Microscopic Varicocelectomy Research Articles

Microscopic Varicocelectomy under Local Anesthesia as the Treatment of Varicocele.

Varicocele, characterized by the dilation of veins within the spermatic cord, is a prevalent disease in males, accounting for 35%-40% of infertility cases among men of reproductive age. This condition may disrupt normal neuroregulation, blood supply, and temperature regulation in the testicles, thereby impacting sperm count, quality (morphology, fragmentation rate), and functionality (motility). It may even induce symptoms such as pain and testicular atrophy. The international standard treatment method is microscopic varicocelectomy, typically performed under general anesthesia. This requires patients to fast before surgery and necessitates recovery and fasting care postoperatively. The arterial blood pressure drop caused by anesthesia may obscure the fluctuation of the spermatic artery, making the precise intraoperative isolation and protection of the spermatic artery more challenging. Therefore, this study proposes and implements microscopic varicocelectomy under local anesthesia. This method facilitates rapid and precise identification of the fluctuating spermatic artery, reducing the risk of spermatic artery damage. It also provides more humane care for patients, reduces economic burden, and offers a new perspective on the treatment of varicocele.

Comparison of Outcomes of different Varicocelectomy Techniques: Open Inguinal, Laparoscopic and Subinguinal Microscopic Varicocelectomy

Comparison of Outcomes of different Varicocelectomy Techniques: Open Inguinal, Laparoscopic and Subinguinal Microscopic Varicocelectomy

Outcomes following inguinal and subinguinal urologic procedures under deep intravenous sedation.

We aimed to investigate the surgical outcomes following inguinal and subinguinal urologic procedures under deep intravenous sedation (DIVS) with multimodal local anesthesia (LA). We conducted a retrospective cohort study from September 2022 to December 2023 including adult patients deemed eligible for day surgery (American Society of Anesthesiologist score 1-3) undergoing radical orchiectomy (RO), microscopic varicocelectomy (MV), or microscopic denervation of the spermatic cord (MDSC). All procedures were performed at a single urologic ambulatory surgical center and outpatient clinic, and by a single surgeon (PP). Procedures were performed through a subinguinal or inguinal approach with DIVS and adjunctive multimodal LA. We evaluated intraoperative complications and relevant surgical outcomes and parameters. A total of 103 patients were included in the analysis with a mean age ± standard deviation of 37.3±9.6. This included 25 patients who underwent RO, 54 patients who underwent MV, and 24 patients who underwent MDSC. All procedures were completed successfully without intraoperative complications. Oncologic outcomes were preserved, fertility outcomes improved, and pain scores reduced similarly to the expected rates in the literature. Our preliminary results demonstrate the safety, effectiveness, and feasibility of performing inguinal and subinguinal urologic procedures under DIVS with LA. These findings suggest that this technique preserves high-quality care while avoiding the unnecessary risks of general or spinal anesthesia, representing an opportunity to transfer these cases outside of hospitals' operating rooms into outpatient ambulatory centers.

Improved semen parameters and sperm deoxyribonucleic acid fragmentation following microscopic varicocelectomy: short term results of a prospective study

Background: Assessment of sperm deoxyribonucleic acid (DNA) damage post varicocelectomy, has brought about new prospects in treating men with infertility. Improvements in spermatogenesis with decrease in sperm DNA damage has been demonstrated which has led to significant enhancement in fertility rates. Therefore, we evaluated the efficacy of microscopic varicocelectomy on the reduction in sperm DNA damage in concurrence to the conventional improvement of semen parameters. Methods: All patients with a diagnosis of varicocele leading to infertility and planned for microscopic varicocelectomy from January 2013 through September 2019, were included in the study. Sperm chromatin structure assay (SCSA) was done preoperatively and at 3 and 6 months postoperatively for sperm DNA integrity assessment and the results expressed as sperm percentage DFI were compared. A p value <0.05 was considered statistically significant. Results: 105 infertile men underwent microscopic varicocelectomy. Mean age and infertility period from the date of unprotected sex were 26.5±5.6 years and 30 months respectively. Baseline mean sperm concentration was 29 million/ml, mean progressive motility 24% and a percentage DFI ranged from 5–36% with a mean of 16%. Sperm DNA integrity improved significantly with a DFI decrease from 25±11% to 18±6%, 3 months post-surgery which was consistent at 6 months (13±5%). Sperm concentration and progressive motility increased with a mean sperm count improvement by 21.9 million/ml and mean motility by 20.3%. Conclusions: Microscopic varicocelectomy provides durable improvement in DNA integrity and semen parameters. Sperm DNA integrity assessment using SCSA is a useful tool to demonstrate change in the semen quality post treatment.

Nomograms for Predicting Postoperative Sperm Improvements in Varicocele Patients

BackgroundVaricocele is a condition that seriously affects male fertility. It can cause pathological changes in the testicles and affect their spermatogenesis and endocrine function. ObjectiveTo formulate nomograms to predict sperm improvements after microscopic varicocelectomy. Design, setting, and participantsA retrospective analysis was conducted on varicocele patients who met the research criteria and were enrolled from March 2020 to June 2022. They were divided into a development and a validation cohort in a 2:1 ratio. Outcome measurements and statistical analysisData on preoperative testicular atrophy index, bilateral testicular elastic modulus, testosterone, pre- and postoperative 6-mo total sperm count, sperm concentration, and sperm vitality were collected. An increase of ≥25% is considered a postoperative improvement in sperm parameters. Predictive nomograms were constructed through forward stepwise LR regression, based on independent risk factors filtered by univariate and multivariate logistic regression analyses. Receiver operating characteristic curve analysis, calibration curve, and decision curve analysis were employed to assess the performance of the models. Results and limitationsThe areas under the curve of nomograms for predicting the postoperative improvement of total sperm count, sperm concentration, and sperm vitality were 0.915, 0.986, and 0.924 respectively. The nomogram models demonstrated good predictive performance. The single-center sample size was a limitation of this study. ConclusionsIn this study, we developed effective predictive nomogram models for anticipating postoperative improvements in sperm quality among varicocele patients. These models offer a significant value in providing accurate predictions of surgical outcomes. However, it is crucial to conduct further external validation. Patient summaryIn this study, a predictive nomogram model was constructed for assessing the improvement of sperm quality in varicocele patients after surgery. The model offered satisfactory results.

Effect of Microsurgical Varicocele Repair on Sperm Capacitation and Probability of Generating a Pregnancy as Measured by Pre and Postoperative Novel Testing With Cap-Score

To study whether varicocele repair would improve sperm capacitation and probability of generating a pregnancy. Data were collected prospectively from 40 consecutive adult men who presented with infertility confirmed by semen analysis (SA) and found to have a varicocele on exam or ultrasound who underwent unilateral or bilateral subinguinal microscopic varicocelectomy. We recorded pre and postoperative SA, Cap-Score, and probability of generating a pregnancy (PGP) with a 3-month follow-up. Values were compared using paired t test and Wilcox rank-sum test. Results showed a 17.4% relative increase in Cap-Score (23%-27% capacitation), 25% relative increase in PGP (24%-30%), as well as statistically significant improvements in sperm concentration, motility, and total sperm count postoperatively. This study confirms that microsurgical varicocelectomy significantly improves sperm capacitation ability and improves the expected probability of generating a pregnancy within 3 rounds of intrauterine insemination. The improvement in sperm capacitation ability may help explain how varicocele repair may improve the chance of pregnancy, regardless of standard semen parameter improvements.

Patient Satisfaction and Long-Term Clinical Outcomes in Adolescent Sub-inguinal Microscopic Varicocelectomy.

The long-term outcomes of varicocelectomy in adolescents is debated. The aim of this study was to evaluate symptom improvement, hypogonadism, and paternity in those who underwent adolescent sub-inguinal microscopic varicocelectomy. A retrospective chart review was done of adolescents (median=19, interquartile range (IQR)=16-19.75 years) who underwent microscopic varicocelectomy between 2011 and 2021. Demographics, surgical indications, and outcomes were collected, as well as pre- and postoperative hormone levels and semen parameters. A questionnaire was prospectively collected to evaluate orchialgia, paternity, and symptoms of hypogonadism. Descriptive statistics and t-tests were performed, with significance assessed at p-value < 0.05. A total of 46 adolescents were included. Age at the time of diagnosis and surgery was 19 (IQR=16-20) and 19 (IQR= 18-21) years, respectively. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), and total testosterone were not affected after surgery. Similarly, semen parameters were preserved after varicocelectomy, with median concentration increasing from 12x106/ml to 16x106/ml but not reaching significance (p=0.272). A total of 26 men completed the questionnaire. The age of responders was 22 (IQR=21-24) years, and the time after having had the varicocelectomy was 36.5 (IQR= 18.25-62.25) months. Orchialgia persisted in five men, and three reported having a recurrence. Two men, who had a preoperative abnormal semen analysis, were actively trying to have children and reported successfully having achieved natural pregnancies. None of the patients reported having hypogonadism, and none were receiving testosterone therapy. Our study suggests that microscopic varicocelectomy in adolescents appears to be a safe and feasible procedure with a low rate of syndrome recurrence and no association with symptoms or biochemical evidence of hypogonadism.

Effect of physical activity level and occupation on resolution of pain after varicocelectomy: A prospective clinical study

Introduction and objectivesPersistent scrotal pain after varicocelectomy is stressful for both surgeon and patient. The number of researches focusing on which patient will benefit more from the operation is increasing in the literature. In this prospective study, we aimed to investigate whether the patient's physical activity levels and occupations affect the success of varicocelectomy in terms of pain relief. Materials and methodsThe data of 176 patients who underwent subinguinal microscopic varicocelectomy were analyzed according to BMI, age, varicocele grade, laterality, duration of pain, testicular volume difference, quality of pain, level of physical activity, and profession. The International Physical Activity Questionnaire was used to evaluate the level of physical activity. Patients were grouped as inactive, moderately active, and active according to this scale. Visual analog scale (VAS) scores of the patients were recorded before and after the procedure. Results135 patients (76.7%) reported complete resolution of their pain. Partial resolution of pain was observed in 34 patients (19.3%). Seven patients (4%) complained of the same pain level. Univariate analysis showed that patient occupations and physical activity levels significantly affected the pain level (p=0.041, p=0.032, respectively). In the multivariate analysis, only physical activity levels of the patients were statistically significant in predicting the resolution of pain (p=0.024). ConclusionsPatients with low physical activity levels who underwent microscopic varicocelectomy surgery are less likely to have postoperative pain.

(524) Adolescent Varicocelectomy: Long-term Follow-up of Clinical Outcomes and Patient Satisfaction

Abstract Introduction Worldwide 10–15% of male adolescents have a varicocele, which is the most common surgically correctable cause of male subfertility. In young adult men, varicocele can be associated with smaller testis volume and abnormal semen parameters. However, there is still controversy in whether surgical repair has better long-term outcomes than just active surveillance. Objective To evaluate satisfaction, symptoms improvement, hypogonadism, and paternity in patients who underwent varicocelectomy when they were adolescents. Methods We performed a retrospective chart review of adolescents undergoing varicocelectomy from 2011-2021. Inclusion criteria were having primary varicocele, having 12-21 years at time of surgery, having had the varicocelectomy &amp;gt;1-year ago, ≥1 postoperative visits, and having answered the questionnaire. Exclusion criteria were having a diagnosis of secondary varicocele (renal malignancy or venous abnormality) and incomplete records. Data about clinical, surgical, and postoperative outcomes were gathered. Patients were contacted by phone and were asked about orchialgia, paternity, varicocele recurrence, diagnosis and treatment for hypogonadism, and satisfaction after surgery. Descriptive analysis and paired t-test were used, statistical significance was assessed at p&amp;lt;0.05. Results From a total of 50 patients meeting the inclusion criteria, we were able to contact 23 patients. The mean age at varicocele diagnosis was 17.43±2.52 years. Varicocele was grade 3 in 16 (69.6%) patients and left-sided in 17 (73.9%) patients. Eight (34.8%) patients had a preoperative testicular ultrasound, that in 2(25%) patients showed testicular volume discrepancy &amp;gt;20%. At the physical exam, 6(26.1%) patients were found to have asymmetric testicles. Overall, 2(8.7%) patients had a previous varicocele repair and 7(30.4%) had a preoperative abnormal semen analysis. Mean age at surgery was 18.78±2.02 years. Microscopic varicocelectomy was performed in 22 (95.7%) patients, mainly in the left-side (78.3%). Pre- and postoperative FSH and T levels were done in 10 patients, without any significant difference after surgery (p=0.074 and p=0.069, respectively). Pre- and postoperative semen analysis were performed in 12 patients and showed a significant improvement in motility after varicocelectomy (p=0.022). Mean follow-up after surgery was 1.42±1.40 months. The questionnaire was performed in a mean of 3.43±2.55 months after varicocelectomy and the mean age of the responders was 22.3±3.11 years. Orchialgia persisted in 7 patients (30.4%), predominately in the left side (71.4%). None of the patients had been diagnosed with varicocele recurrence nor had required a surgical reintervention. Twenty-one (86.9%) patients were not actively trying to achieve a natural conception nor had been involved in a pregnancy after varicocelectomy. Two patients (8.7%), with a preoperative abnormal semen analysis, were able to conceive. None of the patients referred to have hypogonadism nor being under testosterone therapy. The majority of patients (86.9%) referred to be satisfied with the postoperative results. Conclusions Our results suggested that long-term outcomes of varicocelectomy in adolescents would show high patient satisfaction, low rate of recurrence, no association with hypogonadism, and a significant persistence of testicular pain. Although male fertility after varicocelectomy demonstrated promising results, a longer follow-up assessment should be done when patients are actively trying to conceive, to have a more representative sample size. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Acerus, Boston Scientific, Endo Pharmaceuticals and Coloplast

MP43-15 MICROSURGICAL VARICOCELE REPAIR IMPROVES SPERM CAPACITATION AND PROBABILITY OF GENERATING A PREGNANCY, AS MEASURED BY PRE- AND POST-OPERATIVE TESTING WITH CAP-SCORE

You have accessJournal of UrologyCME1 Apr 2023MP43-15 MICROSURGICAL VARICOCELE REPAIR IMPROVES SPERM CAPACITATION AND PROBABILITY OF GENERATING A PREGNANCY, AS MEASURED BY PRE- AND POST-OPERATIVE TESTING WITH CAP-SCORE Muhamed Qalawena, Eric Seaman, Jared Johnson, Ahmed El-Sakka, and Joshua Bodie Muhamed QalawenaMuhamed Qalawena More articles by this author , Eric SeamanEric Seaman More articles by this author , Jared JohnsonJared Johnson More articles by this author , Ahmed El-SakkaAhmed El-Sakka More articles by this author , and Joshua BodieJoshua Bodie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003289.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Infertility is a worldwide problem, with up to 40-50% of cases involving male infertility. Varicocele represents the most common correctable cause of male infertility. While semen analysis (SA) remains the primary diagnostic tool of infertility, it does not provide information about sperm function. The Cap-Score is designed to assess sperm capacitation via localization patterns of ganglioside GM-1, which has been shown to be a viable surrogate of capacitation-competent human sperm. The predicted probability of generating a pregnancy (PGP) is a validated metric based on semen volume, concentration, and Cap-Score. PGP is defined as the percent chance of obtaining a pregnancy within three consecutive rounds of intrauterine insemination (IUI). The objective of this study was to determine the effect of microscopic varicocelectomy on sperm capacitation and the probability of generating a pregnancy. METHODS: Data were collected prospectively of 40 consecutive adult men who presented with infertility confirmed by SA and found to have a varicocele on exam or ultrasound who underwent unilateral or bilateral subinguinal microscopic varicocelectomy. We recorded pre and post-operative SA, Cap-Score, and PGP with a 3-month follow up. Values were compared using paired t-test and Wilcox rank-sum test. RESULTS: Of the 40 men enrolled, 29 (72.5%) demonstrated improved Cap-Score with an average increase of 4% (p=0.001). The absolute change in probability of generating a pregnancy was 6% higher (p=0.001) after varicocelectomy, which represents a 25% relative increase in PGP. The change in Cap-Score was not associated with the grade of varicocele (p=0.0703) or whether the patient had a unilateral or bilateral repair (p=0.9682). There were no differences in semen volume (p=0.061) or morphology (p=0.091), however, there was improvement in sperm motility (p=0.021), total sperm count (p=0.030) and concentration (p=0.004). CONCLUSIONS: It is known that varicocelectomy improves semen parameters and chances of conception in the majority of cases, including pregnancies via intercourse or via assisted reproduction. This study confirms that varicocelectomy augments male fertility by improving sperm capacitation, and that varicocele repair improves the probability of generating an IUI pregnancy to a statistically-significant degree. The improvement in sperm capacitation ability may explain how varicocele repair may improve the chance of pregnancy, regardless of standard semen parameter improvements. Source of Funding: This study did not receive industry support. The only external funding for the study came from doctor M. Qalawena, a scholar visiting the University of Minnesota from the faculty of Medicine Suez Canal University, Egypt, whose personal educational grant by the Egyptian ministry of higher education funded the sixteen tests for the eight patients contributed from the University of Minnesota. Patients from the New Jersey site had received Cap-Score testing by Androvia LifeSciences Lab at patient expense. Physicians received no funding from Androvia for running the study, and the Androvia Labs did not have editorial control of the study results © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e607 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Muhamed Qalawena More articles by this author Eric Seaman More articles by this author Jared Johnson More articles by this author Ahmed El-Sakka More articles by this author Joshua Bodie More articles by this author Expand All Advertisement PDF downloadLoading ...

Do YouTube videos on microscopic varicocelectomy provide reliable information?

This study aimed to assess the quality of YouTube videos about microscopic varicocelectomy. On November 20, 2022, a YouTube search for "Microscopic Varicocelectomy" was conducted. Non-English videos uploaded by producers for commercial purposes that lacked audio and subtitles were excluded from the study. A total of 50 videos were evaluated using the Journal of the American Medical Association Benchmark Score and the Global Quality Score, both of which are recognized internationally. Additionally, the researcher developed the Microscopic Varicocelectomy Score to evaluate the videos' technical content. The upload source, video length, number of views, likes, dislikes, and video power indexes were evaluated. The Global Quality Score, Journal of the American Medical Association Benchmark Score, and Microscopic Varicocelectomy Score of the academically prepared videos were significantly higher than those of the physician-prepared videos (p<0.05). The Global Quality Score, Journal of the American Medical Association Benchmark Score, and Microscopic Varicocelectomy Score of uploaded videos with audio, audio, and subtitles were significantly higher than those with only subtitles (p<0.05). The video duration was positively correlated with Journal of the American Medical Association Benchmark Score, Global Quality Score, and Microscopic Varicocelectomy Score. The video power index had a strong positive correlation with the number of likes. Moreover, a strong positive correlation was observed, indicating that the Global Quality Score and Journal of the American Medical Association Benchmark Score increased as the Microscopic Varicocelectomy Score increased. YouTube videos regarding microscopic varicocelectomy were of notably low quality. If the video content created by specialist physicians and academic centers is more meticulously organized, more accurate data can be transmitted. Consequently, viewing video content may not be advised based on the available data.

Mikroskopik varikoselektomi ile ilgili YouTube videolarının kalitesinin ve güvenilirliğinin değerlendirilmesi

OBJECTIVE: In this study, our aim is to evaluate the quality and reliability of Turkish videos associated with Microscopic Varicocelectomy on YouTube. MATERIAL and METHODS: YouTube’s search function was used to find videos associated with Microscopic Varicocelectomy. On January 1, 2023, systematic research was performed using the term “Microscopic Varicocelectomy”, covering the last 5 years in order to be up to date. The first 50 videos were included in the study. The quality of the videos was evaluated using the Global Quality Score (GQS). The modified DISCERN scale was used to evaluate the reliability of the videos. RESULTS: A total of 50 videos associated with microscopic varicocelectomy were analyzed. 64% videos were repaired by a urologist who deals with infertility. 56% of the medical doctors had academic titles. The most frequently discussed topics in the videos were comparison with other methods (54%), factors that increase the success of the microscopic varicocelectomy procedure (52%), success rates of the microscopic varicocelectomy procedure (30%), postoperative complications (22%) and operation time (%20). The mean GQS of the videos was 2,86±1,17. When the reliability of the sources was evaluated using the DISCERN score, the mean score of the videos was 2,57±0,84. There were no fullrated videos from DISCERN. CONCLUSION: The present study shows that the level of knowledge in Turkish sources on YouTube associated with micro TESE is at an acceptable level, but its scientific reliability is low. Therefore, short and concise videos that contain accurate and up-to-date information and refer to scientific facts in plain language should be prepared by the relevant associations. Keywords: microscopic varicocelectomy, YouTube, quality

Effects of probiotic supplementation on semen parameters after varicocelectomy: A randomized controlled trial.

The use of probiotics in the treatment of infertility is a new area of research. In this study, our objective was to examine the efficacy of probiotic supplementation on semen parameters following varicocelectomy. We included infertile men in our study who were the candidates for subinguinal microscopic varicocelectomy. After the surgical procedure, the patients were randomly assigned into two groups: 38 individuals received probiotic supplementation (FamiLact®), while 40 individuals received a placebo for 3 months. We compared the preoperative semen parameters with the postoperative parameters to evaluate the effects of probiotic supplementation. A total of 78 patients were included in the study. The two groups were similar in terms of age, body mass index, infertility period, and semen parameters at baseline (P > 0.05). A statistically significant difference was found in sperm concentration (33.7 ± 22.5 vs. 21.1 ± 16.1 × 106/mL, P = 0.046), and the percentage of sperms with normal morphology (15.0 ± 8.9 vs. 12.0 ± 11.5, P = 0.016) at 3 months favoring the probiotic group. Although the probiotic group exhibited higher values for semen volume and sperm motility at 3 months, the differences were not statistically significant (P = 0.897 and P = 0.177, respectively). Our study demonstrates that the short-term use of probiotics after varicocelectomy can provide additional benefits in improving semen parameters. Probiotic supplements are cost-effective and well tolerated, making them a suitable option for enhancing the outcomes of varicocelectomy.

Varikoseli olan hastalarda nötrofil/lenfosit oranı (NLR), platelet/ lenfosit oranı (PLR), monosit/eozinofil oranı (MER) gibi enflamatuvar belirteçlerin varikoselektomi sonrası spermiogram parametrelerinin değişimine etkisini öngörme

OBJECTIVE: In this study, we aimed to predict the changes in postoperative spermiogram parameters in patients who underwent varicocelectomy by using pre- and post-operative hemogram parameters and inflammatory blood markers. MATRERIAL and METHODS: 25 patients who underwent microscopic varicocelectomy in our clinic and met the study criteria were included in the study. Hemogram parameters were measured just before and twenty (20) days after the surgery, and spermiogram parameters were measured 6 months after the surgery. The patients seperated into two groups. Patients with &gt;50% improvement in postoperative Total Motile Sperm Count (TMS) were included in the recovered patients group, and patients with less than 50% improvement were included in the non-recovered patients group. Neutrophil / lymphocyte ratio (NLR), platelet / lymphocyte ratio (PLR), monocyte / eosinophil ratio (MER), and blood counts such as neutrophil, lymphocyte, platelet, monocyte, eosinophil were compared in groups, also were compared before and after surgery, separate RESULTS: Improvement in TMS was observed in patients with a statistically significant decrease in postoperative NLR (p = 0.009; p &lt;0.01). As a result of the calculations, cut-off point for the NLR change was accepted as 1.06% and above. PLR and MER parameters were not statistically significant in predicting the improvement of TMS. Among the neutrophil, lymphocyte, platelet, monocyte, eosinophil counts, preoperative neutrophil and preoperative monocyte counts were found to be higher in patients with postoperative TMS improvement. Cut-off points for these preoperative neutrophil and monocyte counts were calculated as 3.77 and 0.47, respectively. In our study, we could not reach any statistically significant result for lymphocyte, eosinophil and platelet counts. CONCLUSION: Preoperative and postoperative results of NLR, neutrophil or monocyte counts can be used as a marker to predict improvement in TMS. Keywords: varicocele, NLR, PLR, MER, inflammation

Nomogram for Predicting Semen Parameters Improvement after Microscopic Varicocelectomy in Infertile Men with Abnormal Semen Parameters.

Information on the prediction of improved semen parameters following varicocelectomy is scarce and mostly contradictory. Therefore, we developed and validated a nomogram to predict whether abnormal semen parameters in infertile men could improve following microscopic varicocelectomy (MSV). From January 2018 to December 2021, 460 consecutive patients who underwent MSV were included. Of them, 336 patients as a development cohort at the Xiang Hua institution. As a validation cohort, Hu Nan Center (124 patients) was used. Clinicopathologic patient information was recorded. The likelihood ratio test using Akaike's information criteria was employed as the stopping rule, and multivariate logistic regression was utilized to create a prediction model with regression coefficients. The effectiveness of this prediction model was evaluated based on its ability of discrimination, calibration, and clinical utility. The initial total progressively motile sperm count (TPMSC) and vein diameter were predictors of this model. The model demonstrated strong discrimination for the validation cohort, with an area under the receiver operating characteristic (AUROC) of 0.925 (p &lt; 0.001), and strong calibration (unreliability test, p = 0.522). The decision curve study proved the model's clinical applicability. According to our research, the improvement of semen parameters in infertile men following MSV was significantly predicted by greater vein diameter and higher initial TPMSC. This nomogram aids in individualized decision-making on the varicocele preoperative treatment plan and may help to enhance the therapeutic result.

Prospective Randomized Controlled Trial Comparing Laparoscopic Palomo Surgery versus Scrotal Antegrade Sclerotherapy in Adolescent Varicocele.

Varicocele is a common condition in adolescence and the most common correctable cause of infertility. This study aimed to analyze and compare the outcomes of scrotal antegrade sclerotherapy (SAS) and laparoscopic Palomo surgery (LPS) in a tertiary referral centre. Patients with left grade 3 varicocele indicated for surgery were prospectively enrolled and randomly allocated to the SAS and LPS groups, with their respective contralateral normal testes taken as controls. The primary outcome measures were clinical varicocele recurrence, testicular catch-up growth, and post-operative hydrocele. All patients were evaluated clinically and using Doppler ultrasound by radiologists. From 2015 to 2020, 113 patients completed the study and were statistically analyzed (SAS, n = 57; LPS, n = 56). All patients had significantly smaller testes pre-operatively that the testicular volume differences with control testes were -23% in SAS and -19% in LPS. At 12-month follow-up, there were no statistical significant difference in clinical recurrences between the 2 groups (SAS = 5.3% vs LPS = 5.4%, P>.05, non-inferiority test). Testicular catch-up growths were observed in both groups, the mean testicular volume difference between the treatment and control testes reduced from -23% to -8.1% in SAS (P<.001) and -19% to -9.3% in LPS (P<.001) at 12-month follow-up. There was no post-operative hydrocele in SAS compared to 7 in LPS (0% vs 13%, P = .006). Both SAS and LPS are safe and effective procedures for treatment of adolescent varicocele with significant positive effect on testicular catch-up growth. SAS is not inferior to LPS in terms of clinical recurrence rate and with significantly less post-operative hydrocele.

Prospective Comparison of Local Anesthesia with General or Spinal Anesthesia in Patients Treated with Microscopic Varicocelectomy.

It is unclear whether local anesthesia (LA) is a viable and safe alternative to general anesthesia (GA) or spinal anesthesia (SA) for microscopic varicocelectomy. As a result, we designed a prospective trial to compare the pain relief, complications, and cost of LA with GA or SA in subinguinal microscopic varicocelectomy (MSV), using the propensity score matching method (PSM). This prospective study was conducted in a tertiary hospital from February 2021 to April 2022. Patients who underwent subinguinal MSV for varicocele were enrolled. The perioperative visual analog scale (VAS) scores, anesthesia-associated side effects, and cost data were recorded, and PSM analysis was performed. Finally, 354 patients were included, of whom 61.0% (216) were treated with LA, and 39.0% (138) underwent GA or LA. After PSM, the patients in the LA group exhibited lower VAS scores both three hours and one day after surgery, and a lower incidence of postoperative analgesic requirement; a lower ratio of patients who experienced anesthesia-associated side effects was also observed in the LA group, compared with the GA or SA group (all p &lt; 0.001). The rate of perioperative satisfaction for patients was higher, the hospital stays and days to return to normal activity were shorter, and the cost was less in the LA group than in the patients in the GA or SA group (all p &lt; 0.001). This prospective PSM cohort demonstrated that LA has the advantages of perioperative pain relief, reduced anesthesia-associated side effects, and cost, compared with GA or SA. It indicated that LA is an effective and safe technique for subinguinal MSV, and may guide clinical practice.

Nomogram for predicting spontaneous pregnancy after microscopic varicocelectomy in infertile men with normal hormone

IntroductionThe current challenge for the treatment of varicocele is identifying patients who could benefit the most from surgery. We aimed to develop and validate a nomogram for predicting spontaneous pregnancy following microscopic varicocelectomy in infertile men, based on a large cohort.MethodsTwo hundred eighty-two consecutive patients who underwent microscopic varicocelectomy from January 2018 to December 2020 were enrolled as participants in the study. Xiang Hua center (206 patients) as a development cohort. Hu Nan center (76 patients) as a validation cohort. Patient clinicopathologic data were recorded. Multivariate logistic regression was used to build a predictive model with regression coefficients. Then, backward stepwise selection was applied, and the likelihood ratio test with Akaike’s information criterion was used as the stopping rule. The performance of this predictive model was assessed for discrimination, calibration, and clinical usefulness.ResultsPredictors of this model included the age of female partners, diameter of veins, initial and increased total progressively motile sperm count. The model demonstrated good discrimination with an AUROC of 0.925 (p < 0.001) and calibration (Unreliability test, p = 0.522) in the validation cohort. Furthermore, the model was clinically useful, according to decision curve analysis.ConclusionsOur findings indicated that younger female partners, larger diameter of veins, higher initial and increased total progressively motile sperm count were significant predictors of spontaneous pregnancy in infertile men, post microscopic varicocelectomy. This nomogram may assist in individual decision-making on the treatment strategy of varicocele preoperatively and improve the treatment outcome.

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.

Long-term efficacy of varicocele repair in middle-aged men with erectile dysfunction (ED) and low testosterone: Five cases with follow-up from 16 to 60 months

We report five cases of middle-aged men with low testosterone levels and erectile dysfunction (ED) who were successfully treated with varicocelectomy with long-term follow-up. All five patients presented to our clinic with ED. Upon initial physical examination, each patient had varicoceles on his scrotum, and two consecutive morning samplings showed testosterone levels below 400 ng/mL. Age at varicocelectomy was from 40 to 53 years. Four patients underwent microscopic subinguinal varicocelectomy, whereas one patient underwent inguinal varicocelectomy. After surgery, testosterone increased in all cases, and the normal testosterone level was maintained during follow-up (16–60 months). In addition, all cases reported improvement of ED after surgery. In our clinical cases, microscopic varicocelectomy increased serum testosterone levels and improved erectile function, and this increase and improvement continued up to a follow-up of 60 months. Varicocelectomy would be a good option to treat testosterone deficiency in men with varicocele.