Varicocoele and saphenofemoral reflux: are they coincidentally related?

Metformin's effects on varicocele, erectile dysfunction, infertility and prostate-related diseases: A retrospective cohort study

Objectives: To investigate the risk of varicocele, erectile dysfunction (ED), infertility, prostatitis, benign prostate hyperplasia (BPH) and prostate cancer associated with metformin use. Materials and methods: A total of 261,838 males, mean age 52.39 years (SD: 11.39), with a new-onset type 2 diabetes mellitus in 1999-2009 were identified from Taiwan's National Health Insurance. Among them, 175,171 were metformin initiators [metformin (+)] and 86,667 were non-metformin initiators [metformin (-)] in the initial 12-month prescriptions of antidiabetic drugs. Follow-up started after the initial 12-month prescriptions. Outcomes were followed up until 31 December 2011. Intention-to-treat (ITT) and per-protocol (PP) hazard ratios comparing metformin (+) to metformin (-) were estimated by Cox regression incorporated with the inverse probability of treatment-weighting using propensity scores. Results: The median follow-up time ranged 5.55-6.82 years in metformin (-) and 4.36-5.17 years in metformin (+) for different outcomes in ITT analyses. The respective median follow-up time in PP analyses ranged 2.20-2.61 years in metformin (-) and ranged 3.99-4.65 years in metformin (+). In the ITT analyses, for metformin (-), the incidence rates (per 100,000 person-years) of varicocele, ED, infertility, prostatitis, BPH and prostate cancer were 26.42, 455.89, 22.82, 590.23, 4226.19, and 141.69, respectively; and the respective incidence rates for metformin (+) were 25.65, 488.10, 32.60, 510.30, 3685.66, and 116.57. The hazard ratios (95% confidence intervals) comparing metformin (+) to metformin (-) in the ITT analyses were 0.960 (0.784-1.174) for varicocele, 1.077 (1.026-1.130) for ED, 1.368 (1.116-1.676) for infertility, 0.887 (0.849-0.927) for prostatitis, 0.883 (0.868-0.899) for BPH and 0.878 (0.802-0.961) for prostate cancer. The hazard ratios for the respective outcomes in the PP analyses were 0.845 (0.662-1.078), 1.350 (1.264-1.441), 1.396 (1.078-1.808), 0.800 (0.756-0.846), 0.875 (0.855-0.895), and 0.613 (0.548-0.686). Conclusion: Metformin use in patients with type 2 diabetes mellitus is associated with a neutral effect on varicocele, a higher risk of sexual dysfunction (ED and infertility) and a reduced risk of prostate-related health (prostatitis, BPH and prostate cancer).

The association between varicocele and other vascular diseases: A systematic review and meta-analysis

OBJECTIVE

This study is aimed to evaluate the association between varicocele and other vascular diseases through a systematic reviews and meta-analyses.

MATERIAL AND METHODS

We searched Cochrane Central Register of Controlled Trials, Embase, PubMed, and Web of Science for studies that reported varicocele and other vascular diseases published before 30 June 2021. The meta-analysis was performed by Revman V.5.2 to calculate the pooled odds ratios and corresponding 95% confidence intervals. Subsequently, the impact of publication bias was evaluated, and sensitivity analysis as performed to assess our results' robustness.

RESULTS

In total, seven case-control studies, including 803 varicocele cases and 727 controls, were included. Our meta-analysis results showed that the varicocele patients had a higher risk of saphenofemoral insufficiency when compared with the control group (odds ratio [OR]: 2.80; 95% confidence intervals [CIs]: 2.03, 3.84; p < 0.00001). Additionally, varicocele patients also had a higher risk of lower extremity venous insufficiency when compared with the control group (OR: 2.34; 95% CI: 1.58, 3.47; p < 0.0001). However, there was no statistical difference in hemorrhoid risk between both groups (OR: 1.13; 95% CI: 0.28, 4.59; p = 0.87).

CONCLUSION

Our study demonstrated that varicocele patients have higher risk of saphenofemoral and lower extremity venous insufficiencies but not the risk of hemorrhoids.

The relationship between saphenofemoral junction insufficiency and varicocele

The aim of the study was to investigate whether or not there is a significant relationship between varicocele and SFJ insufficiency. This study included 200 men with (study group) and 200 men without (control group) primary varicocele which was initially diagnosed by observation during the Valsalva manoeuver. Subsequently, scrotal and lower extremity venous Doppler ultrasonography (USG) was performed by a senior radiologist, and participants with testicular veins >3.0 mm in diameter and reverse blood flow were determined to have varicocele. SFJ insufficiency was defined as retrograde flow in the SFJ of longer than 0.5 s. Retrograde venous flow in the pampiniform plexus was determined 3.5% (study) versus 0.0% (control) and 77.0% (study) versus 0.0% (control) in the right testis and left testis, respectively, and bilaterally at 11.5% (study) versus 0.0% (control). The presence of SFJ insufficiency was also found to be higher in the study group than in the control group (unilaterally: 26.0% versus 15.0%; bilaterally: 14.0% versus 5.0%). The current study demonstrates a statistically significant relationship between varicocele and SFJ insufficiency and supports the argument that varicocele is not a local disease and may be attributable to a systemic vascular insufficiency. Additional studies with larger series are needed to further elucidate this topic.

Evaluation of hemorrhoidal disease and lower extremity venous insufficiency in primary adult varicocele: A prospective controlled study

Background

The study investigated the association between varicocele, lower extremity venous insufficiency and hemorrhoidal disease.

Methods

The study included 62 patients with varicocele and 60 voluntary subjects with no varicocele. Patients who were diagnosed as having varicocele on physical examination and Doppler ultrasonography were included in the study group. Examination of lower extremity venous insufficiency was performed by physical examination and Doppler ultrasonography. Examination of hemorrhoidal disease was performed by a general surgery specialist.

Results

The patients with varicocele had a statistically significant ( p < 0.05) higher rates of venous insufficiency of the lower extremities and had a borderline significant difference of higher hemorrhoidal disease rates ( p = 0.05). Therewithal incidences of hemorrhoidal disease and lower extremity venous insufficiency were significantly higher in body mass index > 25 and age > 30 years of varicocele patients.

Conclusion

There is a statistically significant relation between varicocele, lower extremity venous insufficiency, and hemorrhoidal disease. In particular, varicocele patients who are aged over 30 years and overweight are at higher risk.

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

BACKGROUND

The study investigated the association between lower extremity varicose veins in men and varicocele.

METHODS

A total of 100 patients who presented to the Department of Vascular Surgery in the First Affiliated Hospital of Anhui Medical University with the diagnosis of lower extremity varicose veins were included in the study group. A total of 100 adults without vascular disease were included as controls. The prevalence of varicocele between the study group and the control group was compared. We compared the prevalence of varicocele and the mean diameter of spermatic veins between the patients with and without reflux in the saphenofemoral junctions. We analyzed the association between the maximum spermatic vein diameter and the maximum diameter of lower extremity varicose veins in patients who had both lower extremity varicose vein and varicocele in the study group. According to their clinic signs, patients with lower extremity varicose veins were divided into C1-C6 by clinic sign grade of Clinical-Etiology-Anatomy-Pathophysiology (CEAP), and we investigated the trend of the incidence of varicocele and the mean diameter of spermatic veins in different grades.

RESULTS

The patients with lower extremity varicose veins had a statistically significant (χ² = 20.05, P < 0.01) higher rate of varicocele when compared with controls. We compared the prevalence of varicocele and the mean diameter of spermatic veins between the patients with and without reflux in the saphenofemoral junctions and found no statistically significant differences between them (prevalence of varicocele P > 0.05, diameter P > 0.05). We found a linear correlation between the maximum spermatic vein diameter and the maximum diameter of lower extremity varicose veins in the patients who had both lower extremity varicose veins and varicocele in the study group (coefficient of rank correlation r = 0.4072, P < 0.01). The patients in the study group were classified into 6 grades by CEAP. After the analysis by trend chi-square, we found that the prevalence of varicocele had no statistical trend in different grades (χ² = 0.8798, P > 0.05), and the mean diameter of spermatic vein also had no statistical trend in different grades (F = 1.59, P > 0.05).

CONCLUSIONS

In conclusion, we demonstrated that the prevalence of varicocele is higher in patients with varicose veins in lower extremity than the patients without vascular diseases. The reason for the association between varicose vein in lower extremity and varicocele remains uncertain.