Scrotal Varicocele Research Articles

Reduction of testosterone levels in Schistosoma haematobium- or Schistosoma mansoni-infected men: a cross-sectional study in two schistosomiasis-endemic areas of the Adamawa region of Cameroon

BackgroundThe incidence of schistosomiasis‐induced male reproductive dysfunction and infertility is probably underestimated compared to female genital schistosomiasis. This study aimed to investigate the impact of Schistosoma haematobium or S. mansoni infection on the reproductive function of men of reproductive age in Tibati and Wouldé, two endemic schistosomiasis areas in the Adamawa region of Cameroon.MethodsA total of 89 men of reproductive age (range 14–56 years) from two localities were enrolled in the study, with 51 in Tibati and 38 in Wouldé. Each participant was submitted to a questionnaire to document data on sociodemographic and stream contact behaviors. A medical examination was performed to measure the testes’ circumference and evaluate genital tract pathologies. Stool and urine samples were collected and screened for the presence of S. haematobium or S. mansoni ova. Blood serum was used to assess the levels of transaminases and testosterone.ResultsSchistosoma haematobium was present only in Tibati, with a prevalence of 31.37%. The S. mansoni prevalence was 3.92% at Tibati and 44.71% at Wouldé. The intensity of infection was 22.12 ± 9.57 eggs/10 mL for S. haematobium and 128.10 ± 3.76 epg for S. mansoni. Serum transaminase activity and the mean testicular circumference of Schistosoma-positive individuals were close to Schistosoma-negative individuals. However, the testes size was more prominent in S. mansoni-positive individuals than in S. haematobium-positive individuals (P < 0.05). The serum testosterone levels of S. haematobium- and S. mansoni-positive men were significantly reduced by 56.07% (P < 0.001) and 51.94% (P < 0.01), respectively, in comparison to those of Schistosoma-negative men. A significant and negative correlation was established between schistosomiasis and the low serum testosterone level. Male genital tract pathologies such as scrotal abnormalities, varicocele, nodular epididymis, inguinal hernia, and hydrocele were recorded in both Schistosoma-positive and Schistosoma-negative men. However, no significant link was established between schistosomiasis infection and these pathologies.ConclusionThese results demonstrated that infection with S. haematobium or S. mansoni is associated with low production of the reproductive hormone testosterone and may be a significant cause of male infertility.

Concomitant Occurrence of Inguinal Hernia and Scrotal Varicocele in a Diabetic Patient

Concomitant Occurrence of Inguinal Hernia and Scrotal Varicocele in a Diabetic Patient

Right-sided scrotal varicocele and its association with malignancy: a multi-institutional study.

To determine the prevalence of isolated right-sided varicocele due to an obstructing malignancy in patients with no other evidence of malignancy. This retrospective, multi-institutional study included a text search for right-sided varicocele in consecutive reports of scrotal ultrasound studies performed between 4/22/1999 and 06/24/2018. Diagnosis was confirmed by a radiologist based on the following criteria: pampiniform plexus vein diameter of ≥ 2mm, which has augmented flow or increases by ≥ 1mm on Valsalva. Inclusion criteria for adequate follow-up were (1) abdominopelvic CT or MRI performed within 3months prior to, or any time after, the ultrasound study; or (2) presence of clinical documentation more than 2years after the ultrasound date. Exclusion criteria were existing cancer diagnosis in the abdomen or pelvis, epididymo-orchitis, intratesticular or intrascrotal mass, and prior scrotal surgery. Images of available CT or MRI studies were reviewed for presence of any explanation of right-sided varicocele. 210 patients with right-sided varicocele met inclusion and exclusion criteria. 118/210 had abdominopelvic CT or MRI in the assigned timeframe. Of these, no patients had malignancy that could account for right-sided varicoceles. Of the 92/210 patients without CT or MRI but with available clinical follow-up, none had a malignancy that could have caused an isolated right-sided varicocele. There was no underlying malignancy to explain the right-sided varicocele in any of the patients, 0/210, 95% CI [0.0-1.4%]. No associated malignancy was found in patients with isolated right-sided varicoceles to support additional imaging for malignancy screening.

Varicocele and Testicular Pain: A Review.

Varicocele is the dilatation of the scrotal portion of pampiniform plexus and the internal spermatic venous system. About 15% of men suffer from scrotal varicocele and 2% to 10% of them complain of pain. The probable mechanisms for pain include compression of the surrounding neural fibers by the dilated venous complex, elevated testicular temperature, increased venous pressure, hypoxia, oxidative stress, hormonal imbalances, and the reflux of toxic metabolites of adrenal or renal origin. Testicular pain associated with varicoceles is typically described as a dull, aching, or throbbing pain in the testicle, scrotum, or groin; rarely, it can be acute, sharp, or stabbing. The management of testicular pain associated with varicocele starts with a conservative, non-surgical approach and a period of observation. Varicocelectomy in carefully selected candidates with clinically palpable varicocele resolves nearly 80% of all cases of testicular pain. Microsurgical techniques for varicocelectomy have gained popularity with minimal complication rates and favorable outcomes. The grade of varicocele, the nature and duration of pain, body mass index, prior conservative management, and the type of surgical method used, are predictors for the success of varicocelectomy.

Right ectopic intrathoracic kidney: Unusual clinical presentation in a young patient affected by scrotal varicocele

Intrathoracic kidney is a partial or complete displacement of the kidney above the hemidiaphragm into the mediastinal compartment of the thorax. It is usually seen as an incidental finding discovered on chest radiograph or abdominal ultrasound. However computed tomography consents the correct detection of intrathoracic masses and defines their shape, size, and extent. We here report a case of ectopic thoracic kidney in a 22-year-old man who had a long history of scrotal discomfort associated with right varicocele. Frequently, this ectopia does not affect renal function and the stretched ureter provides good drainage. In literature, a small number of cases shows that varicocele is a possible mode of presentation of kidney tumors, but this is the first case of varicocele secondary to intrathoracic kidney ectopia.

‘Opening a can of worms’: Bilateral varicoceles as an indicator of underlying portal-hypertension

The scrotal varicocele is a common finding encountered during clinical examination. A porto-systemic shunt presenting with an associated varicocele is exceptionally rarely reported. Herein, we report such a case in an HIV positive man who presented with bilateral varicoceles. This is only the fifth case of such an association in the world literature. A literature review and the possible underlying pathophysiological mechanisms of this rare association are expanded further.

Is There a Co-Association Between Renal or Retroperitoneal Tumours and Scrotal Varicoceles? A Systematic Review

Scrotal varicoceles, which are relatively common, are sometimes caused by venous flow disturbance resulting from a renal or retroperitoneal tumour. Consequently, it is common practice to perform ex...

Ultrasonography of tubular ectasia of the rete testis with associated scrotal findings.

Tubular ectasia of the rete testis (TERT) is a rare disorder that can be seen on ultrasonography (US) during a routine examination. In this study, we aim to discuss 15 cases of TERT and concomitant scrotal pathologies. A total of 405 patients who were admitted to our department between March 2009 and December 2011 for scrotal US with different complaints such as scrotal pain, palpable mass, infertility, varicocele, or hydrocele were evaluated. Presence or absence of TERT and associated scrotal anomalies if TERT was present were considered on gray-scale US and color Doppler US. Tubular ectasia of the rete testis was detected in 15 patients (3.7%). It was unilateral in eleven patients (73.3%) and bilateral in four patients (26.7%). The mean age of the patients with TERT in this study was 43.7years (range 24-85years). Five patients (33.3%) with TERT presented with infertility, four of them (26.7%) presented with palpable mass, and six of them (40%) were admitted with scrotal pain. In 14 patients (93.3%), at least oneof the following disorders associated with TERT was seen: epididymal cyst, spermatocele, hydrocele, and varicocele. Tubular ectasia of the rete testis shows characteristic appearances on gray-scale and Doppler US evaluation, and no other modality is necessary for diagnosis. TERT is usually associated with epididymal pathologies such as epididymal cyst or spermatocele located on the same side. Testicular neoplasms, intratesticular varicocele, and cystic dysplasia of the testis should be considered in the differential diagnosis of TERT.

Case 17-2008

A 63-year-old man was admitted to this hospital because of a mass in the left kidney, associated with abdominal pain, weight loss of 3.2 kg, and cough. Physical examination disclosed scrotal varicoceles; imaging studies disclosed a mass in the left kidney, a mass in the left adrenal gland, and multiple pulmonary nodules. A diagnostic procedure was performed, and management decisions were made.

Soluble Fas and gonadal hormones in infertile men with varicocele

To assess gonadal hormones in serum and semen as well as seminal antiapoptotic factor; soluble fibroblast associated (sFas) in infertile men associated with scrotal varicocele. Prospective. Academic setting. Eighty-eight males: fertile healthy controls (Gr1, n = 12), fertile normozoospermia with varicocele (Gr2, n = 31), and infertile oligoasthenozoospermia with varicocele (Gr3, n = 45). Serum and seminal gonadal hormones: follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), and testosterone (T), in addition to seminal sFas. There were significant higher mean levels of serum FSH, serum, and seminal LH with significant lower seminal T levels in cases of Gr3 compared with Gr2. Mean seminal sFas in Gr3 were significantly higher than its levels in Gr1 and 2 (mean +/- SE 8.34 +/- 0.36 vs. 6.8 +/- 0.53 and 6.06 +/- 0.39 ng/mL, respectively). Nonsignificant differences between serum and seminal gonadal hormones were elicited between Gr2 and controls. Seminal sFas in various varicocele grades demonstrated nonsignificant differences. There were significant positive correlations between seminal sFas with serum FSH, serum LH, semen FSH, sperm abnormal forms percentage, and significant negative correlations with sperm concentration and sperm motility. sFas could play a role in germ cell apoptosis in varicocele-associated cases.

Seminal mast cells in infertile asthenozoospermic males

This work aimed to assess the possible association between the presence of seminal mast cells and asthenozoospermia. One hundred and seventy-six male subjects were investigated: group (Gr)1 (n=46) normozoospermic fertile controls, Gr2 (n=62) idiopathic asthenozoospermia, Gr3 (n=32) asthenozoospermia with scrotal varicocele and Gr4 (n=36) asthenozoospermia with leucocytospermia. Four smear slides were prepared for each semen sample to be stained with toluidine blue-pyronin to detect mast cells. A significant increase was shown in mast cell-positive samples among varicocele-associated and idiopathic asthenozoospermic patients in comparison with fertile controls. Seminal mast cells were also detected at higher frequency among smokers and in age group over 40 years. It is concluded that mast cells and their products may play a pivotal role in the pathogenesis of asthenozoospermia, possibly proposing a new goal for medical treatment of infertile males to pursue. In addition, this concept may in a way detain smoking as a cause of male infertility considering the clear abundance of mast cells in semen samples of smokers.

Treatment of Bleeding Varicose Veins of the Scrotum With Percutaneous Coil Embolization of the Left Spermatic Vein: A Case Report

Percutaneous coil embolization of the spermatic vein offers a minimally invasive method for treating symptomatic varicose veins of the scrotum. We describe the case of a 63-year-old man with multiple comorbidities and persistent bleeding from scrotal varicosities. Venography revealed significant left spermatic vein reflux and a large left varicocele. Percutaneous coil embolization of the left spermatic vein completely resolved the bleeding from the left side of the patient's scrotum. Although many vascular specialists possess the technical skills to perform this procedure, they may not be familiar with its use in the treatment of scrotal varicosities and varicoceles.

?-1,4-Glucosidase activity in infertile oligoasthenozoospermic men with and without varicocele

This work aimed to assess seminal alpha-1,4-glucosidase activity in infertile oligoasthenozoospermic men associated with and without scrotal varicocele. Eighty men were investigated. They were divided into three groups: group 1 (n = 20), fertile normozoospermic men; group 2 (n = 30), oligoasthenozoospermia with varicocele; and group 3 (n = 30), oligoasthenozoospermia without varicocele. The patients underwent medical history, clinical examination, conventional semen analysis and estimation of seminal plasma alpha-1,4-glucosidase activity by double-beam spectrophotometer method and serum testosterone by radioimmunoassay method. There was a significant decrease in the mean seminal alpha-1,4-glucosidase activity levels in infertile men versus controls (mean +/- SD; 7.66 +/- 0.433, 2.088 +/- 0.565, 5.384 +/- 0.85 mU ml(-1) respectively). Mean serum testosterone levels demonstrated nonsignificant differences between studied groups. Seminal alpha-1,4-glucosidase activity levels demonstrated significant correlation with sperm count, sperm motility percentage and serum testosterone in oligoasthenozoospermia with varicocele group and demonstrated nonsignificant correlation in other groups. It is concluded that varicocele-induced hypoxia is the adverse effect that causes both oligoasthenozoospermia and decreased seminal alpha-1,4-glucosidase levels.

A Proposed Anatomic Typing of the Right Internal Spermatic Vein: Importance for Percutaneous Sclerotherapy of Varicocele

When, in 1975, I successfully performed my first left spermatic vein sclerotherapy [1], I was a young doctor and I didn’t know that scrotal varicocele could produce infertility. Moreover, I had never imagined that this simple and personal technique could, in such a short time, become a very interesting but controversial subject for so many medical specialists, such as andrologists, urologists, androurologists, gynaecologists, surgeons, endocrinologists, and interventional radiologists, therefore causing many endless discussions. I am replying to you because I believe that young interventional radiologists must not be so excited by an excessive therapeutic enthusiasm; I think they should be free to establish the most appropriate therapy and rational indications. Scrotal varicocele represents an important social and sanitary problem, affecting approximately 15%–20% of young males; reversible infertility (subfertility) and, sometimes, irreversible testicular damage are observed in 20%–40% of them. The remaining 60%–80% with clinically manifested varicocele do not have fertility problems. Since we are dealing with high numbers (about 150,000 males per million) and since the varicocele is bilateral in 70% of cases, then we should treat approximately 60,000 (40% of 150,000) varicoceles on the left and 42,000 (70% of 60,000) on the right side, amounting to 102,000 per million males. Such a huge number is obviously not conceivable even in rich countries! Nevertheless, we should always keep in mind that infertility is primarily attributed to female causes (58% of cases), whereas male causes amount only to 25% of cases, while in 17% of couples it is unexplained. My clinical maneuver, performed always with ultrasound (US) color Doppler examination, deliberately ignores the question of the so-called ‘‘subclinic varicocele’’! We recommend the use, for US assessment, of the five degrees of Sarteschi’s classification [2], in which the first degree concerns subclinical varicocele, characterized only by upper inguinal reflux without scrotal pampiniform plexus dilations. Moreover, in my opinion and in many others’, subclinic varicocele is not considered one of the causes of male infertility. In fact, when I was invited to the III World Congress of Andrology in Tel Aviv (Israel), to give a lecture at the ‘‘Varicocele Symposium’’ [3], I found an unanimous consensus among the most important andrologists of the world to avoid treating not only subclinic but also small varicoceles. This consensus has been recently confirmed by Nagler [4]. On the other hand, it is obvious that a high US grade (5th) left scrotal varicocele is very often the cause of the so-called ‘‘false bilateral varicocele,’’ characterized by dilation of the right pampiniform plexus due to anasthomotic trans-septal vessels [5]. In these cases the right dilation spontaneously disappears after treatment of the left side. In fact, in the case of the left and low-degree varicocele, we never see a bilateral dilation, except in the true bilaterality. This condition can explain why 60%–80% of clinically manifested left varicoceles are curiously fertile, probably because of the lack of scrotal trans-septal collateral veins to the other side, because only the left testis is functionally V. Iaccarino Department of Radiological Sciences, Faculty of Medicine, University of Naples ‘‘Federico II,’’ Naples, Italy

P-607: Varicocele size and scrotal Doppler sonography

Though little difficulty is encountered in the identification of large or moderated-sized varicoceles, diagnosis of scrotal varicocele depends on an accurate physical exam. It has been reported that small varicoceles may impair spermatogenesis as often as the larger varicoceles, so it is important to diagnose the varicocele that could otherwise go unnoticed. The debate on treating all degrees of varicocele is ongoing; many authors suggest that scrotal Doppler sonography could be a useful ancillary tool in the diagnosis of varicoceles.

“Scrotal varicocele, exclude a renal tumour”. Is this evidence based?

A scrotal varicocele is a common finding during both a scrotal clinical examination or during the course of a scrotal ultrasound examination and invariably found in the left hemiscrotum. Traditionally when a scrotal varicocele is found, the referring clinician requests a renal ultrasound examination or the sonographer extends the examination to include a renal examination; to exclude a retroperitoneal or renal tumour as the cause for the varicocele. The present article examines the relevance of performing the extended ultrasound examination by reviewing the pathophysiological pathways for the development of a varicocele in the presence of a renal or retroperitoneal tumour; the prevalance of co-existing renal or retroperitoneal tumours and a varicocele; and the male population in whom this extended examination may be necessary. The conclusion from available evidence suggests that a retroperitoneal tumour will manifest in other ways before the development of a varicocele, the young patient with a varicocele will almost never have a retroperitoneal tumour, and only when a varicocele develops in an older patient will an extended examination be relevant. Even then it will be a rare finding and there will be other clinical manifestations of the primary tumour.

Sonographic Quantitative Evaluation of Scrotal Veins in Healthy Subjects: Normative Values and Implications for the Diagnosis of Varicocele

ObjectivesTo define the normative values of scrotal vein diameters, investigate the eventual presence and characteristics of scrotal reflux in healthy subjects, and describe its implication for the diagnosis of scrotal varicocele. MethodsColor-Doppler ultrasonography was performed on a population of 145 healthy, symptomless subjects, with clinical examinations and semen analyses within normal limits. ResultsThe upper limit of the scrotal veins diameter (3.7–3.8mm) exceeds values presently employed for a diagnosis of varicocele. Furthermore, a high percentage of healthy subjects (53%) were found to have reflux in the scrotal veins, currently considered one of the criteria for diagnosing varicocele, especially in its subclinical form. ConclusionsTo reduce the risk of misinterpretations between the various specialists involved in Color-Doppler ultrasonography and urologists, quantitative data of the scrotal veins (i.e., maximum diameter and the presence, velocity, and duration of reflux) should be described in reports of sonographic examinations performed for scrotal varicocele.

The incidence and significance of testicular microlithiasis in a subfertile population.

The objective of this study was to assess the frequency of testicular microlithiasis (TM) in infertile men who underwent testicular ultrasound and to determine any causative or associated factors. The case notes of 159 consecutive patients who were referred for testicular ultrasound in the investigation of male factor infertility were reviewed. Microcalcification was found in 10 cases (6.2%). This was unilateral in all cases and six patients had clinical evidence of a varicocele. Five cases had minimal calcification and five had marked TM. On patient had a past history of testicular maldescent and another of testicular torsion. Sperm function (as assessed by sperm count, motility and the sperm migration test) was variable within the 10 patients and there was no correlation with hormone profiles or testicular size. There was a statistical difference between a number of investigations in those patients with minimal degrees of calcification and those with TM (sperm migration test (SMT), namely sperm migration and sperm motility (p < 0.05, Mann-Whitney U test)). The results showed a higher than expected incidence of TM. Patients with marked TM seemed to have poorer sperm function than those with minimal calcification. There was a high incidence of co-existing pathology, for instance scrotal varicocele and cryptorchidism, although the numbers in this study were small and further studies need to be carried out to determine the exact nature and significance of this condition.

Testicular microlithiasis: association with male infertility.

We studied the frequency of testicular microlithiasis (TM) in a select group of otherwise healthy infertile men with abnormal semen. We reviewed scrotal sonography records of 180 consecutive patients with abnormal semen who were referred for evaluation of male infertility. The pampiniform plexus was evaluated for possible varicocele, and the testes were examined for the presence or absence of intratesticular calcifications and/or masses. Five patients with more than 5 echogenic foci per transducer field in either testis were identified. The medical records and sonograms of this subgroup of patients were analyzed. Of the 180 patients, 5 (2.8%) had TM. Three patients with TM had concomitant small varicoceles; 2 others had a history of testicular maldescent. Two patients eventually became fertile. Our results indicate a higher than expected frequency of TM in otherwise healthy infertile men. We speculate that the magnitude of hypospermatogenesis in patients with TM is variable and may relate to both the degree of testicular dysgenesis and the presence or absence of concomitant scrotal pathology (eg, scrotal varicocele and cryptorchidism).

Comparison of Laparoscopic and Open Ligation of the Testicular Vein

Scrotal varicoceles undoubtedly contribute to subfertility in an as yet undefined group of patients. The best method of treatment of varicoceles, however, remains controversial. Laparoscopic testicular vein ligation has recently been offered as a new option. We examined the feasibility of laparoscopic testicular vein ligation (n = 11) compared with standard high ligation (n = 11). The mean post-operative stay in the open group was 25.6 h compared with 7.1 h in the laparoscopic group. Analgesic requirements were a mean of 4.73 Co-proxamol tablets for the open group and 0.18 tablets for the laparoscopic group. All operations were successful. Laparoscopic ligation of the testicular vein is an effective treatment of varicocele with decreased post-operative morbidity.