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PubMedDate not supplied

Studies on varicocele III: ultrastructural sperm evaluation and 18, X and Y aneuploidies.

The idea that varicocele plays a detrimental role in fertility is supported by the presence of a higher frequency of affected men among the infertile population than among men with normal semen parameters. In this research we examined ejaculates from a large group of selected men affected by varicocele by light and electron microscopy. The effect of varicocele on chromosome meiotic segregation was investigated by fluorescence in situ hybridization (FISH). The potential benefits of varicocelectomy on sperm quality were evaluated by analyzing sperm characteristics before and after surgical correction of varicocele. Transmission electron microscopy (TEM) analysis, elaborated previously, showed that the incidence of immaturity, apoptosis, and necrosis was higher in the varicocele group than in controls. FISH analysis performed on sperm nuclei from selected patients with varicocele showed that the mean frequencies of disomies and diploidies were generally out of the normal range, indicating a severe disturbance in meiotic segregation. Sperm characteristics evaluated before and after varicocele repair showed a general improvement. As a consequence, the varicocele seem to affect sperm morphology and function concomitantly with meiotic segregation derangement. In consideration of these data, we suggest that TEM and FISH analyses should be performed for all varicocele patients.

Adult↗
PubMed2004

The influence of left renal vein entrapment on outcome after surgical varicocele repair: a color Doppler sonographic demonstration.

OBJECTIVE: To evaluate the impact of left renal vein entrapment on outcome after surgical varicocele repair using color Doppler sonography. METHODS: Eighty-four men had varicoceles on color Doppler sonography (2 right sided, 74 left sided, and 8 bilateral), which were diagnosed on the basis of a venous diameter of 3 mm or greater and venous retrograde flow in the pampiniform plexus of veins during the Valsalva maneuver or when changing from a supine to an upright position. Diagnosis of the left renal vein entrapment was based on the following criteria: antero-posterior diameter of greater than 1 cm and peak velocity of less than 15 cm/s for the left renal vein at the mid portion and anteroposterior diameter of less than 0.2 cm and peak velocity of greater than 110 cm/s (or, alternatively, a diameter ratio and peak velocity ratio of >5) for the left renal vein between the aorta and superior mesenteric artery. All patients underwent surgical varicocele repair. In postoperative follow-up, we compared the presence of left renal vein entrapment with the frequency of varicocele recurrence. RESULTS: Sixteen (19%) of 84 patients had left renal vein entrapment with a left-sided varicocele. Postoperatively (mean follow-up +/- SD, 19.3 +/- 11.7 months), 27 (32.2%) of 84 had varicocele recurrence, including all 16 patients with left renal vein entrapment and 11 (20.1%) of 68 patients without left renal vein entrapment. The varicocele recurrence rate was significantly greater in patients with left renal vein entrapment (P < .001, Fisher exact test). CONCLUSIONS: The presence of left renal vein entrapment resulted in a significantly higher varicocele recurrence rate. Patients with varicoceles should routinely be evaluated for the presence of left renal vein entrapment before surgical repair.

Adult↗
PubMedDate not supplied

[Spermatologic studies in 300 patients with varicocele of different degrees of severity and in various age classes].

Spermatologic investigations were made in 227 patients with varicocele at the age of 19-23 years (average age 20.4 years) and in 73 patients with varicocele at the age of 24-40 years (average age 28.0 years). The spermatologic findings of the patients with varicocele were compared with the results of 55 andrologic healthy young men without varicocele. The diverse degrees have a different effect to the sperm quality. Only patients with the clinical signs of the varicocele-orchidiopathy present a decreased sperm quality. The degree varicocele combined with other testicular disorders shows the worst sperm quality. The results in the higher age group explain, that the damage of the testicle increases with longer duration of the varicocele. Differentiating the spermatozoal morphology according to the "Düsseldorf morphological classification" you can find characteristic forms with hyperelongation of the head in patients with varicocele and spermatozoa with acrosomal defects in the degree varicocele combined with other testicular disorders.

Adult↗
PubMed1985

Evaluation and treatment of the preadolescent varicocele.

Varicocele is the most common surgically correctable cause of male infertility. In adult patients with varicocele and infertility, pregnancy rates following varicocelectomy range as high as 55 per cent in comparison with a pregnancy rate of only 7 per cent in unoperated controls. The initial presentation of varicocele occurs during puberty with the incidence in 13-year-old boys already equivalent to that in the general male population. This occurrence has been referred to as the childhood or adolescent varicocele. Varicocele is a progressive disorder in many if not in all cases, with an obvious individual variation in the time course of progression. The effects of a unilateral lesion are often noted in the contralateral testis. Based upon present knowledge, it is not possible to predict accurately the time course of progression in individual cases of childhood varicocele. However, significant prognostic features in adolescents with varicocele include the following: (1) testicular atrophy, or arrested testicular growth; (2) high-grade varicocele (grade II or III); (3) bilateral lesions; (4) pathologic GnRH stimulation test; and (5) histologic picture of Leydig-cell hyperplasia. The presence of these features either alone or in combination is an indication for treatment in our hands. Unlike adults with varicocele, it is not practical to follow children and adolescents with spermatograms.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1983

[Right varicocele: contribution of spermatic phlebography. Results on 250 cases].

Full details of the technique employed for right testicular vein phlebography during investigation of male sterility are exposed, and the presence of a varicocele defined among 250 cases explored. Diagnosis of a varicocele is confirmed when there is reflux filling of the pampiniform plexus veins at the scrotal level, the lesion being considered absent when a continent valve prevents any descent of the contrast medium column. Successful catheterization of the right testicular vein was accomplished in 193 cases (66%) of the last 250 bilateral testicular vein phlebographs performed, enabling data concerning the radiological anatomy of this vein to be obtained. In 95%t of cases it emptied into the inferior vena cava and in the other 5% into the renal vein, between L1 and L3, while in 7% the vein emptied into both. Anastomoses are frequent: with the exorenal circle (15 to 18% of cases); the intercostal veins; the lumbar and perivertebral system; the inferior vena cava; the peri-ureteral veins; the testicular vein itself, and finally the portal system through a colic trunk emptying into the inferior mesenteric vein (29% of cases). The frequency and characteristics of right-sided varicocele in patients with male secretory infertility is discussed in relation to findings in these 250 cases. Bilateral phlebography in 187 patients showed normal appearances in 25 cases, bilateral varicoceles in 96, and unilateral varicoceles (including 27 on the right) in 66 cases. Unilateral phlebography in 55 patients revealed the presence of an isolated right-sided varicocele in 4 patients. The question is raised as to the need for phlebography in patients with clinically evident varicoceles, and inversely, the significance of a varicocele demonstrated only on radiology. Physiopathological studies could possibly determine the effect of a varicocele on testicular function. A suggested means of treatment is by embolization of the valvular incontinent venous system.

Humans↗
PubMed1994

[Bilateral varicocele: diagnostic implications].

If a varicocele is appreciated on the clinical examination, its presence may then be confirmed by Doppler examination. A pencil-probe Doppler stethoscope is utilized with ultrasonic conduction gel. The patient is examined in the upright position, and conducting medium is applied to the upper aspect of the scrotum. It is important that there is complete acoustic silence prior to having the patient perform the Valsalva maneuver. However, if a clinical varicocele is found on either the left or right side, the opposite side is evaluated for the presence of a "subclinical" varicocele by Doppler examination. When a "subclinical" varicocele is associated with a controlateral clinical varicocele, it is treated at the same time as the coexistent clinical varicocele. Venography is employed for the diagnosis of varicoceles only for patients in whom physical examination and Doppler studies are equivocal but highly suggestive of the presence of a varicocele. In that situation, rather than subjecting the patient to an unnecessary surgical procedure, venography may be employed to confirm the varicocele. Nowadays another diagnostic procedure is successfully used, that consists in a color ultrasound of the scrotum associated with Doppler velocimetry of the spermatic cord.

Humans↗
PubMed1997

Ipsilateral testicular hypotrophy is associated with decreased sperm counts in infertile men with varicoceles.

PURPOSE: The presence of ipsilateral testicular growth retardation (hypotrophy) is the most common indication for prophylactic varicocele repair in adolescents in an effort to prevent future infertility. We examined the relationship between semen parameters and ipsilateral versus contralateral testicular size in men with unilateral varicoceles to determine whether testicular size is an appropriate parameter for predicting future fertility. MATERIALS AND METHODS: We studied the records of consecutive patients with palpable unilateral left varicoceles for whom a history, physical examination and semen analysis were available. Total motile sperm counts of men with and without ipsilateral testicular hypotrophy were compared. RESULTS: We identified 611 patients with unilateral clinical left varicoceles, including 305 (50%) with ipsilateral testicular hypotrophy. Mean total motile sperm counts plus or minus standard error of mean were significantly less in the patients with than without testicular hypotrophy (80 +/- 5.2 versus 126 +/- 7.8 x 10(6) sperm, p = 0.0018). Hypotrophy was more common in patients with large varicoceles (73%) than in those with medium (53%) or small (43%) varicoceles. CONCLUSIONS: Infertile patients with testicular hypotrophy associated with unilateral varicoceles have worse semen parameters than those without hypotrophy. These data support the practice of varicocele repair in adolescents with varicocele associated testicular growth retardation.

Adult↗
PubMed1997

Genital Ureaplasma urealyticum infection in varicocele-related infertility.

OBJECTIVE: To assess the existence of a possible infectious factor in varicocele-related infertility. METHODS: A total of 925 seminal plasmas from 590 infertile men with varicocele and 335 infertile patients without palpable varicocele were cultured for Ureaplasma urealyticum infection, and routine semen analysis was made. RESULTS: The infection rate of Ureaplasma urealyticum in seminal plasmas was 48.22%. The asymptomatic genital infection of Ureaplasma urealyticum was traced in 329 (55.76%) varicocele men and 117 (34.93%) infertile patients without varicocele (control group). A significant quantitative difference in the incidence of genital Ureaplasma urealyticum infection between the varicocele and control group was observed (P < 0.005) and asthenozoospermia was significantly more prevalent in the patients with varicocele than in the other patients (P < 0.05). CONCLUSIONS: Genital Ureaplasma urealyticum infection may play a role in varicocele-related infertility. To prevent future infertility, men with both varicocele and genital Ureaplasma urealyticum infection may benefit from early evaluation and treatment.

Adult↗
PubMed2003

Evaluation of low ligation and high ligation procedures of varicocele.

OBJECTIVE: To describe the mode of presentation of varicocele and to compare the low ligation (Inguinal approach/Ivanissevich's procedure) and high ligation (Retroperitoneal approach/modified Palomo's procedure) of varicocele repair regarding efficacy and postoperative complications. DESIGN: Institutional-based randomized comparative clinical trial. PLACE AND DURATION OF STUDY: This study was conducted at the Urology Department, Bolan Medical College and Sandeman Provincial Teaching Hospital, Quetta from December 1996 to November 2001 (5 years). SUBJECTS AND METHODS: A total of 213 patients of varicocele who underwent treatment in the department and completed 6 months follow-up were included in the study. The mode of presentation of varicocele was recorded for all patients. For treatment purpose patients were randomly divided into two groups: in group I (n: 115) varicocele was ligated by inguinal approach (Ivanissevich's procedure) while in group II (n: 98) by retroperitoneal approach (modified Palomo's procedure). The efficacy and postoperative complications of the two procedures were carefully recorded and compared between the two groups. RESULTS: The mean age of the patients of group-I and group-II was 27.2 and 27.5 years respectively. More than 50% patients of both groups presented with feeling of heaviness/dragging sensation on ipsilateral side. Presentation with infertility/sub fertility in group-I and group-II was 16.5% and 15.3% respectively. Majority of patients of both groups had grade III varicocele with visible deformity. The rate of postoperative complications was very low in both groups of patients. Recurrence of varicocele and postoperative hydrocele formation were slightly more common in group-II as compared to group-I but the difference was statistically not significant (p>0.05). An extremely significant improvement occurred postoperatively in both sperms density and motility in infertile/sub fertile patients of both groups. CONCLUSION: Both procedures of varicocele repair are equally effective and have a low rate of complications. There is no significant difference in postoperative complications. An extremely significant improvement occurs in semen parameters of infertile/sub fertile patients postoperatively, irrespective of method/technique of varicocelectomy

Adolescent↗
PubMedDate not supplied

Prognosis of subfertility in men with corrected or uncorrected varicocele.

To evaluate whether correction of varicocele improves fertility, pregnancy rates were compared in 115 varicocele patients consulting for infertility and having oligozoospermia, asthenospermia, or teratozoospermia, in any combination, and FSH levels within the normal range. Ninety of these patients had corrected, and 25 had uncorrected varicoceles, respectively. The value of clinical and seminal parameters for predicting the eventuality of pregnancy for varicocele patients was also studied. Although both groups were comparable in terms of duration of infertility, mean age, sperm density, motility or fertility index, cumulative pregnancy rates over 12 months were similar, whether or not the varicocele was corrected. The value of clinical or seminal parameters, in any combination, for the prediction of outcome for varicocele patients was poor. The prognosis was poor for men with less than 15% of spermatozoa with normal morphology, FSH levels higher than the mean + 3 SD of those values found in young fathers, and a fertility index below 3. In subjects who achieved pregnancy within one year, pretreatment sperm characteristics were similar in both the corrected and uncorrected groups. Correction of varicocele slightly improved sperm characteristics. It seems likely that in most men with subfertility and varicocele, other factors besides venous reflux are responsible for their infertility.

Adult↗
PubMed1994

Changes in testicular testosterone and acid and alkaline phosphatase activity in testis and accessory sex organs after induction of varicocele in Noble rats.

The present study was undertaken to determine the effects of surgically induced varicocele on testicular androgen production, seminiferous tubular diameter, and acid and alkaline phosphatase activities in testis and accessory sex organs in adult Noble rats. Testosterone concentrations in plasma and in both left and right testis were estimated in both sham-operated and varicocele-induced rats. The activities of acid and alkaline phosphatase were measured in both left and right testis, seminal vesicle, and ventral prostate gland in varicocele-induced and sham-operated rats. The levels of testosterone in plasma in rats with varicocele were lower than those in the sham-operated rats. The concentration of testosterone in the left testis was lower than that in the right testis in varicocele-induced rats while no such differences were observed in sham-operated rats. The seminiferous tubular diameter in the left testis is reduced in varicocele-induced rats from that in the right testis. In the sham animals, testicular acid phosphatase activity was higher in the left testis than the right, while in varicocele-induced animals, no differences in acid phosphatase activity between left and right testis were observed. In varicocele-created rats, the activity of alkaline phosphatase was higher in the left testis than in the right while no differences in alkaline phosphatase activity between left and right testis in sham-operated rats were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid Phosphatase↗
PubMed1991

The significance of elevated scrotal temperature in an adolescent with a varicocele.

Simultaneous measurements of left and right scrotal, and axillary skin temperatures were recorded in 58 consecutive adolescents (mean age 14.4 years) with a grade II-III left sided varicocele, and nine control adolescents without genital pathology (mean age 15.7 years). Left and right testicular volumes were determined in both groups. The adolescents with a varicocele had a significant bilateral elevation of the scrotal temperatures compared to the control subjects. This relative hyperthermia was present in both supine and standing positions. The mean left scrotal temperature of varicocele patients was significantly higher in the standing position than in the supine position, which may reflect the dependent venous filling of the varicocele. Those varicocele patients who maintained a left scrotal temperature at least 1.4 degrees C cooler than axillary did not have significant left testicular volume loss, whereas those whose left temperature was approximately equal to axillary did have significant growth retardation of the left testis. Following successful varicocele surgery, left scrotal temperatures were significantly cooler, and statistically indistinguishable from controls. The left testicular volumes were also significantly improved with respect to corresponding right testicular volumes. These observations suggest that adolescents with a moderate to large left varicocele have a significant bilateral loss of testicular thermoregulation. In those individuals with a significantly warmer left hemiscrotum, there is a definite increased potential for left testicular volume loss. Varicocele surgery can reverse this process.

Adolescent↗
PubMed2001

Lack of evidence of a genetic origin in the impaired spermatogenesis of a patient cohort with low-grade varicocele.

Varicocele is the most common clinical finding in infertile men but controversy continues to surround the utility of its treatment. An increased response of FSH to gonadotrophin-releasing hormone testing has been described in patients with varicocele, while the co-influence of Yq chromosome microdeletions in the infertility associated to this pathology is still under investigation. We studied 30 patients with first- and second-grade varicocele, 15 idiopathic oligozoospermic men and 21 age-matched healthy controls. All subjects underwent testicular Doppler ultrasonography, semen analysis, gonadotrophin-releasing hormone testing and baseline blood sampling for total and free testosterone, PRL, 17beta-estradiol, SHBG evaluation and Yq chromosome analysis. Apart from FSH, no difference in baseline hormonal levels was found between the groups. The patients with varicocele showed both an increased basal (p=0.007) and GnRH-induced FSH response (peak and AUC) (p=0.004) in comparison with the controls, while the idiopathic oligozoospermic men had only higher GnRH-induced FSH AUC (p=0.04). In the varicocele group, FSH peaks after GnRH testing correlated positively with the grade of disease (r=0.42, p=0.02) and negatively with sperm count (r=-0.50, p=0.005) and bilateral testis volume (r=-0.52, p=0.005). Sperm count and sperm motility were similarly significantly reduced both in patients with varicocele and in patients with idiopathic oligozoospermia in comparison with healthy controls. Yq chromosome analysis by sequence-tagged site PCR revealed no microdeletion in the AZF regions in any subject studied. Given the quite small number of subjects studied, our overall findings can only prompt us to suggest a possible causal role of varicocele in the impairment of spermatogenesis in our patients. Furthermore, although a genetic co-influence (i.e. Yq microdeletions) does not seem to be involved in the pathogenesis of infertility in men with varicocele and mild to moderate oligozoospermia, genetic screening seems to be advisable, especially in those patients who present a severe impairment of sperm count, as has been suggested by recent literature data.

Adult↗
PubMed1999

Decrease in apoptosis of germ cells in the testes of infertile men with varicocele.

To determine whether the regulation of apoptosis in the testes of patients with varicocele testes was abnormal, affecting germ-cell differentiation and sperm production, we studied apoptosis in the testes of normal men and infertile men with varicocele. In all, 56 testicular biopsy specimens were collected from 28 varicocele patients. The specimens from the testes of five normal volunteers with informed consent were used as controls. In situ end-labeled cells were counted with a CAS 200 image analyzer, and an apoptotic index (AI) was calculated by division of the number of labeled cells by the total number of spermatocytes and spermatogonia in over 20 seminiferous tubules. The apoptosis was also examined by electron microscope. The mean AI was 9.67 +/- 0.93% in normal testes (n = 5). In contrast, the mean AIs determined in the right and left testes of varicocele patients (n = 28) were 3.90 +/- 2.28% and 3.78 +/- 2.87%, respectively. The AIs recorded for the testes of varicocele patients were significantly lower than those noted for normal men (P < 0.05). In varicocele patients the AI obtained in the right testis was not statistically significantly different from that found in the left testis. The numbers of apoptotic cells per Sertoli cell also decreased in the testes of varicocele patients as compared with normal men (P < 0.01). Evaluation of all specimens, including the normal controls, revealed no significant correlation either between the AI and the sperm concentration on the seminogram or between the AI and Johnsen's mean score. There was also no relationship between the AI and the serum level of follicle-stimulating hormone, lutenizing hormone, testosterone, or estradiol. In conclusion, apoptosis is decreased in germ cells in the testes of infertile men with varicocele as compared with normal men.

Adult↗
PubMed1995

Clinical and subclinical varicocele: a useful distinction?

OBJECTIVE: The purpose of the study was to establish whether it is useful to make a distinction between clinical and subclinical varicoceles with a view to deciding for treatment or not. Therefore, we compared our results of treatment of clinical vs. subclinical varicoceles. STUDY DESIGN: The changes of semen parameters and the occurrence of pregnancies in 40 infertile men treated for clinical varicocele were compared with those in 46 infertile men treated for subclinical varicocele. The significance of individual semen changes was analysed by paired t-test in both groups and the results of both groups were compared by analysis of covariance. The pregnancy rates were calculated and the life table curves of pregnancy of both groups were compared. RESULTS: There were statistically significant increments in sperm density, motility and morphology both after treatment of clinical and subclinical varicoceles, and these increments did not differ significantly between both groups. The cumulative pregnancy rates after a mean follow-up period of 6.6 years amounted to 42.5% for clinical varicoceles and to 39.1% for subclinical varicoceles and the life table curves of pregnancy ran a rather similar course in both groups. CONCLUSION: We conclude that there is no reason to emphasize the palpatory findings in infertile men with varicocele.

Adult↗
PubMed1987

Relationship between testicular volume and presence of varicocele. A comparative study.

The varicocele, present in many of the male partners of infertile couples continues to generate controversy, particularly as related to its diagnosis and pathophysiology. The purpose of our study was to determine the relationship between testicular volume and the presence or absence of a varicocele. Testicular volume was determined by the use of an orchiometer; the presence of a varicocele was determined by palpation during a Valsalva maneuver. The patients utilized in the study were those seen in our Andrology and General Urology Clinics; 291 patients with varicoceles and 83 control patients (no evidence of varicocele) were used. The left (mean = 21.4 mL) and right (mean = 23.4 mL) testicular volumes of patients with a varicocele were significantly reduced compared with that of the control group (left, mean = 23.4 mL; right, mean = 26.2 mL; p = 0.0041 and p = 0.002, respectively). The testicular volume corrected on the basis of the body mass (V/m2) also was significantly reduced in the varicocele group compared with controls (left p = 0.007; right p = 0.001). Reduced testicular volume relative to body size may be detected prior to actual demonstration of the stress pattern and the presence of a varicocele, and may be useful in early diagnosis. It is suggested that measurement of testicular volume may be a useful adjunct to routine examination of the infertile male.

Adult↗
PubMed2006

"Scrotal varicocele, exclude a renal tumour". Is this evidence based?

A scrotal varicocele is a common finding during both a scrotal clinical examination or during the course of a scrotal ultrasound examination and invariably found in the left hemiscrotum. Traditionally when a scrotal varicocele is found, the referring clinician requests a renal ultrasound examination or the sonographer extends the examination to include a renal examination; to exclude a retroperitoneal or renal tumour as the cause for the varicocele. The present article examines the relevance of performing the extended ultrasound examination by reviewing the pathophysiological pathways for the development of a varicocele in the presence of a renal or retroperitoneal tumour; the prevalance of co-existing renal or retroperitoneal tumours and a varicocele; and the male population in whom this extended examination may be necessary. The conclusion from available evidence suggests that a retroperitoneal tumour will manifest in other ways before the development of a varicocele, the young patient with a varicocele will almost never have a retroperitoneal tumour, and only when a varicocele develops in an older patient will an extended examination be relevant. Even then it will be a rare finding and there will be other clinical manifestations of the primary tumour.

Adult↗
PubMed2004

Varicocele: a bilateral disease.

OBJECTIVE: To evaluate the prevalence of varicocele in the left and right spermatic veins in infertile men by several methods of examination. DESIGN: Prospective study. SETTING: Andrology unit of a department of obstetrics and gynecology, and interventional radiology unit of the radiology department at a tertiary care facility. PATIENT(S): Two hundred eighty-six infertile men evaluated for varicocele. INTERVENTION(S): Patients underwent evaluation for infertility. Physical examination was followed by contact thermography, Doppler sonography, and venography of both testes. MAIN OUTCOME MEASURE(S): We measured the prevalence of varicocele in the left and right spermatic veins in infertile men, and the response of semen parameters after embolization of internal spermatic vein. RESULT(S): Varicocele was detected by one of the noninvasive methods and confirmed by venography in 255 patients (89.2%): the left site in 45 (17.6%), the right side in 4 (1.5%), and bilaterally in 206 (80.8%). All patients were treated by embolization. Mean sperm concentration increased from 6.12 +/- 1.02 to 21.3 +/- 1.69 million/mL; mean sperm motility from 16.81 +/- 1.51 to 35.90 +/- 1.41%; and mean sperm morphology from 9.75 +/- 0.85 to 16.92 +/- 1.17%. Pregnancy rate was 43.5%. CONCLUSION(S): The present study finds that what was traditionally considered a predominantly unilateral anatomical abnormality apparently has a strikingly high bilateral prevalence (80.7%). This may suggest that we should consider varicocele a bilateral disease. The second finding is the high rate of varicocele detected by venography, thermography, and sonography when compared with physical examination results. Our study may have important implications for treatment, indicating that patients with clinical evidence of unilateral left varicocele should be carefully evaluated for bilateral varicocele.

Functional Laterality↗