improvement in sperm concentration postoperatively (p<0.05). It is concluded that preoperative sequential scrotal scintigraphy can be a more useful technique for assessing the prognosis for postoperative improvement of seminal findings than the grade decision of varicocele.

Adult↗
PubMed2001

Varicocele in adolescence induces left and right testicular volume loss.

OBJECTIVE: To determine the effect of a palpable left-sided varicocele (which in adolescent patients can adversely affect left testicular volume) on right testicular volume with progressive Tanner development and increasing varicocele grade. PATIENTS AND METHODS: The right and left testicular volumes were measured with a standard orchidometer in 70 control patients (mean age 14.6 years, SD 2.2) with no palpable testicular abnormality and in 434 (mean age 14.3 years, SD 2.3) with a palpable left-sided varicocele. Patients with bilateral and right-sided varicoceles were excluded from the study. RESULTS: There was no significant difference between the left and right testicular volumes in the control patients. The testicular volumes of patients with a grade I varicocele were similar to those in control patients. Patients with a grade II varicocele had a significantly smaller left testis than the controls at Tanner stages 4 and 5 (P < or = 0.05). Patients with a grade III varicocele had a significantly smaller left testis than controls at each Tanner stage (P < or = 0.05) and significantly smaller right testis than controls at Tanner stages 4 and 5 (P < or = 0.05). CONCLUSION: The presence of a grade I varicocele in adolescence appears to have no effect on normal testicular growth. Some patients with a grade II varicocele are at risk of left testicular volume loss with time and should have their testicular volume measured annually. Patients with grade III varicocele are at risk of bilateral testicular volume loss; a careful evaluation and early surgical intervention are recommended in this group of patients.

Adolescent↗
PubMed1998

Outcomes of varicocele ligation done for pain.

PURPOSE: Surgical ligation is an option in the management of patients with painful varicocele. Little objective data exist addressing the effectiveness of this treatment. We reviewed records from 58 patients who underwent varicocele ligation at our institution from January 1985 to May 1996 to establish success of surgical ligation of the painful varicocele. MATERIALS AND METHODS: ICD-9 billing codes were used to identify all patients who had undergone varicocele ligation for pain since 1985. We documented patient age, grade and location of varicocele, duration and quality of pain, response to conservative therapy and surgical approach to ligation. Telephone interviews and chart reviews were conducted to determine resolution of pain, complications of the procedure and if the patient would choose surgery again. RESULTS: We obtained followup on 35 of the 58 painful varicocele patients (60%). Average patient age was 25.7 years (range 15 to 65). The varicocele was on the left side in 30 men and bilateral in 5. Of the patients 31 described the pain as a dull throbbing ache, 2 as sharp and 2 as a pulling sensation. Initial conservative therapy failed in all 35 men. Varicocele was grade III in 18 cases, grade II in 16 and grade I in 1. The inguinal or subinguinal approach was used in 24 patients, high ligation in 10 and laparoscopic repair in 1. In 30 patients there was (86%) complete resolution of pain postoperatively and 1 had partial resolution. Only 4 patients (11%) had persistent or worse symptoms. CONCLUSIONS: This retrospective review supports the conclusion that varicocele ligation is an effective treatment for painful varicocele in properly selected patients.

Adolescent↗
PubMed2004

8-hydroxy-2'-deoxyguanosine in leukocyte DNA of spermatic vein as a biomarker of oxidative stress in patients with varicocele.

PURPOSE: We examined oxidative damage to leukocyte DNA in the spermatic vein and sperm DNA of patients with varicocele. MATERIALS AND METHODS: A total of 32 young male patients with varicocele (group 1), 20 young male patients with subclinical varicocele (group 2) and 15 normal young males without varicocele (group 3) were recruited in this study. Varicocele and subclinical varicocele were confirmed by physical examination and Doppler ultrasonography. Blood samples were drawn from peripheral and spermatic veins of controls and patients before varicocelectomy. The 8-hydroxy-2'-deoxyguanosine (8-OHdG) in leukocyte DNA and sperm DNA were measured by high performance liquid chromatography. The 4977 bp deletion of mitochondrial DNA (mtDNA) in spermatozoa was detected by polymerase chain reaction. RESULTS: The mean 8-OHdG level +/- SD in leukocyte DNA of spermatic veins was significantly higher than that of corresponding peripheral veins in groups 1 and 2 (12.39 +/- 2.90 vs 7.11 +/- 0.75/10 deoxyguanosine for group 1 and 10.28 +/- 2.43 vs 6.82 +/- 0.62/10 deoxyguanosine for group 2, p <0.001). The 8-OHdG level in leukocyte DNA of the spermatic vein and 8-OHdG in sperm DNA were highest in group 1 followed by those in groups 2 and 3, and correlated inversely with motility, morphology and density of spermatozoa. The incidence of 4977 bp deletion of mtDNA in sperm was 40.6%, 20% and 0% in groups 1, 2 and 3, respectively. These results indicate that oxidative stress in patients with varicocele or subclinical varicocele was greater than in healthy subjects. CONCLUSIONS: 8-OHdG in leukocyte DNA of the spermatic vein and in sperm DNA, and 4977 bp deletion of mtDNA in sperm might be useful markers for the assessment of oxidative stress in patients with varicocele and subclinical varicocele.

8-Hydroxy-2'-Deoxyguanosine↗
PubMed2005

Testicular hypotrophy does not correlate with grade of adolescent varicocele.

PURPOSE: Testicular hypotrophy is the most widely accepted indication for correcting adolescent varicocele. Previous studies in adolescents have shown a relationship between increasing grade of varicocele and the likelihood of testicular hypotrophy. As this relationship has significant clinical implications, we studied the correlation between grade and testicular volume disproportion in our adolescent varicocele population. MATERIALS AND METHODS: We reviewed the adolescent varicocele database at our institution. A total of 168 patients 8 to 21 years old were studied. We routinely calculated testis volumes using scrotal ultrasound. Testicular disproportion was calculated using the equation [(size of unaffected testis) - (size of affected testis)]/(size of unaffected testis) x 100%. Disproportion was categorized as less than 10%, 10% to 20% and more than 20%. Varicoceles were graded by an attending urologist with the patient standing, using the system of Dubin and Amelar. Analysis of variance and Pearson chi-square indicated no significant differences in volume differential between varicocele grades. RESULTS: Mean +/- SD volume differential was 18% +/- 15% for grade I, 25% +/- 20% for grade II and 19% +/- 14% for grade III. ANOVA revealed no significant difference in mean volume differential between the 3 varicocele grades (p = 0.10). When categorizing patients into 3 levels of volume differential (less than 10%, 10% to 20%, more than 20%) no significant correlation was observed between varicocele and volume differential (p = 0.48, chi-square test). CONCLUSIONS: Grade of varicocele does not correlate with presence or severity of testicular disproportion in adolescent boys with varicocele as measured by scrotal ultrasound.

Adolescent↗
PubMed2006

Antegrade scrotal sclerotherapy for treating primary varicocele in children.

OBJECTIVE: To evaluate the effectiveness and limitations of antegrade sclerotherapy (AS) for the treatment of primary varicocele in childhood. PATIENTS AND METHODS: From December 1996 to December 2004, 88 patients (mean age 13.3 years, range 9-18) with primary varicocele underwent AS (91 varicocele ablations in all). The indications for surgery were testicular pain (16 boys, 18%), a large varicocele with cosmetic implications, testicular hypotrophy (one) and in 71 (81%) the varicocele was detected incidentally during a routine physical examination; all were left-sided. According to the classification used by Tauber, 46 (52%) varicoceles were grade II and 42 (48%) grade III. The clinical and ultrasonography (US) results were evaluated over a median (range) follow-up of 11 (3-60) months, and the operative duration, X-ray exposure time, persistence rate of varicoceles and complications were compared with those using other techniques. RESULTS: In 11 patients there was a palpable difference in size between the testicles, but in only five (6%) was testicular hypotrophy (testicular volume (<75% testicular volume vs the normal side) confirmed by US. The mean (sem) operative duration for AS was 33.2 (2.14) min. In 16 (18%) patients it was necessary to expose a second or third vein because the first vein chosen was unsuitable for sclerotherapy. The mean operative radiation exposure was 2.18 (0.21) s. One patient (1%) was treated with a high ligature of the testicular vein (Palomo procedure) after initial unsuccessful AS, and was excluded from the analysis. Eighty-four (97%) patients were eligible for follow-up: six (7%) had a persistent varicocele (four grade II, two grade III), four of whom had repeat sclerotherapy successfully (no recurrence at follow-up). Fourteen (15%) patients had enlarged testicular veins only on US (varicocele grade 0). No patient developed a hydrocele after AS, There were complications after surgery in three (3%) patients (two superficial wound infections, one scrotal haematoma together with focal testicular necrosis). CONCLUSIONS: AS is an efficient minimally invasive surgical method for correcting varicoceles in older children, although the operative duration is sometimes longer than in adults, and surgery can be more difficult because of the smaller veins. Partial testicular necrosis, despite correct AS, is a very rare but serious complication.

Adolescent↗
PubMed2001

Color doppler ultrasonography and spectral analysis of venous flow in diagnosis of varicocele.

OBJECTIVE: The standardization of diagnostic criteria for varicocele has not yet been established. This causes difficulty in evaluating both the incidence and clinical studies. Our aim was to establish diagnostic criteria for varicocele in Doppler procedures. METHODS: The characteristics of blood flow in the internal spermatic vein were investigated with color Doppler ultrasonography (CDU) and venous flow spectral analysis in 100 infertile men without clinical varicocele (group I), 100 infertile men with clinical left varicocele (group II), and 50 fertile men without clinical varicocele served as controls (group III). RESULTS: Three types of flow pattern were found in the spectral analysis of venous flow. If the venous flow was directed to the heart and did not change direction with an intra-abdominal pressure increase, it was classified as type I; venous flow directed to the heart, but changing direction with an intra-abdominal pressure increase, was classified as type II, and blood flow directed to the testicles and augmenting with an intra-abdominal pressure increase, was classified as type III. In group I, flow patterns were 39, 56 and 5% on the left side and 55, 42 and 3% on the right side for types I, II and III, respectively. In group II, flow patterns were 0, 35 and 65% on the left side and 61, 38 and 1% on the right side for type I, II and III patterns, respectively. In group III, the figures were 44, 54 and 2% for the left and 54, 46 and 0% for the right. Type II and III flow patterns were seen more frequently than type I in patients with clinical left varicocele (p<0.001). Whereas type I and II flow patterns were more common than type III in subjects without clinical varicocele (p<0.05). A type II flow pattern during normal breathing was seen at a lower rate in the control group than in the other groups (p<0.05). CONCLUSION: Spectral analysis of Doppler waves should be used in combination with CDU for the diagnosis of varicocele. Varicocele should not only be diagnosed with a type II flow pattern which occurs during valsalva. For the diagnosis of varicocele, the main criterion must be a type III pattern flow, as well as a type II pattern during normal breathing.

Adult↗
PubMed1993

Use of color Doppler sonography in the evaluation of varicoceles.

Color flow Doppler sonography (CFDS) has been used to evaluate the blood flow to the testes, because of its ability to visualize small vessels with low flow. A total of 39 infertile men, 18 with clinical varicocele and 21 without, were examined using CFDS to assess the clinical usefulness of this technique. In patients with varicocele, venous diameter in the pampiniform plexus was greater than 2 mm, whereas those without varicocele showed diameters of less than 1.8 mm. Of 21 patients without varicocele on physical examination, 13 were found to have reflux by CFDS. According to clinical and CFDS findings, patients were divided into five groups: varicocele negative, suspicious subclinical varicocele, subclinical varicocele, manifest varicocele with Valsalva-induced reflux, and manifest varicocele. These data suggest that the CFDS technique is a simple, sensitive and noninvasive modality for the accurate diagnosis of varicocele.

Adult↗
PubMed2002

Medical backgrounder on varicocele.

Varicocele is an extremely common entity, present in 15% of the male population. Varicoceles are found in approximately 35% of men with primary infertility but 75%-81% of men with secondary infertility. Mounting evidence clearly demonstrates that varicocele causes progressive duration-dependent injury to the testis. Larger varicoceles appear to cause more damage than small varicoceles and, conversely, repair of large varicoceles results in greater improvement of semen quality. Varicocelectomy can halt the progressive duration-dependent decline in semen quality found in men with varicoceles. The earlier the age at which varicocele is repaired, the more likely is recovery of spermatogenic function. Varicocelectomy can also improve Leydig cell function resulting in increased testosterone levels. The most common complications after varicocelectomy are hydrocele formation, testicular artery injury and varicocele persistence or recurrence. The incidence of these complications can be reduced by employing microsurgical techniques, with inguinal or subinguinal operations, and exposure of the external spermatic and scrotal veins. Employment of these advanced techniques of varicocelectomy provide a safe, effective approach to elimination of varicocele, preservation of testicular function and, in a substantial number of men, an increase in semen quality and likelihood of pregnancy.

Animals↗
PubMed1994

Doppler sonography of varicocele: long-term follow-up after venography and transcatheter sclerotherapy.

Sixty-eight patients with unilateral left-sided idiopathic varicocele who had not been treated previously were examined with Doppler sonography before and 1, 3, and 12 months after selective venography with balloon occlusion and transcatheter sclerotherapy of the internal spermatic vein. Varicocele and its persistence or recurrence was diagnosed by reflux only. Reflux was differentiated into stop-type and shunt-type by Doppler sonography. The resolution of varicocele was defined by absence of any reflux. The rate of resolution was greatest 3 months after sclerotherapy (49 patients, 72%). The diagnosis of persisting or recurring varicocele at this time does not seem to be justified, however, as in our study both further improvement and deterioration were observed up to 12 months after treatment. Twenty patients (29%) had a persisting or recurring varicocele 12 months after sclerotherapy. Reflux is the parameter of significance for diagnosing varicocele and its persistence or recurrence after therapy. Improvement of clinical aspects of varicocele (e.g., sperm count, sperm motility, and conception rates) depends on therapy of even subclinical varicoceles. Therefore, diagnosis and retreatment of persistent or recurrent varicoceles seems essential. The high sensitivity of Doppler sonography permits adequate assessment of the therapeutic result and evaluation of real rates of persistent or recurrent varicoceles after venography with balloon occlusion and transcatheter sclerotherapy.

Adult↗
PubMed1996

Seminal improvement following repair of ultrasound detected subclinical varicoceles.

PURPOSE: We determined whether repair of subclinical varicoceles detected by scrotal duplex ultrasonography results in significant seminal improvement and identified the best ultrasonographic criteria to use in the selection of patients for subclinical varicocelectomy. MATERIALS AND METHODS: Of 256 consecutive infertile men being evaluated by physical examination and color duplex scrotal ultrasonography 76 underwent varicocele repair and were followed with serial semen analyses. All subclinical varicoceles were confirmed by venography. The outcome of varicocelectomy was determined by changes in total motile sperm count and compared among patients with different clinical grades of varicoceles and ultrasonographically measured in veins sizes. RESULTS: A significant overlap was observed between ultrasonographically measured venous diameter and clinical grade of varicocele. There was no correlation between venous diameter and postoperative outcome when controlled for clinical grade. Significant postoperative improvement in semen parameters was noted in 67% of patients with clinical and only 41% with subclinical varicocelectomy (p<0.05). The best ultrasonographic cutoff to predict a positive outcome after subclinical varicocelectomy was venous diameter greater than 3mm. Patients with larger clinical varicoceles had greater postoperative seminal improvement than those with small or subclinical varicoceles regardless of baseline sperm count. CONCLUSION: Varicocele size has a direct impact on the probability and amount of seminal improvement after varicocelectomy. Outcome following subclinical varicocelectomy is significantly less than after repair of clinical varicoceles. Although 41% of patients with subclinical varicoceles had significant postoperative improvement in semen parameters, an equal number were worse postoperatively and, thus, mean sperm count was unchanged for the group. The results of our study suggest that subclinical varicocelectomy is of questionable benefit.

Adult↗
PubMed1996

[Quantitative analysis of testicular varicocele by scintigraphy].

Testicular varcocele is the most common factor affecting male fertility. The determental effects of the varicocele on semen quality and fertility are codonsidered to be related to its severity. The aim of this study was to establish a quantitative radioisotopic method for the diagnosis and evaluation of testicular varicocele. 31 men attending our infertility clinic underwent scintigraphy with a gamma camera scanner (Apex 415) equipped with a pinhole low energy collimator (zoom factor 2). The evaluation was performed in the supine position and the collimator at 8.5 cm above the testicular area. The patients' red blood cells were labeled in-vivo by injection of SN-pyrophosphate before i.v. administration of To-99. An image of the scrotal area was obtained and the computer processing consisted of a drawing of the region of interest over the area of the varicocele, with background subtraction. The following indices were calculated: testes total count, varicocele area (in pixels) and average count per pixel (ACPP). The patients also underwent high resolution duplex sonography (HRDS) using a Multigon duplex scanner with a 7.5 Mhz transducer. Spermatic vein diameter, and reflux when present, were determined. HRDS was performed to compare and to validate the results obtained by scintigraphy. In men without varicocele mean ACPP was 2.80, in those with mild varicocele 3.76, in those with moderate varicocele 5.40 and in those with severe varicocele 7.48. A significant positive correlation was found between ACPP values and severity of the varicocele, as determined either by the diameter of the spermatic veins or by reflux of blood in the veins. We conclude that the ACPP index obtained by this new technique enables objective diagnosis and quantitative grading of testicular varicocele.

Analysis of Variance↗
PubMed2004

Surgery or embolisation for varicocele in subfertile men.

BACKGROUND: A varicocele is a meshwork of distended blood vessels in the scrotum, usually left-sided, due to dilatation of the spermatic vein. Although the concept that varicocele causes, and varicocelectomy cures, male subfertility has been around for almost fifty years, the mechanisms by which varicocele would affect fertility have not yet been satisfactorily explained, and neither have the mechanisms by which varicocelectomy would restore fertility. Furthermore, it has been questioned whether a causal relation exists at all between the distension of the pampiniform plexus and impairment of fertility. OBJECTIVES: To evaluate the effect of varicocele treatment on pregnancy rate in subfertile couples. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group trials register (searched 12 Sept 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2004), MEDLINE (January 1966 to May 2004), EMBASE (January 1985 to May 2004) and reference lists of articles. In addition, we hand searched 22 specialist journals in the field from their first issue until 2004. We also checked cross references, references from review articles, and contacted researchers in the field. SELECTION CRITERIA: RCTs were included if they were relevant to the clinical question posed, if they reported pregnancy rates as an outcome measure, and if they reported data in treated (surgical ligation or radiological embolization of the internal spermatic vein) and untreated groups. DATA COLLECTION AND ANALYSIS: Nine studies met the inclusion criteria for this review. One was an extension of a previously published study (Nieschlag 1995/1998), which left eight studies for analysis (Nilsson 1979; Breznik 1993; Madgar 1995; Yamamoto 1996; Nieschlag 1995/1998; Grasso 2000; Unal 2001; Krause 2002). All eight only included men from couples with subfertility problems, one (Madgar 1995) excluded men with sperm counts <5 mill/mL, one (Krause 2002) men with sperm counts <2 mill/mL and/or progressive motility <10%, two trials involving clinical varicoceles included some men with normal semen analysis (Nilsson 1979; Breznik 1993). Three studies (Yamamoto 1996; Grasso 2000; Unal 2001) specifically addressed only men with subclinical varicoceles. Two authors independently screened potentially relevant trials. Any differences of opinion were resolved by consensus (none occurred for this review). Studies were excluded from meta-analysis if they made comparisons other than those specified above. MAIN RESULTS: The combined Peto odds ratio (OR) of the eight studies is 1.10 (95%CI 0.73 to 1.68), indicating no benefit of varicocele treatment over expectant management in subfertility couples in whom varicocele in the man is the only abnormal finding. REVIEWERS' CONCLUSIONS: There is no evidence that treatment of varicocele in men from couples with otherwise unexplained subfertility improves the couple's chance of conception.

Embolization, Therapeutic↗
PubMedDate not supplied

Reproductive history and semen analysis in prevasectomy fertile men with and without varicocele.

A group of 598 allegedly fertile men requesting vasectomy were investigated; varicocele was found in 97 (16.2%) of these men. The mean ages and age distributions of men with and without varicocele were not significantly different. Reproductive histories (number of pregnancies, living children and spontaneous abortions, as well as incidence of present pregnancy) were similar in both groups. The average seminal characteristics (semen volume, sperm count, total sperm count, percentage of motile spermatozoa, quality of motility, morphology) were not different for men with and without varicocele, except for a slight, but significantly higher incidence of oval-headed sperm in men without varicocele. However, the incidence of varicocele was significantly higher in men with sperm counts below 40 million/ml. Three important observations may be made from this study: 1) the incidence of varicocele in this prevasectomy population was similar to that reported for the general population, but lower than the incidence reported for male partners of infertile couples; 2) in this population of allegedly fertile men, the presence of a varicocele did not significantly affect reproductive performance; 3) even though the incidence of varicocele was higher in men with sperm counts below 40 million/ml, the average seminal characteristics were not different in men with and without varicocele.

Adult↗
PubMedDate not supplied

Repair of experimental varicoceles in the rat. Long-term effects on testicular blood flow and temperature and cauda epididymidal sperm concentration and motility.

The effects of varicocele and varicocele repair on testicular blood flow, temperature, sperm counts, and sperm motility were assessed in adult male rats. The duration of the experimental varicocele and the varicocele repair were three and two times as long, respectively, as that studied previously. Varicoceles were created by partial ligation of the left renal vein and repairs were accomplished by high ligation of the left spermatic vein. Testicular blood flow was determined by using the radiolabeled microsphere technique. Testicular temperature was taken via needle probe thermometer. Sperm samples were obtained by micropuncture of the cauda epididymidis, and were counted on a hemacytometer and observed for motility under the light microscope. Varicoceles were studied 100 days after their creation. Repairs were performed on varicoceles that had lasted 100 days and the animals were studied 60 days after repair. Mean testicular blood flow (ml/100 g tissue/min) was significantly increased (P less than 0.05) in animals with varicocele (left testis (LT) = 42.2 +/- 1.1, right testis (RT) = 39.1 +/- 1.2) when compared with normal controls (LT = 29.3 +/- 1.6, RT = 29.6 +/- 1.7), animals with varicocele repair (LT = 30.7 +/- 1.3, RT = 30.0 +/- 1.6), or sham-operated animals (LT = 29.7 +/- 1.4, RT = 31.1 +/- 1.4).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

Chromosomal abnormalities and y chromosome microdeletions in infertile men with varicocele and idiopathic infertility of South Indian origin.

Various factors cause spermatogenesis arrest in men and, in a large number of cases, the underlying reason still remains unknown. Little attention is paid to determining the genetic defects of varicocele-related infertility. The objective of our present study was to investigate the chromosomal abnormalities and Y chromosome microdeletions in infertile men of South Indian origin with varicocele and idiopathic infertility. Metaphase chromosomes of 251 infertile men with varicocele and unexplained infertility were analyzed using Giemsa-Trypsin-Giemsa (GTG) banding and fluorescence in situ hybridization (FISH). The microdeletions in 6 genes and 18 sequence-tagged-sites (STS) in the Yq region were screened using polymerase chain reaction (PCR) techniques. Out of 251 infertile men, 57 (22.7%) men were with varicocele, of which 8.77% were azoospermic, 26.31% were severely oligozoospermic, 21.05% were mildly oligozoospermic, and 43.85% were oligoasthenoteratozoospermic (OAT), and 194 (77.29%), with idiopathic infertility, of which 51% were azoospermic, 13.40% were severely oligozoospermic, 19.07% were mildly oligozoospermic, and 16.4% were with OAT. Genetic defects were observed in 38 (15.13%) infertile individuals, including 14 (24.56%) men with varicocele and 24 (12.37%) men with idiopathic infertility. The frequencies of chromosomal defects in varicocele and idiopathic infertility were 19.3% and 8.76%, respectively, whereas Y chromosome microdeletions were 5.26% and 3.60%, respectively. Overall rate of incidence of chromosomal anomalies and microdeletions in 251 infertile men were 11.5% and 3.98%, respectively, indicating a very significant higher association of genetic defects with varicocele than idiopathic male infertility. Our data also demonstrate that, among infertile men with varicocele, severely oligozoospermic and OAT men with varicocele have higher incidences of genetic defects than mildly oligozoospermic and azoospermic men.

Adult↗
PubMedDate not supplied

Cinnoxicam and L-carnitine/acetyl-L-carnitine treatment for idiopathic and varicocele-associated oligoasthenospermia.

The objective of this study was to detect a therapy for idiopathic and varicocele-associated oligoasthenospermia (OAT). Idiopathic and varicocele OAT patients were randomized into 3 groups. Each group was composed of varying degrees of left varicoceles (graded into 5 grades with echo-color Doppler) and of idiopathic OATs. Group 1 used a placebo, group 2 used oral L-carnitine (2 g/d) + acetyl-L-carnitine (1 g/d), group 3 used L-carnitine/acetyl-L-carnitine + 1 x 30-mg cinnoxicam suppository every 4 days. Drugs were administered for 6 months. The groups were composed as follows: group 1, 71 varicoceles and 47 idiopathic OATs; group 2, 62 varicoceles and 39 idiopathic OATs; group 3, 62 varicoceles and 44 idiopathic OATs. Sperm concentration, motility, and morphology before during and after treatments were assessed. Pregnancy rates and side effects were recorded. Group 1 did not have modified sperm patterns during treatment. Group 2 had significantly increased sperm patterns at 3 and 6 months into therapy in idiopathic patients and in patients with grades I, II, and III varicocele, but not in grades IV and V. Group 3 had significantly increased sperm parameters in all patients, with the exception of grade V varicocele. Group 3 sperm patterns proved significantly higher during therapy than group 2. All sperm patterns fell to baseline after therapy suspension. Minor side effects occurred. Pregnancy rates were 1.7% (group 1), 21.8% (group 2), and 38.0% (group 3) (P <.01). L-carnitine/acetyl-L-carnitine + cinnoxicam suppositories proved a reliable treatment for low-grade varicoceles and idiopathic OATs.

Acetylcarnitine↗
PubMed1997

Assessment of adolescent varicocele.

Varicocele is the most important male factor responsible for decreased fertility potential in married couples. From March through June 1994, 2,470 school boys aged 10-20 years were examined to establish the incidence of consecutive grades of varicocele and to develop a protocol for diagnosis and treatment of adolescents with varicocele. Grade 1 varicocele was found in 18%, grade 2 in 12%, and grade 3 in 5% of the population examined. An original protocol of ultrasonographic (US) examination (previously verified by angioscintigraphy) was introduced to assess boys with clinically diagnosed varicocele. The volume of each testis, testicular volume decrease (TVD), pampiniform vein diameter (PVD), and basal (BBF) and maximum blood flow (MBF) velocities were measured in 625 boys. In 74 cases a semen analysis was performed. The statistical analysis revealed that the presence of venous reflux and PVD correlated with the grade of varicocele. Decreases in testicular volume were highly dependent on the grade of varicocele, PVD, and BBF and MBF velocities. Analysis of the relationship between spermatic (boys over 17 years) and US findings revealed that the quality of spermatogenesis can be predicted by US examination in adolescents with varicocele. The authors recommend multiparametric US examination as a reliable, objective, and repeatable technique for establishing criteria for operative treatment in boys under 18 years of age with varicocele as well as for postoperative evaluation.

Adolescent↗