Spermatic Vein Diameter Research Articles

Shugan Tongluo Qiangjing recipe protects against varicocele of EVC rats through modulating sperm DNA damage, telomere expression and oxidative stress

Varicocele (VC) refers to expansion and tortuosity of spreading venous plexus in spermatic cord due to poor blood flow. This study aimed to investigate effects of Shugan Tongluo Qiangjing recipe (SGTL) on sperm DNA damage and oxidative stress in experimental VC (EVC) rats. EVC model was established by partial ligation of left renal vein. Spermatic vein diameter, testicular weight, sperm DNA fragmentation index (DFI) were evaluated. Telomere reverse transcriptase (TERT) expression, telomere gene transcription, and testicular tissue morphology were determined·H2O2, catalase, SOD, T-AOC were measured with colorimetry. SGTL significantly decreased spermatic vein diameter (P=0.000) and increased testicular weight (P=0.013) of rats compared those of EVC rats. SGTL maintained testicular tissue morphology in EVC rats. SGTL markedly reduced sperm DFI value in sperm of rats compared to EVC rats (P=0.000). SGTL significantly enhanced TERT expression and telomere gene transcription (P=0.028) in testis of rats compared to EVC rats. SGTL reduced H2O2 levels (P=0.001) and promoted CAT activity (P=0.016), SOD activity (P=0.049), and T-AOC activity (P=0.047) of rats, compared to EVC rats. In conclusion, SGTL could reduce pathogenic process of EVC by reducing sperm DNA damage and regulating telomere length in EVC rats, which may be related to oxidative stress regulation.

Echocardiographic and hemodynamic changes in patients with high-grade varicocele.

Varicocele is abnormal tortuosity and dilatation of the pampiniform plexus veins within the spermatic cord. Varicocele is associated with testicular atrophy, hypogonadism, impaired semen analysis values, or decreased testosterone production. Varicocele is a progressive disease and should be treated because it may be a systemic disease that can be associated with cardiovascular abnormalities. We hypothesize in this study that cardiovascular and hemodynamic pathologies may occur in varicocele patients. In this prospective, multicentric, multidisciplinary study, patients diagnosed with high-grade left varicocele in the urology clinic underwent semen analysis, total testosterone determination, and scrotal Doppler ultrasonography. In addition, blood pressure measurement and echocardiographic evaluation were performed by blinded cardiologists in both the varicocele patients and the healthy control group. The study was carried out with 103 varicocele patients and 133 healthy individuals who formed the control group. Diastolic blood pressure (P = 0.016), left ventricular end diastolic (P < 0.001) and systolic diameter (P < 0.001), ejection fraction (P < 0.001), pulmonary arterial pressure (P < 0.001), and aortic distensibility (P < 0.001) values were significantly higher in varicocele patients compared with controls; interventricular septum wall thickness (P = 0.022), aortic systolic (P < 0.001) and diastolic diameter (P < 0.001), aortic systolic (P < 0.001) and diastolic diameter index (P < 0.001), and aortic stiffness index (P < 0.001) values were significantly lower in varicocele patients. The mean aortic distensibility of non-normozoospermic group was lower than that of normozoospermic group (P = 0.041). There was no statistically significant relationship between thickest vein diameter in spermatic cord and cardiological parameters. This study showed that symptomatic patients with high-grade varicocele had a higher risk of cardiovascular and hemodynamic disease. We recommend that men with high-grade symptomatic varicocele with impaired semen analysis undergo cardiovascular and hemodynamic evaluation regardless of their spermatic vein diameter.

Relationship between varicocele and platelet indices: changes of mean platelet volume before and after operation.

The correlation between the increased mean platelet volume and varicocele is controversial. We designed this research to demonstrate the correlation relationship between varicocele and mean platelet volume by studying the changes of mean platelet volume in patients with varicocele before and after operation. A total of 317 patients with left unilateral varicocele underwent operation, and 293 healthy adult males were enrolled in the study. We collected diagnostic data for preoperative patients through physical examination, color Doppler ultrasonography, and blood routine, and recorded the follow-up data at 6months after operation for varicocele. Platelet indices and the degree of varicocele or the diameter of spermatic vein correlation analysis were performed. Mean platelet volume values of preoperative and 6-month postoperative were statistically evaluated. We found that the degree of varicocele and the diameter of spermatic vein were positively correlated with mean platelet volume (p=0.001 or p<0.001). When the left unilateral varicocele patients and healthy subjects were compared, there was a significant increase in mean platelet volume (p=0.003). Mean platelet volume values of 96 varicocele patients who were cured by operation for varicocele after 6months were decreased significantly more than preoperative (p=0.039), but 32 varicocele patients of 6-month postoperative recurrence could not prove this change (p=0.930). Our research proves that mean platelet volume was positively correlated with the degree of varicocele and the diameter of spermatic vein and varicocele patients showed significantly higher mean platelet volume than healthy subjects. The mean platelet volume of varicocele patients cured by operation for varicocele after 6months was lower than before, but there was no difference in mean platelet volume between 6-month postoperative recurrent patients with preoperative.

Effects of varicocele on 4-aminobutyrate aminotransferase expression and its potential role in surgically varicocele-induced rat testes

Objective To investigate the expression of 4-aminotransferase (ABAT) and its effect on spermatogenesis in experimental varicocele rat model. Methods A total of 36 specific pathogen free (SPF) male SD rats were randomly divided into varicocele group and sham operation group, with 18 rats in each group. The experimental rat varicocele was induced by partially occluding left renal vein and completely ligating the branches of the left spermatic vein (LSV). After 4 weeks, the using hematoxylin and eosin (HE) staining, Masson and glycogen staining were used to evaluate the two groups of kidney and testis histology change, evaluation of varicocele rat model. After the model was constructed, the localization of ABAT protein in rat testis was further analyzed by immunofluorescence, and the expression of ABAT protein in varicocele was detected by Western blotting, and the possible role was analyzed. Results 4, 6, 8 weeks after the operation, the varicocele group in the kidney tissue pathological changes were not found, and the left spermatic vein diameter was greater than 1 mm [(1.52±0.23) mm vs. (0.26±0.03) mm], the weight of the left testis [(1.61±0.08) g vs. (1.93±0.11) g] and the percentage of seminiferous tubules (58% vs. 18%) were lower than the control group, which indicates that the successful construction of varicocele animal model. Immunofluorescence analysis showed that ABAT protein was mainly expressed in the cytoplasm of spermatogenic cells. Compared with the control group, with the prolonged duration of varicocele, Western blotting showed that the expression of ABAT protein was down regulated in the varicocele group, which is positive with the degree of spermatogenesis damage. Conclusion In experimental rat varicocele model, varicocele affects the expression of ABAT protein, which may be related to varicocele damage spermatogenesis. Key words: 4-transaminase; Varicocele; Rat testis

573 Effectiveness and safety of microsurgical varicocelectomy for treating nutcracker phenomenon associated varicocele

The aim of our study was to access the clinical effectiveness and safety of microsurgical varicocelectomy in the treatment of male nutcracker phenomenon associated varicocele. We retrospectively analyzed 66 patients with varicocele in our institution between August 2015 and February 2017. Patients were categorized into two groups. In group 1, 35 patients with nutcracker phenomenon associated varicocele were included. Furthermore, 25 patients underwent microsurgical varicocelectomy were classified as group 1A, and the rest 10 patients underwent microsurgical spermatic-inferior epigastric vein anastomosis were classified as group 1B. Group 2 included 31 patients with varicocele alone underwent microsurgical varicocelectomy. The preoperative serum hormone levels (E2, FSH, LH, PRL), results of scrotal ultrasound and semen analysis between group 1 and group 2 were observed no significant difference except in age, BMI, T level and peak velocity ratio. There was no significant difference in preoperative value between group 1A and group 1B. However, group 1A spent less surgical time compared with group 1B (p<0.001). Significant decreases in post-operative left internal spermatic vein diameter and the reflux time without the Valsalva maneuver were observed compared with preoperative among group 1A, 1B and 2, respectively. In addition, semen parameters significantly improved at 6 months postoperatively compared with preoperative among group 1A and 1B. But, the postoperative parameters like the results of scrotal ultrasound and semen analysis showed no statistically different among group 1A, 1B and 2.

With a new clip technique surgically inducing varicocele in Sprague-Dawley rats

BackgroundWe introduced and recreated a more consistent and effective experimental varicocele rat model by a new clip technique.MethodsA total of 40 rats were numbered and randomly assigned to 5 groups of 8 each, including sham surgery (Group I), conventional (Group II) and clip groups with 0.7, 0.8, 0.9 mm gap widths, respectively (Group III, IV, V). All of the rats in each group were sacrificed at 8 weeks after initial surgery, and the rats forming out with less than 1 mm diameter of left spermatic vein or no presence of the pampiniform plexus dilation were excluded from the experimental groups. The left spermatic vein (LSV) diameter, testicular weight, left kidney weight to body weight coefficients, kidney and testicular histology were determined.ResultsThe baseline mean diameter of the LSV in Group I, II and III was 0.22 ± 0.02, 0.23 ± 0.02 and 0.22 ± 0.03 mm, respectively (P = 0.7504). At 8 weeks after initial surgery, varicocele was successfully created in 6/8 (75%), 7/8 (87.5%), 3/8 (37.5%), 3/8 (37.5%) in GroupII-V, no varicocele was observed in Group I. In Group I, II and III, no pathological changes were observed and the left kidney weight to body weight coefficients showed no significant differences. The diameter of LSV was remarkably increased both in Group II and III compared to Group I (1.72 ± 0.13, 1.57 ± 0.19 and 0.25 ± 0.02, respectively), and Group II and III had a smaller testicular weight than the rats in Group I (1.67 ± 0.05, 1.62 ± 0.06, and 1.92 ± 0.12, respectively).ConclusionsWith a new clip technique, surgically inducing varicocele rat model becomes convenient and safe. This appears to improve the effectiveness of the model and this innovation may allow us to further understand the pathophysiology of varicocele.

Expression and significance of miR-210 in the epididymis in rats with varicocele and following varicocelectomy

Objective: To investigate the expression of microRNA 210 (miR-210) in the epididymis of rats with varicocele and changes in miR-210 expression following high spermatic vein ligation, so as to explore the significance of the surgery in treating varicocele. Methods: A total of 21 male Sprague-Dawley (SD) rats aged 7 weeks were randomly divided into control group (n=7), experimental group (n=7), and surgical group (n=7). Varicocele model was established in both the experimental and surgical groups, while only vein isolation was performed in the control group. After 8 weeks, spermatic vein diameter were measured in the control and experimental rats, and collected the left epididymis (fixed in formaldehyde and frozen in refrigerator at -80 ℃). In the surgical group, left high spermatic vein ligation was performed, and the left epididymis was collected after 4 weeks as in the control and the experimental groups. The fixed epididymis tissues were treated with HE staining for observation of tissue injuries. The miR-210 expression in the epididymis was detected with reverse transcription-polymerase chain reaction (RT-PCR). At last every group had 5 rats. Results: The pathological examination showed that the number and distribution of mature sperms in epididymal duct in the experimental group were lower and less even compared to the control group, while the two indicators in the surgical group were better than those in the experimental group. The diameter of the left spermatic vein in the experimental group and pre-treatment surgical group were significantly enlarged than in the control group (P<0.01). The expression of miR-210 in the left epididymis in the experimental group was significantly higher compared with the control group(1.32±0.06 vs 0.98±0.14, P<0.01), while the expression of miR-210 in the left epididymis in the surgical group was significantly decreased compared with the experimental group (0.96±0.16 vs 1.32±0.06, P<0.01); the difference between the control group and the surgical group was not statistically significant (P>0.05). Conclusion: The expression of miR-210 in the epididymis may be increased by varicocele and reduced after high ligation of the affected spermatic vein.

Association between Clinical and Ultrasonic Characteristics of Varicocele and Lower Extremity Varicose Vein in Men

The study investigated the association between lower extremity varicose veins in men and varicocele. A total of 100 patients who presented to the Department of Vascular Surgery in the First Affiliated Hospital of Anhui Medical University with the diagnosis of lower extremity varicose veins were included in the study group. A total of 100 adults without vascular disease were included as controls. The prevalence of varicocele between the study group and the control group was compared. We compared the prevalence of varicocele and the mean diameter of spermatic veins between the patients with and without reflux in the saphenofemoral junctions. We analyzed the association between the maximum spermatic vein diameter and the maximum diameter of lower extremity varicose veins in patients who had both lower extremity varicose vein and varicocele in the study group. According to their clinic signs, patients with lower extremity varicose veins were divided into C1-C6 by clinic sign grade of Clinical-Etiology-Anatomy-Pathophysiology (CEAP), and we investigated the trend of the incidence of varicocele and the mean diameter of spermatic veins in different grades. The patients with lower extremity varicose veins had a statistically significant (χ2=20.05, P<0.01) higher rate of varicocele when compared with controls. We compared the prevalence of varicocele and the mean diameter of spermatic veins between the patients with and without reflux in the saphenofemoral junctions and found no statistically significant differences between them (prevalence of varicocele P>0.05, diameter P>0.05). We found a linear correlation between the maximum spermatic vein diameter and the maximum diameter of lower extremity varicose veins in the patients who had both lower extremity varicose veins and varicocele in the study group (coefficient of rank correlation r=0.4072, P<0.01). The patients in the study group were classified into 6 grades by CEAP. After the analysis by trend chi-square, we found that the prevalence of varicocele had no statistical trend in different grades (χ2=0.8798, P>0.05), and the mean diameter of spermatic vein also had no statistical trend in different grades (F=1.59, P>0.05). In conclusion, we demonstrated that the prevalence of varicocele is higher in patients with varicose veins in lower extremity than the patients without vascular diseases. The reason for the association between varicose vein in lower extremity and varicocele remains uncertain.

AB113. The function of miR-210 in varicocele rats with infertility

ObjectiveTo evaluate the function of miR-210 in varicocele rats with infertility.MethodsThirty male SD rats (7-week-old) were divided into control group, experimental group and surgical group (10 rats in each group). We operate on abdominal incision, then narrow the left renal vein and ligature the vein between left spermatic vein and the left iliac vein in experimental group and operation group. The control group is exposed as the same as the experimental group, but the vein was not narrowed and ligatured. Eight weeks after modeling, we measure anesthesia spermatic vein diameter and collect the left testis and epididymis fluid. In operation group, we ligature left anesthesia. Four weeks later, we collect the same specimen as the other two groups. RT-PCR was used to test the miR-210. Western blot was used to test the expression of HIF-α.ResultsThe left spermatic vein diameter, the expression of HIF-α and miR-210 in testis and epididymis fluid in experimental group is larger than in control group. The weight of testis is lower than in control group. In operation group, the left spermatic vein diameter, the expression of HIF-α and miR-210 decreased significantly. HIF-α was positively correlated with miR-210.ConclusionsIncreased level of miR-210 is an important reason of male infertility caused by varicocele. miR-210 can be a predictor of infertility caused by varicocele and a marker of curative effect of operation. Varicocele caused male infertility may through miR-210/HIF-1α pathway.

MP70-17 RECOVERY OF SPERMATOGENESIS AFTER TESTICULAR DAMAGE VIA COLD ISCHEMIA IN RATS WITH AND WITHOUT VARICOCELES

You have accessJournal of UrologyInfertility: Basic Research & Pathophysiology1 Apr 2016MP70-17 RECOVERY OF SPERMATOGENESIS AFTER TESTICULAR DAMAGE VIA COLD ISCHEMIA IN RATS WITH AND WITHOUT VARICOCELES Aaron Bernie, Bobby Najari, Nicholas Hauser, Jennifer Reifsnyder, Brian Robinson, Barry Zirkin, Haolin Chen, Philip Li, Peter Schlegel, and Marc Goldstein Aaron BernieAaron Bernie More articles by this author , Bobby NajariBobby Najari More articles by this author , Nicholas HauserNicholas Hauser More articles by this author , Jennifer ReifsnyderJennifer Reifsnyder More articles by this author , Brian RobinsonBrian Robinson More articles by this author , Barry ZirkinBarry Zirkin More articles by this author , Haolin ChenHaolin Chen More articles by this author , Philip LiPhilip Li More articles by this author , Peter SchlegelPeter Schlegel More articles by this author , and Marc GoldsteinMarc Goldstein More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1442AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The pathophysiology of varicoceles and their effect on spermatogenesis is poorly understood. Using a cold ischemia model in rats, spermatogenesis can be temporarily disrupted. The ability to interrupt spermatogenesis and observe its recovery in the presence and absence of a varicocele could give insight into the effects of varicocele on spermatogenesis. We hypothesized that varicoceles would impair the recovery of spermatogenesis after cold ischemia. METHODS We randomly assigned 23 Sprague Dawley rats to 3 groups: sham surgery (sham), cold ischemia alone (cold-ischemia) and microsurgical varicocele creation with cold ischemia (varicocele + cold-ischemia). During the first surgery, baseline characteristics were measured. Rats then underwent sham surgery, cold-ischemia (clamping of testicular vessels, freeze to <4 degrees for 45 minutes) or varicocele + cold-ischemia based on group assignment. All rats were sacrificed at 3 months, and weight, spermatic cord and vein diameters, testicular length and weight, epididymal sperm analysis, Johnsen score, intratesticular and serum testosterone were measured. RESULTS There were no differences in the baseline characteristics between groups (p>0.05). At 3 months, the varicocele + cold-ischemia group had decreased testicular length and weight as well as increased spermatic cord and vein diameter compared to the cold-ischemia and sham groups (p<0.05). On sperm analysis, the varicocele + cold-ischemia group had lower % motility compared to the cold-ischemia and sham groups (34.9% vs 67.3% vs 75.9%, respectively, p<0.05) as well as lower Johnsen scores (4.7 in varicocele + cold-ischemia vs 8.5 in cold-ischemia and 9.5 in sham; p<0.05) on the side of the varicocele, suggesting spermatogenesis was significantly altered in the presence of a varicocele. Total intratesticular testosterone was lower in the varicocele + cold-ischemia group compared to the cold-ischemia and sham groups (104 ng vs 214 ng vs 127 ng, respectively, p<0.05). CONCLUSIONS In a rat model, the presence of a varicocele seems to impair recovery of spermatogenesis and testicular function after a testicular insult. This can be seen at the anatomic level with adverse effects on vessel and testicular measurements, as well as at the histopathologic level with decreased quality of epididymal sperm parameters and lower Johnsen scores. Lower total intratesticular testosterone also suggests a negative effect of the varicocele on the ability of the testis to recover from an insult or injury. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e913 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Aaron Bernie More articles by this author Bobby Najari More articles by this author Nicholas Hauser More articles by this author Jennifer Reifsnyder More articles by this author Brian Robinson More articles by this author Barry Zirkin More articles by this author Haolin Chen More articles by this author Philip Li More articles by this author Peter Schlegel More articles by this author Marc Goldstein More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Outcomes of experimental rat varicocele with and without microsurgery.

BackgroundExperimental rat varicocele was usually developed by the conventional technique but with varied success; and microsurgical rat varicocele model was an effective alternative. In this study we further analyzed differential outcome of experimental rat model with and without microsurgery.MethodsOne hundred and twenty male Sprague-Dawley rats were randomly assigned to two groups. In Group A, experimental rat varicocele model was developed with conventional technique. The left renal vein was partially ligated with concurrent ligation of communicating branches between the left spermatic vein and common iliac vein. In Group B, all the above procedures were finished with microsurgical manipulation under operating microscope. Before and after model development, the mean diameter of the left internal spermatic vein was compared; and at 8 weeks after initial surgery the mean sperm concentration and motility in both groups was analyzed.ResultsThe baseline mean diameter of the left internal spermatic vein in Group A and Group B was 0.14 ± 0.04 and 0.15 ± 0.03 mm, respectively (P =0.3157). In Group A 9 rats had severe complications resulting in model failure; while in Group B all rats had successful model except for one died of anesthetic accident (P = 0.008). At 8 weeks after initial surgery the mean left internal spermatic vein, sperm concentration and motility in both groups was 1.65 mm, 321.5×106/gm and 51.9%; and 1.65 mm, 318.9×106/gm and 53.5% respectively. There was nonsignificant difference of internal spermatic vein diameter, sperm concentration and motility between two groups.ConclusionsMicrosurgery makes developing experiment rat varicocele model easy. Compared with conventional technique, microsurgical rat varicocele model has higher success rate and less complication.

Real-time scrotal ultrasound of patients with varicoceles: correlation with impaired semen analysis.

To evaluate the potential relationship between scrotal ultrasound findings and abnormal semen analysis. Eighty-seven patients with varicoceles underwent semen analysis and scrotal sonography. On ultrasound, estimated testes volume and the largest pampiniform vein diameters on the affected side at rest and with Valsalva manoeuvre in both the supine and upright positions were examined. In addition, the differences between the largest venous diameters at rest and during the Valsalva manoeuvre in each position (supine and upright) and also the differences between the largest venous diameter in the supine position and the upright position in each condition (at rest and during the Valsalva manoeuvre) were calculated. The relationship between various ultrasound parameters and impaired semen analysis was evaluated using receiver operating characteristic curves. Seventy-one patients had spermatogenesis impairment, and the remaining 16 had normal semen analysis. The difference in the mean spermatic vein diameter at rest between the supine and upright positions (cut-off point, 0.25 mm) had the highest diagnostic accuracy in differentiating the patients with abnormal sperm analysis from those with normal spermatogenesis with an area under the curve of 0.86. Real-time scrotal ultrasound can be helpful in predicting abnormal sperm analysis in patients with varicoceles. Scrotal ultrasound is a non-invasive method to evaluate spermatic veins in varicoceles. Ultrasound can evaluate venous dimension change at rest after upright position (ΔD(R) ). ΔD( R) > 2.5 mm distinguishes patients with abnormal semen analysis. ΔD( R) has the most accuracy in predicting abnormal spermatogenesis. Ultrasound findings improve differentiation between patients with abnormal and normal spermatogeneses.

Is there any relationship between mean platelet volume and varicocele?

Mean platelet volume (MPV) is a parameter that is obtained from an automatic haemogram device during routine blood count and measures platelet reactivity. Increased platelet volume has been considered to be a risk factor for vascular diseases. The aim of this study was to evaluate the relationship between the presence of varicocele and the MPV, platelet count (PLT) and platelet distribution width (PDW) values. We included 264 patients with a diagnosis of varicocele in Group 1, and 220 patients with no varicocele in Group 2. The varicocele diagnosis was performed both with physical examination findings and colour Doppler ultrasonography (CDU). Mean platelet volume values were statistically significantly high (P < 0.001) whereas PLT and PDW values were statistically significantly low (P = 0.011), (P = 0.008) in the varicocele group compared with the control group respectively. However, no significant correlation was found between MPV and PDW in patients diagnosed with varicocele and the varicocele grade on examination and spermatic vein diameter on CDU. Mean platelet volume, which is used widely to measure the size of platelets and indicates platelet reactivity, can provide guidance in the investigation of varicocele pathophysiology and the relevant vascular pathologies.

Effects of acute exercise on the diameter of the spermatic vein, and duration of reflux in patients with varicocele

Objective.The aim of this study was to investigate the effects of acute exercise on the diameter of the spermatic vein, and on the duration of reflux in patients with varicocele. Material and methods. The study included 38 patients with complaints of infertility and scrotal pain between 2009 and 2010. The diagnoses were made by physical examination and colour Doppler ultrasound, with both performed before and after exercise tests. Results.The mean age of the participants was 25.7 ± 4.9 years. During the first examination, the grades of the varicoceles detected were as follows: grade I, n = 7; II, n = 10; and III, n = 21. The diameters of veins in patients with grades I, II and III varicocele were 2.1 mm, 2.9 mm and 4.2 mm, respectively, before exercise, whereas they were 2.6 mm, 3.2 mm and 4.3 mm, respectively, after exercise. In patients with grade I varicoceles, compared with pre-exercise values, the diameter of the left spermatic vein and duration of reflux measured during Valsalva manoeuvres were increased significantly after exercise (p = 0.042 and p = 0.034, respectively); similar results were obtained for the patients with grade II varicoceles (p = 0.007 and p = 0.008, respectively). However, the minimal relative increase in cases with grade III varicoceles was not statistically significant (p > 0.05). Conclusions.This study demonstrates that acute exercise increases the spermatic vein diameter and reflux time in patients with varicoceles. These outcomes demonstrate that acute exercise may be an aggravating factor for varicocele, as seen in chronic exercise.

2096 TALLER AND LEANER MEN ARE MORE LIKELY TO DEVELOP VARICOCELE

mented significant associations of MPV with type 2 diabetes mellitus, pre-diabetes, obesity, and other metabolic risk factors. The objectives of this study were to examine relationship between MPV and varicocele to clarify the etiopathogenesis of varicocele. METHODS: MPV levels were measured in 60 varicocele subjects (group I) and 57 healthy controls (group II) from 2009 to 2010. Age was were similar between two groups. The diagnosis of varicocele was based on the findings from both physical examination and color Doppler ultrasound. RESULTS: The average patient age at the time of examination was 28.12 6.4 years in group I and 28.10 5.8 in group II. Mean MPV levels were 9.59 1.58 fl in group I and 7.97 0.88 fl in group II. MPV levels were statistically significantly higer in group I than in group II (p 0.001). Positive correlations were found between the MPV and varicocele grade like as between MPV and diameter of left spermatic vein (p 0.05). CONCLUSIONS: The increase in MPV is independent of the disease, and the increase in varicocele grade is associated with higher MPV in varicocele patients. Based on the importance of the vascular component in the pathophysiology of varicoceles, we would suggest to do more studies with platelets in varicocele patients.

Relationship Between Mean Platelet Volume and Varicocele: A Preliminary Study

To examine the relationship between the mean platelet volume (MPV) and varicocele to clarify the etiopathogenesis of varicocele. MPV levels were measured in 60 varicocele subjects (group I) and 57 healthy controls (group II) from 2009-2010. Ages were similar between the 2 groups. The diagnosis of varicocele was based on the findings from both physical examination and color Doppler ultrasound. The average patient age at the time of examination was 28.12 ± 6.4 years in group I and 28.10 ± 5.8 in group II. MPV levels were statistically significantly higher in group I than in group II (P < .001). Positive correlations were found between MPV and varicocele grade as between MPV and diameter of left spermatic vein (P < .05). The increase in MPV is independent of the disease, and the increase in varicocele grade is associated with higher MPV in varicocele patients. On the basis of the importance of the vascular component in the pathophysiology of varicocele, we would suggest conducting more studies with platelets in varicocele patients.

Ultrasonographic parameters of the spermatic veins at the inguinal and scrotal levels in varicocele diagnosis and post-operative repair

Varicocele has been identified as an important cause of male infertility where its influence on men's reproductive capacity is due to its markedly diverse effects on the testicles. This study aimed to assess the value of ultrasonographic parameters of the spermatic veins at the inguinal and scrotal levels in varicocele diagnosis and post-operative evaluation. Forty-five infertile men associated with varicocele and 15 fertile men were subjected to history taking, genital examination and semen analysis. In addition, inguinal and scrotal ultrasonography was carried out pre-varicocelectomy and 3 months post-varicocelectomy. At both the scrotal or inguinal levels, the mean spermatic vein diameter demonstrated significant post-operative decrease compared with the pre-operative resting condition and on Valsalva' manoeuvre. The mean diameters of the pampiniform plexus of veins also demonstrated significant decreases post-operatively compared with the pre-operative resting condition or on Valsalva' manoeuvre. It is concluded that colour Doppler ultrasound is a reliable and noninvasive method that is useful not only for diagnosis but also for post-varicocele repair follow-up.

Escin improves sperm quality in male patients with varicocele-associated infertility

To evaluate the efficacy of escin to improve sperm quality in Chinese male patients with varicocele-associated infertility. This study included 219 male patients with varicocele-associated infertility. These patients were randomly assigned into three groups: the control, the surgery and the escin group. 106 patients, with a mean age of 30 years old and a mean period of infertility of 5.0 years, were recruited in the escin group and a daily dose of 60mg (30mg every 12h) of escin was administered orally during an uninterrupted period of 2 months. The diameter of spermatic vein was also measured using color Doppler ultrasonography before and after treatment in the escin group. Patients in all groups took composite medicines favorable for sperm quality and semen were obtained and analyzed before and after treatment. In response to treatment, the improvement rates in sperm density in the control, the surgery and the escin group, were 38.5%, 68.8%, and 57.5%, respectively. The differences in the surgery and the escin groups were significant compared to that in the control group (68.8% or 57.5% vs. 38.5%, P<0.05). The improvement rates in sperm motility in the control, the surgery and the escin group were 46.2%, 77.1%, and 55.7%, respectively. Significant difference was only observed between the surgery and the control group (77.1% vs. 46.2%, P<0.05). In the escin group, when severity of varicocele was classified to mild, moderate or severe degree according to the diameter of the spermatic vein, the improvement rates in disease severity were higher in the mild (41.7% vs. 20.0%, P<0.05) and moderate severity subgroups (64.4% vs. 20.0%, P<0.05) when compared to that in the severe subgroup (20.0%). The improvement rate in disease severity was also higher in the moderate subgroup when compared to that in the mild subgroup (64.4% vs. 41.7%, P<0.05). During the period of treatment, only very low frequencies of mild adverse effects were observed, most of which resolved without further symptomatic drug therapy after advising the patients to take escin after meal. Escin has little effect on vital signs, blood counts, liver or kidney function. Escin is a safe and effective drug to improve sperm quality in Chinese male patients with varicocele-associated infertility.

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.

Intraoperative Varicocele Anatomy: A Microscopic Study of the Inguinal Versus Subinguinal Approach

The groin approach to varicocelectomy is performed by an inguinal (aponeurosis of external oblique opened) or subinguinal (external oblique aponeurosis intact) technique. We describe the number and relationship of internal and external spermatic arteries, veins and lymphatics within the subinguinal portion of the spermatic cord in infertile men undergoing microscopic varicocelectomy and compare these findings to the microanatomy observed with the inguinal approach. A total of 48 consecutive patients underwent 84 microsurgical subinguinal varicocelectomies during which the detailed intraoperative microanatomy of the spermatic cord and gubernacula was recorded. These observations were compared with a previously reported group of 83 consecutive patients that underwent 115 inguinal varicocelectomies. Subinguinal microscopic findings were also evaluated relative to clinical varicocele grade. The spermatic cord in the subinguinal dissection was characterized by a smaller number of large (greater than 5 mm) internal spermatic veins and a greater number of small (less than 2 mm) internal spermatic veins than the cord in the inguinal dissection (mean 0.4 vs 1.9 large veins and mean 7.9 vs 4.7 small veins, respectively). The subinguinal dissection was also characterized by a significantly greater percentage of external spermatic veins greater than 2 mm than that observed during inguinal dissection (93% vs 74%, respectively, p <0.05). Multiple spermatic arteries were identified in 75% of subinguinal dissections and in only 31% of inguinal dissections (p <0.03). Internal spermatic arteries were surrounded by a dense complex of adherent veins in 95% of cases using the subinguinal approach, whereas this finding was true in only 30% of cases with the inguinal approach (p <0.001). The clinical grade of a varicocele was significantly associated with the number of internal spermatic veins greater than 2 mm found intraoperatively (p <0.001) but not with the maximum internal spermatic vein diameter. Although the subinguinal approach to microsurgical varicocelectomy obviates the need to open the aponeurosis of the external oblique, it is associated with a greater number of internal spermatic veins and arteries compared with the inguinal approach. The primary branch point for the testicular artery occurs most commonly during its course through the inguinal canal. Internal spermatic arteries at the subinguinal level are more than 3 times as likely to be surrounded by a dense network of adherent veins than when they are identified at the inguinal level. Taken together, these data suggest that microscopic dissection is more difficult with a subinguinal incision.