Surgical Treatment Of Varicocele Research Articles

OVERCOMING MALE FACTOR INFERTILITY AMONG MEN WITH VARICOCELE

Varicocele is a disease that often occurs in infertile men. The prolonged existence of venous reflux in the pampiniform plexus of the scrotum contributes to the progress of the deterioration of the ejaculate, up to the total absence of germ cells in it. Aim: To assess the effect of varicocele on male infertility. Methods: All men (n=72) with varicocele and azoospermia included in the study were divided into two groups. In the first group (n=31), surgical treatment of varicocele was not performed and testicular biopsy was performed immediately. The men of the second group first underwent the microscopic subinguinal varicocelectomy, and after 6 months, according to indications, microTESE was performed. As a result, in the first group of patients, spermatozoa extraction was successful in 1/3 of men, and in the second group - in 2/3 (p<0.01). Conclusion: In patients with azoospermia, surgical treatment of varicocele helps to restore spermatogenesis in 16.6%. Also, the operation according to the microscopic subinguinal varicocelectomy improves the effectiveness of testicular biopsy by 26.3%.

The Management of Clinical Varicocele: Robotic Surgery Approach.

Varicocele is a pathologic dilation of the testicular veins within the spermatic cord. Varicocele is considered the most common problem in reproductive medicine practice. It is identified in 15% of healthy men and up to 35% of men with primary infertility. The exact pathophysiology of varicoceles is not very well understood, and several theories have been proposed to explain it. Varicocele can impair sperm quality and fertility via various mechanisms: reflux of adrenal metabolites, increased testicular hypoxia, oxidative stress, and increased testicular temperature have been proposed. Several studies have reported the significant benefits on semen parameters with the surgical treatment of varicocele: reducing oxidatively induced sperm DNA damage and potentially improving fertility. Varicocele repair should be offered as a part of treatment option for male partners of infertile couples presenting with palpable varicoceles. Nowadays, there are several surgical approaches available for the treatment of varicocele, such as the retroperitoneal approach, inguinal approach, and the subinguinal approach. The subinguinal microscopic approach offers the best outcomes, such as shorter hospital stays, preservation of the testicular arteries and lymphatics, least number of postoperative complications, recurrence, and a higher number of pregnancies. Currently robotic-assisted laparoscopic surgery is widely adopted in urology and surgeons began to explore the potential applications of the robotic platform to male infertility microsurgical operations. Robotic approach offers many advantages: elimination of tremor, retraction with third arm, high quality, 3-dimensional visualization and surgeon ergonomics, all contributing to the precision of surgery.

Reproductive potential repair in men with varicocele

Relevance. In majority of men, varicose veins of the testicle - varicocele - does not cause discomfort and is asymptomatic, and scrotal pain only bothers 10 % of patients. In 2/3 of cases, varicocele is a clinical finding. In this case, varicocele is the most common cause of male infertility. Aim of the study. Recovery of the reproductive potential of patients with varicocele. Materials and Methods. In 219 patients with varicocele, weve carried an ejaculate study out (WHO, 2010) 3, 6, 12 months after surgical treatment of varicocele. We considered the reproductive function restored by normozoospermia in the ejaculate and the onset of pregnancy in the spouse during the follow - up period of 12 months. Results and Discussion. The 2/3 men of the 219 patients with varicocele had ejaculate abnormalities. The age of patients who were diagnosed with pathospermia was 31+11 years. 66 (39.5 %) patients with varicocele had spermatozoa with reduced mobility. After surgical treatment (varicocelectomy according to Marmara), normozoospermia was present almost in every second man. Nevertheless, the number of pregnancies in a married couple was higher than 6 months after varicocelectomy - 24(32.8 %). The surgical method of treatment of varicocele allows to restore the reproductive function of a man in 30 %. In our study, normozoospermia after varicocelectomy was recorded in almost every second patient. Ultrasound changes in the testicle with varicocele are an unfavorable prognosis for the restoration of male fertility. Conclusion. Surgical treatment of varicocele can recover the reproductive potential of almost every second man of reproductive age. Moreover, a greater number of pregnancies six months right after the operation were registered in spouses.

Reproductive potential repair in men with varicocele

Relevance. In majority of men, varicose veins of the testicle - varicocele - does not cause discomfort and is asymptomatic, and scrotal pain only bothers 10 % of patients. In 2/3 of cases, varicocele is a clinical finding. In this case, varicocele is the most common cause of male infertility. Aim of the study. Recovery of the reproductive potential of patients with varicocele. Materials and Methods. In 219 patients with varicocele, weve carried an ejaculate study out (WHO, 2010) 3, 6, 12 months after surgical treatment of varicocele. We considered the reproductive function restored by normozoospermia in the ejaculate and the onset of pregnancy in the spouse during the follow - up period of 12 months. Results and Discussion. The 2/3 men of the 219 patients with varicocele had ejaculate abnormalities. The age of patients who were diagnosed with pathospermia was 31+11 years. 66 (39.5 %) patients with varicocele had spermatozoa with reduced mobility. After surgical treatment (varicocelectomy according to Marmara), normozoospermia was present almost in every second man. Nevertheless, the number of pregnancies in a married couple was higher than 6 months after varicocelectomy - 24(32.8 %). The surgical method of treatment of varicocele allows to restore the reproductive function of a man in 30 %. In our study, normozoospermia after varicocelectomy was recorded in almost every second patient. Ultrasound changes in the testicle with varicocele are an unfavorable prognosis for the restoration of male fertility. Conclusion. Surgical treatment of varicocele can recover the reproductive potential of almost every second man of reproductive age. Moreover, a greater number of pregnancies six months right after the operation were registered in spouses.

Modern approaches to the surgical treatment of varicocele in childhood

In the structure of male infertility, varicocele is being detected in 30–40 % cases of primary infertility, and in 80 % cases of secondary infertility. At the age of 10 years during the screening, only 1 % of boys have a varicocele, but in the pubertal period this figure increases to 15–20 %. Indications for surgery in childhood differ from those in adults, since grade III varicocele must be associated with ipsilateral testicular atrophy more than 20 % compared to contralateral, or combined with pain. Surgical methods of varicocele treatment are different. Discussions are ongoing regarding the choice of ligation of the internal spermatic vein. There is no general agreement on the technique of surgical intervention. There are about 100 different methods of internal spermatic vein ligation in the world, the most popular of which are the retroperitoneal approach according to Palomo, transinguinal access according to Ivanissevich, subinguinal ligation according to Marmar, vascular embolization and laparoscopic suprainguinal approach. Currently, there is no gold standard for surgical treatment of varicocele in pediatric surgery in contrast to adulthood, where microsurgical subinguinal varicocelectomy has already become a classic method of intervention. This is due to a lower complication rate compared to high ligation. Subinguinal varicocelectomy can sometimes lead to testicular atrophy due to damage to the testicular artery, which is difficult to visualize during surgery. In childhood, Marmar operation is complicated by the small size of the spermatic cord structures, which requires the search for new methods of intraoperative visualization of vascular structures. In this article, intratesticular injection of 1% methylene blue was used for lymphatic vascular contrast and indirect visualization of the testicular artery, which allows for the use of subinguinal varicocelectomy in adolescents.

Male fertility: a review of the publications July — September 2021

The article provides an overview of the most significant publications on the topic of male infertility. The main selection criteria were considered the practical significance of the article, as well as the impact factor of the journal in which it was published according to the SCImago Journal Rank (SJR). As a result, we formed a list of 10 articles published in the III quarter (July — September) of 2021. The review included articles concerning the following issues: the ability of oocytes to repair damaged DNA-chains of sperm cells, the effectiveness of ICSI in AZF-c microdeletions, the advanced paternal age, artificial intelligence in reproductive clinics, genetic causes of infertility, the effect of surgical treatment of varicocele concerning DNA fragmentation, the role of ICSI in the frequency of chromosomal abnormalities in offspring, the safety of COVID-19 vaccination for spermatogenesis, as well as the novel WHO 6 manual for semen investigation.

Antioxidant therapy of male infertility in patients with varicocele

BACKGROUND: The study of the relationship between the presence of varicocele and male infertility is the subject of numerous studies, while many aspects of impaired spermatogenesis remain unclear. It has been established that after surgical treatment of varicocele, fertility is not restored in a significant number of patients. In this regard, the search for new and pathogenetically substantiated methods of treating such patients seems to be very relevant.
 AIM: To evaluate the effectiveness of antioxidant therapy in spermatogenesis disorders in men with varicocele, prescribed both in combination with surgery and as monotherapy.
 MATERIALS AND METHODS: Three groups of infertile men with varicocele were observed, who were treated with Speroton (a complex containing folic acid, L-carnitine, zinc, selenium, vitamin E) 1 sachet once a day, the duration of the course was three months. Patients of the first group (n = 43) were prescribed the drug after the Ivanissevich operation, the patients of the second group (n = 37) received antioxidant therapy during three months before the Ivanissevich operation and continued for three months after it. Patients of the third group (n = 21) did not undergo surgery, but received only antioxidant therapy for six months. The results of the combined treatment and conservative therapy with Speroton were compared with the results of treatment of 65 infertile patients who underwent only Ivanissevichs operation.
 RESULTS: In patients with varicocele with initially pathological parameters of ejaculate, who were prescribed drugs with antioxidant properties in the postoperative period as an adjuvant treatment for 3 months, in 76.7% of cases there was a change in spermogram indicators towards improvement. The most significant changes were observed six months after the operation and subsequent adjuvant therapy. The indicators characterizing sperm motility underwent more noticeable changes. In patients who received only antioxidant therapy for six months, in all cases, there was a statistically significant (p 0.001) improvement in sperm motility, which persisted for six months and exceeded these changes in groups of patients with adjuvant therapy and neo- and adjuvant therapy.
 CONCLUSIONS: The results obtained allow us to conclude that there is no need for surgical treatment for varicocele in order to treat male infertility, since the operation itself can negatively affect the state of spermatogenesis, and conservative antioxidant therapy leads to better results in infertility treatment than the performed operation or any combination of it with antioxidant therapy.

A network meta-analysis protocol of efficacy and safety evaluation of different surgery regimens for varicocele patients with infertility: A study protocol.

Background:Surgical treatment of varicocele is still one of the most common important treatments for male infertility. Surgery regimens for varicocele (VC) is various, including high ligation, sub-inguinal, inguinal, retroperitoneal, laparoscopic, and microsurgery. The surgery regimens applied for VC patients are various in clinic, however, the significance, advantages, and disadvantages of different varicocelectomies for male infertility are still in controversial. Therefore, this network meta-analysis is mainly to assess the relative efficacy and safety of different surgery regimens for VC patients with infertility.Methods:To compare the relative efficacy and safety among different varicocelectomies for VC patients, we systematic searched randomized controlled trials (RCTs) and non-RCTs were in five electronic databases: Pubmed, Web of Science, EMBASE database, Clinical Trials, and Cochrane Library. Using R-3.4.1 software to process and analyze data. The bias risk of RCTs and non-RCTs will be evaluated through the tool of Cochrane Handbook version 5.1.0 and non-randomized studies of interventions (ROBINS-I), respectively.Results and conclusion:The result of this network meta-analysis aim is to evaluate the relative effectiveness and safety and rank the interventions among all surgery methods for VC patients and provide more evidence-based guidance in clinical practice.Protocol registration number:CRD42020162051.

ОПЕРАТИВНОЕ ЛЕЧЕНИЕ ВАРИКОЦЕЛЕ: ШУНТИРУЮЩИЕ, ОККЛЮЗИРУЮЩИЕ И ЭНДОВАСКУЛЯРНЫЕ ВМЕШАТЕЛЬСТВА

The frequency of recurrence after surgical treatment of varicocele reaches 29%. This circumstance encourages the medical community to search for the optimal surgical aid to prevent pathological reflux of blood into the venous plexuses of the testicle from the overlying parts of the vascular network. The operation is indicated in case of presence of the clinical symptoms, the development of orchopathy and disorders of spermatogenesis, regardless of the degree of development of varicocele (WHO classification 2010). Operations aimed at eliminating varicocele are divided into 2 large groups: the first group – preserving the renocaval shunt or shunting operations and the second group – not preserving the renocaval shunt or occlusive operations. Shunting operations include the creation of intervenous anastomoses: proximal, distal and bidirectional. Proximal anastomoses are aimed at eliminating renal venous hypertension as the direct cause of the disease. The imposition of bidirectional and distal anastomoses is considered inappropriate, since in the first case, the time of surgical intervention increases, and in the second case, renal hypertension is not eliminated. Occlusive operations are indicated for primary varicocele and the absence of pronounced venous hypertension. According to the level of vein ligation, they are divided into supra-inguinal and sub-inguinal, by selectivity into selective and non-selective, and by operative access into open, laparoscopic and endovascular. The lowest number of relapses and postoperative complications is observed in sub-inguinal selective and endovascular techniques. They are the most universal ones and eliminate all hemodynamic types of varicocele. Supra-inguinal selective techniques show their high effectiveness in the renospermatic type of varicocele and, unlike sub-inguinal operations, there is no risk of damage to the testicular artery during the operation. Thus, a differentiated approach to choosing the type of surgery reduces the risk of postoperative complications and prevents recurrence of the disease.

Features of clinical observation of varicocele with pathospermia

Varicocele is the most common cause of spermatogenesis disorders. Pathogenesis of pathospermia in combination with varicocele has not been fully studied. Many authors believe that the disruption of germ cell formation is associated with DNA fragmentation and oxidative stress. We present an example of clinical observation of a patient with varicocele combined with pathospermia. This article demonstrates that when treating infertile patients with varicocele, it is necessary to expand the diagnostic search to determine the percentage of DNA fragmentation of the sperm with the aim of identifying the reasons for violations of spermatogenesis. Pathogenetically justified antioxidant therapy after varicocelectomy improves the quality of the ejaculate and reduces the level of DNA fragmentation. Conclusions: surgical treatment of varicocele (varicocelectomy) is indicated for infertile men to improve sperm fertility.

Варикоцеле: роль в развитии мужского бесплодия и методики хирургического лечения

Varicocele is the most common and treatable cause of male infertility. Therefore, surgical treatment of varicocele should be recommended for motivated patients and infertile couples who do not have other identified causes of infertility. Varicocelectomy has been proved to improve sperm parameters and improve chances of successful conception in most patients. However, surgical treatment is associated with certain risks, and therefore, the choice of the optimal treatment is under discussion. A total of 78 articles using a search in MEDLINE database (PubMed) were found and included in the review, dedicated to current concepts of functional anatomy of testicular arteries and veins. The current recommendations of professional communities regarding the selection of patients for varicocelectomy are described. The efficiency and safety of various surgical procedures for varicocele is analyzed. This review suggests high inconsistences in the literature. The available information on the indications for surgical treatment, as well as comparative data on the efficiency and safety of the inguinal, laparoscopic and microsurgical sub-inguinal approaches are presented. When urologist faces with a diagnosis of varicocele, individual approach should be applied, with a discussion of both benefits and possible complications of surgical treatment. Of the many existing techniques, microsurgical ligation of dilated veins is the most preferred.

Influence of operative treatment of variсocele on the development of arterial hypertension

Purpose of the research. To assess the incidence of arterial hypertension in men with varicocele and to identify the relationship between increased blood pressure and surgical treatment of varicocele.
 Material and methods. A survey of 412 men receiving treatment for arterial hypertension, 482 men previously operated on for varicocele and 68 patients with varicocele who had no surgical treatment was conducted.
 Results. Varicose veins of the spermatic cord in patients with arterial hypertension were detected in 44.6% of cases, which exceeds the incidence of varicocele occurrence in men of a comparable age category by 1.52 times. Surgical treatment of the left spermatic cord varicocele is combined with the development of arterial hypertension in 51.2% of patients, which is three times higher than the incidence of hypertension in men who didnt undergo surgical treatment for varicocele and twice the frequency of hypertension in the general population of men of comparable age. The more frequent occurrence of renal arterial hypertension in patients who underwent surgical treatment for varicocele may indicate an adverse effect of occlusion of the internal spermatic vein on the state of renal venous hemodynamics.
 Conclusion. Varicocele should be considered as a compensatory process for renal venous hypertension due to obstruction of blood flow through the renal vein, and elimination of compensatory blood flow can lead to renal venous hypertension, hypoxia and the development of arterial hypertension.

Место медикаментозной терапии в лечении мужчин с варикоцеле

Varicocele-related infertility is traditionally considered an indication for surgery. At the same time in some specific clinical settings, especially with subclinical varicocele, conservative therapy using hormonal or antioxidant drugs is also possible. The potential role of drug therapy in this patient category remains controversial. The article discusses the options and treatment regimens for men with varicocele-related infertility. Given the difficulties in interpreting the results of studies and the heterogeneity of the data, it is not yet possible to recommend abandoning varicocelectomy in favor of drug therapy. The most promising option for drug therapy is adjuvant antioxidants after surgical treatment of varicocele.

Ergonomic varicocele ligation

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

Comparison of Two Methods in Surgical Treatment of Varicocele: Laparascopic and Open Surgery

Comparison of Two Methods in Surgical Treatment of Varicocele: Laparascopic and Open Surgery

765 COMPARATIVE IMPACT OF SEMINAL VESICAL INVASION VERSUS LYMPH NODE METASTASES ON SURVIVAL FOR PATIENTS FOLLOWING RADICAL PROSTATECTOMY

reproductive system were excluded. Mean age was 37 y and mean follow-up postoperatively 19,6 months. In 5 patients (14%) the varicocele was bilateral and they were subjected to bilateral varicelectomy. In the rest of the patients (n 30, 86%) the laparoscopic procedure was unilateral–29 on the left side (83%) and 1 on the right side (3%). The grade of varicocele was 3 in 17 patients (48.5%), 2 in another 17 (48.5%) and 1 in 1 patient (3%). The mean pre-op visual analogue score (VAS), was 2.39 in the scale of 0-5, and in all patients fertility was not an issue. All patients were followed up at 3 months and bi-annually thereafter. RESULTS: After the operation 32 patients (91%) had significant improvement in (VAS), two had partial improvement (6%), and one had no change (3%). In our cohort we haven’t observed post-op worsening of the symptoms. Mean VAS score post-op at 3 months was 0.4. During the follow-up period we observed 4 recurrences (12%) with 2 re-do procedures, performed by inguinal approach. In 3 of these recurrences (75%) the improvement in pain symptoms was significant, and in 1 (3%) it remained unchanged even after the re-do procedure. We have observed two cases of wound infection (6%). Post operatively three cases (9%) of de novo developed hydroceles were observed. CONCLUSIONS: Laparoscopic varicocelectomy is a highly successful option for surgical treatment of varicocele in our cohort, with significant improvement of symptoms in approximately 90% of the patients and minimal complications. We feel that this high success rate can be attributed to the careful selection of patients and by excluding those with sharp radiating scrotal pain. Another factor that possibly contributes to these results is the fact that our cohort doesn’t include small subclinical varicoceles, although this was not explicit excluding criteria.

C131 Surgical treatment of varicocele in children with open suprainguinal microscopic lymphatic sparing varicocelectomy

C131 Surgical treatment of varicocele in children with open suprainguinal microscopic lymphatic sparing varicocelectomy

Surgical Treatment of Varicocele in Children With Open and Laparoscopic Palomo Technique: A Systematic Review of the Literature

We systematically reviewed the results of varicocelectomy by Palomo procedure in children and adolescents. We performed a search of the English literature through the MEDLINE((R)) database and the Cochrane Central Search library. The key words used were "varicocele and children" and "varicocele and adolescents." Of 264 articles published with data on varicocele surgery in children and adolescents 27 concerned the classic Palomo procedure and 20 dealt with the modified Palomo technique, in which the testicular artery was spared. Laparoscopic Palomo varicocelectomy was compared with the open Palomo technique. Totals of 1,344 and 496 patients were treated with the laparoscopic and open Palomo techniques, respectively. The rates of hydrocele in the open and laparoscopic groups were 9.7% and 6.9%, respectively (p = 0.81). The rate of recurrence was 2.9% in the open group and 4.4% in the laparoscopic group (p = 0.146). A modified Palomo procedure was used in 715 operations and the classic technique in 1,454. Hydrocele was diagnosed in 3.2% of patients in the modified group and 7.7% in the classic group (p <0.001). Varicocele recurred in 4.2% of patients undergoing the modified procedure and 3.4% of those undergoing the classic procedure (p = 0.506). Mean +/- SD testicular catch-up growth was 54.7% +/- 38.9% in the modified group and 66.7% +/- 19.9% in the classic group (p = 0.584). Three studies documented improvement of the quality of semen examination postoperatively compared to a control group of uncorrected cases. No study evaluated the rate of fertility after varicocelectomy. The rate of hydrocele is high with the classic Palomo technique and less with the modified technique. The rate of varicocele recurrence is around 3% to 4% with both procedures. The percentage of testicular catch-up growth is variable.

Surgical Treatment of Varicocele in Children by the open and Laparoscopic Palomo Technique. a Metanalysis

PURPOSE To evaluate the surgical RESULTS of the varicocele treatment in children by open and laparoscopic and open varicocele technique by means of a systematic review of the literature. MATERIAL AND METHODS A systematic review was performed based on an English literature search using the MEDLINE ® database between 1970 and 2006. The key words used were varicocele and children. All articles that were related to treatment of varicocele in children and adolescents with Palomo technique were selected. The exclusion criteria were age higher than 18 years old and articles which the type of treatment and the outcome were not clear. Of 264 papers evaluated 27 were selected. RESULTS 1090 patients who underwent Palomo surgery were included in the analisis. 744 and 1346 patients were treated by the open and the laparocopic Palomo technique, respectively. The rate of postoperative hydrocele, recurrence of the varicocele, testicular catch up and testicular atrophy in the open and laparoscopic Palomo surgery was 10,6 % and 11 % (p > 0,05), 7,08 % and 4,8 % (p > 0,05), 65,6 % and 80 % (p < 0,05), 6 % and 11,2 % (p < 0,05), respectively. CONCLUSIONS This metanalysis of the literature demonstrates that because of the high rate complication, open and laparoscopic Palomo technique should not be recomended.

Varicocele and Adolescents: Semen Quality After 2 Different Laparoscopic Procedures

The aim of this prospective study was to assess long-term functional results (spermiograms) in subjects who underwent laparoscopic varicocelectomy via either of 2 procedures (ligation or preservation of testicular artery). A total of 122 patients underwent laparoscopic varicocelectomy performed via either of the 2 different procedures: complete ligation of the spermatic vessels or preservation of the spermatic artery. After surgery when patients achieved 18 years, they were asked to undergo semen analysis. Spermiogram results were divided into 2 subgroups: "normal" and "abnormal." We analyzed volume, sperm count per mL, percentage of motile spermatozoa, percentage of normal spermatozoa, and percentage of vitality for each group. Both groups showed the same results in terms of "normal" and "abnormal" spermiograms (World Health Organization criteria), but analysis showed higher sperm concentration per mL, sperm motility, volume, vitality, and rate of morphologically normal sperm for the group with arteries preserved and "normal" spermiograms (P < .01). Analysis of data from the spermiograms showed that preservation of the testicular artery was the best possible option in terms of semen quality. Therefore, we believe that surgical treatment of varicocele should be carried out using procedures involving artery preservation.