Varicocele

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Varicocele

  • clinical varicocele

  • Terms modified by Varicocele

  • varicocele patient
  • varicocele repair

  • Selected Abstracts


    Varicocelectomy reduces reactive oxygen species levels and increases antioxidant activity of seminal plasma from infertile men with varicocele

    INTERNATIONAL JOURNAL OF ANDROLOGY, Issue 5 2001
    T. Mostafa
    Several theories have been advanced to explain the mechanisms by which varicocele impairs male fertility. These theories include scrotal hyperthermia, retrograde flow of adrenal or renal metabolites, Leydig cell dysfunction and hypoxia. Varicocele is reported to be associated with elevated reactive oxygen species (ROS) production in spermatozoa and diminished seminal plasma antioxidant activity. The aim of this study was to investigate whether surgical correction of varicocele might reduce ROS or increase the antioxidant capacity of seminal plasma from infertile patients with varicocele. The study group consisted of 68 infertile males, selected from patients scheduled for varicocelectomy at Cairo University Hospital during the year 1999. Seminal plasma levels of two ROS [malondialdehyde (MDA), hydrogen peroxide (H2O2)] and one ROS radical [nitric oxide (NO)] were estimated as well as six antioxidants [superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), vitamin C (Vit C), vitamin E (Vit E), albumin) on the day prior to varicocelectomy. For comparison, the same parameters were measured again 3 and 6 months post-operatively. A statistically significant reduction in the 3 month post-operative levels of MDA, H2O2 and NO was observed when compared with the pre-operative values. A further significant reduction took place during the following 3 months. Four of the six antioxidants tested (SOD, CAT, GPx, and Vit C) showed a significant increase in seminal levels when comparing 3-month post-operative with pre-operative values. A further significant increase of the four antioxidant levels took place during the following 3 months. No significant change in the level of seminal plasma albumen took place during the first 3 months after varicocelectomy, however, a significant increase was noted during the next 3 months. In contrast to other antioxidants, seminal plasma levels of Vit E showed a significant decrease when comparing 3-month post-operative with pre-operative values. A further significant decrease took place during the following 3 months. It is concluded that varicocelectomy reduces ROS levels and increases antioxidant activity of seminal plasma from infertile men with varicocele. [source]


    Is varicocelectomy indicated in subfertile men with clinical varicoceles who have asthenospermia or teratospermia and normal sperm density?

    INTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2007
    Linus Okeke
    Objective: Varicocele is the most common treatable cause of male infertility and is associated with progressive decline in testicular function. Varicocelectomy, a commonly performed operation, is indicated in infertile males with varicoceles who have oligospermia, asthenospermia, teratospermia or a combination of these factors. It is not clear if varicocelectomy is indicated if the patients have normal sperm density associated with asthenospermia or teratospermia. Methods: We reviewed 167 patients with varicocele-associated male infertility over a 7-year period (December 1999,November 2005). Pre- and post-varicocelectomy seminal fluid analyses, assessed using the World Health Organization criteria, were obtained at intervals of 4,6 months. Wilcoxon signed rank tests were used to evaluate for statistical significance and P , 0.05 was considered significant. Results: The mean age of the patients and their spouses were 35 and 28 years, respectively. The mean duration of infertility was 3.2 years (range, 1.5,7.5). Oligospermia, teratospermia, asthenospermia, oligospermia, asthenospermia and teratospermia (OAT) syndrome and azoospermia were found preoperatively in 106 (63.5%), 58 (34.7%), 154 (92%), 118 (71%) and 15 (9%) patients, respectively. Overall, significant improvements in semen volume (P < 0.001), sperm density (P < 0.001), sperm motility (P < 0.001) and sperm vitality (P < 0.001) were obtained after varicocelectomy. There was, however, no significant improvement in sperm morphology after varicocelectomy (P = 0.220). When patients with preoperative oligospermia (sperm density, <20 million/mL) were considered separately, varicocelectomy led to significant improvement in all the semen parameters except the sperm morphology (P = 0.183). Conversely, when varicocele patients with a sperm density of ,20 million/mL (normospermia) associated with asthenospermia and/or teratospermia were considered separately, they did not show significant improvement in any of the semen parameters after varicocelectomy (P > 0.05). In addition, azoospermic patients did not show significant improvement in any of the semen parameters (P > 0.05) Conclusion: No significant improvement in semen parameters may be obtained in patients with clinical varicocele and preoperative normospermia. It is possible that only patients with preoperative oligospermia may benefit from varicocelectomy. Larger multi-institutional studies are needed to determine more definitively if asthenospermia or teratospermia in normospermic subfertile males with clinical varicoceles are in fact indications for varicocelectomy. [source]


    Association between varicocele and chronic obstructive pulmonary disease

    JOURNAL OF CLINICAL ULTRASOUND, Issue 2 2006
    Besir Erdogmus MD
    Abstract Purpose: To evaluate the relationship between varicocele and chronic obstructive pulmonary disease (COPD) via color duplex sonography. Materials and Methods: Forty-four male patients with COPD (age range, 50,89 years; mean ± SD, 66 ± 9) and 44 male healthy controls (age range, 47,75 years; mean ± SD, 65 ± 6) were evaluated with color duplex sonography for unilateral or bilateral varicocele. Results: The incidence of right, left, and bilateral varicocele was 47.7%, 65.9%, and 38.6% respectively, in the COPD group, versus 22.7%, 52.3%, and 13.6% in the control group. The incidence of right and bilateral varicocele in the COPD group was significantly higher than in the control group (p < 0.05). The incidence of varicocele also increased with increase in COPD severity. Conclusions: The incidence of varicocele in COPD patients is high. Varicocele might be one of the most important causes of scrotal pain and infertility in COPD patients. © 2006 Wiley Periodicals, Inc. J Clin Ultrasound 34:55,59, 2006 [source]


    Decreased protein tyrosine phosphorylation and membrane fluidity in spermatozoa from infertile men with varicocele

    MOLECULAR REPRODUCTION & DEVELOPMENT, Issue 12 2006
    M.G. Buffone
    Abstract Varicocele is a prevalent pathology among infertile men. The mechanisms linking this condition to infertility, however, are poorly understood. Our previous work showed a relationship between sperm functional quality and the ability of spermatozoa to respond to capacitating conditions with increased membrane fluidity and protein tyrosine phosphorylation. Given the reported association between varicocele, oxidative stress, and sperm dysfunction, we hypothesized that spermatozoa from infertile patients with varicocele might have a combined defect at the level of membrane fluidity and protein tyrosine phosphorylation. Semen samples from infertile patients with and without grade II/III left varicocele were evaluated for motion parameters (computer-assisted semen analysis [CASA]), hyperactivation (CASA), incidence and intensity of protein tyrosine phosphorylation (phosphotyrosine immunofluorescence and western blotting), and membrane fluidity (Laurdan fluorometry), before and after a capacitating incubation (6 hr at 37°C in Ham's F10/BSA, 5% CO2). Spermatozoa from varicocele samples presented a decreased response to the capacitating challenge, showing significantly lower motility, hyperactivation, incidence and intensity of tyrosine phosphorylation, and membrane fluidity. The findings reported in this article indicate that the sperm dysfunction associated to infertile varicocele coexists with decreased sperm plasma membrane fluidity and tyrosine phosphorylation. These deficiencies represent potential new pathophysiological mechanisms underlying varicocele-related infertility. Mol. Reprod. Dev. 73: 1591,1599, 2006. © 2006 Wiley-Liss, Inc. [source]


    Sperm ultramorphology as a pathophysiological indicator of spermatogenesis in males suffering from varicocele

    ANDROLOGIA, Issue 3 2000
    M. Reichart
    Summary. Varicocele of spermatic veins is considered to be one of the major causes of male infertility associated with reduction of sperm quality. The pathophysiology of this condition is not yet completely understood. The aim of this study was to shed light on the pathophysiology of varicocele by identifying semen parameters, especially sperm ultramorphology, which improve following high ligation of the spermatic vein. Seventy-five males with diagnosed varicocele were included in this study. Semen parameters were assessed prospectively using light microscopy, semen biochemistry and sperm quantitative ultramorphological analysis, before high ligation and 3,9 months after high ligation. The control group consisted of twenty-five untreated varicocele patients who underwent two semen examinations within 3,9 months. No statistical difference in any of the examined variables was found between the two examinations in the control group. The treated patients exhibited a significant improvement in sperm density, progressive motility, percentage of normally formed spermatozoa, agenesis of sperm acrosome, chromatin condensation and incidence of amorphous heads compared with the pretreatment condition (P,0.01). In contradiction, no significant improvement was observed following treatment in any of the sperm tail subcellular organelles. It is concluded that varicocele may cause deleterious alterations in early spermatid head differentiation during spermiogenesis and that varicocele patients with a high incidence of sperm acrosome and nucleus malformations are appropriate candidates for varicocele correction. [source]


    Surgical Atlas Varicocele: antegrade scrotal sclerotherapy

    BJU INTERNATIONAL, Issue 6 2006
    Roland Tauber
    First page of article [source]


    Leptin and varicocele-related spermatogenesis dysfunction: animal experiment and clinical study

    INTERNATIONAL JOURNAL OF ANDROLOGY, Issue 5 2009
    Bin Chen
    Summary The objective of this study was to explore the relationships between varicocele-related spermatogenesis dysfunction and the expression of leptin and leptin receptors. In rats with experimental varicocele, the function of spermatogenesis, the expression of leptin and leptin receptors in testes were analysed; and in patients with varicocele-related male infertility, serum and seminal plasma levels of leptin, gonadal hormones and semen parameters were evaluated. In the testes of rats, leptin was expressed in seminiferous tubules and intersitium, leptin receptor was predominantly expressed in interstitium. The expression of leptin and its receptor in the testis of rats was not related to the weight of rat, but was inversely related to the weight of testis (r = ,0.408, p = 0.009 and r = ,0.433, p = 0.005, respectively), the Johnsen scores (r = ,0.916, p = 0.000 and r = ,0.863, p = 0.000, respectively), the seminiferous tubules diameter (r = ,0.853, p = 0.000 and r = ,0.870, p = 0.000, respectively) and the thickness of seminiferous epithelium (r = ,0.929, p = 0.000 and r = ,0.948, p = 0.000, respectively). In varicocele patients (N = 40), the sperm concentration and motility were significantly lower (p = 0.000) than those in the control group (N = 25), and the leptin level in seminal plasma was significantly higher (p = 0.000) than that in the control group. The leptin in serum and seminal plasma was positively related (r = 0.223, p = 0.002). The seminal plasma leptin level was inversely related to sperm concentration (r = ,0.632, p = 0.000) and motility (r = ,0.635, p = 0.000). There was no significant relation between serum leptin and seminal parameters and between leptin and gonadal hormone values. The dysfunction of spermatogenesis in varicocele-related infertile male is associated with increase in leptin and leptin receptors. Leptin may have local effects on the function of testis and spermatogenesis. [source]


    The relationship between varicoceles and obesity in a young adult population

    INTERNATIONAL JOURNAL OF ANDROLOGY, Issue 4 2009
    Chih-Wei Tsao
    Summary To determine whether a relationship between obesity and varicocele occurrence exists, the prevalence and severity of varicoceles related to obesity were investigated in a general population of young males. A total of 1050 young males attending the Navy Recruit Training Center were evaluated from their physical screening examinations. All subjects underwent history taking and physical examinations to evaluate for the presence and severity of varicocele. The anthropometric indexes including body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) were recorded. All subjects were categorized by quartiles according to each anthropometric index. Means were compared with the Student's t -test. Severity was compared by analysis of variance testing and frequency was analysed using the chi-square method. Statistical significance was considered at p <0.05. A total of 490 (46.67%) subjects had varicoceles. The means of BMI, WC and WHR of those without varicoceles was 23.99 ± 3.82 kg/m2, 83.20 ± 9.97 cm and 0.85 ± 0.05, respectively. These judged values were greater than those with varicoceles (22.02 ± 3.18 kg/m2, 79.19 ± 9.01 cm and 0.83 ± 0.05) (p < 0.001). In the univariate regression analysis, BMI, WC and WHR all had a significantly negative correlation with severity of varicocele (all p < 0.001). Analysis comparing varicocele frequency based on each grade per anthropometric index group was performed. The logistic regression revealed that the prevalence of grade II and III varicoceles showed a statistically inverse association with all three anthropometric indexes. The prevalence and severity of varicoceles inversely correlated with obesity. The present data support the explanation that obesity may result in a decreased nutcracker effect, which accounts for prevention of the renal vein compression by the adipose tissue. [source]


    Infertility among couples in a population-based study in Iran: prevalence and associated risk factors

    INTERNATIONAL JOURNAL OF ANDROLOGY, Issue 3 2008
    Mohammad Reza Safarinejad
    Summary To explore the prevalence and risk factors of infertility in Iran, a total of 12 285 ever-married women aged 15,50 years old and their husbands (if available) were interviewed by 82 female general practitioners and answered a self-administered questionnaire on several aspects of infertility. They were identified from the national population in 30 counties, and invited to a confidential interview. Data were obtained about their age, education, marital status, toxic habits, medical history, disabilities and illnesses, help-seeking, economy, ethnicity, geographic location, contraceptive use and age at which they had first intercourse. This study used the definition of childlessness proposed by World Health Organization: ,the woman has never conceived despite cohabitation and exposure to pregnancy for a period of 2 years'. The overall prevalence of infertility was 8% (95% CI: 3.2,15.0). The weighted national estimate of primary infertility was 4.6% (95% CI: 3.6,5.2). There was a pronounced regional pattern in the levels of primary infertility. The primary infertility increased significantly from 2.6 to 4.3 to 5.5% for the 1985,1989, 1990,1994 and 1995,2000 marriage cohorts. The prevalence of secondary infertility was 3.4% (95% CI: 2.4,5.1). Overall the prevalence of infertility falls within a relatively wide range being high in the Southern counties, and low in the Northern counties. The probability of first pregnancy at the end of 2 years of marriage was 0.78 for all ever-married women. The prevalence of infertility increased with age (linear chi-square 198.012, 1 d.f., p = 0.01). The age pattern of infertility also varies quite markedly across the counties analysed. No effect of race was detected; neither the intercept (analysis of covariance p = 0.36) nor the slope of the age relationship was influenced by race (analysis of covariance p = 0.41). Infertility were observed as significantly higher in the presence of history of tubo-ovarian surgery [odds ratio (OR): 1.43; 95% CI: 1.28,2.23; p = 0.01], salpingitis (OR: 2.34; 95% CI: 1.31,4.3; p = 0.016), ectopic pregnancy (OR: 2.45; 95% CI: 1.90,3.44; p = 0.04), varicocele (OR: 2.85; 95% CI: 1.61,5.20; p = 0.01) and cryptorchidism (OR: 3.81; 95% CI: 2.51,4.28; p = 0.031). This study provides a quantitative estimate of the prevalence and main risk factors for infertility in Iranian couples. Yet, further studies on the cause of primary and secondary infertility and geographical variations in the incidence and prevalence of infertility in Iran are needed. [source]


    Varicocelectomy reduces reactive oxygen species levels and increases antioxidant activity of seminal plasma from infertile men with varicocele

    INTERNATIONAL JOURNAL OF ANDROLOGY, Issue 5 2001
    T. Mostafa
    Several theories have been advanced to explain the mechanisms by which varicocele impairs male fertility. These theories include scrotal hyperthermia, retrograde flow of adrenal or renal metabolites, Leydig cell dysfunction and hypoxia. Varicocele is reported to be associated with elevated reactive oxygen species (ROS) production in spermatozoa and diminished seminal plasma antioxidant activity. The aim of this study was to investigate whether surgical correction of varicocele might reduce ROS or increase the antioxidant capacity of seminal plasma from infertile patients with varicocele. The study group consisted of 68 infertile males, selected from patients scheduled for varicocelectomy at Cairo University Hospital during the year 1999. Seminal plasma levels of two ROS [malondialdehyde (MDA), hydrogen peroxide (H2O2)] and one ROS radical [nitric oxide (NO)] were estimated as well as six antioxidants [superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), vitamin C (Vit C), vitamin E (Vit E), albumin) on the day prior to varicocelectomy. For comparison, the same parameters were measured again 3 and 6 months post-operatively. A statistically significant reduction in the 3 month post-operative levels of MDA, H2O2 and NO was observed when compared with the pre-operative values. A further significant reduction took place during the following 3 months. Four of the six antioxidants tested (SOD, CAT, GPx, and Vit C) showed a significant increase in seminal levels when comparing 3-month post-operative with pre-operative values. A further significant increase of the four antioxidant levels took place during the following 3 months. No significant change in the level of seminal plasma albumen took place during the first 3 months after varicocelectomy, however, a significant increase was noted during the next 3 months. In contrast to other antioxidants, seminal plasma levels of Vit E showed a significant decrease when comparing 3-month post-operative with pre-operative values. A further significant decrease took place during the following 3 months. It is concluded that varicocelectomy reduces ROS levels and increases antioxidant activity of seminal plasma from infertile men with varicocele. [source]


    Isolated right-sided varicocele as a salvage pathway for portal hypertension

    INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 6 2005
    G-M. Pinggera
    Summary Retrograde blood flow can occur in the testicular veins and in the pampiniformis plexus in the absence of valves or if the valves are incompetent, resulting in tortuosity and dilatation of the veins. These abnormal alterations in the anatomy of the veins, termed varicoceles, are associated with infertility in the male. Most varicoceles occur on the left. We report the case of a rare isolated right-sided varicocele in a male evaluated for infertility in whom extensive work-up revealed venous anomalies and a spontaneous porto-systemic shunt. In such cases, standard approaches to infertility treatment are fruitless. [source]


    Is varicocelectomy indicated in subfertile men with clinical varicoceles who have asthenospermia or teratospermia and normal sperm density?

    INTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2007
    Linus Okeke
    Objective: Varicocele is the most common treatable cause of male infertility and is associated with progressive decline in testicular function. Varicocelectomy, a commonly performed operation, is indicated in infertile males with varicoceles who have oligospermia, asthenospermia, teratospermia or a combination of these factors. It is not clear if varicocelectomy is indicated if the patients have normal sperm density associated with asthenospermia or teratospermia. Methods: We reviewed 167 patients with varicocele-associated male infertility over a 7-year period (December 1999,November 2005). Pre- and post-varicocelectomy seminal fluid analyses, assessed using the World Health Organization criteria, were obtained at intervals of 4,6 months. Wilcoxon signed rank tests were used to evaluate for statistical significance and P , 0.05 was considered significant. Results: The mean age of the patients and their spouses were 35 and 28 years, respectively. The mean duration of infertility was 3.2 years (range, 1.5,7.5). Oligospermia, teratospermia, asthenospermia, oligospermia, asthenospermia and teratospermia (OAT) syndrome and azoospermia were found preoperatively in 106 (63.5%), 58 (34.7%), 154 (92%), 118 (71%) and 15 (9%) patients, respectively. Overall, significant improvements in semen volume (P < 0.001), sperm density (P < 0.001), sperm motility (P < 0.001) and sperm vitality (P < 0.001) were obtained after varicocelectomy. There was, however, no significant improvement in sperm morphology after varicocelectomy (P = 0.220). When patients with preoperative oligospermia (sperm density, <20 million/mL) were considered separately, varicocelectomy led to significant improvement in all the semen parameters except the sperm morphology (P = 0.183). Conversely, when varicocele patients with a sperm density of ,20 million/mL (normospermia) associated with asthenospermia and/or teratospermia were considered separately, they did not show significant improvement in any of the semen parameters after varicocelectomy (P > 0.05). In addition, azoospermic patients did not show significant improvement in any of the semen parameters (P > 0.05) Conclusion: No significant improvement in semen parameters may be obtained in patients with clinical varicocele and preoperative normospermia. It is possible that only patients with preoperative oligospermia may benefit from varicocelectomy. Larger multi-institutional studies are needed to determine more definitively if asthenospermia or teratospermia in normospermic subfertile males with clinical varicoceles are in fact indications for varicocelectomy. [source]


    Foreskin development before adolescence in 2149 schoolboys

    INTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2006
    TENG-FU HSIEH
    Background:, We examined the external genitalia of 2149 elementary schoolboys in the suburban area of Taichung in Taiwan for an understanding of foreskin development before adolescence. Methods:, The study's subjects comprised 692 first-grade boys, 725 fourth-grade boys, and 732 seventh-grade boys. The foreskin's condition was classified as: type I (normal prepuce), type II (adhesion of prepuce), type III (partial phimosis), type IV (phimosis) and type V (circumcised foreskin). Other abnormalities of the genitalia also were recorded. All of the examinations were performed by the same urologist. Results:, The incidence of type I foreskin was 8.2% in first-grade boys, 21.0% in fourth-grade boys, and 58.1% in seventh-grade boys. The incidence of type IV foreskin was 17.1% in first-grade boys, 9.7% in fourth-grade boys, and 1.2% in seventh-grade boys. Only one boy had balanoposthitis. Other abnormalities included inguinal hernia (n = 2), hydrocele (n = 12), cryptorchitism (n = 8), varicocele (n = 22), and subcoronal-type hypospadia (n = 1). Conclusions:, Physiological phimosis declines with age. Most boys with phimosis in this study did not require treatment. [source]


    Spontaneous rupture of varicocele testis associated with advanced pancreatic cancer

    INTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2004
    YOSHIYUKI MATSUI
    Abstract, We report a rare case of strain-induced spontaneous rupture of varicocele associated with renal vein involvement by advanced pancreatic cancer. Computed tomography and color Doppler sonography yielded the correct diagnosis and the patient could maintain quality of life without surgery for acute scrotum. [source]


    Long-term effect of varicocele repair on intratesticular arterial resistance index

    JOURNAL OF CLINICAL ULTRASOUND, Issue 3 2008
    Ali Balci MD
    Abstract Purpose To investigate the long-term effect of varicocele repair on ipsilateral intratesticular arterial resistance index (RI) using color Doppler sonography (CDS). Methods A total of 26 infertile patients with left varicocele who underwent a testicular artery and lymphatic-sparing subinguinal varicocelectomy were examined with CDS for intratesticular flow parameters before and at least 6 months after surgery. We also evaluated preoperative and postoperative semen parameters. Results The mean values of RI, end-diastolic velocity and pulsatility index decreased significantly after surgery, whereas no significant change was observed in peak systolic velocity. Repair of the varicocele resulted in a statistically significant increase in the total sperm count, motility, morphology, and total motile sperm count. However, no significant correlation was found between sperm parameters and RI values (p > 0.05). Conclusions Our data show that a significant improvement occurs in testicular blood supply and sperm parameters after surgical varicocele repair, without significant correlation between these 2 changes. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2008 [source]


    Association between varicocele and chronic obstructive pulmonary disease

    JOURNAL OF CLINICAL ULTRASOUND, Issue 2 2006
    Besir Erdogmus MD
    Abstract Purpose: To evaluate the relationship between varicocele and chronic obstructive pulmonary disease (COPD) via color duplex sonography. Materials and Methods: Forty-four male patients with COPD (age range, 50,89 years; mean ± SD, 66 ± 9) and 44 male healthy controls (age range, 47,75 years; mean ± SD, 65 ± 6) were evaluated with color duplex sonography for unilateral or bilateral varicocele. Results: The incidence of right, left, and bilateral varicocele was 47.7%, 65.9%, and 38.6% respectively, in the COPD group, versus 22.7%, 52.3%, and 13.6% in the control group. The incidence of right and bilateral varicocele in the COPD group was significantly higher than in the control group (p < 0.05). The incidence of varicocele also increased with increase in COPD severity. Conclusions: The incidence of varicocele in COPD patients is high. Varicocele might be one of the most important causes of scrotal pain and infertility in COPD patients. © 2006 Wiley Periodicals, Inc. J Clin Ultrasound 34:55,59, 2006 [source]


    Intratesticular arterial resistance and testicular volume in infertile men with subclinical varicocele

    JOURNAL OF CLINICAL ULTRASOUND, Issue 8 2004
    Nevbahar Akcar MD
    Abstract Purpose The aim of this study was to evaluate whether intratesticular arterial resistance and testicular volume differed between infertile men with subclinical varicoceles and infertile men without varicoceles. Materials and Methods Fifty-eight infertile men were examined by gray-scale and color Doppler sonography for presence of varicocele, testicular volume, and arterial resistance. For men in the study group, mean testicular volume and resistance index (RI) in testes with varicoceles were compared with those in the contralateral testis by the paired t-test; statistical analyses between the study and control groups were performed by independent t-tests. Results Twenty-seven men had left-sided varicoceles (96% of which were subclinical), and 31 infertile men without varicoceles served as controls. Mean volumes of the right and left testes of study subjects were 14.8 ml and 14.6 ml, respectively, and in controls were 14.2 ml and 13.6 ml, respectively. Mean RI values for the right and left testes of study subjects were 0.61 and 0.58, respectively, and in controls were 0.61 and 0.58, respectively. There were no statistically significant differences in volume or RI, either between the right and left testes within patient groups or between the control and study groups' combined mean values. While the mean intertesticular volume differences for the study and control groups were 2.2 ml and 3.4 ml, respectively, the mean intertesticular RI differences were 0.04 and 0.07, respectively. These values also did not differ significantly between the 2 groups. Conclusions Subclinical varicocele is not associated with ipsilateral testicular atrophy, and does not affect the intratesticular arterial RI. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 32:389,393, 2004 [source]


    Decreased protein tyrosine phosphorylation and membrane fluidity in spermatozoa from infertile men with varicocele

    MOLECULAR REPRODUCTION & DEVELOPMENT, Issue 12 2006
    M.G. Buffone
    Abstract Varicocele is a prevalent pathology among infertile men. The mechanisms linking this condition to infertility, however, are poorly understood. Our previous work showed a relationship between sperm functional quality and the ability of spermatozoa to respond to capacitating conditions with increased membrane fluidity and protein tyrosine phosphorylation. Given the reported association between varicocele, oxidative stress, and sperm dysfunction, we hypothesized that spermatozoa from infertile patients with varicocele might have a combined defect at the level of membrane fluidity and protein tyrosine phosphorylation. Semen samples from infertile patients with and without grade II/III left varicocele were evaluated for motion parameters (computer-assisted semen analysis [CASA]), hyperactivation (CASA), incidence and intensity of protein tyrosine phosphorylation (phosphotyrosine immunofluorescence and western blotting), and membrane fluidity (Laurdan fluorometry), before and after a capacitating incubation (6 hr at 37°C in Ham's F10/BSA, 5% CO2). Spermatozoa from varicocele samples presented a decreased response to the capacitating challenge, showing significantly lower motility, hyperactivation, incidence and intensity of tyrosine phosphorylation, and membrane fluidity. The findings reported in this article indicate that the sperm dysfunction associated to infertile varicocele coexists with decreased sperm plasma membrane fluidity and tyrosine phosphorylation. These deficiencies represent potential new pathophysiological mechanisms underlying varicocele-related infertility. Mol. Reprod. Dev. 73: 1591,1599, 2006. © 2006 Wiley-Liss, Inc. [source]


    REVIEW ARTICLE: Clinical Relevance of Oxidative Stress in Male Factor Infertility: An Update

    AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 1 2008
    Ashok Agarwal
    Male factor has been considered a major contributory factor to infertility. Along with the conventional causes for male infertility such as varicocele, cryptorchidism, infections, obstructive lesions, cystic fibrosis, trauma, and tumors, a new, yet important cause has been identified: oxidative stress. Oxidative stress (OS) is a result of the imbalance between reactive oxygen species (ROS) and antioxidants in the body, which can lead to sperm damage, deformity and eventually male infertility. This involves peroxidative damage to sperm membrane and DNA fragmentation at both nuclear and mitochondrial levels. OS has been implicated as the major etiological factor leading to sperm DNA damage. OS-induced DNA damage can lead to abnormalities in the offspring including childhood cancer and achondroplasia. In this article, we discuss the need of ROS in normal sperm physiology, the mechanism of production of ROS and its pathophysiology in relation to male reproductive system. The benefits of incorporating antioxidants in clinical and experimental settings have been enumerated. We also highlight the emerging concept of utilizing OS as a method of contraception and the potential problems associated with it. [source]


    Increased IL-18 Levels in Seminal Plasma of Infertile Men with Genital Tract Infections

    AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 6 2006
    Ioannis M. Matalliotakis
    Problem Interleukin (IL)-18 is a novel cytokine, previously known as interferon (IFN)- , inducing factor. We evaluated the levels of IL-18 and IFN- , in seminal plasma (SP) of fertile and infertile men. Method of study Semen samples were obtained by masturbation from 80 men, and were examined for the levels of IL-18 and IFN- , by enzyme-linked immunosorbent assay. Seven groups were included: (i) fertile men (n = 18), (i) infertile men with genital tract infections (n = 17), (iii) with varicocele (n = 15), (iv) with Klinefelter syndrome (n = 6), (v) with cryptorchidism (n = 7), (vi) with mumps orchitis (n = 7), and (vii) with idiopathic testicular lesions (n = 10). Results Mean levels of IL-18 were higher in SP from infertile men with genital tract infections compared with SP from other groups except Klinefelter syndrome (P < 0.05). However, no significant differences could be detected for IFN- ,. A significant positive correlations was found between IL-18 and IFN- , in total patient population (P < 0.001). Moreover, a negative correlation was observed between IL-18 and sperm concentrations, and motility (P < 0.01 and <0.03, respectively). Furthermore, there was a positive and statistically significant association between IL-18 and IFN- , levels in SP of infertile men with genital tract infections (P < 0.0001). However, there was no relationship between IL-18 and IFN- ,, and semen parameters in the same group. Conclusion SP IL-18 levels were increased in men with urogenital infections. Thus, the elevated expression of IL-18 in SP may be used as a diagnostic marker in the male genital tract infections. [source]


    Distinct Expression Pattern of Cytokines in Semen of Men with Genital Infection and Oligo-Terato-Asthenozoospermia

    AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 3 2002
    Ioannis Matalliotakis
    PROBLEM: The objective of this study was to evaluate the possible relevance of cytokines in seminal plasma (SP) of patients with accessory gland infection and oligo-terato-asthenozoospermia. METHOD OF STUDY: Semen samples were obtained by masturbation from 90 men and were examined for the presence of interleukin (IL)-2, IL-6, IL-8, IL-11 and soluble CD23 (sCD23) by enzyme-linked immunosorbent assay. Five groups were included: (1) fertile men (n=20), (2) infertile men with varicocele and oligo-terato-asthenozoospermia (V-OTA, n=20), (3) infertile men with genital infection and OTA (INF-OTA, n=20), (4) infertile men with idiopathic testicular lesion and OTA (ITL-OTA, n=20) and (5) infertile men with azoospermia (AZOO, n=10). RESULTS: We found that the mean level of IL-2 was higher in SP from infertile men compared with SP from fertile men (P < 0.05). Mean levels of IL-6, IL-8, IL-11 in SP of INF-OTA were higher than that of all other groups (P < 0.05, P < 0.05, P < 0.001, respectively). However, no significant differences could be detected between other groups. A significant increase was noted in sCD23 levels in SP from men with ITL-OTA compared with all other groups (P < 0.01). We have not observed any correlations between IL-2, IL-6, IL-8, IL-11 and sCD23 levels in SP and semen parameters. Spearman's correlation coefficient revealed that there was a significant association between IL-6, IL-8, IL-11 levels in men with INF-OTA. CONCLUSION: The measurement of each cytokine separately in the SP of men with INF-OTA, in spite of the existing significant differences, does not have a diagnostic value in male infertility. However, a combined determination of IL-6, IL-8, IL-11 in the SP of men with genital infection and oligo-terato-asthenozoospermia may provide clinically useful information for the diagnosis of male accessory gland infection. [source]


    Azoospermia and Sertoli-cell-only syndrome: hypoxia in the sperm production site due to impairment in venous drainage of male reproductive system

    ANDROLOGIA, Issue 5 2010
    Y. Gat
    Summary Sertoli-cell-only (SCO) syndrome, or germ cell aplasia, is diagnosed on testicular biopsy when germ cells are seen to be absent without histological impairment of Sertoli or Leydig cells. It is considered a situation of irreversible infertility. Recent studies have shown that varicocele, a bilateral disease, causes hypoxia in the testicular microcirculation. Destruction of one-way valves in the internal spermatic veins (ISV) elevates hydrostatic pressure in the testicular venules, exceeding the pressure in the arteriolar system. The positive pressure gradient between arterial and venous system is reversed, causing hypoxia in the sperm production site. Sperm production deteriorates gradually, progressing to azoospermia. Our prediction was that, if genetic problems are excluded, SCO may be the final stage of longstanding hypoxia which deteriorates sperm production in a progressive process over time. This would indicate that SCO is not always an independent disease entity, but may represent deterioration of the testicular parenchyma beyond azoospermia. Our prediction is confirmed by histology of the seminiferous tubules demonstrating that SCO is associated with extensive degenerative ischaemic changes and destruction of the normal architecture of the sperm production site. Adequate treatment of bilateral varicocele by microsurgery or by selective sclerotherapy of the ISV resumes, at least partially, the flow of oxygenated blood to the sperm production site and restored sperm production in 4 out of 10 patients. Based on our findings the following statements can be made: (i) SCO may be related in part of the cases to persistent, longstanding testicular parenchymal hypoxia; (ii) germ cells may still exist in other areas of the testicular parenchyma; and (iii) if genetic problems are excluded, adequate correction of the hypoxia may restore very limited sperm production in some patients. [source]


    Effects of varicocele upon the expression of apoptosis-related proteins

    ANDROLOGIA, Issue 4 2010
    F.-W. Chang
    Summary Varicocele-associated apoptosis has been recognised as a cause of male infertility. Thus, we assessed the expression of somatic apoptosis-related proteins (the typical protein-dependent apoptosis markers) in ejaculated sperm plasma from both patients with varicocele and normal donors. We evaluated the relationships between certain apoptosis-related proteins and normal semen quality. Semen samples were obtained from 25 patients with varicocele and from 10 normal fertile controls. These samples were compared using computer-assisted semen analysis for motion parameters and manual analysis for morphology, and were also assayed for apoptosis-related protein activation including caspase-3, poly-ACP-ribose polymerase (PARP), the Bcl-2 family (Bcl-2, Bak) and p53 by means of immunoblot analysis. PARP, Bak and p53 were expressed substantially more in the sperm cells of the varicocele group when compared with the normal group (P < 0.05). The expression of caspase-3 and Bcl-2 did not appear to differ between these two study groups. An increased expression of PARP, Bak and p53 for varicocele-afflicted individuals indicated an increased participation by these agents in the regulating of apoptosis in the ejaculated semen from patients with varicocele, suggesting that certain protein-development apoptotic mechanisms might originate in the cytoplasmic droplet or within mitochondria of spermatocytes and then might function within the nucleus of the cell. [source]


    Heme oxygenase enzyme activity in seminal plasma of oligoasthenoteratozoospermic males with varicocele

    ANDROLOGIA, Issue 4 2010
    M. T. Abdel Aziz
    Summary This work aimed to assess seminal plasma heme oxygenase (HO) enzyme activity in oligoasthenoteratozoospermia (OAT) males with varicocele. Ninety-three men were divided according to their sperm count and clinical examination into: healthy fertile controls (n = 34), OAT without varicocele (n = 37) and OAT associated with varicocele (n = 22). They were subjected to semen analysis and estimation of seminal plasma HO enzyme activity in the form of bilirubin concentration. Seminal plasma HO enzyme activity decreased significantly in OAT cases compared with controls. Seminal plasma HO in OAT cases associated with varicocele decreased significantly compared with OAT cases without varicocele and healthy controls (mean ± SD; 109.2 ± 29.5, 283.6 ± 88.4, 669.5 ± 236.1 nMol bilirubin/mg ptn/min, P < 0.001). There was positive correlation between seminal plasma HO enzyme activity and sperm concentration, per cent of motile spermatozoa, number of motile spermatozoas ml,1 and significant negative correlation with sperm abnormal forms per cent. It is concluded that varicocele has a negative impact on seminal HO enzyme activity. Therefore, improved seminal picture after correcting varicocele repair might be related, in part, to improved HO action(s). [source]


    Polyorchidism: a three-case report and review of the literature

    ANDROLOGIA, Issue 1 2010
    M. Savas
    Summary The presence of more than two testes confirmed by histology is called polyorchidism. Polyorchidism is an extremely rare congenital anomaly with a few more than 100 cases reported in the literature. The majority of reported cases are asymptomatic patients, others present with cryptorchidism, hydrocele, varicocele, epididymitis, infertility, testicular malignancy and testicular torsion. Over a 2-year period, we encountered three patients who were found to have polyorchidism; two men presented with cryptorchidism and one with chronic scrotal pain. Physical examination of the first and the third patient revealed normal testes in the scrotal sac, the other scrotal sac was empty and small solid mass (atrophic left testes) was palpated in the inguinal canal. Ultrasonographic examination of the scrotum and inguinal region confirmed the findings of the physical examination. Ultrasonographic examination of the second patient revealed supernumerary testes within the scrotum. Orchiectomy was made on the first and third patients' supernumerary testes and ipsilateral inguinal high ligation was applied for herniorrhaphy. A conservative approach was preferred for the second patient, maybe preserving a potentially functional supernumerary testis to improve the capacity for spermatogenesis. The risk of malignancy justifies the removal of an atrophic and ectopic testis in polyorchidism. However, it would appear safe to preserve a viable intrascrotal supernumerary testis found incidentally at surgery, provided that the patient is followed-up in the long term. [source]


    Predictors of improved seminal parameters and fertility after varicocele repair in young adults

    ANDROLOGIA, Issue 5 2009
    M. Rodriguez Peña
    Summary The aim of our study was to determine hormonal or biochemical markers in patients with clinically palpable left varicocele but without a history of infertility, with especial emphasis on nitric oxide, related with improved seminal parameters after varicocelectomy. Semen samples were obtained from 202 patients with left varicocele grade II or III. Nitric oxide levels in seminal plasma were determined by the Griess technique. Testicular volume was determined ultrasonographically in both testes and hormonal profile was measured. The post-operative sperm concentration increased significantly in patients with normal sperm count or moderate oligozoospermia, but we did not find an increment in sperm count in patients with mild and severe oligozoospermia after surgery. The mean percentage of normal motility significantly increased after surgery, but we did not observe a significant increment in morphologically normal sperm count and testicular volume after varicocele repair. Moreover, we did not find any correlation between nitric oxide concentrations and severity of oligozoospermia, asthenozoospermia or abnormal sperm morphology in this population. It is concluded that in the general male population, varicocele repair is not associated with an improved semen profile in all cases. We did not observe a significant correlation between nitric oxide concentrations and semen profile. [source]


    Comparison of semen profile and frequency of chromosome aneuploidies in sperm nuclei of patients with varicocele before and after varicocelectomy

    ANDROLOGIA, Issue 3 2009
    H. Acar
    Summary Semen profile and meiotic segregation products are important for assessing aneuploidy risk and risk of resulting infertility. To determine the effect of varicocelectomy on semen profile and aneuploidy frequency, we investigated semen profile and aneuploidy frequency of selected chromosomes in patients with varicocele before and after varicocelectomy. Chromosomal aneuploidy for selected chromosomes was evaluated using chromosome-specific DNA fluorescence in situ hybridisation (FISH) probes. There was a significant difference in the level of normal sperm morphology before and after varicocelectomy (P > 0.007). There were no significant differences in aneuploidy frequency of chromosomes 1, 16, 17 and 18 in sperm nuclei obtained from patients before varicocelectomy compared with 6,7 months after varicocelectomy (P > 0.05), although FISH analysis with chromosomes 17 and 18 combination showed a higher aneuploidy frequency before varicocelectomy than after varicocelectomy (7.81 ± 9.67 versus 4.03 ± 1.46 respectively). In conclusion, varicocele seems to affect the semen profile but minimally affects aneuploidy frequency. Varicocelectomy demonstrates a repairing effect on the semen profile and contributes to a slight decrease in aneuploidy frequency in some but not all chromosomes. [source]


    Seminal reactive oxygen species-antioxidant relationship in fertile males with and without varicocele

    ANDROLOGIA, Issue 2 2009
    T. Mostafa
    Summary The aim of this study was to assess seminal reactive oxygen species (ROS)-antioxidants relationship in fertile and infertile men with and without varicocele. One hundred and seventy six males were studied; fertile healthy volunteers (n = 45), fertile men with varicocele (n = 45), infertile oligoasthenozoospermia (OA, n = 44) without varicocele and infertile OA with varicocele (n = 42). In their seminal plasma, two ROS parameters (malondialdehyde, hydrogen peroxide) and five antioxidants (superoxide dismutase, catalase, glutathione peroxidase, vitaminE, vitaminC) were estimated. Compared with fertile healthy men, in all other studied groups, estimated seminal ROS were significantly higher and estimated antioxidants were significantly lower. Infertile men with varicocele showed the same relationship as infertile men without varicocele. Sperm concentration, total sperm motility as well as sperm normal forms were negatively correlated with seminal malondialdehyde and were positively correlated with vitaminC. It is concluded that varicocele has an oxidative stress (OS) in fertile normozoospermic bearing conditions. This may allow understanding that, within men with varicocele, there is a threshold value of OS over which male fertility may be impaired. [source]


    Programmed cell death in varicocele-bearing testes

    ANDROLOGIA, Issue 1 2009
    A. Hassan
    Summary Accelerated apoptosis is a significant factor in the pathophysiology of male infertility disorders associated with abnormal spermatogenesis. This study aimed to investigate apoptosis in varicocele-bearing testes. Sixty four men with varicocele (18 fertile and 46 infertile) were studied compared with eight men with obstructive azoospermic as controls. Apoptosis was assessed in testicular biopsy specimens using terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick end labeling (TUNEL) method as well as electron microscopy. The results demonstrated that the occurrence of apoptotic changes comprised all types of germ cells but not affecting Sertoli cells. Mean tubular apoptotic indices of fertile or infertile men with varicocele were significantly higher than controls (mean ± SD 4.55 ± 1.03%, 6.29 ± 1.82% versus 2.71 ± 0.45%, P < 0.05). Mean Leydig cells apoptotic indices of infertile men with varicocele were significantly higher than those of fertile men without varicocele as well as controls (1.18 ± 0.38%, 0.68 ± 0.15%, 0.31 ± 0.21%, P < 0.05). Apoptotic indices were nonsignificantly correlated with Johnsen score, testicular volume or varicocele grade. It is concluded that testicular apoptosis is increased in varicocele-associated men either fertile or infertile who may be implicated in associated spermatogenic dysfunction. [source]


    Reversal of benign prostate hyperplasia by selective occlusion of impaired venous drainage in the male reproductive system: novel mechanism, new treatment

    ANDROLOGIA, Issue 5 2008
    Y. Gat
    Summary The prostate is an androgen-regulated exocrine gland producing over 30% of the noncellular components of the semen and promoting optimal conditions for survival and motility of sperm in the vagina. Benign prostate hyperplasia (BPH) is the most common benign neoplasm in men. Its aetiology is not clear, and therefore, current medical treatments are directed towards the symptoms. Though testosterone is known to be the promoter of prostate cell proliferation, no causal relation between serum testosterone levels and BPH has been found. In this study, we propose a novel and tested pathophysiological mechanism for the evolution of BPH and suggest a tested and effective treatment. We found that in all BPH patients, the one-way valves in the vertically oriented internal spermatic veins are destroyed (clinically manifested as varicocele), causing elevated hydrostatic pressure, some 6-fold greater than normal, in the venous drainage of the male reproductive system. The elevated pressure propagates to all interconnected vessels leading to a unique biological phenomenon: venous blood flows retrograde from the higher pressure in the testicular venous drainage system to the low pressure in the prostatic drainage system directly to the prostate (law of communicating vessels). We have found that free testosterone levels in this blood are markedly elevated, with a concentration of some 130-fold above serum level. Consequently, the prostate is exposed to: (i) increased venous pressure that causes hypertrophy; (ii) elevated concentration of free testosterone causing hyperplasia. We have treated 28 BPH patients using a technique that restores normal pressure in the venous drainage in the male reproductive system. The back-pressure and the back-flow of blood from the testicular to the prostate drainage system were eliminated and, consequently, a rapid reduction in prostate volume and a regression of prostate symptoms took place. [source]