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At least 19 recordsLinked to original sources
PubMed1990

Improvement of semen characteristics after surgical repair of bilateral testicular varicocele as compared to unilateral varicocele patients.

The operative treatment for surgical repair of bilateral testicular varicoceles was evaluated in terms of the improvement achieved in the sperm density and percentage progressive motile sperm. These parameters were compared for 27 cases of bilateral varicocele diagnosed by palpation and subjected to bilateral high ligation of the internal spermatic vein and for 40 cases of left unilateral testicular varicocele. There were no significant differences in preoperative values (such as sperm density; progressive motile sperm; serum levels of luteinizing hormone, follicle-stimulating hormone, and testosterone; and Johnson's score count) between the bilateral and unilateral testicular varicocele groups. The improvement in postoperative sperm density in the cases with bilateral testicular varicocele was apparently less satisfactory than in the cases with testicular varicocele only on the left side.

Adult↗
PubMedDate not supplied

Surgical repair of secondary right varicocele in rats with primary left varicocele: effects on fertility, testicular temperature, spermatogenesis, and sperm maturation.

To evaluate whether or not dilation of the right testicular vein is a constant finding in animals with left varicocele and to illustrate its contribution to the detrimental effect of a left varicocele on the right testis, an experimental varicocele model was produced in 40 rats. Ten other rats had a sham operation (group A). Seven weeks after the operation, all 50 rats underwent laparotomy and dilation of both testicular veins was seen in 23 rats, which were randomly assigned to group B (n = 11) and group C (n = 12). One week later, groups A and C underwent sham ligation of the right testicular vein, whereas group B rats underwent resection of this vein. At 84 days after the initial operation, group C rats showed a significant reduction in right epididymal sperm content, motility, and fertilizing capacity, right testicular weight, and right testicular vs. intraabdominal temperature difference when compared with groups A and B. Since surgical repair of the secondary right varicocele improved all the parameters indicating the harmful consequences of the primary left varicocele on the right testis, it appears that dilation of the right testicular vein contributes to the detrimental effect of a left varicocele on the right testis.

Animals↗
PubMed1990

[Male varicocele. Analysis of the incidence of varicocele in a population of 18,800 young men].

The authors evaluate the incidence of varicocele after having examined 18,800 healthy white men members of the Italian Army Corps born in 1966 and visited in 1985. They found a varicocele in 775 patients (4.12%), in 5 was present bilaterally, and in 770 in the left side. In 45 patients the surgical treatment was already done at the time of the examination and there were 3 recurrences. The patients with varicocele were divided according to the classification of Dubin-Amelar and were: grade I n. 175 (0.93%); grade II n. 515 (2.74%); grade III n. 35 (50.18%). In 566 (73.03%) the diagnosis was done at the moment of the examination, 152 (19.62%) discovered the varicocele at the self examination; in 57 (7.37%) the diagnosis was already done by the family doctor. Infertility is sometime associated to the varicocele and with the unrelieved local discomfort are the main indications for surgery. It should be also emphasized the need of education on the infertility problems during the high school that is a time of the life in which there is the highest incidence of varicocele.

Adult↗
PubMed1992

Surgical repair versus medical treatment of varicocele in the rat: pharmacological manipulation of the varicocelized testicle.

Human chorionic gonadotropin, kallikrein, indomethacin, and hydralazine were administered to different groups of varicocelized rats, while surgical repair of the varicocele was performed in another group of rats. The effects of conservative and surgical treatment on epididymal sperm content and motility, the weights of the testes, epididymis, and male accessory genital glands, and fertility were compared between each group and a sham-treated group of rats. Surgical repair significantly improved all the evaluated parameters and all the conservative regimens, except hydralazine, resulted in a significant improvement in most parameters. Our results indicate that stimulation of the Leydig or/and Sertoli cells of a varicocelized testicle can counteract some of the detrimental consequences of the varicocele itself.

Animals↗
PubMed1979

[Improvement of male fertility through ligation of varicocele? A study of 100 subfertile varicocele patients three months after ligation (author's transl)].

With 100 subfertile varicocele patients, three months after ligation (high ligation of the left internal spermatic vein in accordance with Bernardi) had control spermiograms made. An improvement of sperm count (upgrade in a higher class according to MacLeod's partition) was found in 28% of the cases, whereas an improvement of progressive motility was found only in 13%. The percentage of patients reaching the normal value in sperm count of over 40 mill./ml increased from 23% to 39%. The increase in these patients came primarily from the class of 20--40 mill./ml. In progressive motility, there was an increase of patients reaching the standard value of over 40%, from 6 to 11. However, if sperm count and progressive motility together were evaluated in the individual patients after ligation, only 6 patients presented a normospermia, i.e. a sperm count of more than 40 mill./ml with normal progressive motility. Thus 94 of the 100 patients must be considered as subfertile three months after ligation. A significant fertility improvement through ligation of varicocele has not yet taken place.

Adult↗
PubMed1990

[Diagnostic screening of varicocele: role of echography and Doppler examination in our experience with 216 cases of primary varicocele].

We compared two non-invasive methods to evaluate primary varicoceles: ultrasonography and Doppler examination. We submitted to ultrasonography and Doppler 216 patients, 147 of them were treated by sclerotherapy and 69 by surgery. All ultrasonographic studies were performed by means of a real-time equipment (7.5 Mhz transducer), while Doppler examination was performed with continuous wave equipment. Ultrasonographic findings are reliable for testicular morphology. Doppler examination is useful to evaluate reversed flow. In 4.1% of cases ultrasonography did not agree with the Doppler examination.

Humans↗
PubMed1992

Clinical versus subclinical varicocele: improvement in fertility after varicocelectomy.

OBJECTIVE: To assess the fertility after varicocelectomy in men with subclinical varicocele. DESIGN: We define subclinical varicocele as the varicocele detected by Doppler examination of the scrotum, in which no varicocele was found on clinical examination. Varicocelectomy was performed on subclinical varicocele, and fertility was assessed. SETTING: We reviewed the records of 54 men who underwent unilateral varicocelectomy at the Department of Urology, Wayne State University, between 1986 and 1987. PATIENTS: Records of 54 men were analyzed. Thirty-eight (70%) of the varicocele were diagnosed clinically (confirmed by Doppler examination) in group 1. In 16 (30%) men, the varicocele was diagnosed by Doppler examination only, with no varicocele detectable clinically, subclinical varicocele (group 2). RESULTS: Spermiograms improved in 76% of the patients in group 1 and in 81% of the patients in group 2. Fertility was assessed after 2 years of varicocelectomy. Eighteen (47%) of 38 patients in group 1 and 8 (50%) of 16 men in group 2 managed to impregnate their partners. Statistical analysis by chi 2 shows similar improvement in fertility potential between the two groups (P = 0.86). Multivariate repeated measure analysis showed significant improvement in sperm density (P = 0.0006) and sperm morphology (P = 0.0016) after varicocelectomy. CONCLUSIONS: These data suggest that varicocelectomy, in infertile men with subclinical varicocele, leads to fertility in 50% of the patient population as compared with 47% in clinical varicocele group. We suggest that the use of sophisticated, noninvasive techniques such as Doppler may have a place in the management of male infertility to detect subclinical varicocele.

Adult↗
PubMed1990

[Scrotal scintigraphy in the diagnosis and grading of varicocele].

Scrotal scintigraphy with 99mTc-red blood cells has been reported as a useful method for detecting varicocele. In this study we analysed the scintigraphy of 251 infertile males with clinically diagnosed or suspected varicocele, in an attempt to establish a grading system of varicocele. Scintigraphically varicocele was diagnosed in 207 patients on the basis of pooling in hemiscrotum in static images and/or early flow through the spermatic cord vessels in dynamic images; physical examination overlooked 17 of them. Of the 207 patients, all had pooling (153 left-sided, 1 right-sided, and 53 bilateral pooling) and 52 had early flow. The early flow was a less sensitive sign for varicocele than the pooling and invariably accompanied by the intense pooling. The early flow may be related to increased shunt flow through varicocele. According to the scintigraphic findings, varicocele was classified as follows: Grade I (small varicocele with faint early flow or mild localized pooling, n = 103), Grade II (medium varicocele with obvious early flow or curvilinear mottled pooling, n = 67) and Grade III (large varicocele with marked early flow or pooling, n = 37). Clinical assessment (93 small, 68 medium, and 54 large varicocele) supported the scintigraphic classification. Scrotal scintigraphy, therefore, facilitates precise evaluation of varicocele based on its morphology and hemodynamics.

Adult↗
PubMed1991

Varicoceles. Radiologic diagnosis and treatment.

The association of clinically apparent varicoceles with male subfertility and infertility has been noted in the urology literature since the late nineteenth century, and surgical ligation of varicoceles has been considered appropriate therapy in an attempt to improve semen quality and increase fertility for the past 40 years. It has been established by several authors cited herein that varicocele size does not predict prognosis after ligation reliably. Because subclinical varicoceles may affect testicular function and histologic characteristics adversely and because age at time of therapy may affect probability of successful enhancement of fertility, the interest of radiologists and urologists has been directed toward diagnosis and treatment of both clinically obvious and clinically occult varicoceles, particularly in young adult men or adolescent boys. Testicular growth after varicocele ligation in adolescent boys also suggests a benefit from early intervention. Sonographic evidence of a varicocele must be correlated with analysis of semen for sperm density, motility, and morphology, as not all patients with varicoceles are infertile. Although surgical therapy is standard for varicocele occlusion, fairly extensive evidence exists to show that percutaneous transvenous occlusion of varicoceles is feasible, safe, and effective, particularly in the setting of varicocele recurrence after conventional surgical treatment.

Embolization, Therapeutic↗
PubMed1992

Intraoperative spermatic venography during varicocele surgery in adolescents.

Intraoperative internal spermatic venography performed immediately following varicocele ligation in the adolescent has been touted as reducing varicocele persistence rates. Previously published data corroborate this statement with low persistence rates. Other series in which venography was not performed report a failure rate of 9 to 30%. During a 5-year period a total of 64 varicocele ligations was performed in 62 male adolescents at our institution. Followup postoperatively revealed an overall varicocele persistence rate of 9%. All patients had intraoperative internal spermatic venography on the affected side. Of 64 venograms 16% had shown collateral drainage that, if not ligated, may have resulted in varicocele persistence. These cases accounted for only 1 of the persistent varicoceles. Additionally, venograms had demonstrated filling of the ipsilateral external iliac vein in 8% of the cases. Despite the fact that no attempt was made to ligate these collaterals, none of these patients had a persistent varicocele. After varicocele ligation 30 of 62 patients were followed long enough to evaluate for testicular catch up growth. Of these 30 patients 24 demonstrated an average relative increase in left testicular volume of 17%. These data support routine intraoperative internal spermatic venography while performing varicocele ligation in the adolescent.

Adolescent↗
PubMed1990

The effect of post-pubertal varicocele on testicular volume.

Paediatric varicocele is a well known entity but its effect on adult infertility has not been adequately clarified. Since measurement of testicular volume is currently the best method of estimating the male reproductive potential, 945 boys aged between 13 and 18 years were examined with regard to testicular volume and the incidence of varicocele. The average volumes for right and left testes were 15.087 +/- 0.237 and 14.514 +/- 0.347 ml respectively, and the incidence of varicocele was 16.7%. The incidence increased from 14.5 to 21.7% as the ages increased from 14 to 18. The differences in volume of the 2 testes in boys with varicocele were statistically significant when compared with the normal group, but this significance failed to become more pronounced when the slight varicocele group (grade I) was included with the normal group and compared with the severe varicocele group (grades II and III). There may be no significant differences between the volumes of the 2 testes in boys with varicocele when careful measurement and strict statistical analyses are applied. However, some boys in the varicocele group were found to have testicular volumes below the confidence interval (mean - SE) or under 1 SD, and the 2 testicular volumes differed in certain age groups. This group requires further follow-up. The results of this study have added further contradictory findings to the issue of paediatric varicocele in terms of testicular atrophy, estimation of potential fertility and the indications for immediate surgery. There is a need for further prospective controlled trials.

Adolescent↗
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↗
PubMed1979

A preliminary report of "subclinical varicocele": diagnosis by Doppler ultrasonic stethoscope. Examination and initial results of surgical therapy.

Two hundred sixteen consecutive infertility patients were examined with the Doppler ultrasonic stethoscope to detect incompetence of the gonadal vein valves, the precursor of frank varicocele. All 75 men with clinically palpable varicoceles had positive Doppler findings. In 33 cases varicocele could not be definitely excluded because of unsatisfactory physical examinations; the Doppler findings were negative in 13, positive in 13 and equivocal in 7 of these men. Eighty-nine men had no evidence of varicocele on physical examination and negative Doppler findings. However, 19, patients with no palpable varicocele had positive Doppler examinations. With respect to testicular size and semen quality, this subclinical varicocele group could not be clearly distinguished from patients with idiopathic semen quality depression. Nevertheless, five men with subclinical varicocele and oligoasthenospermia underwent internal spermatic vein ligation. Postoperatively, four had negative Doppler examinations. Two patients showed a significant improvement in semen quality, and both men fathered children after several months. We believe that these preliminary results justify further investigation of "subclinical varicocele".

Adult↗
PubMed1976

The value of scrotal thermography as compared with selective retrograde venography of the internal spermatic vein for the diagnosis of "subclinical" varicocele.

The accuracy of scrotal thermography as a diagnostic method to confirm or detect spermatic venous reflux in patients with palpable and subclinical varicocele, respectively, was evaluated. In all, 118 scrotal thermograms were performed in 110 patients, and the results were compared with the findings by selective retrograde venography of the internal spermatic vein whenever required. Normal thermograms were recorded in 23 oligospermic men without varicocele. Of 39 patients with palpable varicocele, 37 had abnormal thermograms; normal recordings occurred in 2 patients with associated unilateral testicular atrophy. Among 36 men suspected of having subclinical varicocele, 19 had abnormal thermograms and 16 presented reflux on the venogram. Venography was performed in 5 of the remaining 17 men with normal thermograms; only 1 had reflux. Screening for varicocele by means of scrotal thermography thus revealed reflux in 16 of 36 patients with unexplained infertility. Postoperative thermograms were disturbed in 6 of 20 cases, 5 of which presented reflux. Only 1 of 14 postoperative patients with normal thermograms underwent venography, and no reflux was demonstrable. Both the difference in temperature between the affected and contralateral hemiscrotum and the area of hyperthermia were significantly greater in patients with grades II and III varicocele, compared with those with subclinical and grade I varicocele. It is concluded that scrotal thermography is a valuable screening method for the detection of spermatic venous reflux. The technique allows selection of patients to be subjected to retrograde venography.

Adult↗
PubMed1991

Testis volumes, semen quality, and hormonal patterns in adolescents with and without a varicocele.

OBJECTIVE: To study the effects of varicocele on testicular function in adolescents. DESIGN: A prospective controlled study in 88 randomly selected adolescents. SETTING: All participants were referred to the fertility outpatient clinic of our University Hospital. PARTICIPANTS: All participants with a grade II varicocele (group 2) or a grade III varicocele (group 3) were selected at a district military medical council, whereas a similar group of healthy volunteers without a varicocele served as controls (group 3). INTERVENTIONS: Testis volumes were measured using an orchiometer. Semen analysis was performed according to standard procedures, and serum hormone levels were determined using a radioimmunoassay. MAIN OUTCOME MEASURE(S): Testis volumes, semen quality, and hormonal parameters in adolescents with and without a varicocele were compared. RESULTS: In group 1 (n = 21), the mean left testis volume (24.5 mL; 95% confidence interval [CI]: 22.8 to 26.2) was significantly (P less than 0.05) different from group 2 (n = 15) (20.9 mL: 95% CI: 18.5 to 23.4) and group 3 (n = 52) (20.7 mL; 95% CI: 19.2 to 22.2) (P less than 0.01) adolescents. In adolescents with a pronounced varicocele-associated left testicular growth failure, the total sperm number was reduced. However, sperm concentration, motility, and morphology were not altered. Luteinizing hormone, follicle-stimulating hormone, testosterone, and prolactin levels were all within the normal ranges in the three groups. CONCLUSIONS: Left testicular growth failure in adolescents with a varicocele is only associated with a decrease in total sperm number.

Adolescent↗
PubMed1978

Relationship of varicocele to sperm output and fertility of male partners in infertile couples.

Both partners of 455 infertile couples seen consecutively were evaluated. When indicated the female partners were treated. Six semen specimens from each male subject were analyzed. A varicocele was diagnosed in 23.7 per cent of the men. More than 60 per cent of the men with a varicocele had sperm counts less than 40 million per ml., while 67 per cent without a varicocele had sperm counts more than 40 million per ml. The mean and total sperm counts of men with a varicocele were significantly lower than those without a varicocele. However, the pregnancy rates were not significantly different. The pregnancy rate was 46 per cent in couples whose male partners underwent a varicocelectomy, not significantly different from the pregnancy rate achieved in couples when the varicoceles were not corrected surgically (51 per cent). Varicocelectomy resulted in improvement in sperm count only when preoperative counts were more than 10 million per ml. Pregnancy rates for couples in which a varicocelectomy did or did not result in improvement in sperm count or motility were identical (45.1 and 45.5 per cent, respectively). These findings suggest that in male partners of infertile couples the presence of a varicocele is associated with compromised semen quality but not with diminished fertility when the female partners are treated. This observation emphasizes the importance of considering infertility as a problem of a couple, rather than a specific disorder of one of the partners.

Cell Count↗
PubMed1977

Progressive testicular atrophy in the varicocele patient.

We examined 82 healthy volunteers, 61 subfertile men with varicoceles and 27 subfertile men without varicoceles for testicular size and semen quality. In 13 volunteers we found unsuspected varioceles and a left testicle significantly smaller than the other 69 volunteers. The size of the right testicle and the sperm density in these patient groups were similar. Both testicles of subfertile male subjects with varicoceles were significantly smaller than the testicles of subfertile male subjects without varicoceles. However, the sperm densities of these 2 groups were similar. Finally, although subfertile male subjects with varicoceles had obviously statistically lower sperm densities than volunteers with varicoceles, the testicular sizes were similar. Perhaps varicocele ligations should be performed on all male subjects with this lesion at an early age to prevent progressive testicular atrophy and decreased fertility potential.

Adult↗