Varicocele
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Testicular atrophy
Testicular pain
Varicocele is characterized by elongation, dilatation, and tortuosity of the veins draining the testis and its covers, causing circulatory reflux along the inner spermatic vein [ 1 ]. Varicocele results in progressive testicular lesions and, if untreated, can lead to testicular atrophy [ 2 ]. Varicocele is considered the most frequently identified cause of male infertility [ 3 ]. The mechanisms involved in varicocele formation are not well known and probably are multiple, differing from one patient to another.
Testicular atrophy
Spermatic Vein
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Varicocele, the most important treatable cause of male infertility, is present in 15% of adult males, 35% of men with primary infertility, and 80% of men with secondary infertility. On the other hand, 80% of these men will not present infertility. Therefore, there is a need to differentiate a varicocele that is exerting a deleterious effect that is treatable from a "silent" varicocele. Despite the growing evidence of the cellular effects of varicocele, its underlying molecular mechanisms are still eluding. Proteomics has become a promising area to determine the reproductive biology of semen as well as to improve diagnosis of male infertility. This review aims to discuss the state-of-art in seminal plasma proteomics in patients with varicocele to discuss the challenges in undertaking these studies, as well as the future outlook derived from the growing body of evidence on the seminal proteome.
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We examined 67 adolescents aged 11 to 14 years referred for left varicocele. Atrophy of the testes was present in 38 (75%). Several techniques, including laparoscopic surgery were used. The best method appears to be ligation of the spermatic veins via an inguinal approach without touching the artery if possible. Recurrence (5%) is always caused by missing a vein. Growth of the testis occurred in all cases after treatment of the varicocele.
Testicular atrophy
Spermatic Vein
Testicular artery
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Background: Varicocele is the abnormal dilatation of pampiniform venous plexus and internal spermatic vein. It is the commonest surgically correctable cause of male infertility. We reviewed pattern of presentation and management of varicocele in our hospital.Methodology: This is a retrospective review of 100 patients managed for varicocele in our hospital from January 2011 to August, 2020. Data was collected via a proforma and was analyzed using SPSS version 25.0. The results were reported in percentages, mean ± standard deviation.Results: The mean age of the patients was 35.2 ± 8.4 years with a range of 17 to 58 years. The varicocele was asymptomatic in 86 patients (86%), it was during evaluation for infertility. There were symptoms in 16 single young patients. The symptoms include scrotal pain and discomfort in 14 patients (14%) each and scrotal swelling in 7 patients (7%). There were co-morbidities in 7 patients (7%). There were abnormal seminal fluid parameters in 75 patients (75%), low testosterone in 23 patients (23%), testicular atrophy and or primary testicular failure in 51 patients (51%). Open sub-inguinal varicocelectomy was done in 67 patients (67%), 60% as day cases. The overall rate of improvement in seminal fluid parameters and pregnancy rates were 68.6 % and 11.9% respectively. There was resolution of symptoms in all the 16 symptomatic cases. Conclusion: Varicocele is a common cause of infertility in our environment and most patients are discovered during evaluation for infertility. Patients present late with testicular dysfunction with or without primary testicular failure. Varicocelectomy was associated with good symptomatic response, improvement in seminal fluid parameters but low pregnancy rate due to testicular atrophy.
Testicular atrophy
Testicular pain
Presentation (obstetrics)
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Varicocele is the most common cause of male infertility. Several theories have been proposed to explain how varicocele induces infertility. The role of epididymis in male infertility is not fully well established. Fibrinogen-like protein 2 is one of serine proteases and is a potent coagulant in membranous form and immune-modulator in soluble form (sFGL-2) and expressed in the epididymis. There are no previous reports about its possible role in varicocele. This case-controlled study aimed to evaluate the seminal level of sFGL-2 in infertile men with varicocele and in men with idiopathic infertility. This study included 85 participants divided into three groups; 25 normal fertile men, 30 infertile men with varicocele and 30 infertile men of idiopathic cause. Clinical examination, Doppler ultrasound, semen analysis and measurement of seminal level of sFGL-2 were done to all participants. Seminal level of sFGL-2 was significantly elevated in infertile than normal fertile men. Seminal level of sFGL-2 showed negative correlations with sperm concentration, motility and normal morphology. Seminal level of sFGL-2 had a positive correlation with seminal liquefaction time. This study concluded that seminal level of sFGL-2 is increased in infertile men with idiopathic cause and with varicocele induced infertility and affects seminal liquefaction.
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Objective To determine the prevalence and site of varicocele and varicocele‐related testicular atrophy in children and adolescents. Patients and methods The study included 4052 boys aged of 2–19 years, divided into four age groups; the findings of a physical examination, any testicular atrophy and testicular volume were recorded. Results Varicocele was detected in 293 (7.2%) of the 4052 boys; the prevalence was 0.79% in those aged 2–6 years, 0.96% at 7–10 years, 7.8% at 11–14 years and 14.1% at 15–19 years. The prevalence was 0.92% in 1232 children aged 2–10 years and 11.0% in 2531 adolescents aged 11–19 years ( P < 0.001). The prevalence increased significantly at age 13 years ( P < 0.005). The varicocele was unilateral in 263 of the 293 (89.7%) boys with varicocele; of these, one (0.38%) was on the right and the others on the left side. Varicoceles were bilateral in 30 of 279 boys (10.8%) aged 11–19 years but none were detected in those aged < 11 years. Varicocele‐related testicular atrophy was not present in those aged < 11 years, but seven boys (7.3%) aged 11–14 years and 17 (9.3%) aged 15–19 years had testicular atrophy. The difference in prevalence between the last two age groups with atrophy was not significant. Conclusion These findings support the view that varicocele is a progressive disease and that the prevalence of varicocele and testicular atrophy increases with the puberty.
Testicular atrophy
Testicular volume
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We investigated the clinical characteristics of patients with varicocele according to the presence or absence of scrotal pain. We retrospectively reviewed the records of patients who underwent varicocelectomy. The age, body mass index, grade, laterality of varicocele, testicular volume difference, time to hospital visit, serum testosterone level and semen parameters were evaluated. A total of 954 patients were included. The painful group had lower mean age, lower BMI, higher grade of varicocele, smaller testicular volume difference and shorter time to hospital visit than the painless group. In addition, the median serum total testosterone level and total sperm count, concentration and motility were higher in the painful group than in the painless group. In multivariate analysis, there were significant differences between the two groups in age, grade of varicocele, testis volume difference, time to hospital visit, total sperm count and concentration. Patients with painful varicocele visited hospital earlier because of the pain and tended to start treatment sooner. They were also younger, had smaller testis atrophy and had higher sperm concentration, even though they had a higher grade of varicocele than patients without pain. Although scrotal pain in varicocele patients is difficult to treat, it leads to early diagnosis and treatment.
Testicular atrophy
Scrotal Pain
Testicular pain
Semen Analysis
Testicular volume
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Pathophysiology
Etiology
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The varicocele is one of the most commen disease of urine and reproduction system in males.Its influence has been paied more attention in recent years.The WHO has listed it as the first importantreason which induces male infertility.Although many experiments have been done,the mechanism of infertility in varicocele patients is not clear to date.Therefore it is significant to carry on the research about mechanism of infertility in varicocele.This article revuews the study progress about the mechanism of infertility in varicocele in recent years.
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Varicocele is one of the main causes of male infertility. This pathology, in fact, is responsible for progressive anatomical and functional testicular damage. Constant monitoring of subjects suffering from varicocele is therefore necessary. In the present study, we evaluated the effect of varicocele surgical treatment on seminal parameters, testicular growth and pregnancy rate in patients with grade I varicocele. We operated on 47 patients with left grade I varicocele associated with sperm abnormalities and with testicular hypotrophy. A high ligation of the internal spermatic vein and all its collaterals was performed in all patients. The postoperative follow-up showed a significant improvement in seminal parameters (motility, morphology and sperm count) and in testicular volumes. Moreover, a pregnancy rate of 58% was observed. These results confirm the observations of other investigators and suggest that surgical therapy of varicocele is capable of improving seminal parameters, of reversing varicocele-related testicular hypotrophy and of achieving high pregnancy rates even in patients with grade I varicocele.
Testicular atrophy
Spermatic Vein
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