Does total testicular volume predict testicular volume difference in adolescent males with varicocele?

ABSTRACT Introduction: We evaluated the relationship between total testicular volume (TTV) and testicular volume differential (TVD) in adolescent males with varicocele. Both low TTV and high TVD have been independently associated with higher incidences of infertility later in life, but a predictive relationship between TTV and TVD directly has yet to be described. Materials and Methods: We retrospectively analyzed a database of Tanner 5 boys ages 16-21 who presented with varicocele at a single institution between 2009 and 2017. All patients had a scrotal sonogram prior to surgical intervention. TTV and TVD were calculated for each individual and four non-exclusive groupings of patients were created for statistical analysis. We chose 30 cc as a cut off value for low TTV based on prior studies. Results: 209 patients met our inclusion criteria. Mean age was 18.3 years (16-21, SD 1.7) with a mean total testicular volume of 36 cc (13.5-78.2, SD 11.1). Cut off points of TVD of 20% and TTV of 30 cc were used to separate patients. There were 65 boys (31%) with TTV < 30 cc and 58 boys (28%) with TVD ≥ 20%. Among males with TTV < 30 cc, 23 (35%) had a TVD ≥ 20%. Among males with TTV ≥ 30 cc, 35 (24%) had a TVD ≥ 20%. The relationship between TVD and TTV was found to be non-significant (p > 0.05). Discussion: Adolescent varicoceles continue to pose a challenge to pediatric urologists. The dilemma of over-aggressive treatment has proven difficult to balance with the risk of infertility. We hoped that elucidating the relationship between TTV and TVD could be useful in identifying patients who are at greater risk for infertility while decreasing the need for more intrusive testing, such as semen analysis, in an adolescent population. We looked at the direct relationship between low TTV and high TVD. In our population, there was a non-significant relationship between TTV < 30 cc and TVD ≥ 20% (p > 0.05) indicating that in adolescents with varicocele, TTV and TVD are independent variables. Our study limitations include the inherent user dependent bias of ultrasound measurements and data collection at a single institution with high ethnic diversity, possibly not comparable to all patient populations. Conclusions: Low TTV (< 30 cc) itself is not predictive of high TVD (≥ 20%) in adolescent boys with varicocele, despite their reported independent associations with impaired fertility in other studies.

Hydrodynamic Relationship between Color Doppler Ultrasonography Findings and the Number of Internal Spermatic Veins in Varicoceles

PURPOSE: The improvement of testicular volume, testosterone levels and sperm concentration was suggested to be significantly associated with the number of internal spermatic veins (ISVs) ligated during varicocelectomy. Herein, we investigated preoperative color Doppler ultrasonography (CDU) findings as potential preoperative predictors of the number of ISVs requiring ligation during microsurgical subinguinal varicocelectomy. MATERIALS AND METHODS: In a prospective evaluation of 40 patients, maximal vein size and maximal reflux velocity were measured, while the total cross-sectional area of the affected testicular veins during a Valsalva maneuver was calculated using CDU by a single uroradiologist. Microsurgical subinguinal varicocelectomies were performed by one urologist. RESULTS: Among the semen parameters, semen morphology showed significant improvement (p=0.033), which was much clearer in the patients with a higher number of ISVs ligated than a lower number of ISVs ligated. Among the various preoperative variables, maximal reflux velocity and total cross-sectional area on CDU were related to the number of ISVs ligated (r=-0.442, p=0.004; r=0.594, p=0.000, respectively). Furthermore, univariate and multivariate linear regression analyses showed that maximal reflux velocity and total cross-sectional area on CDU were independent predictive factors of the number of ISVs ligated. CONCLUSION: Maximal reflux velocity and total cross-sectional area on CDU were related to the number of ISVs ligated. This means that the maximal reflux velocity and total cross-sectional area measured by preoperative CDU can predict the number of ISVs requiring ligation during microsurgical subinguinal varicocelectomy, which might be related to significant improvement of semen parameters after varicocelectomy.

The ameriorating effects of grapefruit seed extract on testicular morphology and function of varicocelized rats

Varicoceles are abnormal tortuosity and dilatation of the veins of the pampiniform plexus that drain the testis. The pathophysiology of testicular damage in varicocele has not been completely understood. However there is an increasing body of evidence pointing towards the role of reactive oxygen species and oxidative stress in the pathogenesis of varicocele related subfertility. In the present study we examined the role of proanthocynidin-rich ethanol extract of grapefruit seed as an antioxidant in protecting the testis against damage in experimental varicocele. Three groups of rats were constructed as the first group had intact rats; experimental bilateral varicoceles were established by complete ligation of the left and right main spermatic veins in the later two groups. The third group had in addition daily gavage administration of 1 Omg/ kg body weight ethanol extract of grapefruit seed. Eight weeks after varicocele induction, bilateral testicular weights, bilateral testicular volumes, bilateral caudal epididymal sperm characteristics, and bilateral testicular histology and serum hormone levels were tested. It was found that the testes of grapefruit seed extract treated animals had better functional and histological profiles compared to the untreated varicocelized animals. These results indicated the effectiveness of grapefruit seed extract for preservation of testes function morphology in varicocelized subjects.

Los varicoceles son tortuosidades anormales y dilataciones de las venas del plexo pampiniforme que drenan el testículo. La fisiopatología del daño testicular en el varicocele no se ha entendido completamente. Sin embargo, existe un creciente cúmulo de evidencias que apunta hacia el papel de especies reactivas al oxígeno y al estrés oxidativo, en la patogénesis del varicocele relacionados con subfertilidad. En el presente estudio, se examinó el papel de proantocianidina en el extracto etanólico de semilla del pomelo, como un antioxidante en la protección contra el daño testicular experimental en el varicocele. Tres grupos de ratas fueron seleccionados, un grupo de ratas control y dos grupos experimentales. En estos dos últimos grupos, se provocó varicocele bilateral a través de la ligadura completa de las venas testiculares principales izquierda y derecha. El tercer grupo tuvo además una sonda de administración diaria de 10 mg /kg de peso corporal, de extracto etanólico de semilla de pomelo. Ocho semanas después de la inducción de varicocele, se determinó el peso testicular bilateral, volúmenes testiculares bilaterales, características de los espermatozoides de la cola del epidídimo bilateral, la histología testicular bilateral y los niveles séricos de hormona. Se determinó que los testículos de los animales tratados con extracto de semilla de pomelo presentaban una mayor funcionalidad y mejores perfiles histológicos, en comparación con los animales varicocelizados no tratados. Estos resultados indican la eficacia de extracto de semilla de pomelo para la conservación de la morfología funcional testicular, en sujetos varicocelizados.

Role of spermatic vein inhibin B and LDH activity as predictors of testicular dysfunction in varicocele patients

lnhibin B generated by Sertoli cells provides negative feedback on FSH secretion. In men, inhibin B seems to be physiologically important form of inhibin. Lactic dehydrogenase [LDH], an intracellular enzyme that indicates cellular damage. Varicocele has been associated with infertility and disturbed spermatogenesis. We aimed to investigate the relationship between varicocele, LDH and inhibin B. This study was conducted on forty infertile men with varicocele and twenty age matched control men. LDH and inhibin B were measured in the blood samples of these 40 patients with varicocele which were obtained synchronously from spermatic and peripheral veins during operation and in peripheral vein of control men. Varicocele patients were classified into two groups: group I twenty patients with normal sperm concentration [> 20 million /ml], and group II twenty patients with low sperm concentration [< 20 million /ml]. FSH and testosterone were measured by chemilurninescence while inhibin B was measured by enzyme immunoassay method. LDH enzyme activities were assayed by enzymatic U.V methods. Sperm counts ranged from 3.9 to 60 million/ml, while motility ranged from 15 to 48%. LDH level and inhibin B in spermatic vein were significantly higher than the level in peripheral vein. There was no correlation between sperm counts and LDH level in spermatic vein. lnhibin B concentrations in spermatic vein correlated significantly with serum concentration of FSH [r= -0.63, p < 0.001] and free testosterone [r= 0.34, p<0.05] and also correlated significantly with sperm counts [r= 0.44, p < 0.01] and total testicular volume [r= 0.56, p< 0.01]. lnhibin B showed significant reduction in patients with varicocele than in control men, while LDH showed no significant difference. There were significant increases in inhibin B and LDH in both peripheral vein and spermatic vein of men with sperm count > 20 million /ml when compared with men who had count < 20 million/ml. Significant increase in spermatic vein LDH and inhibin B levels were observed in varicocele. These findings suggest that inhibin B may be offer an improved diagnosis of testicular dysfunction. Consequently, spermatic vein LDH activity and inhibin B level can be predictors of testicular dysfunction in varicocele