Dear Editor,Varicocele(VC)is a vascular condition characterized by abnormal tortuosity and dilation of the pampiniform plexus veins within the spermatic cord.VC is commonly observed in young adults,predominantly on th...Dear Editor,Varicocele(VC)is a vascular condition characterized by abnormal tortuosity and dilation of the pampiniform plexus veins within the spermatic cord.VC is commonly observed in young adults,predominantly on the left side;it is a frequent cause of male infertility and can lead to testicular hypofunction,pain,and discomfort.Microsurgical varicocelectomy is the gold standard for treating infertility caused by VC.VC repair is strongly recommended for couple infertility,oligoasthenoteratozoospermia(OAT),Grade 2 or 3 clinical VC,partner age<37 years,patient age<40 years,or testicular hypotrophy in children and adolescents.展开更多
Objective:This study investigated the outcomes of microsurgical subinguinal varicocelectomy(MSV)on semen and hormonal parameters in cases with isolated sperm defects(oligozoospermia,asthenozoospermia,or teratozoosperm...Objective:This study investigated the outcomes of microsurgical subinguinal varicocelectomy(MSV)on semen and hormonal parameters in cases with isolated sperm defects(oligozoospermia,asthenozoospermia,or teratozoospermia).Methods:A retrospective review of charts of patients who underwent MSV for clinically palpable varicocele between January 1,2011 and January 1,2019 at Hamad Medical Corporation was undertaken.All patients diagnosed with isolated oligozoospermia,asthenozoospermia,or teratozoospermia in the preoperative semen analysis were included.Men with multiple sperm defects,genetic abnormalities,azoospermia,history of genitourinary infection,exposure to chemotherapy or radiotherapy,or prior use of peri-operative fertility treatment were excluded.Data extracted from the electronic medical records included(collected before MSV and up to 6 months postoperatively):demographics(age),clinical data(fertility-related medical history and surgical interventions),family history(consanguinity and infertility),physical examination findings from general and local genital exam(varicocele side and grade),laboratory data such as semen analysis,sperm DNA fragmentation tests,and hormone levels(follicle-stimulating hormone,luteinizing hormone,total testosterone,estradiol,and prolactin),and imaging(scrotal color Doppler ultrasound).Results:A total of 331 patients with isolated sperm defects were included.Postoperatively,83.3%of patients showed an improvement in sperm concentration with a median increase of 7 millions/mL.Postoperatively,76.7%of isolated asthenozoospermic patients showed an improvement in total motility and 66.0%had an improvement in progressive motility with median increases of 15.0%and 7.5%,respectively.Postoperatively,70.0%of the teratozoospermic patients showed an improvement in normal sperm morphology with a median increase of 6%.No changes were observed in other semen or hormone parameters that were examined.Conclusion:MSV is a valid and effective treatment modality for patients with isolated sperm defects that significantly corrects their respective semen abnormality and improves their chances of natural conception.展开更多
Dear Editor,Robotic-assisted laparoscopic varicocelectomy(RALV)has been recently described in the pediatric field[1].Although the learning curve of surgical procedures is flattened by a robotic approach[2],complicatio...Dear Editor,Robotic-assisted laparoscopic varicocelectomy(RALV)has been recently described in the pediatric field[1].Although the learning curve of surgical procedures is flattened by a robotic approach[2],complications may occur especially at the beginning of experience.We herein describe an unexpected severe case of parietal blood dripping in a boy who underwent RALV.The study was approved by the institutional review board of Federico Il University Hospital in Naples,Italy(approval number:Fll/2024-PL149).All procedures performed were in accordance with the ethical standards of the institution and/or national research committee.The written informed consent was obtained by his parents to agree the treatment and publish this paper.展开更多
The present meta-analysis was conducted to compare the clinical effect and patient experience of laparoendoscopic single-site varicocelectomy （LESSV） and conventional laparoscopic varicocelectomy. The candidate stud...The present meta-analysis was conducted to compare the clinical effect and patient experience of laparoendoscopic single-site varicocelectomy （LESSV） and conventional laparoscopic varicocelectomy. The candidate studies were included after literature search of database Cochrane Library, PubMed, EMBASE, and MEDLINE. Related information on essential data and outcome measures was extracted from the eligible studies by two independent authors, and a meta-analysis was conducted using STATA 12.0 software. Subgroup analyses were conducted by study design （RCT and non-RCT）. The odds ratio （OR） or standardized mean difference （SMD） and their 95% confidence intervals （95% CIs） were used to estimate the outcome measures. Seven articles were included in our meta-analysis. The results indicated that patient who had undergone LESSV had a shorter duration of back to work （overall： SMD = -1.454, 95% Ch -2.502m0.405, P= 0.007; non-RCT： SMD = -2.906, 95% Ch -3.796-2.017, P= 0.000; and RCT： SMD = -0.841, 95% Ch -1.393-0.289, P = 0.003） and less pain experience at 3 h or 6 h （SMD = -0.447, 95% Ch -0.754-0.139, P = 0.004）, day 1 （SMD = -0.477, 95% Ch -0.905-0.05, P = 0.029）, and day 2 （SMD = -0.612, 95% Ch -1.099-0.125, P= 0.014） postoperatively based on RCT studies. However, the meta-analyses based on operation time, clinical effect （improvement of semen quality and scrotal pain relief）, and complications （hydrocele and recurrence） yielded nonsignificant results. In conclusion, LESSV had a rapid recovery and less pain experience over conventional laparoscopic varicocelectomy. However, there was no statistically significant difference between the two varicocelectomy techniques in terms of the clinical effect and the incidence of hydrocele and varicocele recurrence. More high-quality studies are warranted for a comprehensive conclusion.展开更多
Aim： To determine if robot-assisted varicocelectomy can be safely and effectively performed when compared to microscopic inguinal varicocelectomy. Methods： Eight patients aged 29.1 ± 12.5 years underwent micros...Aim： To determine if robot-assisted varicocelectomy can be safely and effectively performed when compared to microscopic inguinal varicocelectomy. Methods： Eight patients aged 29.1 ± 12.5 years underwent microscopic subinguinal varicocelectomies： seven patients with left-sided repair, and one patient with bilateral repair. Eight patients aged 22.0 ±8.0 years underwent robot-assisted varicocelectomies： seven patients with left-sided repair and one patient with bilateral repair. Results： The average operative time for microscopic inguinal varicocelectomy was 73.9 ±12.2 min, whereas the robot-assisted technique took 71.1± 21.1 min. There were no difficulties in identifying and isolating vessels and the vas deferens with robot-assisted subinguinal varicocelectomy. Hand tremor was eliminated using the robotic procedure. Patients who underwent either microscopic or robot-assisted varicocelectomies were able to resume daily activities on the day of surgery and full activities within 2 weeks. There were no complications or recurrences of varicocele. Conclusion： From our experience, compared to microscopic surgery, robot-assisted varicocelectomy can be safely and effectively performed, with the added benefit of eliminating hand tremor.展开更多
Varicocelectomy is the most commonly performed surgical procedure for the treatment of male infertility. Although several different techniques for varicocele repair have been described in the literature, microsurgical...Varicocelectomy is the most commonly performed surgical procedure for the treatment of male infertility. Although several different techniques for varicocele repair have been described in the literature, microsurgical varicocelectomy performed through a subinguinal or inguinal incision is recognized as the gold-standard approach for varicocelectomy, due to high success rates with minimal complications. Standard indications for varicocelectomy include palpable varicocele（s）, with one or more abnormal semen parameters, and, for the couple trying to conceive, in the setting of normal or correctable female infertility. However, varicocele repair is often recommended and undertaken for reasons other than infertility, including low serum testosterone, testicular pain, testicular hypotrophy and poor sperm DNA quality. This article reviews the technical aspects of microsurgical varicocelectomy, and its indications in adults and adolescents.展开更多
Conventional meta-analyses have shown inconsistent results for the efficacy of various treatments of varicoceles. Therefore, we performed a multiple-treatment meta-analysis to assess the effectiveness and safety of 10...Conventional meta-analyses have shown inconsistent results for the efficacy of various treatments of varicoceles. Therefore, we performed a multiple-treatment meta-analysis to assess the effectiveness and safety of 10 methods of varicocelectomy and embolization/sclerotherapy. We systematically reviewed 35 randomized controlled trials and observational studies, from 1966 to August 5, 2013, which compared any of the following treatments for varococeles： laparoscopic, retroperitoneal, open inguinal and subinguinal varicocelectomy, microsurgical subinguinal and inguinal varicocelectomy, percutaneous venous embolization, Tauber antegrade sclerotherapy, retrograde sclerotherapy and expectant therapy （no treatment）. Inguinal and subinguinal microsurgery, open inguinal, laparoscopic varicocelectomy showed a significant advantage over expectant therapy in terms of pregnancy rates （odds ratio （OR）： 3.48, 2.68, 2.92 and 2.90, respectively）. Compared with retroperitoneal open surgery, inguinal microsurgery showed an improvement of sperm density （mean difference （MD）： 10.60, 95% confidence interval （Cl）： 1.92-19.60） and sperm motility （MD： 9.09, 95% Cl. 4.88-13.30）. Subinguinal and inguinal microsurgery outperformed retroperitoneal open surgery in terms of recurrence （OR： 0.05, 0.06 respectively）. Tauber antegrade sclerotherapy and subinguinal microsurgery were associated with the lowest risk of hydrocele formation. The odds of overall complication, compared with retroperitoneal open varicocelectomy, were lowest for inguinal microsurgery （OR = 0.07, 95% Ch 0.02-0.19）, followed by subinguinal microsurgery （OR = 0.09, 95% CI. 0.02-0.19）. Inguinal and subinguinal micro-varicocelectomy had the highest pregnancy rates, significant increases in sperm parameters, with low odds of complication. These results warrant additional properly conducted randomized controlled clinical studies with larger sample sizes.展开更多
We report the largest single-center experience with robotic-assisted microscopic varicocelectomy （RAMV） in male infertility. From August 2012 to February 2015, men with infertility of at least a year and varicoceles...We report the largest single-center experience with robotic-assisted microscopic varicocelectomy （RAMV） in male infertility. From August 2012 to February 2015, men with infertility of at least a year and varicoceles underwent RAMV by a single surgeon. Varicocele was diagnosed on physical examination and confirmed by ultrasound by a single ultrasonographer. Preoperative hormone panel, semen analyses, and testicular Doppler ultrasound were obtained from all men and repeated at 3 months. One hundred and forty consecutive men （258 varicocelectomies） were included. Mean age and duration of infertility was 36.4 and 2.8 years, respectively. Median total and free testosterone increased by 145 ng dl^-1 and 4.3 pcg ml^-1 （44.3%）, respectively （P 〈 0.0001）. Median sperm concentration increased by 37.3% （P 〈 0.03）. Median sperm motility and morphology did not significantly change. Median left and right testicular volume increased by 22.3% （P 〈 0.0001） and 12.6% （P 〈 0.0006）, respectively. Hydroceles occurred 0.8% of procedures. We had no testicular artery injuries. Persistence of varicocele by Doppler ultrasound was 9.6%. Only 37.3% of patients required pain medications postoperatively. We concluded that RAMV is a safe and effective alternative for varicocele repair with outcomes comparable to historical traditional microsurgical approach.展开更多
In this review,we tried to systematize all the evidence(from PubMed[MEDLINE],Scopus,Cochrane Library,EBSCO,Embase,and Google Scholar)from 1993 to 2021 on the predictors of microsurgical varicocelectomy efficacy in mal...In this review,we tried to systematize all the evidence(from PubMed[MEDLINE],Scopus,Cochrane Library,EBSCO,Embase,and Google Scholar)from 1993 to 2021 on the predictors of microsurgical varicocelectomy efficacy in male infertility treatment.Regarding the outcomes of varicocele repair,we considered semen improvement and pregnancy and analyzed them separately.Based on the 2011 Oxford CEBM Levels of Evidence,we assigned a score to each trial that studied the role of the predictor.We systematized the studied predictors based on the total points,which were,in turn,calculated based on the number and quality of studies that confirmed or rejected the studied predictor as significant,into three levels of significance:predictors of high,moderate,and low clinical significance.Preoperative total motile sperm count(TMSC)coupled with sperm concentration can be a significant predictor of semen improvement and pregnancy after varicocelectomy.In addition,for semen improvement alone,scrotal Doppler ultrasound(DUS)parameters,sperm DNA fragmentation index(DFI),and bilateral varicocelectomy are reliable predictors of microsurgical varicocelectomy efficacy.展开更多
The aim of this study is to evaluate the benefits of laparoscopic Doppler ultrasound （LDU） application during laparoscopic varicocelectomy （LV）, and to compare the surgical outcomes and complications between LDU-a...The aim of this study is to evaluate the benefits of laparoscopic Doppler ultrasound （LDU） application during laparoscopic varicocelectomy （LV）, and to compare the surgical outcomes and complications between LDU-assisted LV （LDU-LV） and conventional LV for infertile patients with varicoceles; 147 infertile patients were randomly divided into two groups. Operative and postoperative parameters, semen parameters, and the pregnancy rate were compared. There were no differences in baseline demographics. The operative time was significantly longer in LDU-LV group than LV group. The incidence of postoperative hydrocele was 1.4% （1/72） in LDU-LV group versus 10.7% （8/75） in LV group, which showed a significant difference （P〈 0.05）. However, other surgical outcomes, such as postoperative hospital stay, postoperative recurrence, and testicular atrophy, were similar between the two groups. Sperm concentration and sperm motility were significantly increased in both groups at 3, 6, and 12 months after surgery （P 〈 0.01）, and they were higher in LDU-LV than LV group in 12 months after surgery （34.21 ± 6.36 vs 29.99 ± 6.04 for concentration, P〈 0.05; 40.72±8.12 vs 37.31 ± 6.12 for motility, P〈 0.05）. Sperm morphology was comparable between the two groups. The pregnancy rate showed no significant difference （44.4% of the LDU-LV vs 37.3% of the LV, P〉 0.05）. In conclusion, compared with LV, LDU-LV could safely and effectively ligate all spermatic veins and preserve spermatic arteries without leading to high varicocele recurrence and postoperative hydrocele. Given the benefits that sperm counts as well as sperm motility favoring LDU-LV, we recommend that LDU should be routinely used as an effective tool to improve outcomes and safety of laparoscopic varicocelectomy.展开更多
The aim of this study was to compare the intraoperative difference in anatomic details between Ioupe-assisted and microscopic varicocelectomy within the same spermatic cord. Between April 2011 and August 2011, 26 men ...The aim of this study was to compare the intraoperative difference in anatomic details between Ioupe-assisted and microscopic varicocelectomy within the same spermatic cord. Between April 2011 and August 2011, 26 men with 33 sides containing grade 2-3 varicocele were enrolled in this study. First, one surgeon performed the open inguinal varicocelectomy under x 3.5 Ioupe magnification. The presumed vascular channels and lymphatics were isolated and marked without ligation. Another surgeon then microsurgically dissected and checked the same spermatic cord using an operating microscope to judge the results in terms of the ligation of the internal spermatic veins and the preservation of the arteries and lymphatics. There were significant differences in the average number of internal spermatic arteries （1.51 vs 0.97）, internal spermatic veins （5.70 vs 4.39） and lymphatics （3.52 vs 1.61） between the microscope and Ioupe-assisted procedures （P 〈 0.001, P 〈 0.001, P 〈 0.001, respectively）. Meanwhile, in varicocele repair with Ioupe magnification, an average of 1.30 β± 1.07 （43/33） internal spermatic veins per side were missed, among the overlooked veins, 1.12 ± 0.93 （37/33） were adhered to the preserved testicular artery, as well as 0.55 ± 0.79 lymphatics and 0.36 ± 0.55 arteries that were to be ligated. In conclusion, microscopic varicocelectomy could preserve more internal spermatic arteries and lymphatics and could ligate more veins than the Ioupe-assisted procedure. To some degree, Ioupe magnification is inadequate for the reliable identification and dissection of the tiny vessels of the spermatic cord, as most of the overlooked veins were adhered to the preserved testicular artery.展开更多
Preoperative and postoperative sperm parameter values from infertile men with varicocele were analyzed by computer-aided sperm analysis （CASA） to assess if sperm characteristics improved after varicocelectomy. Semen...Preoperative and postoperative sperm parameter values from infertile men with varicocele were analyzed by computer-aided sperm analysis （CASA） to assess if sperm characteristics improved after varicocelectomy. Semen samples of men with proven fertility （n = 38） and men with varicocele-related infertility （n = 61） were also analyzed. Conventional semen analysis was performed according to WHO （2010） criteria and a CASA system was employed to assess kinetic parameters and sperm concentration. Seminal parameters values in the fertile group were very far above from those of the patients, either before or after surgery. No significant improvement in the percentage normal sperm morphology （P = 0. 10）, sperm concentration （P = 0.52）, total sperm count （P = 0.76）, subjective motility （%） （P = 0.97） nor kinematics （P = 0.30） was observed after varicocelectomy when all groups were compared. Neither was significant improvement found in percentage normal sperm morphology （P = 0.91）, sperm concentration （P =0. 10）, total sperm count （P = 0.89） or percentage motility （P = 0.77） after varicocelectomy in paired comparisons of preoperative and postoperative data. Analysis of paired samples revealed that the total sperm count （P = 0.01） and most sperm kinetic parameters： curvilinear velocity （P = 0.002）, straight-line velocity （P = 0.0004）, average path velocity （P = 0.0005）, linearity （P = 0.02）, and wobble （P = 0.006） improved after surgery. CASA offers the potential for accurate quantitative assessment of each patient＇s response to varicocelectomy.展开更多
The study aimed to determine the effect of microsurgical sub-inguinal varicocelectomy on semen parameters among men seeking infertility treatment in Ghana. This was an intervention study conducted at Tamale Teaching H...The study aimed to determine the effect of microsurgical sub-inguinal varicocelectomy on semen parameters among men seeking infertility treatment in Ghana. This was an intervention study conducted at Tamale Teaching Hospital in the Tamale Metropolis from September 2017 to August 2021. The study involves two groups;the surgery group (n = 75) and the observed group (n = 63). Duplicate semen samples (mean values adopted) were collected at the onset and assessed according to the criteria established by World Health Organization (WHO), 2010. Varicocelectomy was performed for the surgery group and no intervention was given to the observed group. The two groups were followed for 180 days and repeated semen samples were collected and analyzed. The data was computed using GraphPad Prism (v8.0) at an alpha of 0.05. All the men had varicocele and were aged between 46.0 and 67.0 years old. There was no difference between semen parameters among the two groups before the surgery. However, after 180 days of follow-up, all of the semen parameters significantly improved in the surgery group (p < 0.0001), while sperm concentration (p = 0.0068), progressive motility (p = 0.0281), and normal sperm morphology (p = 0.0015) decreased in the observed group. The surgery group had an overall percent increase in total sperm count (840.7%;p = 0.0197), sperm concentration (582.1%;p = 0.0125), total viable sperms (155.2%;p < 0.0001), and normal sperm morphology (110.9%;p < 0.0001) while immotile sperms (-51.71%;p < 0.0001) reduced. A pregnancy rate of 25.3% (19/75) was reported among the surgery group but none was reported among the observed group after 180 days. Microsurgical sub-inguinal varicocelectomy improves semen parameters and hence effective treatment of infertile men with a clinically palpable varicocele. It is recommended to use this choice for similar patients, however, further studies with a larger sample size are needed to provide more evidence to recommend this therapy.展开更多
Aim： To report a series of varicocelectomy performed under pure local anesthesia. Methods： From July 1988 to June 2003, a total of 575 patients, aged between 15 and 73 years, underwent high ligation of the internal ...Aim： To report a series of varicocelectomy performed under pure local anesthesia. Methods： From July 1988 to June 2003, a total of 575 patients, aged between 15 and 73 years, underwent high ligation of the internal spermatic vein for treatment of a varicocele testis under a regional block in which a precise injection of 0.8 % lidocaine solution was delivered to involved tissues after exact anatomical references were made. A 100-mm visual analog scale （VAS） was used to assess whether the pain level was acceptable. Results： The surgeries were bilateral in 52 cases, and unilateral in 523 cases. All were successfully performed on an outpatient basis except in the case of two patients, who were hospitalized because their surgeries required general anesthesia. Overall, 98.6 % （567/575） of men could go back to work by the end of the first post-operative week and only 8 （1.4 %） men reported feeling physical discomfort on the eighth day. The VAS scores varied from 11 mm to 41 mm with an average of （18.5 ± 11.3） mm that was regarded as tolerable. Conclusion： This study has shown varicocelectomy under local anesthesia to be possible, simple, effective, reliable and reproducible, and a safe method with minimal complications. It offers the advantages of more privacy, lower morbidity, with no notable adverse effects resulting from anesthesia, and a more rapid return to regular physical activity with minor complications.展开更多
<strong>Background:</strong> Varicocele is abnormal dilation and tortousity of the scrotal venous pampiniform plexus that drain blood from each testicle. Recently, it has been linked to low serum total tes...<strong>Background:</strong> Varicocele is abnormal dilation and tortousity of the scrotal venous pampiniform plexus that drain blood from each testicle. Recently, it has been linked to low serum total testosterone (TT) levels by affecting the optimal functioning of the leydig cell via increasing the scrotal temperature. Varicocele repair has been found post-operatively to increase the serum levels of TT. This study looks at the pre and post-subinguinal microsurgical varicocelectomy serum TT levels in male patients with clinical varicocele. <strong>Methods:</strong> The study involved 88 male patients with clinical varicoceles who met the inclusion criteria. These patients after good history taking and physical examination had their serum TT levels measured pre varicocelectomy and 6 months post-subinguinal microsurgical varicocelectomy. The varicoceles were diagnosed by physical examination and use of scrotal color Doppler ultrasonography (US). <strong>Results:</strong> The number of patients with varicocele were 88 males. The mean age of the patients was 33.43 ± 7.82 years. There was isolated left varicocele in 57 (64.8%) patients and bilateral varicocele in 27 (30.7%) patients. Pre varicocelectomy, 61 (69.3%) patients had serum TT of between 100 - 290 nanogram/deciliter (ng/dl) and a mean value of 241 ± 0.91 ng/dl. Post varicocelectomy 56 (63.6%) patients had serum TT in the range of 300 - 490 ng/dl with a mean of 482 ± 2.87 ng/dl, showing a robust significant increase in the serum TT post-operatively (P < 0.001). <strong>Conclusion:</strong> There was statistically significant improvement in the serum TT levels with 55 (79%) patients exhibiting normalization of serum TT levels after subinguinal microsurgical varicocelectomy.展开更多
Background: Long-standing varicocele is often associated with testicular hypoxia and that might worsen Leydig cell function, a significant risk factor for hypogonadism. This may affect both the secretory and endocrine...Background: Long-standing varicocele is often associated with testicular hypoxia and that might worsen Leydig cell function, a significant risk factor for hypogonadism. This may affect both the secretory and endocrine functions of the testis. This study aims to determine the effect of microsurgical sub-inguinal varicocelectomy on gonadal function among men reporting sexual dysfunction in Ghana. Methods: This was an intervention study conducted at the Tamale Teaching Hospital from September 2017 to August 2021. A total of 103 participants were randomized into two groups;the surgery group (n = 52) and the observed group (n = 51). Venous blood samples were collected at baseline, varicocelectomy was performed for the surgery group, and no intervention was given to the other. Blood samples were subsequently collected at 12-, 24-, 36-, and 48-month intervals for assay of serum total testosterone, FSH, and LH. The data were analyzed in GraphPad Prism (v8.0) at an alpha value of 0.05. Results: All the participants had varicocele and were aged between 55.0 to 69.0 years old. At the baseline of the study, all participants presented with sexual dysfunction but a significant improvement (p Conclusions: Microsurgical sub-inguinal varicocelectomy improved gonadal function among varicocele patients reporting sexual dysfunction. It is recommended to use this choice for similar patients;however, these findings should be verified by a multi-institutional study to provide more evidence for this choice.展开更多
Background and Objective: The optimal treatment for varicocele is still controversial. Although there are many treatment methods, none can be considered as the best therapeutic option. We present our initial laparosco...Background and Objective: The optimal treatment for varicocele is still controversial. Although there are many treatment methods, none can be considered as the best therapeutic option. We present our initial laparoscopic varicocelectomy experience by describing the clinical aspects and evaluating the outcomes of this surgical procedure at the Centre medico-chirugicale d’urologie in Douala, Cameroon. Materials and Methods: This was a retrospective study carried out between January 2015 and December 2019 on 35 patients with symptomatic varicoceles who were treated for either testicular pain or infertility. All surgical procedures were performed via laparoscopy, with ligation of the spermatic vein using a hemlock clip in the retroperitoneal space. The patients were followed up for three months after surgery, and data were collected and analyzed to obtain results. Results: The study participants were aged 16 - 55 years, with a mean age of 36.11 ± 8.45 years. Infertility was the main presenting complaint. In 65.7% of cases, varicoceles were bilateral with testicular atrophy occurring in 26 patients (74.28%). The surgery duration ranged from 14 minutes to 60 minutes, with an average duration of 34.8 minutes. There was no case of conversion to open surgery. No major complications were observed and all patients were discharged the day after surgery. Three months after surgery, all patients stopped experiencing pain and semen parameters improved in 71.42% of the study participants, with 42.82% of them impregnating their partners. Conclusion: Laparoscopic varicocelectomy is efficient, less time-consuming, with minimal postoperative complications. It can be performed easily in the outpatient department.展开更多
Introduction: Post-varicocelectomy pain is a considerable pain with probability of promotion toward chronicity. Some reasons, including surgical technique or nerve injury and inappropriate attention to treatment of ac...Introduction: Post-varicocelectomy pain is a considerable pain with probability of promotion toward chronicity. Some reasons, including surgical technique or nerve injury and inappropriate attention to treatment of acute pain play role in the emergence of acute pain. The pain could lead to limitation in movement and working, patient dissatisfaction and waste of medical resources. Transcutaneous electrical nerve stimulation (TENS) therapy as the patient control analgesia (PCA) is associated with reduction of pain intensity and analgesic consumptions. This study aimed to evaluate the effect of TENS therapy on reducing the acute and chronic pain following varicocelectomy. Methods and Materials: The study was conducted after obtaining the approval of the local Institute Ethics Committee and written informed consent from all of the patients. Eighty patients scheduled for undergoing varicocelectomy, were randomly classified according to a randomization list prepared using online software at a 1:1 ratio to Groups A (intervention group) and B (placebo group). In postoperative and recovery period, Group A received TENS therapy for 30 minutes in parallel to surgical scar with high frequency by sensory level. Group B was treated with off-device. The treatment course was replicated for the two groups at 2, 6, 12 and 24 hours after operation. Then, postoperative pain was measured by VAS (visual analogue scale) at the same time and after 1 week and 1, 2 and 3 months. The amount of used analgesics was recorded. Results: The results showed that based on the VAS, pain significantly decreased after intervention in 2 hours (25% with VAS = 5 versus 32.5% with VAS = 8 in control group). The differences among, amount of used analgesics at 2, 6 and 12 hours were significant with p-value = 0.001, <0.0001 and =0.02, respectively. Conclusion: TENS therapy could efficiently decrease pain degree for hours, weeks and months after varicocelectomy;this was associated with decreased post-operation analgesic requirements.展开更多
Varicocele is a common entity found in 15%of men and is the most common reversible cause of male factor infertility.Guidelines have been developed to guide urologists in deciding which patients would benefit from vari...Varicocele is a common entity found in 15%of men and is the most common reversible cause of male factor infertility.Guidelines have been developed to guide urologists in deciding which patients would benefit from varicocelectomy.Yet studies published over the last decade showed the emergence of predictors of success of varicocelectomy using nomograms and other predictive models with statistical analysis.The emergence of artificial intelligence(AI)and machine learning revolutionized the clinician's approach to medicine.The virtual branch of AI,represented by machine learning,has been a very exciting topic for clinicians and researchers over the last years,especially after the launching of ChatGPT-3.5.Urology has been at the forefront of integrating advances in AI into its everyday practice.We aim to shed light on the present literature describing the use of AI in predicting the outcomes of varicocelectomy.Machine learning is being used to predict the improvement in semen parameters after varicocelectomy.These algorithms are derived from studies and data present in the literature and predictive models developed throughout the last two decades and have a superior performance to that of traditional nomograms.However,these models require further research and validation but are anticipated to surpass the accuracy of all current resources,setting forward a new era of varicocele workup and management in the years to come.This paper offers a wide review on the current evidence behind varicocele surgery and the integration of AI in medicine,urology and its use in predicting improvement in sperm parameters post-varicocelectomy.展开更多
In this insightful narrative review,Nasrallah et al.[1]explore a timely and emerging concept:the use of artificial intelligence(AI)to improve patient selection and outcome prediction for varicocelectomy,a procedure of...In this insightful narrative review,Nasrallah et al.[1]explore a timely and emerging concept:the use of artificial intelligence(AI)to improve patient selection and outcome prediction for varicocelectomy,a procedure often surrounded by clinical ambiguity.The article delivers a clear and concise synthesis of early but promising applications of machine learning(ML)in the context of male infertility,highlighting the potential for AI to move us beyond traditional parameters like semen analysis and toward more clinically meaningful outcomes.展开更多
文摘Dear Editor,Varicocele(VC)is a vascular condition characterized by abnormal tortuosity and dilation of the pampiniform plexus veins within the spermatic cord.VC is commonly observed in young adults,predominantly on the left side;it is a frequent cause of male infertility and can lead to testicular hypofunction,pain,and discomfort.Microsurgical varicocelectomy is the gold standard for treating infertility caused by VC.VC repair is strongly recommended for couple infertility,oligoasthenoteratozoospermia(OAT),Grade 2 or 3 clinical VC,partner age<37 years,patient age<40 years,or testicular hypotrophy in children and adolescents.
文摘Objective:This study investigated the outcomes of microsurgical subinguinal varicocelectomy(MSV)on semen and hormonal parameters in cases with isolated sperm defects(oligozoospermia,asthenozoospermia,or teratozoospermia).Methods:A retrospective review of charts of patients who underwent MSV for clinically palpable varicocele between January 1,2011 and January 1,2019 at Hamad Medical Corporation was undertaken.All patients diagnosed with isolated oligozoospermia,asthenozoospermia,or teratozoospermia in the preoperative semen analysis were included.Men with multiple sperm defects,genetic abnormalities,azoospermia,history of genitourinary infection,exposure to chemotherapy or radiotherapy,or prior use of peri-operative fertility treatment were excluded.Data extracted from the electronic medical records included(collected before MSV and up to 6 months postoperatively):demographics(age),clinical data(fertility-related medical history and surgical interventions),family history(consanguinity and infertility),physical examination findings from general and local genital exam(varicocele side and grade),laboratory data such as semen analysis,sperm DNA fragmentation tests,and hormone levels(follicle-stimulating hormone,luteinizing hormone,total testosterone,estradiol,and prolactin),and imaging(scrotal color Doppler ultrasound).Results:A total of 331 patients with isolated sperm defects were included.Postoperatively,83.3%of patients showed an improvement in sperm concentration with a median increase of 7 millions/mL.Postoperatively,76.7%of isolated asthenozoospermic patients showed an improvement in total motility and 66.0%had an improvement in progressive motility with median increases of 15.0%and 7.5%,respectively.Postoperatively,70.0%of the teratozoospermic patients showed an improvement in normal sperm morphology with a median increase of 6%.No changes were observed in other semen or hormone parameters that were examined.Conclusion:MSV is a valid and effective treatment modality for patients with isolated sperm defects that significantly corrects their respective semen abnormality and improves their chances of natural conception.
文摘Dear Editor,Robotic-assisted laparoscopic varicocelectomy(RALV)has been recently described in the pediatric field[1].Although the learning curve of surgical procedures is flattened by a robotic approach[2],complications may occur especially at the beginning of experience.We herein describe an unexpected severe case of parietal blood dripping in a boy who underwent RALV.The study was approved by the institutional review board of Federico Il University Hospital in Naples,Italy(approval number:Fll/2024-PL149).All procedures performed were in accordance with the ethical standards of the institution and/or national research committee.The written informed consent was obtained by his parents to agree the treatment and publish this paper.
文摘The present meta-analysis was conducted to compare the clinical effect and patient experience of laparoendoscopic single-site varicocelectomy （LESSV） and conventional laparoscopic varicocelectomy. The candidate studies were included after literature search of database Cochrane Library, PubMed, EMBASE, and MEDLINE. Related information on essential data and outcome measures was extracted from the eligible studies by two independent authors, and a meta-analysis was conducted using STATA 12.0 software. Subgroup analyses were conducted by study design （RCT and non-RCT）. The odds ratio （OR） or standardized mean difference （SMD） and their 95% confidence intervals （95% CIs） were used to estimate the outcome measures. Seven articles were included in our meta-analysis. The results indicated that patient who had undergone LESSV had a shorter duration of back to work （overall： SMD = -1.454, 95% Ch -2.502m0.405, P= 0.007; non-RCT： SMD = -2.906, 95% Ch -3.796-2.017, P= 0.000; and RCT： SMD = -0.841, 95% Ch -1.393-0.289, P = 0.003） and less pain experience at 3 h or 6 h （SMD = -0.447, 95% Ch -0.754-0.139, P = 0.004）, day 1 （SMD = -0.477, 95% Ch -0.905-0.05, P = 0.029）, and day 2 （SMD = -0.612, 95% Ch -1.099-0.125, P= 0.014） postoperatively based on RCT studies. However, the meta-analyses based on operation time, clinical effect （improvement of semen quality and scrotal pain relief）, and complications （hydrocele and recurrence） yielded nonsignificant results. In conclusion, LESSV had a rapid recovery and less pain experience over conventional laparoscopic varicocelectomy. However, there was no statistically significant difference between the two varicocelectomy techniques in terms of the clinical effect and the incidence of hydrocele and varicocele recurrence. More high-quality studies are warranted for a comprehensive conclusion.
文摘Aim： To determine if robot-assisted varicocelectomy can be safely and effectively performed when compared to microscopic inguinal varicocelectomy. Methods： Eight patients aged 29.1 ± 12.5 years underwent microscopic subinguinal varicocelectomies： seven patients with left-sided repair, and one patient with bilateral repair. Eight patients aged 22.0 ±8.0 years underwent robot-assisted varicocelectomies： seven patients with left-sided repair and one patient with bilateral repair. Results： The average operative time for microscopic inguinal varicocelectomy was 73.9 ±12.2 min, whereas the robot-assisted technique took 71.1± 21.1 min. There were no difficulties in identifying and isolating vessels and the vas deferens with robot-assisted subinguinal varicocelectomy. Hand tremor was eliminated using the robotic procedure. Patients who underwent either microscopic or robot-assisted varicocelectomies were able to resume daily activities on the day of surgery and full activities within 2 weeks. There were no complications or recurrences of varicocele. Conclusion： From our experience, compared to microscopic surgery, robot-assisted varicocelectomy can be safely and effectively performed, with the added benefit of eliminating hand tremor.
文摘Varicocelectomy is the most commonly performed surgical procedure for the treatment of male infertility. Although several different techniques for varicocele repair have been described in the literature, microsurgical varicocelectomy performed through a subinguinal or inguinal incision is recognized as the gold-standard approach for varicocelectomy, due to high success rates with minimal complications. Standard indications for varicocelectomy include palpable varicocele（s）, with one or more abnormal semen parameters, and, for the couple trying to conceive, in the setting of normal or correctable female infertility. However, varicocele repair is often recommended and undertaken for reasons other than infertility, including low serum testosterone, testicular pain, testicular hypotrophy and poor sperm DNA quality. This article reviews the technical aspects of microsurgical varicocelectomy, and its indications in adults and adolescents.
文摘Conventional meta-analyses have shown inconsistent results for the efficacy of various treatments of varicoceles. Therefore, we performed a multiple-treatment meta-analysis to assess the effectiveness and safety of 10 methods of varicocelectomy and embolization/sclerotherapy. We systematically reviewed 35 randomized controlled trials and observational studies, from 1966 to August 5, 2013, which compared any of the following treatments for varococeles： laparoscopic, retroperitoneal, open inguinal and subinguinal varicocelectomy, microsurgical subinguinal and inguinal varicocelectomy, percutaneous venous embolization, Tauber antegrade sclerotherapy, retrograde sclerotherapy and expectant therapy （no treatment）. Inguinal and subinguinal microsurgery, open inguinal, laparoscopic varicocelectomy showed a significant advantage over expectant therapy in terms of pregnancy rates （odds ratio （OR）： 3.48, 2.68, 2.92 and 2.90, respectively）. Compared with retroperitoneal open surgery, inguinal microsurgery showed an improvement of sperm density （mean difference （MD）： 10.60, 95% confidence interval （Cl）： 1.92-19.60） and sperm motility （MD： 9.09, 95% Cl. 4.88-13.30）. Subinguinal and inguinal microsurgery outperformed retroperitoneal open surgery in terms of recurrence （OR： 0.05, 0.06 respectively）. Tauber antegrade sclerotherapy and subinguinal microsurgery were associated with the lowest risk of hydrocele formation. The odds of overall complication, compared with retroperitoneal open varicocelectomy, were lowest for inguinal microsurgery （OR = 0.07, 95% Ch 0.02-0.19）, followed by subinguinal microsurgery （OR = 0.09, 95% CI. 0.02-0.19）. Inguinal and subinguinal micro-varicocelectomy had the highest pregnancy rates, significant increases in sperm parameters, with low odds of complication. These results warrant additional properly conducted randomized controlled clinical studies with larger sample sizes.
文摘We report the largest single-center experience with robotic-assisted microscopic varicocelectomy （RAMV） in male infertility. From August 2012 to February 2015, men with infertility of at least a year and varicoceles underwent RAMV by a single surgeon. Varicocele was diagnosed on physical examination and confirmed by ultrasound by a single ultrasonographer. Preoperative hormone panel, semen analyses, and testicular Doppler ultrasound were obtained from all men and repeated at 3 months. One hundred and forty consecutive men （258 varicocelectomies） were included. Mean age and duration of infertility was 36.4 and 2.8 years, respectively. Median total and free testosterone increased by 145 ng dl^-1 and 4.3 pcg ml^-1 （44.3%）, respectively （P 〈 0.0001）. Median sperm concentration increased by 37.3% （P 〈 0.03）. Median sperm motility and morphology did not significantly change. Median left and right testicular volume increased by 22.3% （P 〈 0.0001） and 12.6% （P 〈 0.0006）, respectively. Hydroceles occurred 0.8% of procedures. We had no testicular artery injuries. Persistence of varicocele by Doppler ultrasound was 9.6%. Only 37.3% of patients required pain medications postoperatively. We concluded that RAMV is a safe and effective alternative for varicocele repair with outcomes comparable to historical traditional microsurgical approach.
文摘In this review,we tried to systematize all the evidence(from PubMed[MEDLINE],Scopus,Cochrane Library,EBSCO,Embase,and Google Scholar)from 1993 to 2021 on the predictors of microsurgical varicocelectomy efficacy in male infertility treatment.Regarding the outcomes of varicocele repair,we considered semen improvement and pregnancy and analyzed them separately.Based on the 2011 Oxford CEBM Levels of Evidence,we assigned a score to each trial that studied the role of the predictor.We systematized the studied predictors based on the total points,which were,in turn,calculated based on the number and quality of studies that confirmed or rejected the studied predictor as significant,into three levels of significance:predictors of high,moderate,and low clinical significance.Preoperative total motile sperm count(TMSC)coupled with sperm concentration can be a significant predictor of semen improvement and pregnancy after varicocelectomy.In addition,for semen improvement alone,scrotal Doppler ultrasound(DUS)parameters,sperm DNA fragmentation index(DFI),and bilateral varicocelectomy are reliable predictors of microsurgical varicocelectomy efficacy.
文摘The aim of this study is to evaluate the benefits of laparoscopic Doppler ultrasound （LDU） application during laparoscopic varicocelectomy （LV）, and to compare the surgical outcomes and complications between LDU-assisted LV （LDU-LV） and conventional LV for infertile patients with varicoceles; 147 infertile patients were randomly divided into two groups. Operative and postoperative parameters, semen parameters, and the pregnancy rate were compared. There were no differences in baseline demographics. The operative time was significantly longer in LDU-LV group than LV group. The incidence of postoperative hydrocele was 1.4% （1/72） in LDU-LV group versus 10.7% （8/75） in LV group, which showed a significant difference （P〈 0.05）. However, other surgical outcomes, such as postoperative hospital stay, postoperative recurrence, and testicular atrophy, were similar between the two groups. Sperm concentration and sperm motility were significantly increased in both groups at 3, 6, and 12 months after surgery （P 〈 0.01）, and they were higher in LDU-LV than LV group in 12 months after surgery （34.21 ± 6.36 vs 29.99 ± 6.04 for concentration, P〈 0.05; 40.72±8.12 vs 37.31 ± 6.12 for motility, P〈 0.05）. Sperm morphology was comparable between the two groups. The pregnancy rate showed no significant difference （44.4% of the LDU-LV vs 37.3% of the LV, P〉 0.05）. In conclusion, compared with LV, LDU-LV could safely and effectively ligate all spermatic veins and preserve spermatic arteries without leading to high varicocele recurrence and postoperative hydrocele. Given the benefits that sperm counts as well as sperm motility favoring LDU-LV, we recommend that LDU should be routinely used as an effective tool to improve outcomes and safety of laparoscopic varicocelectomy.
文摘The aim of this study was to compare the intraoperative difference in anatomic details between Ioupe-assisted and microscopic varicocelectomy within the same spermatic cord. Between April 2011 and August 2011, 26 men with 33 sides containing grade 2-3 varicocele were enrolled in this study. First, one surgeon performed the open inguinal varicocelectomy under x 3.5 Ioupe magnification. The presumed vascular channels and lymphatics were isolated and marked without ligation. Another surgeon then microsurgically dissected and checked the same spermatic cord using an operating microscope to judge the results in terms of the ligation of the internal spermatic veins and the preservation of the arteries and lymphatics. There were significant differences in the average number of internal spermatic arteries （1.51 vs 0.97）, internal spermatic veins （5.70 vs 4.39） and lymphatics （3.52 vs 1.61） between the microscope and Ioupe-assisted procedures （P 〈 0.001, P 〈 0.001, P 〈 0.001, respectively）. Meanwhile, in varicocele repair with Ioupe magnification, an average of 1.30 β± 1.07 （43/33） internal spermatic veins per side were missed, among the overlooked veins, 1.12 ± 0.93 （37/33） were adhered to the preserved testicular artery, as well as 0.55 ± 0.79 lymphatics and 0.36 ± 0.55 arteries that were to be ligated. In conclusion, microscopic varicocelectomy could preserve more internal spermatic arteries and lymphatics and could ligate more veins than the Ioupe-assisted procedure. To some degree, Ioupe magnification is inadequate for the reliable identification and dissection of the tiny vessels of the spermatic cord, as most of the overlooked veins were adhered to the preserved testicular artery.
文摘Preoperative and postoperative sperm parameter values from infertile men with varicocele were analyzed by computer-aided sperm analysis （CASA） to assess if sperm characteristics improved after varicocelectomy. Semen samples of men with proven fertility （n = 38） and men with varicocele-related infertility （n = 61） were also analyzed. Conventional semen analysis was performed according to WHO （2010） criteria and a CASA system was employed to assess kinetic parameters and sperm concentration. Seminal parameters values in the fertile group were very far above from those of the patients, either before or after surgery. No significant improvement in the percentage normal sperm morphology （P = 0. 10）, sperm concentration （P = 0.52）, total sperm count （P = 0.76）, subjective motility （%） （P = 0.97） nor kinematics （P = 0.30） was observed after varicocelectomy when all groups were compared. Neither was significant improvement found in percentage normal sperm morphology （P = 0.91）, sperm concentration （P =0. 10）, total sperm count （P = 0.89） or percentage motility （P = 0.77） after varicocelectomy in paired comparisons of preoperative and postoperative data. Analysis of paired samples revealed that the total sperm count （P = 0.01） and most sperm kinetic parameters： curvilinear velocity （P = 0.002）, straight-line velocity （P = 0.0004）, average path velocity （P = 0.0005）, linearity （P = 0.02）, and wobble （P = 0.006） improved after surgery. CASA offers the potential for accurate quantitative assessment of each patient＇s response to varicocelectomy.
文摘The study aimed to determine the effect of microsurgical sub-inguinal varicocelectomy on semen parameters among men seeking infertility treatment in Ghana. This was an intervention study conducted at Tamale Teaching Hospital in the Tamale Metropolis from September 2017 to August 2021. The study involves two groups;the surgery group (n = 75) and the observed group (n = 63). Duplicate semen samples (mean values adopted) were collected at the onset and assessed according to the criteria established by World Health Organization (WHO), 2010. Varicocelectomy was performed for the surgery group and no intervention was given to the observed group. The two groups were followed for 180 days and repeated semen samples were collected and analyzed. The data was computed using GraphPad Prism (v8.0) at an alpha of 0.05. All the men had varicocele and were aged between 46.0 and 67.0 years old. There was no difference between semen parameters among the two groups before the surgery. However, after 180 days of follow-up, all of the semen parameters significantly improved in the surgery group (p < 0.0001), while sperm concentration (p = 0.0068), progressive motility (p = 0.0281), and normal sperm morphology (p = 0.0015) decreased in the observed group. The surgery group had an overall percent increase in total sperm count (840.7%;p = 0.0197), sperm concentration (582.1%;p = 0.0125), total viable sperms (155.2%;p < 0.0001), and normal sperm morphology (110.9%;p < 0.0001) while immotile sperms (-51.71%;p < 0.0001) reduced. A pregnancy rate of 25.3% (19/75) was reported among the surgery group but none was reported among the observed group after 180 days. Microsurgical sub-inguinal varicocelectomy improves semen parameters and hence effective treatment of infertile men with a clinically palpable varicocele. It is recommended to use this choice for similar patients, however, further studies with a larger sample size are needed to provide more evidence to recommend this therapy.
文摘Aim： To report a series of varicocelectomy performed under pure local anesthesia. Methods： From July 1988 to June 2003, a total of 575 patients, aged between 15 and 73 years, underwent high ligation of the internal spermatic vein for treatment of a varicocele testis under a regional block in which a precise injection of 0.8 % lidocaine solution was delivered to involved tissues after exact anatomical references were made. A 100-mm visual analog scale （VAS） was used to assess whether the pain level was acceptable. Results： The surgeries were bilateral in 52 cases, and unilateral in 523 cases. All were successfully performed on an outpatient basis except in the case of two patients, who were hospitalized because their surgeries required general anesthesia. Overall, 98.6 % （567/575） of men could go back to work by the end of the first post-operative week and only 8 （1.4 %） men reported feeling physical discomfort on the eighth day. The VAS scores varied from 11 mm to 41 mm with an average of （18.5 ± 11.3） mm that was regarded as tolerable. Conclusion： This study has shown varicocelectomy under local anesthesia to be possible, simple, effective, reliable and reproducible, and a safe method with minimal complications. It offers the advantages of more privacy, lower morbidity, with no notable adverse effects resulting from anesthesia, and a more rapid return to regular physical activity with minor complications.
文摘<strong>Background:</strong> Varicocele is abnormal dilation and tortousity of the scrotal venous pampiniform plexus that drain blood from each testicle. Recently, it has been linked to low serum total testosterone (TT) levels by affecting the optimal functioning of the leydig cell via increasing the scrotal temperature. Varicocele repair has been found post-operatively to increase the serum levels of TT. This study looks at the pre and post-subinguinal microsurgical varicocelectomy serum TT levels in male patients with clinical varicocele. <strong>Methods:</strong> The study involved 88 male patients with clinical varicoceles who met the inclusion criteria. These patients after good history taking and physical examination had their serum TT levels measured pre varicocelectomy and 6 months post-subinguinal microsurgical varicocelectomy. The varicoceles were diagnosed by physical examination and use of scrotal color Doppler ultrasonography (US). <strong>Results:</strong> The number of patients with varicocele were 88 males. The mean age of the patients was 33.43 ± 7.82 years. There was isolated left varicocele in 57 (64.8%) patients and bilateral varicocele in 27 (30.7%) patients. Pre varicocelectomy, 61 (69.3%) patients had serum TT of between 100 - 290 nanogram/deciliter (ng/dl) and a mean value of 241 ± 0.91 ng/dl. Post varicocelectomy 56 (63.6%) patients had serum TT in the range of 300 - 490 ng/dl with a mean of 482 ± 2.87 ng/dl, showing a robust significant increase in the serum TT post-operatively (P < 0.001). <strong>Conclusion:</strong> There was statistically significant improvement in the serum TT levels with 55 (79%) patients exhibiting normalization of serum TT levels after subinguinal microsurgical varicocelectomy.
文摘Background: Long-standing varicocele is often associated with testicular hypoxia and that might worsen Leydig cell function, a significant risk factor for hypogonadism. This may affect both the secretory and endocrine functions of the testis. This study aims to determine the effect of microsurgical sub-inguinal varicocelectomy on gonadal function among men reporting sexual dysfunction in Ghana. Methods: This was an intervention study conducted at the Tamale Teaching Hospital from September 2017 to August 2021. A total of 103 participants were randomized into two groups;the surgery group (n = 52) and the observed group (n = 51). Venous blood samples were collected at baseline, varicocelectomy was performed for the surgery group, and no intervention was given to the other. Blood samples were subsequently collected at 12-, 24-, 36-, and 48-month intervals for assay of serum total testosterone, FSH, and LH. The data were analyzed in GraphPad Prism (v8.0) at an alpha value of 0.05. Results: All the participants had varicocele and were aged between 55.0 to 69.0 years old. At the baseline of the study, all participants presented with sexual dysfunction but a significant improvement (p Conclusions: Microsurgical sub-inguinal varicocelectomy improved gonadal function among varicocele patients reporting sexual dysfunction. It is recommended to use this choice for similar patients;however, these findings should be verified by a multi-institutional study to provide more evidence for this choice.
文摘Background and Objective: The optimal treatment for varicocele is still controversial. Although there are many treatment methods, none can be considered as the best therapeutic option. We present our initial laparoscopic varicocelectomy experience by describing the clinical aspects and evaluating the outcomes of this surgical procedure at the Centre medico-chirugicale d’urologie in Douala, Cameroon. Materials and Methods: This was a retrospective study carried out between January 2015 and December 2019 on 35 patients with symptomatic varicoceles who were treated for either testicular pain or infertility. All surgical procedures were performed via laparoscopy, with ligation of the spermatic vein using a hemlock clip in the retroperitoneal space. The patients were followed up for three months after surgery, and data were collected and analyzed to obtain results. Results: The study participants were aged 16 - 55 years, with a mean age of 36.11 ± 8.45 years. Infertility was the main presenting complaint. In 65.7% of cases, varicoceles were bilateral with testicular atrophy occurring in 26 patients (74.28%). The surgery duration ranged from 14 minutes to 60 minutes, with an average duration of 34.8 minutes. There was no case of conversion to open surgery. No major complications were observed and all patients were discharged the day after surgery. Three months after surgery, all patients stopped experiencing pain and semen parameters improved in 71.42% of the study participants, with 42.82% of them impregnating their partners. Conclusion: Laparoscopic varicocelectomy is efficient, less time-consuming, with minimal postoperative complications. It can be performed easily in the outpatient department.
文摘Introduction: Post-varicocelectomy pain is a considerable pain with probability of promotion toward chronicity. Some reasons, including surgical technique or nerve injury and inappropriate attention to treatment of acute pain play role in the emergence of acute pain. The pain could lead to limitation in movement and working, patient dissatisfaction and waste of medical resources. Transcutaneous electrical nerve stimulation (TENS) therapy as the patient control analgesia (PCA) is associated with reduction of pain intensity and analgesic consumptions. This study aimed to evaluate the effect of TENS therapy on reducing the acute and chronic pain following varicocelectomy. Methods and Materials: The study was conducted after obtaining the approval of the local Institute Ethics Committee and written informed consent from all of the patients. Eighty patients scheduled for undergoing varicocelectomy, were randomly classified according to a randomization list prepared using online software at a 1:1 ratio to Groups A (intervention group) and B (placebo group). In postoperative and recovery period, Group A received TENS therapy for 30 minutes in parallel to surgical scar with high frequency by sensory level. Group B was treated with off-device. The treatment course was replicated for the two groups at 2, 6, 12 and 24 hours after operation. Then, postoperative pain was measured by VAS (visual analogue scale) at the same time and after 1 week and 1, 2 and 3 months. The amount of used analgesics was recorded. Results: The results showed that based on the VAS, pain significantly decreased after intervention in 2 hours (25% with VAS = 5 versus 32.5% with VAS = 8 in control group). The differences among, amount of used analgesics at 2, 6 and 12 hours were significant with p-value = 0.001, <0.0001 and =0.02, respectively. Conclusion: TENS therapy could efficiently decrease pain degree for hours, weeks and months after varicocelectomy;this was associated with decreased post-operation analgesic requirements.
文摘Varicocele is a common entity found in 15%of men and is the most common reversible cause of male factor infertility.Guidelines have been developed to guide urologists in deciding which patients would benefit from varicocelectomy.Yet studies published over the last decade showed the emergence of predictors of success of varicocelectomy using nomograms and other predictive models with statistical analysis.The emergence of artificial intelligence(AI)and machine learning revolutionized the clinician's approach to medicine.The virtual branch of AI,represented by machine learning,has been a very exciting topic for clinicians and researchers over the last years,especially after the launching of ChatGPT-3.5.Urology has been at the forefront of integrating advances in AI into its everyday practice.We aim to shed light on the present literature describing the use of AI in predicting the outcomes of varicocelectomy.Machine learning is being used to predict the improvement in semen parameters after varicocelectomy.These algorithms are derived from studies and data present in the literature and predictive models developed throughout the last two decades and have a superior performance to that of traditional nomograms.However,these models require further research and validation but are anticipated to surpass the accuracy of all current resources,setting forward a new era of varicocele workup and management in the years to come.This paper offers a wide review on the current evidence behind varicocele surgery and the integration of AI in medicine,urology and its use in predicting improvement in sperm parameters post-varicocelectomy.
文摘In this insightful narrative review,Nasrallah et al.[1]explore a timely and emerging concept:the use of artificial intelligence(AI)to improve patient selection and outcome prediction for varicocelectomy,a procedure often surrounded by clinical ambiguity.The article delivers a clear and concise synthesis of early but promising applications of machine learning(ML)in the context of male infertility,highlighting the potential for AI to move us beyond traditional parameters like semen analysis and toward more clinically meaningful outcomes.
