The great debate: varicocele treatment and impact on fertility

Will, M.; Swain, Jason E.; Fode, Mikkel; Sønksen, Jens; Christman, Gregory M.; Ohl, Dana A.

doi:10.1016/j.fertnstert.2011.01.002

Cited by 140 publications

(111 citation statements)

References 146 publications

(157 reference statements)

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“…2 To date, several factors have been proposed to account for varicocele-induced testicular injuries and it appears that the pathophysiology of varicocele is complex and multifaceted. The higher frequency of varicocele appearances in men with infertility has drawn attention and resulted in increased research at the molecular level towards treatments.…”

Section: Discussionmentioning

confidence: 99%

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Role of TNF-related apoptosis-inducing ligand (TRAIL) in the pathogenesis of varicocele-induced testicular dysfunction

Çelik¹,

Kutlu²,

Tekcan³

et al. 2012

Asian J Androl

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The higher frequency of varicocele in men with infertility has drawn attention and resulted in increased research at the molecular level towards treatments. The aim of this study was to investigate the role of tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) and its receptors in varicocele-induced testicular dysfunction in an experimental rat model. The rats were divided into three groups: control, sham and varicocele. Varicoceles in rats were induced by partial ligation of the left renal vein and left testes. The rats were analyzed 13 weeks after surgery. The degree of DNA fragmentation within cells in the testis was determined using terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick end labeling (TUNEL) assay. Tubule degeneration was evaluated using the Johnsen score. The expression of TRAIL and its receptors was detected by immunohistochemical and Western blotting techniques. The apoptotic index, Johnsen score and the expression of TRAIL and TRAIL receptors were examined. The data are presented as the mean6s.d. and were analyzed using computer software. The Kruskal-Wallis and Dunn's multiple comparison tests were used in the statistical analyses. The germ cell apoptotic index was increased in rats with varicoceles when compared with the sham and control groups (P50.0031). The Johnsen score was significantly decreased in the varicocele group when compared with the sham and control groups (P,0.0001). Immunohistochemical and Western blotting analyses showed that after varicocele induction, the expression of TRAIL-R1 and TRAIL-R4 in germ cells was increased and the expression of TRAIL-R2 was decreased. There are no significant differences among the groups in terms of TRAIL and TRAIL-R3 receptor expression. The results of this study indicate that TRAIL and its receptors may have a potential role in the pathogenesis of varicocele-induced testicular dysfunction.

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Section: Discussionmentioning

confidence: 99%

“…1 The association of a varicocele with infertility has been recognized for centuries. 2 Varicoceles are ordinarily accompanied by a decreased testicular volume, an impaired sperm quality and a decline in Leydig cell function. However, the exact mechanism that causes this abnormality remains to be determined.…”

Section: Introductionmentioning

confidence: 99%

Role of TNF-related apoptosis-inducing ligand (TRAIL) in the pathogenesis of varicocele-induced testicular dysfunction

Çelik¹,

Kutlu²,

Tekcan³

et al. 2012

Asian J Androl

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show abstract

“…In contrast, only 41% of the patients with a subclinical varicocele experienced significant improvement in semen parameters and the mean total motile sperm count for the entire group was unchanged. Despite the above mentioned, it remains unclear the reasons why about 2/3 of men with varicocele retain their fertility [52,57] and not all of them achieve fertility improvement after varicocelectomy [58,59]. Moreover, reports on the ineffectiveness of varicocele treatment to increase the chances of conceiving are intriguing.…”

Section: Progressive Effect Of Varicocelesmentioning

confidence: 99%

Varicocele and Male Infertility: Current Issues in Management-A Review

Sv¹

2014

Med Surg Urol

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Varicocele is the most common correctable cause of male factor infertility. The role of varicocele in the etiology of male infertility is still controversial regarding to whom varicocelectomy should be done and the selection should be meticulous. With the recent advances in biomolecular and development of novel sperm functional tests, it has been possible to better understand the mechanism involved in damage provoked by varicocele and therefore, propose ways to reverse them. Clinical studies have shown that varicocele surgery can improve semen quality sufficient to downgrade the type of assisted reproductive technology (ART) procedure required. This reveiw discusses current concepts on the mechanisms for varicocele induced testicular damage and efficacy of varicocelectomy for treatment of infertility. We also review the current guidelines and need for proper case selection before surgery.The authors critically reviewed the cost effectiveness of the surgical treatment of a varicocele compared with assisted reproductive techniques.

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“…Нарушение фертиль-ности при варикоцеле отмечается в 20-80% случаев, а среди пациентов, страдающих бесплодием, варико-целе выявлено у 30-40%. Связь варикоцеле с бес-e-mail: rasulovjamshid@mail.ru плодием явилась основной причиной включения данной патологии в число программ, разрабатывае-мых ВОЗ [2,5,7].Различают непрямые и прямые комбинирован-ные способы хирургического лечения варикоцеле. Прямые способы операции на венах семенного ка- Цель исследования -улучшить результаты хирургического лечения варикоцеле путем разработки способов с использованием микрохирургической техники.…”

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Method of surgical treatment of varicocele

Rasulov¹

2016

Probl. reprod.

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Варикозное расширение вен семенного канатика (варикоцеле) встречается у 15-19% мужчин молодо-го трудоспособного возраста. Нарушение фертиль-ности при варикоцеле отмечается в 20-80% случаев, а среди пациентов, страдающих бесплодием, варико-целе выявлено у 30-40%. Связь варикоцеле с бес-e-mail: rasulovjamshid@mail.ru плодием явилась основной причиной включения данной патологии в число программ, разрабатывае-мых ВОЗ [2,5,7].Различают непрямые и прямые комбинирован-ные способы хирургического лечения варикоцеле. Прямые способы операции на венах семенного ка- Цель исследования -улучшить результаты хирургического лечения варикоцеле путем разработки способов с использованием микрохирургической техники. Материал и методы. В исследование включены результаты хирургического лечения 105 больных с варикоцеле: 1-ю (основная) группу составили 66 больных, оперированных по разработанному в клинике способу, 2-ю (сравнительная) группу -39 больных, оперированных по способу иваниссевича. В 1-й группе у 41 (82%) больного выявлено нарушение сперматогенеза, у 34 (68%) -бесплодный брак. результаты. После операции в контрольные сроки отмечено уменьшение диаметра семенной вены от 0,47±0,04 до 0,26±0,02 см (р<0,05), снижение градиента температуры кожи левой правой половины мошонки от 1,45 до 0,37 °С, что косвенно говорит о нормализации кровотока и устранении застоя крови в яичке. В основной группе отмечено достоверное повышение количества сперматозоидов и их подвижности в эякуляте на 50-70%, а также снижение количества незрелых клеток сперматогенеза в среднем на 40%. наступление беременности в семье больных 1-й группы отмечено у 11,7%, во 2-й группе -у 6,7%. Выводы. определение гемодинамического типа варикоцеле с помощью ультразвуковой допплерографии и интраоперационная флеботонометрия в системе семенной вены позволяют выбрать оптимальный способ операции и предупредить развитие рецидива заболевания. использование микрохирургической техники позволяет лигировать не только коллатеральные семенные вены, но и периартериальные стволы, исключая интраоперационное повреждение тестикулярной артерии и лимфатических коллекторов. разработанный способ, включающий использование микрохирургии в комбинации с формированием «внутреннего» суспензория, является эффективным методом лечения варикоцеле и предупреждения его рецидива, осложненного бесплодием. Objective -to improve the results of surgical treatment of varicocele with use of microsurgical technique. Material and methods. study included the results of surgical treatment of 105 patients with varicocele. I group (main) included 66 patients operated by method of clinic modification and II (comparing) group included patients operated by Ivanissevich method. I group in 41 (82%) had disturbance of spermatogenesis and 34 (68%) -had infertility. Results. After the operation in spermatic vein had diameter of 0.47±0.04 to 0.26±0.02 cm (p<0.05). reduction in skin temperature gradient of the right half of the left scrotum by 1.45 to 0.37 deg was noted, which indirectly indicates the normalization of blood flow and...

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The great debate: varicocele treatment and impact on fertility

Cited by 140 publications

References 146 publications

Role of TNF-related apoptosis-inducing ligand (TRAIL) in the pathogenesis of varicocele-induced testicular dysfunction

Role of TNF-related apoptosis-inducing ligand (TRAIL) in the pathogenesis of varicocele-induced testicular dysfunction

Varicocele and Male Infertility: Current Issues in Management-A Review

Method of surgical treatment of varicocele

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