1
|
Crafa A, Cannarella R, Condorelli RA, Mongioì LM, Vignera SL, Calogero AE. Predictive parameters of the efficacy of varicocele repair: a review. Asian J Androl 2024:00129336-990000000-00193. [PMID: 38783663 DOI: 10.4103/aja202420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/22/2024] [Indexed: 05/25/2024] Open
Abstract
ABSTARCT Varicocele has a prevalence of 15% in the population and represents a primary cause of infertility in 40% of cases and a secondary cause in approximately 80% of cases. It is considered the major correctable cause of male infertility. Despite its high prevalence in the infertile population, a large number of patients with varicocele do not experience reproductive difficulties. For this reason, it is still highly debated which parameters could be used to predict which patients with varicocele will be most likely to benefit from its repair. The main international and European guidelines state that treatment should only be considered in infertile patients with abnormal sperm quality. However, these guidelines do not help physicians to identify which of these patients may benefit from the treatment. Therefore, this narrative review collects the evidence in the literature on the usefulness of some factors as predictors of improvement, highlighting how some of them may be effective in an initial selection of patients to be treated, while others are promising but further studies are needed. Finally, a brief consideration on the possible role of artificial intelligence is proposed.
Collapse
Affiliation(s)
- Andrea Crafa
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
- Glickman Urology and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
| | - Laura M Mongioì
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
| |
Collapse
|
2
|
He K, Li J, Yang C, Wu J, Wu B, Xia H. Clinical application and nursing experience of the plan-do-check-act cycle in daytime varicocelectomy. BMC Nurs 2024; 23:118. [PMID: 38360590 PMCID: PMC10870602 DOI: 10.1186/s12912-024-01765-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/25/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Varicocele is the most prevalent correctable cause of male infertility. Currently, surgical treatment is the primary method to enhance fertility.For many young varicocele patients who have postponed surgery due to time constraints, daytime surgery is especially crucial. Thus, this study aims to investigate the clinical and nursing application value of the Plan-Do-Check-Act (PDCA) cycle in daytime varicocelectomy. METHODS Retrospective collection of clinical data was conducted on 130 patients undergoing laparoscopic varicocelectomy in the Third Affiliated Hospital of Southern Medical University, Guangzhou,China.Among them, 65 patients who underwent daytime surgery were assigned to the observation group, while 65 patients who underwent routine hospital surgeries were assigned to the control group.The former also implemented PDCA cycle management.A comparison was made between the two groups regarding hospitalization time, hospitalization costs, and patient satisfaction. RESULTS The observation group exhibited a shorter hospitalization time and lower hospitalization costs compared to the control group, with higher patient satisfaction and pre-discharge visual analog scale (VAS) scores noted (P < 0.05).No significant difference was observed in the incidence of postoperative complications between the two groups during hospitalization (P > 0.05). The implementation of the PDCA cycle in the observation group has demonstrated its effectiveness, ensuring the smooth conduct of the daytime varicocelectomy. CONCLUSION In conclusion,daytime varicocelectomy can reduce hospitalization time,lower hospitalization costs, improve patient satisfaction. The PDCA Cycle enhances the rationality and efficacy of the daytime varicocelectomy procedure and is highly recommended. Furthermore, it offers valuable reference for the application of the PDCA Cycle in various other diseases and nursing management approaches. TRIAL REGISTRATION The Trial Registration Number: ChiCTR2300077465;Date of registration: November 9, 2023.
Collapse
Affiliation(s)
- Kang He
- Urology Department of the Third Affiliated Hospital of Southern Medical University, 510630, Guangzhou, Guangdong, People's Republic of China
| | - Jianxiong Li
- Urology Department of the Third Affiliated Hospital of Southern Medical University, 510630, Guangzhou, Guangdong, People's Republic of China
| | - Cheng Yang
- Urology Department of the Third Affiliated Hospital of Southern Medical University, 510630, Guangzhou, Guangdong, People's Republic of China
| | - Junping Wu
- Urology Department of the Third Affiliated Hospital of Southern Medical University, 510630, Guangzhou, Guangdong, People's Republic of China
| | - Biling Wu
- Urology Department of the Third Affiliated Hospital of Southern Medical University, 510630, Guangzhou, Guangdong, People's Republic of China
| | - Hui Xia
- Urology Department of the Third Affiliated Hospital of Southern Medical University, 510630, Guangzhou, Guangdong, People's Republic of China.
| |
Collapse
|
3
|
Mostafa T, Abdel-Hamid I, Taymour M, Ali O. Genetic variants in varicocele-related male infertility: a systematic review and future directions. HUM FERTIL 2023; 26:632-648. [PMID: 34587863 DOI: 10.1080/14647273.2021.1983214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 05/12/2021] [Indexed: 02/08/2023]
Abstract
Genetic association studies (GAS) may have the capability to probe the genetic susceptibility alleles in many disorders. This systemic review aimed to assess whether an association exists between gene(s)/allelic variant(s), and varicocele-related male infertility (VRMI). This review included 19 GAS that investigated 26 genes in 1,826 men with varicocele compared to 2,070 healthy men, and 263 infertile men without varicocele. These studies focussed on candidate genes and relevant variants, with glutathione S-transferase gene being the most frequently studied (n = 5) followed by the nitric oxide synthase 3 (NOS3) gene (n = 3) and the phosphoprotein tyrosine phosphatase 1 gene (n = 2). In one study the genes for NAD(P)H quinone oxidoreductase 1, sperm protamine, human 8-oxoguanine DNA glycosylase 1, methylenetetrahydrofolate reductase, polymerase gamma, heat shock protein 90, mitochondrial DNA, superoxide dismutase 2, transition nuclear protein 1, and transition nuclear protein 2, were assessed. There is no clear indication that any of these polymorphisms are sturdily associated with VRMI. However, three studies established that the polymorphic genotype (GT + TT) for rs1799983 polymorphism of the NOS3 gene is more frequent in varicocele patients. Further endeavours such as standardising reporting, exploring complementary designs, and the use of GWAS technology are justified to help replicate these early findings.
Collapse
Affiliation(s)
- Taymour Mostafa
- Andrology, Sexology & STIs Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ibrahim Abdel-Hamid
- Division of Andrology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mai Taymour
- Dermatology & Andrology specialist, Cairo, Egypt
| | - Omar Ali
- Faculty of Medicine and Surgery, 6th October University, Giza, Egypt
| |
Collapse
|
4
|
Kandevani NY, Namdari F, Hamidi M, Dialameh H, Behzadi A. Developing a novel prediction model for the impact of varicocelectomy on postoperative fertility. Eur J Transl Myol 2022; 32. [PMID: 35502854 PMCID: PMC9295180 DOI: 10.4081/ejtm.2022.10411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 11/23/2022] Open
Abstract
The objective of this study was to evaluate inflammatory markers as predictors of fertility after varicocelectomy and to develop a prediction model. This prospective cohort was conducted on patients with varicoceles who were presented to the clinic of Imam Reza hospital of Tehran during 2019-2020. Semen analysis, complete blood count (CBC), and scrotal ultrasonography was requested. Patients with abnormalities of semen analysis were chosen as candidates for varicocelectomy. 6 months after the operation, semen analysis was repeated. Hematologic and semen analysis parameters were recorded at baseline and follow-up visits. Treatment success was defined as 50% increase in total motile sperm count (TMSC) in cases with preoperative TMSC> 5 million/cc or 100% increase in TMSC in cases with preoperative TMSC< 5 million/cc. Patients were then categorized into two groups based on treatment success and statistical analysis was performed on these two groups. 124 infertile patients with varicocele were evaluated in our study. 52 patients (41.93%) showed improvements in semen analysis after varicocelectomy. After univariate and multivariate analysis three parameters were used in our predictive model as body mass index (BMI)>23.70 kg/m2 (4 scores), neutrophil-lymphocyte ratio (NLR) >1.80 (3 scores), and TMSC<14.69 million (2 scores). A cut-off value of 5 was associated with an 87.5% sensitivity and an 84.6% specificity for the prediction of failure of varicocelectomy. Varicocelectomy can improve semen analysis parameters in almost all infertile men with varicocele. Using BMI, NLR, and baseline TMSC as the suggested scoring system can predict the success of varicocelectomy for improving fertility and determine the appropriate infertile candidates for surgery.
Collapse
|
5
|
De Win G, De Neubourg D, De Wachter S, Vaganée D, Punjabi U. Peak retrograde flow a potential objective management tool to identify young adults with varicocele 'at risk' for a high sperm DNA fragmentation. J Pediatr Urol 2021; 17:760.e1-760.e9. [PMID: 34627700 DOI: 10.1016/j.jpurol.2021.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 07/30/2021] [Accepted: 09/19/2021] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Determining which patients are negatively affected by varicocele would enable clinicians to better select those men who would benefit most from surgery. Since conventional semen parameters, have been limited in their ability to evaluate the negative effects of varicocele on fertility, specialized laboratory tests have emerged. OBJECTIVE To identify clinical and ultrasound parameters (including PRF) which would negatively influence standard and functional semen variables in young adults with a varicocele. DESIGN Prospective, cross-sectional observational study. SETTING Antwerp University Hospital, Belgium. PATIENT(S) Young volunteers between 16 and 26 years, Tanner 5, were recruited. INTERVENTION(S) Every participant had a scrotal ultrasound to calculate testicular volumes. If a varicocele was present, the grade, vein diameter, peak retrograde flow (PRF) in supine position and spontaneous reflux in standing position were measured. All participants provided a semen sample. Standard semen parameters were analyzed and sperm DNA fragmentation. MAIN OUTCOME MEASURE(S) Of all clinical and ultrasound parameters tested, PRF was an objective tool identifying young adults with a varicocele. PRF was highlighted by the prevalence of SDF, both in the total and vital fractions of the spermatozoa, providing opportunities to manage such 'at-risk' adolescents/young adults. RESULT(S) Total SDF was significantly increased in grade 3 varicocele compared to grade 1 and 2 but no significant difference with vital SDF or standard descriptive semen parameters was seen. Total and vital SDF on the other hand were significantly increased when PRF was above 38.4 cm/s. Standard semen analysis showed no difference with PRF as an independent predictor. Testicular atrophy index, varicocele vein diameter and spontaneous reflux revealed no significant differences in both the descriptive and functional semen variables. DISCUSSION Descriptive semen parameters showed no significant difference between the non-varicocele controls and the varicocele group with low and high PRF. Increased PRF negatively influenced sperm quality via increased DNA fragmentation both in the total as in the vital fractions of the semen. CONCLUSION(S) Of all clinical and ultrasound parameters tested, PRF was an objective non-invasive tool to identify varicocele patients at risk for a high SDF.
Collapse
Affiliation(s)
- G De Win
- Department of Urology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium; Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wilrijk, Belgium.
| | - D De Neubourg
- Centre for Reproductive Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium; Department of Reproductive Medicine, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wilrijk, Belgium
| | - S De Wachter
- Department of Urology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium; Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wilrijk, Belgium
| | - D Vaganée
- Department of Urology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - U Punjabi
- Centre for Reproductive Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium; Department of Reproductive Medicine, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wilrijk, Belgium
| |
Collapse
|
6
|
Tsampoukas G, Dellis A, Papatsoris A. Bilateral disease and intratesticular haemodynamics as markers of dyspermia in patients with subclinical varicocele: A prospective study. Arab J Urol 2019; 17:298-304. [PMID: 31723447 PMCID: PMC6830200 DOI: 10.1080/2090598x.2019.1647676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 06/24/2019] [Indexed: 11/28/2022] Open
Abstract
Objective: To study scrotal ultrasonographic characteristics in patients with subclinical varicocele (SV) and investigate their relationship with semen parameters. Patients and methods: In all, 56 men with SV were recruited and divided into two groups, according to their semen characteristics. Group A, comprised 34 men with normal semen analysis; and Group B, comprised 22 men who carried at least one abnormality, regarding sperm concentration, motility and morphology. Between the two groups we compared: age; body mass index (BMI); semen pH and semen volume; total testicular volume (TTV); maximal vein diameter (MVD) and degree of reflux; mean values of peak-systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) of the intratesticular arteries; whether bilateral SV; and serum testosterone and follicle-stimulating hormone (FSH) levels. Results: Asthenospermia was present in all patients in Group B; 10 patients had asthenospermia only, six patients were astheno-oligospermic and six patients had astheno-oligo-teratospermia. Age, BMI, semen pH and volume, TTV, MVD and degree of reflux did not differ significantly between the two groups (P > 0.05). However, EDV, PSV and RI were significantly different (P < 0.05). Bilateral SV was significantly more frequent in patients in Group B (P < 0.05). Finally, FSH was elevated in Group B (P < 0.05), whereas testosterone was normal in both groups, albeit significantly lower in men with abnormal semen analyses (P < 0.05). Conclusion: Classic ultrasonographic characteristics in men with SV, such as venous size or degree of reflux, were insufficient to distinguish patients with abnormal semen analysis. However, bilateral disease and intratesticular haemodynamics differed significantly in patients with SV and abnormal semen analysis. Abbreviations: BMI: body mass index; CDU: colour Doppler ultrasonography; EDV: end-diastolic velocity; MVD: maximal vein diameter; PSV: peak-systolic velocity; RI: resistive index; SV: subclinical varicocele; TTV: total testicular volume; US: ultrasonography
Collapse
Affiliation(s)
| | - Athanasios Dellis
- Urology, National and Kapodistrian University of Athens, Aretaieion Academic Hospital, Athens, Greece
| | - Athanasios Papatsoris
- Urology, National and Kapodistrian University of Athens, 'Sismanoglio' General Hospital, Maroussi, Athens, Greece
| |
Collapse
|
7
|
Abstract
In recent years, there has been increasing interest in transitional urology, or how to best prepare patients with major congenital urologic diseases, such as bladder exstrophy and neuropathic bladder, to manage their own health care with adult urologists. However, common pediatric urologic conditions may be encountered by the adult urologist with more regularity. This review focuses on three relatively common conditions which may be identified in childhood, the consequences from which a patient may seek help from an adult urologist: cryptorchidism, varicocele, and Klinefelter syndrome.
Collapse
Affiliation(s)
- Kristina D Suson
- Children's Hospital of Michigan, 3901 Beaubien, Detroit, MI, 48201, USA.
| |
Collapse
|