Varicocele Patients Research Articles

YES1 Activation Elicited by Heat Stress Is Anti-Apoptotic in Mouse Pachytene Spermatocytes1

Deregulated expression of protein tyrosine phosphorylation has been implicated in testicular response to different stimuli. Herein, YES1, a nonreceptor protein tyrosine kinase, was found to be significantly up-regulated in pachytene spermatocytes (PS) during early recovery from a transient testicular heat stress. Coculture of PS with Sertoli cells (SCs) could enhance the hyperthermia-induced YES1 activation, indicative of a positive regulation of the paracrine signaling. Moreover, SU6656, a selective YES1 inhibitor, was shown to effectively block YES1 activity, thereafter resulting in a dramatic increase of heat stress-induced apoptosis in primary cultured PS. Mechanistically, the antiapoptotic effect of YES1 activation in response to testicular heat insult may mediate via the regulation of extracellular signal-regulated kinase (ERK)/metastasis-associated 1 (MTA1) cascade. From a clinical standpoint, a notably higher level of YES1 expression was observed in the pathological testis from varicocele patients as compared to a negligible staining in the control group. Taken together, our present results provide the first evidence that the YES1/ERK/MTA1/p53 cascade may serve as a naturally occurring, indispensable self-defensive mechanism maintaining apoptotic balance during meiotic heat stress. Our study may have also partially answered the question of how activation of signal pathways at the cell membrane surface interacts with the key regulatory events occurring in the nucleus during testicular heat shock.

Active Surveillance of the Adolescent with Varicocele: Predicting Semen Outcomes from Ultrasound

We hypothesized that active surveillance of the adolescent varicocele is not associated with a high prevalence of suboptimal semen analysis and that patients with abnormal semen analysis have smaller testicular volumes and larger volume differentials. We conducted an institutional review board approved retrospective cohort study of adolescents with a clinically detected varicocele. Patients were initially observed by serial scrotal ultrasound evaluating testicular size and differential. Semen analysis was routinely collected in Tanner V cases, around age 18 years. Prevalence of normal semen analysis parameters was calculated, and logistic regression was used to model the ability of age at presentation and testicular volume parameters to predict a normal semen analysis. A cohort of 73 patients underwent surveillance with a mean ± SD age at presentation of 15.5 ± 2.3 years. Median followup was 2.7 years, during which time subjects underwent a median of 3 scrotal ultrasounds. A low total motile count was found in 48 patients (66%). Neither age at presentation nor testicular volume differential could predict normal semen volume, density, sperm motility or total motile count. Total testicular volume from the final ultrasound predicted total motile count (p = 0.008). However, the collective observations of volume during the entire period of surveillance could not predict total motile count (p = 0.847). There is a high prevalence of suboptimal semen analysis in adolescents with a varicocele who are followed with active surveillance. Total testicular volume can predict total motile count at the end of adolescence but not throughout.

Infrared digital thermography of scrotum in early selection of progressive varicocele

Varicocele is frequent but correctable cause of male infertility. Varicocelectomy is the most commonly performed operative procedure for varicocele. Majority of varicocele patients do not have fertility problem, therefore surgical correction is not recommended in all prevalent cases. On the other hand, varicocele is a progressive condition in some cases and individual with varicocele is at risk for developing impairment which can ultimately lead to semen deterioration and consequent infertility.Selection of patients with varicocele that will progress and cause infertility is beyond our current diagnostic capabilities. Diagnostic assessment of varicocele depends on physical examination and scrotal ultrasound/doppler. Infrared digital thermography of scrotum is a non-invasive and objective diagnostic method for early varicocele detection by means of temperature measurement on the scrotal skin surface. The criteria for diagnostic use of scrotal thermography were recently presented. We hypothesize that the infrared digital thermography of scrotum could be the cornerstone in detection of varicoceles that tend to progress with impairment of semen quality and will require surgical correction, among all prevalent varicocele cases.

Is thioredoxin reductase involved in the defense against DNA fragmentation in varicocele?

We aimed to investigate the role of thioredoxin reductase (TR) and inducible heat shock protein 70 (iHsp70) and their relationship with sperm quality in varicocele (VAR) patients. Semen samples were obtained from 16 subfertile men diagnosed as VAR and 10 fertile men who applied to the Andrology Laboratory of Istanbul Medical Faculty of Istanbul University. The sperm TR and iHsp 70 expression levels were determined using Western blot analysis. The TR activity of the sperm was assayed spectrophometrically. The sperm quality was evaluated both by conventional sperm analysis and by a terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) technique that assayed DNA-fragmented spermatozoa in semen samples. The percentage of TUNEL-positive spermatozoa in the VAR group (16.3%± 5.6%) was higher than that in the fertile group (5.5%± 1.9%). Significant inverse correlations were detected between the percentage of TUNEL-positive cells and both the concentration (r=-0.609; P=0.001) and motility (r=-0.550; P=0.004) of spermatozoa. Both the TR expression and activity were increased significantly in the VAR group (U=22.0; P=0.001 and U=33.5; P=0.012, respectively) as analyzed using the Mann-Whitney U Wilcoxon rank sum W test. Furthermore, significant positive correlations were found between TR expression and activity (r=0.406; P=0.040) and between TR expression and the percentage of TUNEL-positive cells (r=0.665; P=0.001). Sperm iHsp70 expression did not differ between the VAR and fertile groups. In conclusion, increased sperm TR expression might be a defense mechanism against apoptosis in the spermatozoa of men with VAR.

Elevation of Testicular Temperature Predicts Testicular Catch-up Growth and Hypotrophy After Varicocelectomy and Observation in Adolescent Varicocele

To predict testicular catch-up growth after varicocelectomy, we investigated the usefulness of testicular temperature (TT) measurements for adolescent varicocele. The present study included 110 patients with left varicocele patients (age 9-17 years, mean ± standard deviation 12.5 ± 2.4) who had undergone varicocelectomy (87 patients) or observation (23 patients). In addition to the physical examination and duplex/color Doppler ultrasonography, the pre- and postoperative TT was measured using a CoreTemp CTM204 device (Terumo, Tokyo, Japan). Testicular catch-up growth was evaluated 2 years after the operation or initial visit. Univariate and multivariate statistical analyses were performed to determine whether patient age, varicocele grade, testicular asymmetry, TT, and endocrinologic results could be used as determinants of catch-up growth. Left testicular hypotrophy was noted in 34 patients (31%), and TT elevation was observed in 58patients (53%). In the observation group, 9 patients (39%) showed new-onset testicular hypotrophy. Patients with TT elevation in this group had a significantly greater incidence of new-onset hypotrophy compared with those without TT elevation (P<.05). Patients with catch-up growth after varicocelectomy had a greater grade of varicocele, more preoperative testicular hypotrophy, and TT elevation (P<.05, P<.05, and P<.0001, respectively). Multivariate statistical analyses revealed that TT elevation was significantly associated with catch-up growth after varicocelectomy (P<.05). The measurement of scrotal temperature is a helpful approach to identify patients at a greater risk of progressive testicular hypotrophy and catch-up growth after varicocelectomy.

Evaluation of Both Malondialdehyde and Catalase Enzymes In Semen, Tissue And Blood In Adult Men With Grade 3 Varicocele

This work aimed to assess malondialdehyde (MDA) and catalase (CAT) levels in semen, blood and tissue and to investigate their relationship with spermiogram parameters in the presence of grade 3 varicocele patients. Following the partial removal of the varicose vein during varicocelectomy, both MDA and CAT levels were assessed in the tissue and semen fluid. Additionally MDA levels were measured in blood samples collected from varicose veins during varicocelectomy. A total of 88 patients, mean age 21.8, were enrolled in the study. While progressive motility (A + B) was

Sperm DNA damage in varicocele patients

Sperm DNA damage in varicocele patients

Expression of cyclooxygenase‐1 (COX‐1) and COX‐2 in human male gametes from normal patients, and those with varicocele and diabetes: a potential molecular marker for diagnosing male infertility disorders

Rising rates of varicocele and diabetes mellitus (DM) pose a significant problem to human fertility. Recent studies have pointed out the impact of cyclooxygenase (COX) in the regulation of testicular function and male fertility. Prominent COX-2 expression has been described recently in the testes of infertile patients, but little is known about the role and identity of COX isoforms in human sperm under certain disease states such as varicocele and DM. We therefore examined the expression profile and ultrastructural localization of COX-1 and COX-2 concomitantly in semen samples from healthy donors, and patients with varicocele and DM. Using Western blotting assay, 'varicocele' and 'diabetic' sperm showed enhanced COX isoforms expression with respect to the 'healthy' sperm. Immunogold labeling revealed human sperm anatomical regions containing COX-1 and COX-2, confirming their increased expression in pathological samples. Our data demonstrate that both COX isoforms are upregulated in the spermatozoa of varicocele and diabetic patients, suggesting the harmful effect of the diseases also at the sperm molecular level, going beyond the abnormal morphology described to date. In conclusion, COX enzymes may possess a biological relevance in the pathogenesis and/or maintenance of male factor infertility associated with varicocele and DM, and may be considered additional molecular markers for the diagnosis of male infertility disorders.

Varicocele is Associated with Erectile Dysfunction: A Population-Based Case-Control Study

While many studies have been conducted investigating the efficacy of varicocele treatment on fertility, the literature is comparatively sparse concerning the association between varicocele, varicocelectomy, and erectile dysfunction (ED). This study aimed to estimate the associations between varicocele, varicocelectomy, and ED using a population-based dataset. This study used data from the Longitudinal Health Insurance Database 2000 in Taiwan. A total of 32,856 cases and 98,568 randomly selected controls were included in this study. Conditional logistic regression analyses were used to examine associations between ED and having been previously diagnosed with varicocele or having underwent a varicocelectomy. The odds of prior varicocele or having underwent a varicocelectomy between cases and controls. Of the sampled patients, the prevalence of prior varicocele was 3.3% and 1.2% for cases and controls, respectively (P < 0.001). Conditional logistic regression analysis suggested that the odds ratio (OR) of being previously diagnosed with varicocele for cases was 3.09 (95% confidence interval [CI] = 2.67-3.49) when compared with controls after adjusting for monthly income, geographic location, hypertension, diabetes, coronary heart disease, hyperlipidemia, hypogonadism, obesity, and alcohol abuse/alcohol dependence syndrome. Furthermore, cases were 1.92 (95% CI = 1.52-2.43) times more likely to have undergone a varicocelectomy than controls. Furthermore, subjects aged between 18 and 29 had the highest ORs for prior varicocele among cases when compared with controls (OR = 5.20; 95% CI = 3.27-8.28). This investigation succeeded in identifying an association between both varicocele and ED. We also realized that varicocele patients who underwent a varicocelectomy had lower magnitudes of association with ED than those who did not.

Differential Clustering of Sperm Subpopulations in Infertile Males With Clinical Varicocele and Carriers of Rearranged Genomes

Some methods for determining sperm DNA fragmentation, such as the sperm chromatin structure assay (SCSA) and the sperm chromatin dispersion test (SCD), provide additional information about particular subgroups of spermatozoa with specific irregularities. Thus, SCSA recognizes a specific sperm subpopulation, the high-DNA stainability sperm subpopulation (HDS), and SCD recognizes the so-called DNA-degraded sperm (DDS) subpopulation. Although some studies associate the presence of these subpopulations with specific aspects related to infertility, the relationship between both sperm subpopulations and their preponderance in specific clinical groups of infertile males has not been extensively investigated. In this study, HDS and DDS subpopulations were determined in a total of 37 human males: 8 males with proven fertility, 9 infertile males with asthenoteratozoospermia, 10 carriers of chromosomal reorganizations, and 10 infertile males with clinical varicocele. Results showed a significant increase of the DDS subpopulation (P < .001) in both the varicocele patient (16.85 ± 7.24) and carrier of rearranged genome (11.6 ± 5.23) groups, but not in patients with asthenoteratozoospermia (3.88 ± 1.55) or fertile donors (2.62 ± 1.68). No statistical differences were detected for the HDS subpopulation (P = .542), but the highest values were found in the varicocele and rearranged-genome groups. However, no correlation between the HDS and DDS subpopulations were found (r = 0.196; P = .244), suggesting that both represent a different class of sperm subpopulation in the ejaculate. A significant increase in HDS, and especially DDS, can be associated with the presence of varicocele or the rearrangement of chromosomes. Specific diagnostic tests to confirm the diagnosis must be performed in patients with increased DDS and HDS values.

Effect of Varicocelectomy on Testicular Volume in Children and Adolescents: A Meta-analysis

To evaluate the effect of surgical intervention on catch-up growth as determined by a decreased testicular volume discrepancy in children and adolescents with varicocele. A systematic search was performed using MEDLINE and the PubMed database and cross-referenced as of October 28, 2011 using the terms "varicocele," "children," "adolescent," "surgery," and "testicular volume." All relevant studies were of the testicular volume discrepancy variance before and after surgical repair. The outcomes included the number of patients with initial testicular atrophy and those with catch-up growth after surgical repair. The database search, quality evaluation, and data extraction were independently performed by 2 reviewers. Of 75 studies, 14 were included for analysis and involved 1475 patients. The combined analysis showed that the testicular volume discrepancy was significantly reduced after surgery in the ≥10% group (P < .00001) and ≥20% group (P < .00001), respectively. No difference was found between the 2 groups (P = .70). Taken together, the number of patient with testicular volume disproportion in all pediatric and adolescent varicocele patients significantly decreased after surgery (P < .00001). The average proportion of catch-up growth was 76.4% (range 52.6%-93.8%). The meta-analysis suggested clear advantages of surgical intervention on reducing testicular hypotrophy when the discrepancy is ≥10% in children and adolescents with varicocele. Additional prospective and controlled studies are warranted to elucidate the treatment of children and adolescents with varicocele.

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.

The nursing of varicocele high ligation with laparoscope single port transumbilical

Objective To study the nursing measure of the therapy for varicocele patients with laparoscope single port transumbilical.Methods A total of 40 patients were treated with psychology intervention and knowledge teaching before and after operation.After operation,the patients'situation were observed,the complication was prevented,the nursing of diet and activity were strengthened.Results All of the cases in experimental group were successfully cured and discharged.Conclusions The varicocele high ligation is a good therapy with laparoscope single port transumbilical for varicocele,and effective nursing intervention is good for rehabilitation of patients. Key words: Laparoscope single port transumbilical; Varicocele; High ligation; Nursing

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.

The POLG Gene Polymorphism in Iranian Varicocele-Associated Infertility Patients.

Varicocele is associated with impaired testicular function and male infertility, but the molecular mechanisms by which fertility is affected have not been satisfactorily explained. The aim of our study was to investigate whether or not the polymerase gamma (POLG) polymorphism is associated with Iranian varicocele patients. We determined the POLG CAG repeat length in DNA samples extracted from 40 varicocele patients and 30 control subjects by PCR-denature polyacrylamide gel electrophoresis and sequencing. The distribution of the CAG repeat length in varicocele patients showed no notable difference from that in control subjects, but we found a significant statistical inverse correlation between 10/10 and 10/#10 genotypes and varicocele grade. These findings indicate that POLG CAG repeats may affects the varicocele grade, but the mechanisms remain to be elucidated.

Varicocele, leucocitospermia y su impacto en la fragmentación del ADN espermático

IntroductionHigh levels of oxidative stress can explain the presence of high levels of damage in the DNA molecule. The impact of high levels of oxidative stress in 2 clinical circumstances affecting the male germ line has been well established: leukocytospermia and varicocele. ObjectiveTo assess sperm DNA fragmentation in patients diagnosed with leukocytospermic and varicocele. Material and methodsLeukocytospermic and varicocele patients and external controls (donors with proven fertility and patients with undetermined male factor). Unlike in other studies of sperm DNA fragmentation, in this study both the proportion of damaged sperm after using the sperm chromatin dispersion test (Halosperm), and the proportion of degraded sperm in total fragmented (degradation index [DI]) were taken into consideration. ResultsA highly significant increase in sperm DNA fragmentation has been observed in semen samples of patients with varicocele and leukocytospermia. Varicocele patients showed a DI twice as high as that observed in patients with undetermined male factor or in patients with leukocytospermia, and 6 times as high as that observed in the donors. DiscussionThe presence of high levels of oxidative stress could be an acceptable explanation for the high levels of damage observed in the spermatozoa of varicocele patients or with leukocytospermia; the level of sperm degradation is higher in the case of varicocele than those observed in leukocytospermia. ConclusionsSDF levels in patients with leukocytospermia and varicocele are significantly higher than those observed in donors or men with undetermined male factor. The DI in sperm samples from patients with varicocele is the highest of all the samples studied in this analysis. The routine determination of the DI may have a practical value, by guiding the patient towards the potential diagnosis of varicocele, even when this is subclinical.

Comparison of Laparoscopic and Microscopic Subinguinal Varicocelectomy in terms of Postoperative Scrotal Pain

In this study, 2 different varicocelectomy methods were compared with regard to postoperative scrotal pain, length of operation, and complications. Forty varicocele patients, who visited our clinic because of infertility or scrotal pain between 2008 and 2009, were enrolled in this clinical study. Microscopic subinguinal varicocelectomy was performed on 20 patients in Group I, and laparoscopic varicocelectomy was performed on 20 patients in Group II. Following surgery, the patients were assessed for postoperative requirements for analgesia; return to normal activity; varicocele recurrence; hydrocele formation; scrotal pain at postoperative days 1, 3, and 7; and other complications. Mean age was 24.2 +/- 3.4 years in Group I and 25.1 +/- 2.1 years in Group II. Mean pain scores at postoperative 1, 3, and 7 days in Group I were (5.20 +/- 1.14, 4.60 +/- 0.97, and 3.50 +/- 0.97, respectively) significantly higher than those of Group II (0.70 +/- 0.82, 0.60 +/- 0.84, and 0.10 +/- 0.32, respectively). Time to return to normal activity was significantly shorter in Group II (3.7 +/- 2.1 days) compared with Group I (6.8 +/- 3.4 days) (p = 0.028). However, the number of recurrences and hydroceles, as a complication of varicocelectomy, was 2 times higher in Group II (10%) than in Group I (5%). We believe that laparoscopic varicocelectomy is a safe, effective, and minimally invasive procedure. Furthermore, reduced postoperative discomfort and earlier return to normal activity are additional advantages of this method.

Technical aspects of embolization of internal spermatic vein in varicocele treatment

Varicocele is one of the most common causes of infertility in men. A large number of varicocele patients are asymptomatic and discovered after examination by physician because of infertility. This paper reviews the most recent data available on the management of varicocele. It will discuss the advantages and limitations associated with each treatment modality for varicocele. The most common therapeutic methods are surgical ligation and embolization of internal spermatic veins. Embolization of internal spermatic veins is a minimally invasive procedure, performed on outpatient basis, under local anesthesia, the recovery period of patients is short, and the risk of complications is minimal. The use of embolization can provide a safe and effective approach aiming to eliminate varicocele, preserve testicular function and increase fertility.

Elevation of both Reactive Oxygen Species and Antioxidant Enzymes in Vein Tissue of Infertile Men with Varicocele

Objective: To compare reactive oxygen species (ROS) and antioxidants in internal spermatic vein tissue of men with varicocele and a control group with inguinal hernia. Also to compare the levels of oxidants and antioxidants in infertile and fertile men with varicocele. Patients and Methods: 48 varicocele patients and 12 non-varicocele inguinal hernia patients participated in this study. The varicocele group was again divided into two groups – fertile men with varicocele and infertile men with varicocele. Internal spermatic vein tissue samples were obtained. The level of the malondialdehyde (MDA), an indicator of oxidative stress, and the activities of antioxidant enzymes (defense systems) against oxidative stress such as superoxide dismutase (SOD) and catalase (CAT) were estimated in these tissue samples. Results: The mean level of MDA in the varicocele group was significantly higher than in the hernia group, whereas the levels of antioxidants (SOD and CAT) were significantly lower in the varicocele group than in the hernia group. When compared with the subgroups of the varicocele group, the MDA levels and SOD and CAT activities were significantly higher in the infertile varicocele group than in the fertile varicocele group. Conclusions: Antioxidant enzyme levels generally decrease due to a high consumption in varicocele patients. On the contrary, in our study both MDA and antioxidant enzymes increased in the internal spermatic venous wall of infertile varicocele patients. This situation may be explained by an adaptation against oxidative stress in varicocele, which could be defined as a chronic process.

Risk Factors for Progressive Deterioration of Semen Quality in Patients With Varicocele

To assess the risk factors for progressive deterioration of semen quality (PDSQ) in adult patients with varicocele. A total of 32 men with left varicocele and impaired semen quality (group 1) and 30 age-matched patients with left varicocele and normal semen quality (group 2) were recruited for the present study. All the subjects received conservative treatment, and the parameters for evaluation every 12 months included semen quality, peak retrograde flow (PRF) and spontaneous venous reflux by color Doppler ultrasonography, body mass index, serum concentration of follicle-stimulating hormone, luteinizing hormone, prolactin, testosterone, testicular volume and discrepancy, grade of varicocele, and scrotal temperature. The mean follow-up time was 63.2 months (range 60-66). The patients in group 1 had a significantly greater PRF, lower testicular volume, greater testicular volume discrepancy, lower testosterone level, higher scrotal temperature, and greater follicle-stimulating hormone level than those in group 2 at first. The semen quality deteriorated in 28 subjects (87.5%) in group 1, but in only 6 patients (20%) in group 2 during follow-up. Furthermore, the 6 subjects with PDSQ in group 2 had greater PRF and scrotal temperature than those without. The rate of PDSQ was significantly greater in the varicocele patients with an initially abnormal semen quality than in those with initially normal semen quality (87.5% vs 20%). Furthermore, the varicocele patients with initially normal semen quality who had greater PRF and scrotal temperature might have a greater risk of PDSQ.