Clinical Grade Of Varicocele Research Articles

Hormonal evaluation in adolescents with varicocele

Varicocele is one of the most frequent disease affecting the fertility potential; OBJECTIVE: the aim of this study is to assess the correlation between clinical and radiological grade of varicocele and hormonal values. The data about adolescents with left unilateral varicocele aged between 13 and 16 years, with Tanner stage V, followed at the Authors' Institution between September 2016 and September 2019 were investigated; inclusion and exclusion criteria were created. Patients underwent standard visit, Ultrasound, Doppler velocimetry and hormonal tests (at T0 and T1). Those patients with testicular hypotrophy underwent surgery. During the study period, 75 subjects with left unilateral varicocele were enrolled; 8 patients were excluded.A total of 67 patients were then studied. Among these patients, 37 had testicular hypotrophy, while the others had normal testicular volume. There was no correlation between grade of varicocele and testicular hypotrophy (p=0.12); among those patients with testicular hypotrophy, there was a statistical correlation with the grade of spermatic vein reflux (grade 4 vs grades 1-2-3) (p=0.03). Focusing on hormonal values, there was a statistical significant difference between FSH levels, clinical grades of varicocele and grade of spermatic vein reflux: FSH levels were higher in patients with clinical grade 3 varicocele respect to patients with grade 1-2 varicocele and, in particular, patients with grade 3 varicocele, testicular hypotrophy and grade 4 spermatic vein reflux (14 patients) had higher FSH level respect to others (p=0.02). After surgery there was a significant FSH reduction. Our results demonstrate that higher grade of spermatic vein reflux is associated with testicular hypotrophy and higher FSH levels.

Comparison of Color Doppler Ultrasonography and Clinical Grading of Varicocele in Patients Referred to Shahid Faghihi Hospital in Shiraz

Background: Varicocele is one of the most common causes of infertility in men. Although physical examination is the standard method for the diagnosis of varicocele, but in some cases, diagnosis of the disease only by clinical examination is difficult and diagnosis confirmed by ultrasonography. The aim of this study was to compare color doppler ultrasonography and clinical grading of varicocele. Methods: In this cross-sectional study, 66 patients suspected of varicocele referred to urology clinic of Shahid Faghihi hospital in Shiraz were assessed. After physical examination and clinical grading of varicoceles, the patients underwent color doppler ultrasonography was graded based on Sarteschi system. The collected data were analyzed using SPSS-24 statistical software. Results: The mean age of patients was 23.16 6.92 years. 60 cases (91%) had clinical varicocele and 6 cases (9%) were healthy and in ultrasonographic assessment, 63 cases (90%) had varicocele. Clinically, 40 testes were normal(grade0) and 36 testes (27.3%) had grade 1 of varicocele, 36 testes (27.3%) grade 2 and 20 testes (15.2%) had grade 3 and in ultrasound evaluation, 4 testes (3%) were normal (grade0) and 10 testes (7.6%) were in grade 1 of varicocele, 26 testes (19.7%) were in grade 2, 41 testes (31.1%) in grade 3, 53 testes (26.5%) in grade 4 and 16 testes (12.1%) in grade 5. There was a direct consistency between two systems of clinical and ultrasonographic grading (P < 0.05). Also there was a direct correlation with diameter of varicose veins and clinical grade of varicocele (< 0.05). In terms of age, no significant difference in clinical and ultrasonographic grading of varicoceles was observed (P = 0.36). Conclusions: The results showed that clinical and ultrasonographic grading to diagnose varicoceles is directly consistent together and it is possible to make them equivalent together. In addition, the age factor has not a significant impact on disease grading.

Six years' experience of laparoscopic varicocelectomy using bipolar electrosurgery and its effect on semen parameters.

To evaluate postoperative results of laparoscopic varicocelectomy using bipolar electrosurgery and analyze semen according to the grade of varicocele after surgery. In a six-year period, 416 men with clinical varicocele and impaired semen parameters or infertility underwent laparoscopic varicocelectomy using bipolar electrosurgery. All patients were assessed for hydrocele and recurrence of varicocele six months and one year after the procedure. Semen analyses were obtained before and after the surgery and were compared according to the clinical grade of varicocele. Seven patients (1.7%) had right side, 391 (94%) had left side and 18 (4.3%) had bilateral varicoceles. Varicocele grades I, II and III were detected in 113 (27.1%), 232 (55.7%) and 71 (17%) patients respectively. Abdominal wall emphysema and pneumoscrotum were developed in 19 (4.5%) and 11 (2.6%) cases. Recurrence rate was significantly higher in grade III varicocele (P &lt; .001). In patients with varicocele grades of I and II, sperm concentration, motility and morphology significantly improved six months after surgery (P &lt; .05). In patients with grade III varicocele, only sperm concentration improved (P &lt; .05). Sperm motility and morphology did not show any significant change after one year. Laparoscopic varicocelectomy using bipolar cautery is a safe, feasible and cost-effective technique with few complications. It significantly improves sperm parameters. A follow up program for at least one year after the surgery seems reasonable to detect recurrent cases. The study shows that increase in clinical varicocele grade can cause irreversible deleterious effects on sperm motility and morphology. So, earlier treatment is recommended.&nbsp.

Varicocele among infertile men in Qatar.

Objective of this retrospective study was to assess the presence and clinical grade of varicocele among Qatari and non-Qatari men evaluated for infertility. Diagnosis of varicocele was performed clinically and confirmed via colour Doppler ultrasonography. A total of 455 infertile male patients (mean age 36.3±7.6years) were divided into either Qatari (n=91, mean age 37.3±9.1years) or non-Qatari (n=364, mean age 36.0±7.1years) groups. Among all patients, 43.1% (n=196) were confirmed to have varicocele, of which 40 were Qatari and 156 non-Qatari. Among all patients, 171 (37.6%) presented with left-sided varicocele and 25 (5.5%) with bilateral varicocele. Of the 196 patients with varicocele, grade I was given to 40 (20.4%), grade II to 68 (34.7%) and grade III to 88 (44.9%). Grade II and III varicocele were seen significantly more frequently than grade I among all patients and non-Qatari patients (p<.05). Grade II varicocele was seen more frequently than grades I or III among Qatari patients, but difference was not significant. Grade III was seen significantly more frequently than grade I among patients with secondary infertility (p<.05). Varicocele is an important health issue in Qatar among both Qatari and non-Qatari men.

Ergonomic varicocele ligation

Introduction/aim Many surgical and radiological techniques have been introduced for treating varicoceles. The goal of surgical treatment of varicocele is to occlude the refluxing venous drainage to the testis while maintaining the normal testicular function. The aim of this study was to present our initial experience in laparoscopic varicocele treatment using intracorporeal knot-tying with available laparoscopic instruments. Materials and methods A retrospective file review of the patients who were treated with laparoscopic intracorporeal knot-tying between May 2010 and July 2014 was carried out. The patients were evaluated as regards age, symptoms, and clinical grade of varicocele. All patients were diagnosed through physical examination and color Doppler ultrasound, which measured the diameter of spermatic veins and retrograde flow in spermatic veins after the Valsalva maneuver. Results The mean operative time was 35± 8 min. There was no intraoperative complication, and all patients had uneventful postoperative courses. Patients were discharged from hospital on the same day after surgery. No recurrent varicocele, testicular atrophy, postoperative hydrocele, or ematoma were observed. Conclusion Our preliminary results indicate that laparoscopic varicocele ligation carried out with intracorporeal knot-tying is safe and effective and produces cosmetically better results. Therefore, it is a suitable procedure in both pediatric and adolescent patients. Keywords : ergonomics, intracorporeal knot-tying, laparoscopic varicocelectomy

Sperm concentration and forward motility are not correlated with age in adolescents with an idiopathic varicocele and symmetrical testicular volumes

AimIdiopathic varicocele is a common condition that may impair fertility. Its treatment in children and adolescents is reserved for those patients who develop symptoms or testicular growth arrest. We evaluated the trends in sperm parameters among adolescent varicocele patients with symmetrical testicular volumes who have not undergone varicocelectomy. MethodData were prospectively collected from a single institution (2009 to 2014). Post-pubertal patients aged 12 to 17years produced semen samples by masturbation. Outcomes measured were semen volume, sperm concentration, and forward motility. Additional variables recorded included: a) testicular volume (ultrasound measurement), b) clinical varicocele grade, c) venous Doppler grading. Linear regression analysis was performed using Fisher's transformation. P<0.05 was considered significant, and data are presented as median (IQ range). ResultsForty-one patients with a median age of 15.4 (15.0–15.9) years each provided a sperm sample during the study period. Thirty-five had grade 3 (visible) varicocele, and 6 had grade 2 (palpable) varicocele. All patients had spontaneous venous reflux on Doppler ultrasound, and none had undergone varicocelectomy prior to producing the sperm sample. Table 1 summarizes the sperm parameters according to patient age. The overall median sperm concentration was 37 (16–64) millions/ml and was not correlated with age. The overall median forward motility was 55% (44–64) and was not correlated with age. Thirty-four patients had normal sperm parameters, which remained within the WHO range of normality. ConclusionsFollowing the European Association of Urology guidelines does not cause progressive deterioration of sperm parameters between the age of 12 and 17years.

P-648: Clinical, sonographic, and intra-operative assessment of varicoceles: Does the data correlate?

There are no prior studies correlating clinical grade, pre-operative sonographic vein size, and intra-operative vein size measured at the time of microsurgical subinguinal varicocelectomy. The purpose of this study was to compare varicocele grade and pre-operative sonographic data with intra-operative vein size at the time of varicocelectomy. This is a prospective, non-randomized review of 64 consecutive men who underwent microsurgical subinguinal varicocelectomy. A total of 64 consecutive men (mean age 34.5 yrs) were enrolled in this study. Twenty-six underwent unilateral microsurgical subinguinal varicocelectomy, of which 23 were left and 3 right. The remaining 38 patients underwent bilateral varicocelectomy for a total of 102 varicocele units. Varicoceles were clinically graded I-III. Pre-operatively, 53 varicocele units had sonographic size available. At surgery, the diameter of the largest internal spermatic vein at the external inguinal ring was measured using a sterile micro-ruler prior to ligation. For clinical grade I varicoceles, the mean sonographic size (n=15) was 2.7 mm (± 0.7), and the mean intra-operative size (n=20) was 3.5 mm (± 0.9). For grade II varicoceles, the mean sonographic size (n=21) was 2.4 mm (± 1.2), and the mean intra-operative size (n=42) was 3.7 mm (± 0.9). For grade III varicoceles, the mean sonographic size (n=17) was 3.5 mm (± 1.5), and the mean intra-operative size (n=40) was 5.2 mm (± 1.6). Using analysis of variance (ANOVA) with Scheffe multiple comparison adjustment, clinical grade was predictive of intra-operative vein size (p<0.0001). Intra-operative vein size for grade III varicoceles was significantly larger than that of grades I and II varicoceles (p<0.0001). There was no significant difference in intra-operative size between grades I and II (p=0.78). Clinical grade was also predictive of sonographic vein size (p=0.03). However, this correlation was only significant between grades II and III varicoceles after post-hoc adjustment (p=0.03). There was no significant linear correlation between sonographic and intra-operative vein size (r2 = 0.12, p = 0.38). Clinical varicocele grade is predictive of intra-operative vein size. Clinical grade is also predictive of pre-operative sonographic varicocele size, although this difference is only significant between grades II and III varices. There was no significant correlation between pre-operative sonographic vein size and intra-operative vein size. Sonographic and intra-operative vein size may be useful additional predictors of varicocelectomy outcome.

Varicocele and sport in the adolescent age. Preliminary report on the effects of physical training.

The effect of physical training on the natural history of varicocele has received little attention. The aim of the present pilot study was to evaluate the prevalence of idiopathic varicocele in young athletes, in the attempt to find a correlation between the training workload and the clinical grade of varicocele. We evaluated 150 adolescents with an age of 10-16 yr (median age: 13 yr). All these subjects were athletes practicing different sport at agonistic level. One hundred and fifty non-athlete adolescents of matched age (median: 13.5 yr) were used as controls. All underwent physical examination, and if a varicocele was suspected, the diagnosis was confirmed or excluded by echo-color-Doppler examination. The young athletes were stratified into two groups according to the different time spent for training: Group 1-6 h training per week; Group 2-7 to 12 h per week. Statistical analysis was performed. A p<0.05 was considered significant. The physical examination revealed a clinical varicocele on the left side in 20 athletes. A significant positive correlation was observed between the Group 2 and the highest grade of varicocele (r2=0.9918, p=0.0041). In the adolescent group used as control we observed a varicocele in 16 cases. A positive correlation was observed between the number of athletes with varicocele and the highest grade of varicocele (r2=0.96, p=0.02). Sport training does not modify the prevalence of varicocele compared to the general population, but physical activity has to be considered as an aggravating factor in the natural history of varicocele. In countries where sport eligibility is necessary for agonistic sport practice, varicocele should be then considered as a conditioning factor.

Seminal Improvement Following Repair of Ultrasound Detected Subclinical Varicoceles

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

The thermographic characteristics of varicocele: an analysis of 65 positive registrations.

Sixty-five positive thermograms in patients suspected of subclinical varicocele or presenting with clinically palpable varicocele have been analysed. Two distinct patterns of varicocele associated thermograms could be distinguished, herperthermia always exceeding 1 degrees C. A correlation was found between the clinical grade of varicocele and both the extension and the degree of hyperthermia.