Cases Of Varicocele Research Articles

EXPERT SYSTEM DIAGNOSES VARICOCHEL DISEASE USING MAMDANI'S FUZZY LOGIC ALGORITHM METHOD

Varicoceles form when valves in the veins that run along the spermatic cord (the structure that suspends the testicles in the scrotum) prevent blood from flowing properly. Most varicocele cases occur during puberty, from the age of 15 to 25 years. If there are symptoms that are not prolonged, treatment is not necessary. However, if a varicocele causes pain, shrinkage of the testicles, impaired fertility, or swelling, surgery will be performed. Symptoms of this disease are similar to hemorrhoids and bladder stones, so it takes an expert. In the research conducted on the Expert System Application for Diagnosing Hyperthyroid Disease with the Mamdani Fuzzy Logic Inference Method, it can be concluded that the expert system can store expert knowledge from experts in solving problems diagnosing hyperthyroid disease while Mamdani fuzzy inference is used for knowledge processing in order to obtain a more accurate diagnosis conclusion. definitely with accuracy . Making the application is expected to make it easier for people to get information without having to wait for the presence of a doctor/expert for varicocele disease, and is expected to reduce or even solve existing problems.

Semen Parameters Can Be Used As A Credible Marker with Doppler Ultrasonography in the Diagnosis of Subclinical Varicocele Cases

OBJECTIVES: The link between varicoceles and male infertility has been a problem of debate for more than half a century. A substantial amount of data about varicocelectomies’ effects has been provided, but inadequate study designs and heterogeneity of current studies make these data rarely conclusive. This article investigates whether semen and sperm analysis in subclinical varicocele patients without any clinical signs diagnosed by Doppler Ultrasonography (USG) can be used as a diagnostic tool. STUDY DESIGN: The current prospective study included infertile male patients (n=44) enrolled in the Urology Clinic of Biruni University Hospital from January 2017 to January 2018. Patients were divided into two groups: 1st group as the control group (CG) (n=22): No varicocele as determined by Doppler USG, and 2nd group as the test group (TG) (n=22): Subclinical varicocele (SCV) as determined by Doppler USG. A semen analysis was done. Sperm were dyed with aniline blue and chromomycin A3 (CMA3), acridine orange (AO), propidium iodide (PI), and Rhodamine 123 (Rh123) for the determination of sperm maturation, sperm DNA fragmentation, apoptosis, and sperm mitochondrial membrane potential, respectively. Student-t Test was used for statistical analysis. p<0.05 was considered significant. RESULTS: The sperm concentration of the CG was higher than the TG (p=0.98, p>0.05). Forward sperm motility in the CG was higher than in the TG (p<0.001, p<0.05). Sperm with normal morphology in the TG was lower than in the CG (p<0.001, p<0.05). Sperm neck anomalies were higher in varicocele cases (p<0.001, p<0.05). Sperm maturation at the TG was lower than the CG (p<0.001, p<0.05). A high apoptotic sperm rate was found at the TG (p<0.001, p<0.05). Sperm mitochondria potential at the TG was lower than the CG (p<0.001, p<0.05). Sperm chromatin condensation at the TG was higher than the CG (p<0.001, p<0.05). CONCLUSIONS: The analysis of sperm DNA and apoptosis in SCV cases can be used as a reliable diagnostic tool to confirm Doppler USG.

Advanced Sonographic Techniques in the Comprehensive Evaluation and Diagnosis of Male Infertility.

Background Infertility affects many couples, with male factors being responsible for over half of the cases. Male infertility can arise from various testicular illnesses, such as varicocele and cryptorchidism, as well as posttesticular disorders, like ejaculation abnormalities. Infertility is defined as the inability to conceive after 12 months of unprotected sexual activity or after six months for women over 35. Diagnostic techniques such as semen analysis and scrotal ultrasonography are done to evaluate conditions like varicocele and epididymo-orchitis. This study aims to assess the diagnostic utility of ultrasonography for male infertility and compare its findings with those from surgery and clinical care. Methodology All patients were referred to the Department of Radiology,Tertiary Care Hospital, South India, for transrectal and scrotal ultrasonography, using a high-frequency transducer with a frequency of 7.5 MHz and a color Doppler when necessary. The study included all male patients with infertility and abnormal semen analysis, as well as those with infertility accompanied by scrotal abnormalities detected during clinical examination. Patients were placed in the left lateral decubitus position for the transrectal ultrasonography examination. The testes and epididymis were thoroughly examined on both sides and compared regarding symmetry, size, texture, and vascularity. Results Varicocele was the most frequent anomaly detected by both clinical examination and ultrasonography. Ultrasound detected 30 cases of varicocele, whereas clinical examination diagnosed 15 cases. Hydrocele was identified in eight cases through clinical examination and in 15 cases through ultrasound. Epididymal cysts were found in five cases via clinical examination, while both clinical examination and ultrasonography discovered epididymitis in 10 cases. Overall, the number of anomalies detected by ultrasound was significantly higher than those found by physical examination, with a statistically significant p value of 0.001. Conclusion Transrectal ultrasound provides high-resolution imaging of the prostate, seminal vesicles, and distal vas deferens, which aids in diagnosing obstructive azoospermia. Imaging is a valuable supplement to clinical examination and laboratory studies for accurately identifying anatomy and abnormalities. Both transrectal and scrotal ultrasonography offer crucial information in diagnosing male infertility. Ultrasonography is more effective in identifying pathological abnormalities than clinical palpation.

Microscopic subinguinal varicocelectomy with video telescopic operating microscope (VITOM) telescope: outcome analysis.

Conventional techniques of varicocele repair are associated with substantial risks of hydrocele formation, ligation of the testicular artery, and varicocele recurrence. The advantages of the microscopic approach to varicocele repairs are detailed identification and preservation of the vascular structures. In this study, our purpose is to review the outcome of all patients that underwent microscopic subinguinal varicocelectomy with the video telescopic operating microscope (VITOM). Hence, a retrospective review of 23 varicocele patients who underwent microscopic subinguinal varicocelectomy at the center from the year 2019 until 2021 was done. They, ranging between 18 to 58 years of age, comprising one case of right varicocele, fifteen cases of left varicocele, and seven cases of bilateral varicocele, were all having symptoms (pain and swelling) and clinically palpable varicocele. Ultrasounds were done to confirm the diagnosis and measure the testicular size. The surgery was performed by a single surgeon, under spinal anesthesia. The operation was performed using the VITOM telescope system, with an average operative time of one hour. The patients were followed-up at one month postoperatively to review the wound and symptoms. Phone call evaluations of all 23 patients were done to detect any recurrence or complications. All patients were discharged one day after surgery. Post-operative, all of them have a well-formed scar at the previous subinguinal region incision wound during the clinic visits. None of the 23 patients reported with varicocele recurrence, testicular pain, hydrocele formation or sexual dysfunction. The previous testicular pain or discomfort they encountered prior to the surgery was resolved as well. In conclusion, microscopic subinguinal varicocelectomy using the VITOM telescope is feasible and could achieve good outcomes.

A systematic review and meta-analysis on the efficacy of internal spermatic artery ligation during laparoscopic varicocelectomy in children and adolescents: Is it safe?

Challenges in identifying small testicular arteries and lack of microscopic experience have led to a rising trend in the use of laparoscopic technique for pediatric and adolescent varicocele. The controversy over artery ligation (AL) and artery preservation (AP) during laparoscopic varicocelectomy (LV) is still debatable. This study investigates the effectiveness of AL and AP during LV in pediatric and adolescent varicocele cases. The systematic searches based on PRISMA guideline were conducted in PubMed, Scopus, ScienceDirect, Web of Science and ProQuest databases with pre-defined keywords. Both quantitative and qualitative analyses were performed to assess catch-up growth, persistence, recurrence, hydrocele, operative time, post-operative testicular volume, and sperm analysis. A total of 1512 patients from 9 eligible studies were included. There were no significant differences in catch up growth (OR 0.89; 95%CI 0.53, 1.51; p = 0.68) or hydrocele incidence (OR 0.59; 95%CI 0.28, 1.24; p = 0.16). The recurrence rate and persistence rate in AP group is significantly higher compared to AL group (OR 2.95; 95%CI 1.53, 5.68; p = 0.001 and OR 5.13; 95% CI 2.04, 12.88; p = 0.0005, respectively). The mean operative time during laparoscopic varicocelectomy is significantly longer when arteries are preserved as opposed to when they are ligated (OR 5.33; 95%CI 2.05, 8.60; p = 0.001). AL and AP both improved testicular volume and post-operative sperm analysis. AL showed higher efficacy and comparable safety to AP. We recommend using AL with lymphatic sparing to minimize hydrocele complications.

Scrotal Pain after Varicocelectomy: A Narrative Review

Varicocele is a frequently encountered urological disorder, which has a prevalence rate of 8 to 15% among healthy men. However, the incidence is higher in male patients with primary or secondary infertility, with up to 35 to 80% of varicocele cases occurring in this population. The clinical manifestations of varicocele typically include the presence of an asymptomatic mass that feels like a "bag of worms", chronic scrotal pain, and infertility. Most patients with varicocele only undergo varicocelectomy after conservative treatments have failed. Unfortunately, some patients may still experience persistent scrotal pain due to a recurrence of varicocele, the development of hydrocele, neuralgia, referred pain, ureteral lesions, or nutcracker syndrome. Therefore, clinicians should consider these conditions as potential causes of postoperative scrotal pain, and take measures to address them. Several factors can assist in predicting surgical outcomes for patients with varicocele. Clinicians should consider these factors when deciding whether to perform surgery and what type of surgical intervention to use. By doing so, they can increase the likelihood of a successful surgical outcome and minimize the risk of complications such as postoperative scrotal pain.

Elastography and contrast-enhanced ultrasound to assess the effect of varicocelectomy: A case-controlled study.

To evaluate the changes in testicular stiffness and microcirculation caused by spermatic vein ligation in patients with varicocele, we conducted a case-controlled study. A total of 27 grade III left varicocele cases were enrolled. Testicular stiffness and perfusion were evaluated by shear wave elastography and contrast-enhanced ultrasound during subinguinal microscopic varicocelectomy. The external and the internal parenchyma of bilateral testes were selected to compare the shear wave velocity of bilateral testes during the spermatic vein ligation. We mapped and compared the intensity-time curves following bolus contrast injection three times in the same region of interest. Initially, the shear wave velocity of the left internal parenchyma was higher than the right side (1.10 ± 0.06 m/s vs. 1.00 ± 0.03 m/s). It decreased (1.09 ± 0.06 m/s) (p < 0.05) after ligation. Meanwhile, the left epididymis had the higher agent peak intensity (0.90 × 10E-5AU), the largest area under the curve (80.20 × 10E-5AU s), and the longest washout area (54.35 × 10E-5AU s). In addition, the left internal parenchyma presented a sharper slope (0.18 × 10E-5AU/s) (p < 0.05). In conclusion, the spermatic vein ligation improved the perfusion of the internal testicular parenchyma, but it could temporally deteriorate the stasis of the epididymis. These changes caused softer testicular parenchyma.

Clinical study of the management of scrotal swelling in adult patients at a rural medical college and research hospital

Background: Scrotal swellings are commonest clinical entities in surgical practice. Hydrocele is abnormal collection of serous fluid in the tunica vaginalis or any part of the processus vaginalis, which needs to be differentiated from other conditions and surgically managed. Methods: This prospective, observational study was carried out on 90 adult male patients between January 2021 to August 2021 diagnosed with scrotal swelling, admitted, treated at MVJMC and RH. Inclusion criteria were male patients of age &gt;18 years. Exclusion criteria were patients with paediatric scrotal swellings. Routine blood investigations, COVID test and ultrasound of the scrotum was done. The patients underwent one of the standard surgical procedures and were observed for post-operative complications during their stay at the hospital and were followed up for 3 months. The collected data was analyzed using SPSS-21 software.Results: Collected data was analysed using SPSS-21. In our study hydrocele was seen in 48 (53.33%), epididymo-orchitis 5 (5.56%). 3 (3.33%) cases of varicocele, 2 (2.22%) cases of epididymal cyst and 1 (1.11%) each of sebaceous cyst, spermatocele, hematocele, sebaceous cyst, Fournier’s gangrene, infected encysted hydrocele, pyocele, scrotal abscess and filarial hydrocele. 2 (2.22%) testicular tumour and 21 (23.86%) testicular torsion. Of 90 patients 81 (90%) underwent surgery, while 9 (10%) patients were managed conservatively.Conclusions: Primary vaginal hydrocele was the commonest scrotal swelling. Ultrasound of the scrotum is diagnostic tool in differentiating from other swellings in the scrotum especially in testicular torsion when the testis can be saved. Jaboulay’s procedure was the commonest surgery performed with least complications.

CHARACTERISTICS OF UROLOGY PATIENTS TREATED BY STICHTING SAMENWERKING VLISSINGEN-AMBON (SSVA) IN HAULUSSY HOSPITAL 2017-2018

Introduction. BPH, Urolithiasis and UTI are often urology cases found in Indonesia. There is no epidemiological data about Urology Patients in Maluku Province. Some patients in the province were handled either through referral to other cities or rely on charity program (SSVA) because there was no Urologist available yet in the province. Aim. To understand the characteristics of urology patients treated by SSVA in Maluku Province, including age, gender, and diagnosis. Method. This descriptive study used retrospective data from the medical records of patients treated by the SVVA in Haulussy Hospital from 2017–2018. Results. From a total of 281 (100%) urology patients, there were 173 (61.65%) benign prostatic hyperplasia (BPH) cases, 52 (18.50%) nephrolithiasis cases, 20 (7.11%) urinary tract infection cases, 13 (4.62%) hydrocele cases, 9 (3.2%) vesicolithiasis cases, and 5 (1.77%) varicocele cases. The largest number of BPH patients was from 60-69 years old age group with a total of 71 (41.04%) patients, followed by 70-79 years old age group with a total of 45 (26.01%) patients. From a total of 52 nephrolithiasis patients, there were 28 (53.48%) male patients and 24 (46.15%) female patients, and according to patient age, the largest number was from the 40-59 years old age group with a total of 31 (59.62%) patients, followed by the 60-79 years old age group with a total of 11 (21.16%) patients. Conclusion. The largest number of urology patients treated by the SVVA were BPH patients, followed by nephrolithiasis and urinary tract infection patients. The age group that suffered the most from BPH are those aged 60-69 years. In nephrolithiasis patients, it was found that male patients were slightly more prevalent than female. The age group that suffered the most from nephrolithiasis are those aged 40-59 years.&#x0D; Keywords: Characteristics; Urology

The association between varicocele and other vascular diseases: A systematic review and meta-analysis.

This study is aimed to evaluate the association between varicocele and other vascular diseases through a systematic reviews and meta-analyses. We searched Cochrane Central Register of Controlled Trials, Embase, PubMed, and Web of Science for studies that reported varicocele and other vascular diseases published before 30 June 2021. The meta-analysis was performed by Revman V.5.2 to calculate the pooled odds ratios and corresponding 95% confidence intervals. Subsequently, the impact of publication bias was evaluated, and sensitivity analysis as performed to assess our results' robustness. In total, seven case-control studies, including 803 varicocele cases and 727 controls, were included. Our meta-analysis results showed that the varicocele patients had a higher risk of saphenofemoral insufficiency when compared with the control group (odds ratio [OR]: 2.80; 95% confidence intervals [CIs]: 2.03, 3.84; p < 0.00001). Additionally, varicocele patients also had a higher risk of lower extremity venous insufficiency when compared with the control group (OR: 2.34; 95% CI: 1.58, 3.47; p < 0.0001). However, there was no statistical difference in hemorrhoid risk between both groups (OR: 1.13; 95% CI: 0.28, 4.59; p = 0.87). Our study demonstrated that varicocele patients have higher risk of saphenofemoral and lower extremity venous insufficiencies but not the risk of hemorrhoids.

Seminal L-Carnitine In Infertile Oligoasthenoteratozoospermic Men with Varicocele.

Background:Few studies have investigated the relationship of seminal L-Carnitine (LC) with male infertility associated with varicocele. The purpose of this prospective cross-sectional study was to assess seminal plasma LC levels in infertile oligoathenoteratozoospermic (OAT) men with varicocele.Methods:Overall, 86 men were investigated. They were divided into infertile OAT men with varicocele (n=45), infertile OAT men without varicocele (n=21), and fertile men (n=20) as a control group. According to WHO guidelines, these men were subjected to history taking, clinical examination, and semen analysis. Seminal LC levels were evaluated by the colorimetric method. Statistical comparisons were done using Kruskal-Wallis and Mann-Whitney U tests and correlations were verified by the Pearson test. P-value<0.05 was set to be statistically significant.Results:The mean seminal plasma LC levels were significantly lower in infertile OAT men with varicocele (216.3±57.1 ng/ml) compared to infertile OAT men without varicocele (252.9±62.9 ng/ml, p=0.01), or fertile men (382.8±63.6 ng/ml, p=0.001). Besides, the mean seminal plasma LC level exhibited statistically significant decreases in infertile OAT men of varicocele grade III compared to varicocele grade II cases, and in infertile OAT men with bilateral varicocele compared with unilateral varicocele cases. Collectively, there was a statistically significant positive correlation between seminal LC levels with sperm concentration, motility, and normal morphology.Conclusion:Seminal LC levels are expressively reduced in infertile OAT men with varicocele and are influenced by an increase in varicocele grade and laterality.

Outcome of Extended Varicocelectomy in Case of High Grade Varicocele

Abstract Background Varicocele is defined as abnormal dilation and tourtousity of the internal spermatic veins within the pampiniform plexus. It is common among adolescents and may contribute significantly to the risk of subfertility in adulthood. Objective To evaluate the outcome of extended varicocelectomy in case of high grade varicocele. Patients and methods In all, 30 varicocele cases including 12 left sided and 18 bilateral, comprising 48 spermatic cord units with clinically palpable varicocele and affected semen analysis underwent extended varicocele ligation. Testicular delivery was done in all the cases and assessment of the gubernacular veins was reported. The patients underwent clinical evaluation, scrotal doppler ultrasonography, as well as semen analysis to detect varicocele recurrence, hydrocele formation and early changes in semen parameters. The postoperative evaluation period was 3 months. Results No varicocele recurrences were clinically detectable after our surgical approach, No hydrocele formation, and There was improvement in the parameters of semen analysis in the entire patients presented with infertility associated with varicocele as regard improvement in the count, motility, and decrease in the abnormal forms 3 months after varicocelectomy. Conclusion Extended varicocele ligation with delivery of the testis achieve good surgical outcome with minimal varicocele recurrence and hydrocele formation, and offer beneficial effect on semen parameters.

Diagnostic Accuracy of Doppler Ultrasonography for Diagnosis of Epididymo-Orchitis in Patients presenting with Scrotal Swelling

Background and Aims: Epididymitis, orchitis, testicular torsion and appendix testis torsion causes most common and acute scrotal pain. The scrotal pain and complications could be diagnosed with Doppler ultrasound and histopathology post-surgery procedures. The current study aims to determine diagnostic accuracy of Doppler Ultrasonography for diagnosis of epididymis-orchitis in patients presenting with Scrotal Swelling. Materials and Methods: This cross-sectional study was carried out on 121 scrotal masses patients during the period from April 2020 to September 2020 at the radiology department ofLiaquat University of Medical and Health Sciences, Jamshoro. Individuals who met the inclusive criteria were enrolled and consent form was taken from each patient. The patient’s age range was 15 to 68 years old with mean ± SD 34.5 ± 12.4. All the patients were presented with scrotal swelling. After history taken from the individual, Doppler ultrasound (DUS) was conducted. The final outcomes were compared by radiologist and surgeon. All the patients were subjected to linear transducer and Toshiba Xario 200 with 11MHZ. Diagnostic accuracy of Doppler ultrasound was calculated from the sensitivity and specificity. Results: Doppler ultrasound diagnosed allthe epididymitis and orchitis, testicular torsion, hydrocele, spermatic cordinjury, and varicocele cases with specificity and sensitivity 100%. The frequencyof finally diagnoses performed by Doppler ultrasonography was orchitis (7),epididymitis-orchitis (45), testicular malignancy (15), spinal cord injuries(3), testicular torsion (5), hematocele (3), spermatic cord injuries (2),varicocele (14), hydrocele (25), and pyocele (2). Out of 15 testicular subjectsdiagnosed on DUS, only 14 were found to have malignancy. Two cases ofOrchitis were diagnosed falsely as amalignancy. In Orchitis 7 patients, 6 were diagnosed as orchitis but one hadseminoma (specificity 67% and sensitivity 88%). The overall DUS specificity andsensitivity were 67% and 98% respectively. Conclusion: The scrotal disease can be diagnosed with effective, reliable, and safe Doppler Ultrasonography. Testicular tumor diagnosis is an additional advantage of DUS besides minimizing unnecessary exploration operations numbers. Doppler ultrasonographyplays a vital role in need of immediate diagnosis of testicular torsion. Keywords: Doppler ultrasound scan, Scrotal pathologies, Epididymo-Orchitis

15-Year varicocelectomy outcomes in pediatric age: Beware of genitofemoral nerve injury

Varicocele affects 15% of adolescents. The main postoperative complications are recurrence and hydrocele; nerve injury is rarely reported. The aims of this study are: to assess the complications after laparoscopic varicocelectomy, namely nerve injury; and to assess if nerve injury is more frequent using "hot" or "cold" ligation. Retrospective study of varicocele cases submitted to laparoscopic correction in our department from April 2006 to March 2020. Parameters analyzed were: age, clinical findings, surgical indication, operative technique, and outcomes. Comparison was done between the "cold" versus "hot" vessel section technique. 110 patients, with median age 14-years-old, were included. Most cases were on the left side and grade 3. Fifty patients (45%) presented complications: 21% recurrence; 18% hydrocele; and 3% genitofemoral nerve injury. Nerve injury was independent of the technique used. Genitofemoral nerve injury is a complication with unknown cause and all cases are related to laparoscopic technique. It was suggested that "hot" methods of ligation of the vessels can lead to higher incidence of the lesion, but that was not corroborated in our analysis. Possible explanations for its occurrence are: a wide peritoneal window opening created with electrocautery near the internal inguinal ring; and additional dissection required to isolate the testicular veins from the artery. Prospective studies are needed to clarify the real incidence of genitofemoral nerve injury and its causes. Laparoscopic varicocelectomy seems to be safe and effective, although complications remain frequent regardless of the technique used. Genitofemoral nerve injury is a complication rarely described that may require rehabilitation, and so awareness for this problem is of paramount importance.

The effect of ejaculation time on varicose vein diameter and reflux level.

The aim of this study was to investigate whether the time interval between ejaculation and scrotal Doppler ultrasonography affects the results of the varicose vein diameter and reflux time. Age, medication use, operation history, physical examination and semen analysis findings, varicose vein diameters and the presence of reflux and reflux time were evaluated prospectively in the patients older than 18years of age who presented to the urology outpatient clinic with infertility and underwent scrotal Doppler ultrasonography and semen analysis. The time interval between the two scrotal Doppler ultrasonography for semen analysis was noted, the two results were compared. The patients were divided into four groups according to the time interval between ejaculation and scrotal Doppler ultrasonography. The study included 81 varicocele cases, with 57 left-sided and 12 bilateral varicocele. The varicose vein diameters were significantly larger after ejaculation than before ejaculation (p<.001). Similarly, the reflux time after ejaculation in all patients was significantly higher in scrotal Doppler ultrasonography performed before and after ejaculation at rest and during Valsalva manoeuvre (p<.001). In conclusion, the results of the present study suggest that a waiting time of at least 90min must be allowed between ejaculation and scrotal Doppler ultrasonography.

Efficacy of varicocelectomy for sperm DNA integrity improvement: A meta-analysis.

Varicocele is common among male adolescents and adults. Varicocelectomy is the major means of varicocele repair. There is evidence that varicocelectomy could decrease sperm DNA fragmentation. However, studies evaluating the efficacy of varicocelectomy for sperm DNA integrity usually have a small sample size, and there is no up-to-date meta-analysis in this area. The present meta-analysis is to evaluate the efficacy of varicocelectomy for sperm DNA integrity. A literature search was conducted to identify all relevant studies from Medline database (PubMed), Cochrane Library, and OVID Embase from the inception dates to 08 June 2020. A total of 11 prospective studies including 394 cases were included in this meta-analysis. All analysis was performed using Stata version 16.0. In the random-effect model for 11 studies, DNA fragmentation index (%) of clinical varicocele patients decreased by 5.79 (95% CI, -7.39 to -4.19) after varicocelectomy. While after excluding one study with high heterogeneity, from the results of fixed-effect model, DNA fragmentation index decreased by 6.14 (95% CI, -6.90 to -5.37) on average. Sperm DNA integrity of clinical varicocele patients was significantly improved following varicocelectomy. Therefore, it is necessary to include elevated sperm DNA fragmentation index as a molecular indicator for varicocelectomy among clinical varicocele cases.

Estimation of varicocele associated human ARG2 and NOS1 proteins and computational analysis on the effect of its nsSNPs

One of the major causes of varicocele is nitrosative stress. Two genes namely arginase 2 (ARG2) and nitric oxide synthase 1 (NOS1) are important in the mechanism of nitric oxide (NO) in the body. Semen samples from three different categories were taken, fertile (n = 20), Infertile (n = 20), and unilateral varicocele (n = 15). Quantitative estimation of ARG2 and NOS1 was carried out through the ELISA kit method. t-Test and ANOVA were calculated using Graphpad Prism. For the in silico analysis, the sequence of the proteins obtained from dbSNP was used in online tools such as nsSNPAnalyzer, PolyPhen-2, Fathmm, I-Mutant 2.0, SNPs&GO, PhD-SNP, PANTHER, SNAP2, PROVEAN, SIFT, and SNPeffect for screening deleterious mutants. These mutants were further evaluated with Swiss PDB and PyMOL for recording energy minimization, Root mean square deviation (RMSD) value, TM score, Hydrogen bonding, and Comparative modeling. Further, ConSurf, Netsurf, and STRING tools were used for evaluating conserved regions, stability, and protein-protein interactions respectively. The results of ARG2 protein were, fertile = 0.168 ± 0.007 U/ml, infertile = 0.201 ± 0.004 U/ml and, varicocele = 0.092 ± 0.002 U/ml. Results of NOS1 protein were fertile = 32.61 ± 2.8 nM/mg, infertile = 19.33 ± 3.7 nM/mg and, varicocele = 54.74 ± 4.8 nM/mg. From statistical analysis, the parameters were highly significant. From the in silico retrieved data, there were 130 and 499 nsSNPs (non-synonymous SNP) in ARG2 and NOS1 respectively. After screening with online tools, 6 deleterious nsSNPs each of ARG2 and NOS1 were considered for analysis through Swiss PDB. FoldX result of A52P mutant (ConSurf score = 9) of ARG2 was found to severely affect protein stability and that of A363T mutant (ConSurf score = 9) of NOS1 revealed a structural change. A52P had a higher RMSD value and A363T of NOS1 developed a new H-bond with 580th position. In varicocele cases, the ARG2 protein is found in lower quantity. The A52P variant of this protein can cause dysfunction and induce nitrosative stress. However, in infertile cases, NOS1 protein is found in lower quantity and the A363T variant can result in a decrease in NO leading to other forms of infertility.

A clinicopathological study of scrotal swellings in adults

Scrotal swelling is one of the common problem in all age groups and are commonly encountered in surgical outdoor. In our study 100 patients were included who presented with scrotal swelling in surgical outdoor.Factors such as age, presenting complaint, laterality were analysed, a definite diagnosis was made on the basis of USG and histology. Collected data was then analysed and compared to previous studies. In this study hydrocele forms the most common cause of scrotal swelling consisting of 33%.Next common cause was epididymoorchitis (31%).Other causes include 12% cases of varicocele,6% cases each of epididymal cyst and scrotal abscess, 5% cases of testicular tumour, 3% cases of sebaceous cyst and testicular torsion each and only 1% of spermatocele.

Ultrastructural characteristics of the mechanisms of varicose transformation of veins of different localization

To prove the role of UCTD syndrome in the development of varicose transformation of veins, by examining their wall biopsy specimens at the ultrastructural level. Vein wall fragments removed from 25 male patients were examined; their mean age was 19 years. All the patients were divided into 3 groups: 1) cases of left-sided varicocele (VC), 2) those of varicose veins in the lower extremities (VVLE), 3) control cases. Electron microscopy examination (EME) and morphometric and statistical analyses were performed. EME showed similar changes in the vein wall biopsy specimens obtained from both pediatric and adult patients with VC and VVLE. Analysis of the qualitative parameters of collagen fiber bundles revealed considerable differences in their thickness compared to those in the control group; the phenomenon of structural chaos; variability of their number in the bundles; uneven bundle thickness; abruptness of individual fibers due to their tortuous course; bundle disorganization areas and an expanded part of interfiber spaces. Morphometric analysis demonstrated a pronounced variability of numerical series when measuring their bundle thickness. The above changes indicate primary incompetence of the connective tissue framework of the varicose vein walls. The measurements of smooth muscle cells showed a decrease in their volume compared to that in the control group; there was an excessive proliferation of connective tissue between them. No substantial difference was found in the arithmetic mean of the measurements in different degrees of VC and VVLE and in the age groups for these diseases. The ultrastructural analysis and morphometric results confirm the key role of UCTD syndrome in the pathogenesis of VC and VVLE and make it possible to combine these diseases into one - systemic varicose veins.

The Investigation of the Relationship Between Semen Analysis and Doppler Ultrasonografic Findings of Reflux Flow in Patients with Subclinical Varicocele

Objective: The aim of the present study was to the measurement of reflux flow volume, velocity and duration with color doppler ultrasonography (CDUS) in subclinical varicocele cases, and comparison of CDUS findings with semen analysis. Method: 219 infertile men with no clinical overt varicocele are examined with CDUS. 61 people who have vein diameter bigger than 2 mm, or have 1 second or longer reflux flow were classified as subclinical varicocele. CDUS examination is implemented in decubitus position. Reflux flow volume, velocity and duration of reflux in plexus pampiniformis veins were measured bilaterally during Valsalva maneuver. Results: In subclinical varicocele cases, mean vein diameters were measured mean 2.35 mm while resting, and 2.61 mm during Valsalva maneuver. With Valsalva mean reflux flow volume was 13.56 mL/min, duration was 1.32 sec, flow velocity was 5.6 cm/sec. There were anomaly in semen analysis of 13 of these cases (21.3%). A significant correlation between reflux duration and reflux flow velocity are found. However, no significant relation between reflux flow volume, velocity and duration with semen analysis is detected. Conclusion: In subclinic varicocele cases, CDUS is a valuable diagonistic procedure that is quite successful on detecting the vein diameter and reflux. No relation was found between reflux flow volume, velocity and duration with semen analysis. However, a study commited with a larger group could give more useful information.