Varicocele Patients Research Articles

Evaluation the Effect of Interleukin-6 and Tumor Necrosis Factor in Semen Quality of Infertile Men with Varicocele.

Objective: The study was designed to evaluation of effect Interleukin-6 and Tumor necrosis factor in seminal plasma to semen quality in infertile men with varicocele. Methods: A descriptive correlation study was conducted in specialized infertility center / teaching AL-Sadder medical city in Najaf city from first of April 2014 to the first of June 2014.Sample was selected that consisted of (75) infertile men with varicocele, and (25) healthy subject as control, their age between (20-40) years old. A questionnaire format and observational checklist were used which including marriage period, excluding from chronic disease like diabetic, cancer, sexual transmitted disease. The data were collected through the utilization of questionnaire and the structure interview technique with varicocele patients. Data was analyzed by using T-test and Z-test Results: The result of the study sample have revealed that 42% from all subjects has elevated Interleukin-6 concentration in seminal plasma ,and also the elevation Interleukin-6 level in seminal plasma has inversely correlation R = -0.58 with decreased in sperm motility ,also has inversely correlation R = -0.30 with low sperm count. From other hand 41% from all subjects has elevated Tumor necrosis factor levels in seminal plasma ,and also the elevation Tumor necrosis factor concentration in seminal plasma has inversely correlation R = -0.17 with decreased in sperm motility ,also has inversely correlation R = -0.25 with low sperm count. Conclusions: They study concluded there was a significant difference between elevation of Interleukin-6 and Tumor necrosis factor levels in seminal plasma in infertile men with varicocele, and they study concluded there was a significant correlation between increased levels of Interleukin-6 and Tumor necrosis factor in seminal plasma with reduce sperm count and motility . Recommendations: the study recommended that: Varicocele examination and diagnosis should be done to all infertile male. Varicocele patients with abnormal seminal fluid examination should be estimated concentration of Interluekin-6 and Tumor necrosis factor in seminal plasma

Does the number of veins ligated during varicococele surgery influence post-operative semen and hormone results?

Varicocele is a well-established cause of male subfertility, which is directly proportional to its clinical grade. Although newer ultrasonic grading systems have taken into account the existence of pampiniform venous plexi, little is known about the clinical significance of the number of veins ligated during surgery. Very few undersized studies reported an influence which triggered the need to evaluate such association. This is a retrospective study of 378 patients who underwent left microsurgical subinguinal varicocoelectomy. Semen analyses and blood hormone studies performed pre-operatively were compared to those executed 6months after surgery. Patients were divided into abnormal semen and normal semen groups based on their initial semen results. They were also subdivided according to the number of veins ligated intraoperatively into three groups: <5, 5-10, and >10 veins. Sperm count, total motility, and progressive motility were significantly increased in 62, 60.3, and 53.3% of patients post-operatively (p=0.001), respectively. No significant differences in hormone levels were detected overall. Of the 378 patients, 332 had an abnormal semen analysis, while the remaining 46 patients had a normal result. Sperm count, total motility, and progressive motility significantly increased after varicocoelectomy in patients with an abnormal initial semen analysis (p=0.001). In 48.7% of patients, 5-10 veins were ligated during surgery, whereas 28.3% had >10 and 23% had <5 ligated veins. No statistically significant differences were noted in the initial or the follow-up results among the number of vein subgroups. Varicocele ligation improves patients' fertility potential. This improvement, however, is not influenced by the number of veins ligated intraoperatively. Clinical grading maintains its superiority in the evaluation of varicocele patients.

Mean Platelet Volume, Platelet Distribution Width, and Platelet Count in Varicocele: A Systematic Review and Meta-Analysis

Background/Aims: The aim of this study was to elucidate the usefulness of platelet indices, mean platelet volume (MPV), platelet distribution width (PDW), and platelet count in diagnosis and monitoring of varicocele. Methods: The current study included 525 patients and 379 healthy subjects from five eligible studies. We performed meta-analysis of MPV, PDW, and platelet count and mean differences in these platelet indices between healthy subjects and varicocele patients. Results: The pooled MPVs were 8.168 fL (95% confidence interval [CI] 7.589 to 8.747) and 8.801 fL (95% CI 8.028 to 9.574) in healthy subjects and varicocele patients, respectively. The pooled mean difference in MPV between healthy subjects and varicocele patients was 0.834 fL in case-control studies (95% CI 0.195 to 1.473, P = 0.011). In both healthy subjects and varicocele patients, low platelet count subgroups showed higher MPV than high platelet count subgroups. The mean difference in MPV was higher in low platelet count subgroup. There was no significant difference in PDW between healthy subjects and varicocele patients. Conclusion: Taken together, our data showed that platelet count was significantly lower in varicocele patients than in healthy subjects. Varicocele patients showed significantly higher MPV and lower platelet count than healthy subjects. MPV levels of patients differed according to platelet counts.

Diagnosis and Management of Pediatric and Adolescent Varicocele: A Survey of Pediatric Urologists in Korea.

The aim of this study was to evaluate current practice patterns on diagnosis and management of pediatric varicoceles. Questionnaires of approaches to diagnosis and management of pediatric varicoceles were sent electronically to pediatric urologists. Of the 70 questionnaires e-mailed, 37 (53%) responded to the survey. 10 respondents (27%) chose to operate on varicoceles, whereas 9 (24%) chose to observe, and 18 (49%) chose to decide upon treatment depending on the clinical situation. The most important indication for varicocelectomy was a decrease in ipsilateral testicular size (n=29, 78%) followed by testicular or scrotal pain (n=4, 11%) and varicocele grade (n=4, 11%). The optimal age for varicocelectomy was answered as 13.8±2.3 years mean. 32 respondents (86%) have used ultrasonography to aid in the diagnosis of varicoceles, and 26 respondents (70%) have considered repairing varicocele incidentally detected on ultrasonography. In an otherwise asymptomatic patient with varicocele, 17 respondents (46%) considered surgery for grade 3, but 15 respondents (41%) would not repair the varicocele. The most commonly used surgical approach was subinguinal microsurgical (n=19, 51%), followed by inguinal (n=9, 24%) and laparascopic (n=5, 14%) procedures. The most commonly experienced post-operative complication was recurrence (n=22, 59%) followed by persistence (n=13, 35%) and hydrocele (n=10, 27%). 28 respondents (76%) did not have long-term follow-up data including regarding fertility on their varicocele patients. Our survey demonstrates that there is lack of consensus on diagnosis and management of pediatric and adolescent varicoceles among pediatric urologists. A prospective randomized study of pediatric and adolescent varicoceles is needed to assess the outcomes and develop universal management guidelines.

Diagnosis of clinical and subclinical varicocele: how has it evolved?

In this review, we examine the evolution and application of various diagnostic modalities for varicoceles starting with venography, scintigraphy, and thermography and their role in the evaluation of a varicocele patient. Some of these methods have been supplanted by less invasive and more easily performed diagnostic modalities, especially ultrasound and Doppler examination of the scrotum. Advances in ultrasound and magnetic resonance imaging hold the potential to expand the role of imaging beyond that of visual confirmation and characterization of varicoceles. The ability to identify the early indicators of testicular dysfunction based on imaging findings may have implications for the management of varicoceles in the future.

Sperm concentration and forward motility are not correlated with age in adolescents with an idiopathic varicocele and symmetrical testicular volumes

AimIdiopathic varicocele is a common condition that may impair fertility. Its treatment in children and adolescents is reserved for those patients who develop symptoms or testicular growth arrest. We evaluated the trends in sperm parameters among adolescent varicocele patients with symmetrical testicular volumes who have not undergone varicocelectomy. MethodData were prospectively collected from a single institution (2009 to 2014). Post-pubertal patients aged 12 to 17years produced semen samples by masturbation. Outcomes measured were semen volume, sperm concentration, and forward motility. Additional variables recorded included: a) testicular volume (ultrasound measurement), b) clinical varicocele grade, c) venous Doppler grading. Linear regression analysis was performed using Fisher's transformation. P<0.05 was considered significant, and data are presented as median (IQ range). ResultsForty-one patients with a median age of 15.4 (15.0–15.9) years each provided a sperm sample during the study period. Thirty-five had grade 3 (visible) varicocele, and 6 had grade 2 (palpable) varicocele. All patients had spontaneous venous reflux on Doppler ultrasound, and none had undergone varicocelectomy prior to producing the sperm sample. Table 1 summarizes the sperm parameters according to patient age. The overall median sperm concentration was 37 (16–64) millions/ml and was not correlated with age. The overall median forward motility was 55% (44–64) and was not correlated with age. Thirty-four patients had normal sperm parameters, which remained within the WHO range of normality. ConclusionsFollowing the European Association of Urology guidelines does not cause progressive deterioration of sperm parameters between the age of 12 and 17years.

Varicocele and concomitant dilation of the periprostatic venous plexus: effects on semen viscosity sperm parameters.

Since varicocele is often associated with other venous abnormalities, this study was undertaken to evaluate the frequency of dilation of the periprostatic venous plexus (DPVP) in these patients and the effects of this association on sperm parameters before and after varicocelectomy. Sperm parameters were evaluated using the conventional WHO criteria, and seminal fluid viscosity was further evaluated by quantitative viscometry, in 50 patients (aged 20-38 years) who underwent surgical treatment for grade III bilateral varicocele. Thirty patients with varicocele had also DPVP (DPVP+) (60 %). Sperm concentration and the percentage of spermatozoa with normal morphology did not differ significantly in patients with DPVP- or DPVP+ before or after surgical repair. On the other hand, sperm progressive motility was low in all patients and increased significantly after varicocele repair, but only in DPVP- patients. Before varicocele treatment, a significantly higher number of DPVP+ patients (25/30 = 83.3 %) had seminal fluid hyperviscosity compared to DPVP- patient (2/20 = 10.0 %). Viscosity quantitative measurement was significantly higher in DPVP+ patients both before and after varicocele repair compared to DPVP- patients. These latter showed a statistically significant reduction of sperm viscosity after varicocele surgical repair compared to pretreatment values. Finally, periprostatic venous plexus diameter and seminal fluid viscosity correlated directly in DPVP+ patients. In conclusion, these results showed that a large number of patients with varicocele had a concomitant DPVP. This subset of patients did not take advantage from varicocele surgical repair since only DPVP- varicocele patients showed a significant improvement of sperm progressive motility and seminal fluid viscosity. These findings suggest the evaluation of the periprostatic venous plexus and seminal fluid viscosity before patients with varicocele undergo surgical repair for asthenozoospemia.

Effect of Varicocelectomy on the Frequency of Nocturnal Sperm Emissions

The aim of this study was to investigate the frequency of nocturnal sperm emissions (NSE) in varicocele patients after varicocele surgery. A total of 127 patients, 96 varicocele (Group 1) and 31 patients with inguinal hernia (Group 2) were included in this study. Mean age, laterality of surgical procedures, spermiogram results, marital status, and postoperative serum hormone levels were noted for all patients. Two groups were compared in terms of Beck depression score (BDS) and anxiety scores (AS). The frequency of NSE and libido changes in the patients during 10 days postoperatively was evaluated. The number of the patients who had NSE and increased libido were significantly higher in the varicocelectomy group when compared with the control group. No significant difference was noted between the groups in terms of BDS, AS, and serum hormone levels. No association was reported between BDS, AS, and serum hormone levels and the presence of NSE in Group 1. The incidence of NSE was higher in younger men. Increased libido was significantly associated with NSE in Group 1. Cord dissection during surgery may be a factor on increased frequency of NSEs in varicocele patients.

AB104. The deep venous lesions in the patients who suffered varicocele

ObjectiveTo reveal the deep venous lesions in the patients who suffered varicocele.MethodsSince the bilateral varicocele patients who had undergone the varicocele surgery often presented a dissatisfactory outcome. Meanwhile, some patients with unilateral varicocele relapsed after the surgery. So, the two kinds of patients were collected in this research. The method to reveal deep venous lesions is direct computed tomography venography (DCTV).ResultsThe bilateral varicocele patients had a relatively high rate of discovered deep venous anomaly by DCTV. And the relapsed patients received surgery could be found lack of collateral circulation of internal iliac vein and spermatic cord vein.ConclusionsThe deep venous lesions should be considered before any kind of spermatic cord vein ligation. The bilateral varicocele and relapse patients underwent ligation were suggested to do DCTV exam.

Varicocele Negatively Affects Sperm Mitochondrial Respiration

To evaluate the effect of varicocele on oxidative stress, sperm mitochondrial respiratory efficiency, sperm morphology, and semen parameters. A total of 20 patients with varicocele and 20 normozoospermic subjects without varicocele (control group) were recruited from a medical center for reproductive biology. The levels of serum reactive oxygen metabolites and seminal lipid peroxides were assessed for both control and varicocele subjects. Sperm deoxyribonucleic acid fragmentation was measured by sperm chromatin dispersion test. Mitochondrial respiratory activity was evaluated with a polarographic assay of oxygen consumption carried out in hypotonically treated sperm cells. In this study, varicocele patients were compared with men without varicoceles. Oxidative stress was observed in the serum and seminal fluid of varicocele patients. These patients showed an increase of 59% (P <.05) in serum reactive oxygen metabolites and a 3-fold increase in the level of sperm lipid peroxides. A parallel and significant increase (a 2-fold increase; P <.05) in the degree of sperm deoxyribonucleic acid fragmentation was also observed. Varicocele patients showed a 27% decrease (P <.05) in mitochondrial respiratory activity in comparison to the control group. A 32% increase (P <.05) in sperm midpiece defects and a 41% decrease (P <.05) in sperm concentration and motility were also observed. Men with varicocele have increased markers of oxidative stress and decreased mitochondrial respiratory activity. These results correlated with abnormalities in semen parameters. For morphology, these correlated with midpiece defects.

Oral antioxidant treatment partly improves integrity of human sperm DNA in infertile grade I varicocele patients

Infertile males with varicocele have the highest percentage of sperm cells with damaged DNA, compared to other infertile groups. Antioxidant treatment is known to enhance the integrity of sperm DNA; however, there are no data on the effects in varicocele patients. We thus investigated the potential benefits of antioxidant treatment specifically in grade I varicocele males. Twenty infertile patients with grade I varicocele were given multivitamins (1500 mg L-Carnitine, 60 mg vitamin C, 20 mg coenzyme Q10, 10 mg vitamin E, 200 μg vitamin B9, 1 μg vitamin B12, 10 mg zinc, 50 μg selenium) daily for three months. Semen parameters including total sperm count, concentration, progressive motility, vitality, and morphology were determined before and after treatment. In addition, sperm DNA fragmentation and the amount of highly degraded sperm cells were analyzed by Sperm Chromatin Dispersion. After treatment, patients showed an average relative reduction of 22.1% in sperm DNA fragmentation (p = 0.02) and had 31.3% fewer highly degraded sperm cells (p = 0.07). Total numbers of sperm cells were increased (p = 0.04), but other semen parameters were unaffected. These data suggest that sperm DNA integrity in grade I varicocele patients may be improved by oral antioxidant treatment.

Human sperm molecular anatomy: the enzyme 5α-reductase (SRD5A) is present in the sperm and may be involved in the varicocele-related infertility.

The most common cause of male infertility is the testicular varicocele, a condition that impairs production and decreases quality of sperm. Male fertility also strictly depends on androgens acting through their own receptor. The enzyme 5α-reductase (SRD5A) is involved in the conversion of testosterone to 5α-dihydrotestosterone, both required for the development and maintenance of male reproductive function. Here, we evaluated, by western blotting analysis, the presence of SRD5A in human ejaculated spermatozoa and evidenced differences in sperm SRD5A content between healthy donors and varicocele-affected patients. Additionally, SRD5A sperm ultrastructural localization was also assessed by transmission electron microscopy and immunogold assay. We evidenced that SRD5A enzyme is present in the human spermatozoa and that its cellular content is lowered in sperm samples from varicocele patients compared to healthy subjects. The presence of SRD5A in human ejaculated spermatozoa highlights the potential role of this enzyme in sperm physiopathology suggesting that the decrease in its content, by affecting the conversion of testosterone into 5α-dihydrotestosterone, may be an important additional mechanism involved in the harmful effect of varicocele in male fertility.

Single port varicocelectomy using SILS™ multiple access port

Purpose Several surgical approaches have been used for varicocelectomy. We report single port varicocelectomy using SILS™ (Covidien, Norwalk, CT) multiple access port.Case The greade III varicocele patient was 23 years old and placed in supine position. About 2 cm vertical skin incision was made in a crease just lateral to the umbilicus and SILS™ port was placed with three 5-mm trocars. Incision to posterior peritoneum from the point 3 cm superior to the internal inguinal was made by needle holder with a broken 15th blade tip. The testicular vessels were exposed. The lymphatic vessels and testicular artery were identified and separated from the testicular vein with flexible laparoscopic instruments and conventional rigid instruments. Three testicular veins were clipped with hemoclips (EndoClip , Autosuture, Norwalk, CT). Posterior peritoneum was repaired with 4-0 vicryl with one side of 5 mm Hem-o-lok clip (Weck Research,Triangle Park, NC). Than the distal end of suture site was also closed with Hem-o-lok.Results The whole procedure was completed with no complication. The operative time was 85 minutes, and blood loss was minimal. The patient was discharged 2 days after the operation. Left scrotal pain and vein engorgement was disappeared.Conclusions Our single port varicocelectomy method is a safe and effective alternative to conventional method. This will provide minimally invasive surgical option for varicocele and we can expect more potential cosmetic benefit and less morbid.

Natural history of testicular size in boys with varicoceles

Testicular size is commonly used as a proxy for future fertility in adolescent boys diagnosed with varicoceles. Surgery is often performed based on a 15-20% reduction in volume of the ipsilateral testicle when compared to the unaffected side. Recent European Association of Urology guidelines, however, have highlighted the risk of overtreatment. Data on the natural progression of testicular size discrepancy are limited in this population. To evaluate the role of a non-surgical approach, the present study reports on testicular size progression in 35 boys with left-sided varicoceles managed with observation alone. In the present study, 103 consecutive boys who were seen for varicocele were retrospectively evaluated; the 35 who were seen for at least three sequential visits by the same pediatric urologist for a unilateral left varicocele were selected. In the present practice, surgical management of varicoceles in teens is offered, but not recommended unless surgery is being performed for another reason (3/103). The Prader orchidometric testicular volumes that were documented for all visits were recorded and the volume of the left testicle as a percentage of the right was calculated. This analysis was performed for the entire population, and subgroup analysis was conducted for boys with a Grade 3 varicocele, with >10% asymmetry at diagnosis, and by dividing the population into prepubertal and pubertal age groups. Boys with bilateral varicoceles, concurrent testicular masses, or volumes recorded by a nurse practitioner were excluded from the study. The mean left testicular volume in the population was found to measure 96%, 95% and 96% of the right at the first, second and third visit (median interval was 2.0 years), respectively. Among the 26 boys seen for a fourth visit (median 3.3 years) and the 15 seen for a fifth visit (median 4.3 years), the mean left testicular volumes were 98% and 97% of the right at diagnosis and 97% at both the fourth and fifth visits (Figure). Likewise, no differences were seen after dividing the population into prepubertal (9-11 years, n = 9) and pubertal (12-14 years, n = 26) groups. Among the 13 (37%) boys with a Grade 3 varicocele at presentation, the left testicular volume was 95% (SD 11.4) of the right and remained unchanged by the third visit (96%, P = 0.69). In addition, among the 11 boys (31%) with greater than 10% size difference at the first visit, the left testicle measured 82% of the right (SD 5.3) at diagnosis and increased to 92% (SD 6.3) by the third visit (P < 0.001). In the 35 boys observed over a median of 2.0 years or three consecutive visits, there was no worsening of testicular asymmetry. This finding is consistent with some previous observational data on pediatric varicoceles, but carries the advantages of a narrower age range and longitudinal follow-up in all patients. At the same time, these results differ from other studies that show no improvement or worsening of asymmetry during follow-up. This difference is attributed to the inherent characteristics of the present study population and the choice of orchidometer for measurement. The present data have the advantage of excluding selection bias. Recognizing that this study is a retrospective, single-operator study with a small sample size, prospective, randomized trials are recommended to weigh surgery vs observation in adolescent varicocele patients. No progression in atrophy/hypotrophy of the left testis was found in a series of 35 consecutive patients who were followed non-surgically for left-sided varicocele. Our data thus support observation as management for childhood varicocele in younger teens.

294 A correlation between selenium and carnitine levels with hyposmotic swelling test for sperm membrane in low-grade varicocele patients

294 A correlation between selenium and carnitine levels with hyposmotic swelling test for sperm membrane in low-grade varicocele patients

Major protein alterations in spermatozoa from infertile men with unilateral varicocele.

BackgroundThe etiology of varicocele, a common cause of male factor infertility, remains unclear. Proteomic changes responsible for the underlying pathology of unilateral varicocele have not been evaluated. The objective of this prospective study was to employ proteomic techniques and bioinformatic tools to identify and analyze proteins of interest in infertile men with unilateral varicocele.MethodsSpermatozoa from infertile men with unilateral varicocele (n = 5) and from fertile men (control; n = 5) were pooled in two groups respectively. Proteins were extracted and separated by 1-D SDS-PAGE. Bands were digested and identified on a LTQ-Orbitrap Elite hybrid mass spectrometer system. Bioinformatic analysis identified the pathways and functions of the differentially expressed proteins (DEP).ResultsSperm concentration, motility and morphology were lower, and reactive oxygen species levels were higher in unilateral varicocele patients compared to healthy controls. The total number of proteins identified were 1055, 1010 and 1042 in the fertile group, and 795, 713 and 763 proteins in the unilateral varicocele group. Of the 369 DEP between both groups, 120 proteins were unique to the fertile group and 38 proteins were unique to the unilateral varicocele group. Compared to the control group, 114 proteins were overexpressed while 97 proteins were underexpressed in the unilateral varicocele group. We have identified 29 proteins of interest that are involved in spermatogenesis and other fundamental reproductive events such as sperm maturation, acquisition of sperm motility, hyperactivation, capacitation, acrosome reaction and fertilization. The major functional pathways of the 359 DEP related to the unilateral varicocele group involve metabolism, disease, immune system, gene expression, signal transduction and apoptosis. Functional annotations showed that unilateral varicocele mostly affected small molecule biochemistry and post-translational modification proteins. Proteins expressed uniquely in the unilateral varicocele group were cysteine-rich secretory protein 2 precursor (CRISP2) and arginase-2 (ARG2).ConclusionsThe expression of these proteins of interest are altered and possibly functionally compromised in infertile men with unilateral varicocele. If validated, these proteins may lead to potential biomarker(s) and help better understand the mechanism involved in the pathophysiology of unilateral varicocele in infertile men.Electronic supplementary materialThe online version of this article (doi:10.1186/s12958-015-0007-2) contains supplementary material, which is available to authorized users.

Endovascular transcatheter embolization of recurrent postsurgical varicocele: anatomic reasons for surgical failure

Formation or pre-existence of collateral gonadal veins in varicocele patients has been reported as the main cause of surgical treatment failure. To describe venographic findings in patients with postsurgical recurrent varicoceles and to assess the efficacy of the following minimally invasive endovascular treatment. Thirty-three men with failed surgical treatment of left-sided varicocele were examined between 2006 and 2013, using retrograde venography to assess the anatomy of varicocele draining veins before the attempted transcatheter embolization. Anatomic variants of gonadal veins were categorized according to the classification modified for the purpose of the present study. 3% polidocanol was used as an embolic agent together with pushable fibered coils. In 31 (93%) out of 33 patients venography demonstrated incompetence of the gonadal vein or veins draining varicoceles after failed surgical treatment. The most frequent venographic finding was gonadal vein duplication - 66% of cases (39% in its mid-portion). Technical success of embolization was achieved in all 31 patients. No major complications were observed. Retrograde varicocele embolization may be superior to surgery because of its ability to detect gonadal vein variants. In our study group, transcatheter embolization with 3% polidocanol and fibered coils allowed successful, minimally invasive treatment of postsurgical varicoceles.

The evaluation of saphenofemoral insufficiency in primary adult varicocele

PurposeThe aim of this study was to evaluate the possible relationship between varicocele and saphenofemoral insufficiency in patients diagnosed with primary varicocele.Patients and methodsA total of 40 patients with the primary diagnosis of varicocele were included in the study. A total of 40 age-matched healthy adults were also included in the study as a control group. Varicocele was diagnosed by means of palpation and observation of each spermatic cord in standing position before and during a Valsalva maneuver. In addition, scrotal Doppler and lower extremity venous Doppler ultrasonography (US) were performed. Patients who had spermatic varicose vein larger than 3.0 mm were included in the study group as a varicocele patient. At the lower extremity venous Doppler US, a retrograde flow lasting longer than 0.5 s during normal breathing or at the Valsalva maneuver was considered to be indicative of saphenofemoral junction (SFJ) insufficiency.ResultsTwenty-five (62.5%) patients had SFJ insufficiency in the study group, whereas 11 patients (27.5%) had insufficiency in the control group. Of the 40 study participants, 10 participants had recurrent varicocele. All of them were seen to have SFJ reflux on Doppler US (100%) (P = 0.014). The patients with primary varicocele had a statistically significantly (P = 0.02) higher rate of venous insufficiency in their SFJs when compared with the control group.ConclusionThe results of the present study show that the incidence of SFJ reflux increases in individuals with varicocele, with a higher incidence in cases of recurrent varicocele. Depending on the common presence of valvular insufficiency, we believe that the presence of varicocele should be investigated in the young population suffering from SFJ insufficiency.

Efficacy of Collatamp on Pediatric Urologic Surgery

Purpose: The purpose of this study is to evaluate efficacy of Collatamp (EUSA Pharma [Europe]; a gentamicin-containing collagen implant, GCCI) in pediatric urologic surgery. Materials and Methods: The study comprised a retrospective analysis of 35 consecutive children who underwent pediatric urologic surgery for treatment of hydrocele, undescended testis and varicocele between March 2013 and March 2015. Collatamp containing 130 mg gentamicin and 280 mg collagen were immersed in 300 ml normal saline for up to 6 hours. At set times after immersion the GCCI were removed, the saline diluted in normal human serum and the gentamicin content assayed by a validated immunoassay (Cedia, Microgenics Ltd., UK) to provide an estimate of the loss from each implant. Patients were classified according to two groups: patients with Collatamp (group A) and those without Collatamp (group B). Postoperative complication, operative time and age, etc. were assessed at postoperative 7 days. Results: Sixteen hydrocele, 16 undescended testis, and 3 varicocele patients were identified, with a median age of 87.43±54.10 months, operation time of 103.60±29.41 minutes, and hospitalization period of 3.20±0.68 days. Mean age, operation time, and hospitalization period in group A, B was 64.81±60.32 months, 100.80±46.80 months (p=0.02), 122.30±40.70 minutes, 103.61±29.39 minutes (p=0.17), and 3.20±0.40 days, 3.20±0.80 days (p=0.67), respectively. No statistically significant differences in postoperative complication were observed between the two groups. However, cost was higher in group A than in group B (300,000 won vs, 15,900.82±3,905.72 won). Conclusions: Collatamp may be useful and effective in preventing wound infection in pediatric urologic surgery, although Collatamp is more expensive.

Glutathione S-transferase polymorphisms in varicocele patients: a meta-analysis

The glutathione S-transferase (GST) family represents a major group of detoxification and antioxidant enzymes. Studies have shown that high oxidative stress levels are associated with varicocele. The objective of this study was to assess the relationship between GSTM1 and GSTT1 null polymorphisms and varicocele using a study group of 497 varicocele patients and 476 control subjects. A systematic literature search (for articles published up to September 2014) utilizing Google Scholar and PubMed was conducted. The chi-square-based Q test and I(2) index were used to evaluate data from retrieved studies. The possible publication bias was evaluated by Begg funnel plot and the Egger test. No statistically significant association was found between GSTM1 or GSTT1 null genotypes and varicocele in the overall data analysis. In a subgroup analysis, only the null GSTM1 genotype was observed at a significantly higher frequency in Caucasian varicocele patients. In the Chinese subgroup, no association was established between the GSTM1 and GSTT1 null genotypes and this condition. More attention should be drawn to oxidative stress-related pathological manifestations for Caucasian varicocele patients.