varicocele repair

精索静脉曲张修复术
  • 文章类型: Journal Article
    在母亲高龄的时代,关于辅助生殖技术(ART)精索静脉曲张修复治疗结果的确凿证据较少.精索静脉曲张的基础研究进展显着,但有许多临床相关观点需要讨论。
    根据我们2000多例显微外科精索静脉曲张修复的经验,我们专注于精索静脉曲张修复的有效性,病理生理学,手术方法,对艺术的贡献,精子DNA碎片,本综述旨在为精索静脉曲张的基础和临床研究确定更清晰的方向。
    用于精索静脉曲张修复的显微手术低位结扎术有望仍然是手术治疗的金标准。根据一些系统评价和荟萃分析的结果,关于显微外科精索静脉曲张修复在男性不育治疗中的疗效的负面意见几乎不存在。然而,关于手术适应症和有效性的大部分证据与精液参数或非ART妊娠率的改善有关.
    关于精索静脉曲张的病理生理学的进一步理解可能会通过综合遗传获得,转录组,以及使用人类血液和睾丸样本进行表观遗传分析,我们希望开发新的诊断方法和药物治疗。
    UNASSIGNED: In an era of advanced maternal age, there is less conclusive evidence regarding the treatment outcomes of varicocele repair for assisted reproductive technology (ART). Progress in basic research on varicocele is notable whereas there are many clinically relevant points to discuss.
    UNASSIGNED: Based on our experience with more than 2000 cases of microsurgical varicocele repair, we focused on the effectiveness of varicocele repair, pathophysiology, surgical approaches, contributions to ART, sperm DNA fragmentation, and varicocele-associated azoospermia in this review with the aim of identifying clearer directions for basic and clinical research on varicocele.
    UNASSIGNED: Microsurgical low ligation for varicocele repair is expected to remain the gold standard for surgical therapy. Based on the findings from a number of systematic reviews and meta-analyses, negative opinions regarding the efficacy of microsurgical varicocele repair in male infertility treatment have become virtually nonexistent. However, the majority of evidence regarding surgical indications and effectiveness pertains to improvements in semen parameters or non-ART pregnancy rates.
    UNASSIGNED: Further understandings regarding to pathophysiology of varicocele will likely be gained through comprehensive genetic, transcriptomic, and epigenetic analyses using blood and testicular samples from humans and we hope to develop new diagnostic methods and pharmacotherapy.
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  • 文章类型: Journal Article
    精索静脉曲张是一种常见病,尤其是患有原发性和继发性不孕症的男性。在男性不育的背景下,对精索静脉曲张的管理进行了广泛的研究。
    本文旨在探讨不育男性精索静脉曲张的临床实践变化。包括专业协会关于精索静脉曲张管理的当前建议的摘要。
    关于精索静脉曲张和男性不育的知识仍然存在巨大差距,临床方法有很大差异,尽管医学文献中现有数据丰富。
    现有文献留下了许多关于不育男性精索静脉曲张管理的问题。这种缺乏清晰度导致了该领域临床医生之间的持续争议。新的研究对于解决这些有争议的观点和辩论领域至关重要。
    UNASSIGNED: Varicocele is a common occurrence, particularly among men with primary and secondary infertility. There has been extensive research into the management of varicocele in the context of male infertility.
    UNASSIGNED: This article aims to explore the variations in clinical practice in diagnosing and managing varicoceles in infertile men. A summary of the current recommendations on varicocele management from professional societies is included.
    UNASSIGNED: Substantial gaps in knowledge persist regarding varicoceles and male infertility, with significant variation in clinical approaches, despite the wealth of existing data in the medical literature.
    UNASSIGNED: The existing literature leaves many questions surrounding varicocele management in infertile men unanswered. This lack of clarity contributes to the ongoing controversy among clinicians in the field. New research is essential to address these contentious points and areas of debate.
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  • 文章类型: Journal Article
    精索静脉曲张在不孕症中的治疗仍然存在争议。很清楚,事实上,在许多患者中,精索静脉曲张对生育能力没有影响。最近的科学证据表明,当适当选择患者时,精索静脉曲张治疗有利于改善精液参数和妊娠率。治疗成人精索静脉曲张的目的主要是改善目前的生育状况。另一方面,青少年治疗的目标是预防睾丸损伤和维持睾丸功能,以便将来生育。因此,精索静脉曲张治疗成功的关键似乎是正确的适应症。这项研究的目的是回顾和总结目前在管理精索静脉曲张治疗方面的证据,重点是关于青少年和成人患者手术适应症的争议。在其他特定情况下,如无精子症,双侧或亚临床精索静脉曲张,在艺术之前。
    Varicocele treatment in infertility still remains controversial. It is clear, in fact, that in many patients, varicocele has no impact on fertility. Recent scientific evidence demonstrated that varicocele treatment is beneficial in improving semen parameters and pregnancy rate when an appropriate selection of patients is made. The purpose of treating varicocele in adults is mainly to improve current fertility status. On the other hand, the goal of treatment in adolescents is to prevent testicular injury and maintain testicular function for future fertility. Hence, the key to the success of varicocele treatment seems to be a correct indication. The aim of this study is to review and summarize current evidence in managing varicocele treatment focusing on the controversies regarding surgical indications in adolescent and adult patients, and in other specific situations such as azoospermia, bilateral or subclinical varicocele, and prior to ART.
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  • 文章类型: Case Reports
    阴囊热成像是一种精索静脉曲张的诊断方法。总之,精索静脉曲张有五种诊断热像标准,即,指示精索静脉曲张的阴囊热像图,Pampiniform丛温度≥34℃,左右斑状神经丛温差≥0.5C°,Valsalva机动期间的图像增强,并且在盘状神经丛的温度≥同侧大腿的温度。三个或更多的积极迹象表明精索静脉曲张。本报告的目的是介绍使用数字热成像作为评估精索静脉曲张修复结果的诊断方法。我们介绍了一个被诊断为精索静脉曲张III级的学生的案例,并通过阴囊热像术前评估和术后随访。根据热成像指标,我们的患者在手术治疗前精索静脉曲张诊断为阳性。精索静脉曲张修复后三个月,患者未显示精索静脉曲张的热成像指标阳性,而体格检查和彩色多普勒超声检查不一致。该病例报告表明,阴囊的红外数字热像仪对于精索静脉曲张手术后的患者监测非常有价值。然而,应该在更多的患者中得到证实。
    Scrotal thermography is a diagnostic method for varicocele. In short, there are five diagnostic thermographic criteria for varicocele, i.e., pattern of scrotal thermographic image indicative of varicocele, temperature at pampiniform plexus ≥34 C°, temperature difference between left and right pampiniform plexus ≥0.5 C°, enhancement of image during Valsalva maneuver, and temperature at pampiniform plexus ≥ temperature at ipsilateral thigh. Three or more positive signs are indicative of varicocele. The aim of this report is to present the use of digital thermography as a diagnostic method to evaluate the outcome of varicocele repair. We present a case of a student diagnosed with varicocele grade III, and assessed preoperatively and followed up postoperatively by scrotal thermography. According to thermographic indicators, our patient was positive for varicocele diagnosis before surgical treatment. Three months after varicocele repair, the patient did not show positive thermographic indicators of varicocele while physical examination and color Doppler ultrasound were equivocal. This case report suggests that infrared digital thermography of scrotum could be very valuable for monitoring patients in the period after surgery for varicocele, however, it should be confirmed in a larger number of patients.
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  • 文章类型: Journal Article
    UNASSIGNED: Varicocele is one of the most common treatable causes of male infertility. However, the decision to perform varicocelectomy before starting a fertility program remains controversial. This study aimed to thoroughly review and analyze the benefit of varicocele repair and its impact on the success rate of a fertility program.
    UNASSIGNED: A systematic literature search was performed using MEDLINE, Cochrane Library, and Wiley Library. The primary outcome was the pregnancy rate, and the secondary outcomes were live birth rate and surgical sperm retrieval success rate. Outcomes were compared between men who underwent treatment for a varicocele and those that did not. The pooled analysis data are presented as odds ratios with 95% confidence intervals.
    UNASSIGNED: A total of 31 articles were included in the meta-analysis. The pregnancy rate was significantly higher in the treated group (odds ratio = 1.82; 95% confidence interval: 1.37-2.41; P < 0.0001) along with the live birth rate (odds ratio = 2.80; 95% confidence interval: 1.67-4.72; P = 0.0001). The further subgroup analysis revealed a higher pregnancy rate in treated men with azoospermia, subnormal semen parameters, and normozoospermia (P = 0.04, P = 0.0005, and P = 0.002, respectively), while the live birth rate was only significantly higher in the treated men with subnormal semen parameters and normozoospermia (P = 0.001 and P < 0.0001). Treated varicocele also led to a higher sperm retrieval rate in azoospermic patients (odds ratio = 1.69; 95% confidence interval: 1.16-2.45; P = 0.006).
    UNASSIGNED: Varicocele repair increased the pregnancy and live birth rates regardless the semen analysis result, along with the sperm retrieval success rate in azoospermic men. Thus, varicocele repair may be beneficial prior to joining a fertility program.
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  • 文章类型: Journal Article
    Sperm chromatin integrity is essential for normal embryo development and pregnancy outcome. Sperm DNA fragmentation (SDF) testing constitutes a diagnostic tool to measure the proportion of spermatozoa with damaged chromatin in the ejaculate. SDF is associated with potentially treatable conditions, including varicocele, male accessory gland infections, inadequate lifestyle, and gonadotoxin exposure, thus prompting their treatment as a means of improving sperm DNA quality and the reproductive outcomes.
    To provide an up-to-date review of the role of clinical and surgical interventions on SDF values in subfertile men.
    An extensive search of studies examining the relationship between male infertility conditions associated with SDF was performed using PubMed and MEDLINE, with a focus on interventional therapy. The start date for the search was not defined, whereas the end date was March 2019. Randomized and non-randomized controlled trials, observational studies, systematic and narrative reviews, and case series were evaluated.
    Treating the underlying male infertility factor seems a promising way to alleviate SDF and to increase the likelihood of achieving natural and assisted conception, but data remain limited. The best evidence relates to varicocele repair and hormonal therapy with the follicle-stimulating hormone. Antioxidant therapy and lifestyle changes might alleviate oxidative sperm markers and decrease SDF but their effects on pregnancy outcomes are still unclear. Among men with high SDF undergoing assisted reproductive technology, the use of testicular spermatozoa in preference over ejaculated spermatozoa for intracytoplasmic sperm injection (ICSI) has been shown to improve pregnancy rates possibly owing to the better sperm chromatin quality in testicular spermatozoa than in ejaculated spermatozoa.
    Current evidence supports interventional therapy as a means to alleviate sperm DNA damage. Identification of the conditions associated with SDF remains important to enable treatment to potentially improve pregnancy outcomes but given the limited data further research is needed to determine the exact role of specific interventional therapy for subfertile men with impaired sperm chromatin.
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  • 文章类型: Journal Article
    小儿精索静脉曲张的总体患病率为15%,随着青春期的开始变得更加频繁。它会损害睾丸功能,干扰支持细胞增殖和激素分泌,睾丸生长和精子发生。适当的管理对于未来的生育力保护具有关键作用。这篇综述的目的是讨论诊断,从内分泌角度管理和治疗儿童和青少年精索静脉曲张,说明欧洲小儿泌尿外科学会(ESPU)的当前证据,欧洲泌尿外科协会(EAU),美国泌尿外科协会(AUA)和美国生殖医学学会(ASRM)科学学会。根据ASRM/ESPU/AUA实践委员会的说法,在睾丸体积减少或精子异常的情况下,需要治疗青少年精索静脉曲张,虽然它在亚临床精索静脉曲张中是禁忌的。最近的EAS/ESPU荟萃分析报告,在睾丸体积和精子浓度增加方面,儿童和青少年精索静脉曲张治疗的益处存在中度证据。在睾丸体积截止值或峰值逆行流量(PRF)方面没有特定的表型。根据目前的证据,我们建议对PRF<30cm/s的患者建议保守治疗,睾丸不对称<10%,没有精子和激素异常的证据。在10-20%睾丸体积不对称或3038cm/s,不育和睾丸发育失败。
    Pediatric varicocele has an overall prevalence of 15%, being more frequent as puberty begins. It can damage testicular function, interfering with Sertoli cell proliferation and hormone secretion, testicular growth and spermatogenesis. Proper management has a pivotal role for future fertility preservation. The aim of this review was to discuss the diagnosis, management and treatment of childhood and adolescent varicocele from an endocrinologic perspective, illustrating the current evidence of the European Society of Pediatric Urology (ESPU), the European Association of Urology (EAU), the American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM) scientific societies. According to the ASRM/ESPU/AUA practice committee, the treatment of adolescent varicocele is indicated in the case of decreased testicular volume or sperm abnormalities, while it is contraindicated in subclinical varicocele. The recent EAS/ESPU meta-analysis reports that moderate evidence exists on the benefits of varicocele treatment in children and adolescents in terms of testicular volume and sperm concentration increase. No specific phenotype in terms of testicular volume cut-off or peak retrograde flow (PRF) is indicated. Based on current evidence, we suggest that conservative management may be suggested in patients with PRF < 30 cm/s, testicular asymmetry < 10% and no evidence of sperm and hormonal abnormalities. In patients with 10-20% testicular volume asymmetry or 30 < PRF ≤ 38 cm/s or sperm abnormalities, careful follow-up may ensue. In the case of absent catch-up growth or sperm recovery, varicocele repair should be suggested. Finally, treatment can be proposed at the initial consultation in painful varicocele, testicular volume asymmetry ≥ 20%, PRF > 38 cm/s, infertility and failure of testicular development.
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  • 文章类型: Journal Article
    精索静脉曲张修复(VR)与低生育能力患者精子参数的改善有关。我们检查了生殖激素水平的关联,阴囊彩色多普勒超声(CDU)和精液参数,VR之前和之后五十只不生育的雄性,左侧精索静脉曲张,参加了这项回顾性研究。血清FSH水平,LH和总睾酮(TT),同时评估持续的左精索静脉回流(SVR)和CDU时的睾丸体积,通过左侧逆行精索内静脉巩膜栓塞术(SVE)进行VR之前和之后六个月。在VR后所有患者中左侧SVR不再存在或显著降低(p<0.0001)。精子参数,特别是,总精子运动计数(TMC),发现VR后明显改善(p<0.0001)。后VR,生殖激素基线值无差异.在单变量分析中,仅SVR变化可预测TMC变化(p=0.026),而生殖激素变化对TMC变化没有影响(FSH:p=0.85;LH:p=0.44;TT:p=0.76)。总之,精子参数的改善与SVR的消失或降低有关,而与SVE后生殖激素水平的变化无关.因此,CDU时的SVR变化是不育症男性VR后精子质量改善的唯一预测指标。
    Varicocele repair (VR) is associated with improved sperm parameters in subfertile patients. We examined the association of the levels of reproductive hormones, scrotal colour Doppler ultrasound (CDU) and seminal parameters in subfertile men, before and after VR. Fifty subfertile males, with left-side varicocele, were enrolled in this retrospective study. The serum levels of FSH, LH and total testosterone (TT), along with continuous left spermatic venous reflux (SVR) and testicular volumes at CDU were evaluated, before and six months after VR by a left-side retrograde internal spermatic vein sclero-embolisation (SVE). Left-side SVR was either no longer present or significantly reduced in all patients after VR (p < 0.0001). Sperm parameters, in particular, the total sperm motile count (TMC), were found significantly improved after VR (p < 0.0001). Post-VR, no differences were observed in the baseline values of the reproductive hormones. Only SVR change was seen to predict TMC change (p = 0.026) in the univariate analysis, while reproductive hormones change had no effect on TMC change (FSH:p = 0.85;LH:p = 0.44;TT:p = 0.76). In conclusion, the improved sperm parameters were associated with the disappearance or reduction in SVR and not with changes in the levels of reproductive hormones after SVE. Thus, SVR change at CDU was the only predictor of improved sperm quality after VR in subfertile males.
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  • 文章类型: Journal Article
    BACKGROUND: The results of reports on the association between varicocele repair and testosterone levels were conflicting. The aim of the present study is, therefore, to investigate the impact of varicocele repair on testosterone levels.
    METHODS: The study is based on 20 men who experienced microsurgical subinguinal varicoceles repair because of chronic dull scrotal pain. All hormonal profiles available in the clinical records were reviewed. Follow-up evaluation was done at 1 and 12 months after surgery. Men were classified into groups based on the preoperative testosterone levels: euogonadal (serum levels of testosterone > 12 nmol/l), hypogonadal men (serum levels of testosterone ≤ 12 nmol/l).
    RESULTS: Microsurgical subinguinal varicocele repair was associated with a significant improvements of testosterone levels at 1 and 12 months after surgery as compared to the preoperative levels (13 nmol/l vs. 18 nmol/l, p = 0.03; 13 nmol/l vs. 15 nmol/l, p = 0.01). The same trend was seen in men who were classified as being hypogonadal (7.0 nmol/l vs. 15 nmol/l, p = 0.01; 7.0 nmol/l vs. 10 nmol/l, p = 0.02). No significant improvements in testosterone levels were observed in euogonadal men (p > 0.05).
    CONCLUSIONS: Microsurgical subinguinal varicocele repair was associated with a significant improvements of testosterone levels in men with grade II-III lesions and low preoperative testosterone values.
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  • 文章类型: Journal Article
    BACKGROUND: We aimed to evaluate the effectiveness of microsurgical subinguinal varicocele repair in patients with grade II-III lesions and chronic dull scrotal pain.
    METHODS: A total of 29 patients with grade II-III varicocele and chronic dull scrotal pain that had a microsurgical subinguinal varicocele repair were included in the study. They were followed-up for 6-12 months including pain assessment and scrotal examination.
    RESULTS: Of the 29 patients, 28 (97%) reported complete resolution of pain with no palpable varicocele on scrotal examination. No cases of testicular atrophy or hydrocele formation were reported.
    CONCLUSIONS: These results indicated that microsurgical varicocele repair should be considered in patients with grade II-III lesions and chronic dull scrotal pain.
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