Effect of Microsurgical Varicocele Repair on Sperm Capacitation and Probability of Generating a Pregnancy as Measured by Pre and Postoperative Novel Testing With Cap-Score.

OBJECTIVE: To study whether varicocele repair would improve sperm capacitation and probability of generating a pregnancy. METHODS: Data were collected prospectively from 40 consecutive adult men who presented with infertility confirmed by semen analysis (SA) and found to have a varicocele on exam or ultrasound who underwent unilateral or bilateral subinguinal microscopic varicocelectomy. We recorded pre and postoperative SA, Cap-Score, and probability of generating a pregnancy (PGP) with a 3-month follow-up. Values were compared using paired t test and Wilcox rank-sum test. RESULTS: Results showed a 17.4% relative increase in Cap-Score (23%-27% capacitation), 25% relative increase in PGP (24%-30%), as well as statistically significant improvements in sperm concentration, motility, and total sperm count postoperatively. CONCLUSION: This study confirms that microsurgical varicocelectomy significantly improves sperm capacitation ability and improves the expected probability of generating a pregnancy within 3 rounds of intrauterine insemination. The improvement in sperm capacitation ability may help explain how varicocele repair may improve the chance of pregnancy, regardless of standard semen parameter improvements.

Association Between Prostate Zonal Volume and Erectile Dysfunction in Patients With Benign Prostatic Hyperplasia.

INTRODUCTION: The impact of prostate zonal volume on erectile function and penile Doppler parameters is not yet settled. AIM: To assess the association between prostate zonal volume and erectile dysfunction in patients with benign prostatic hyperplasia. METHODS: This cross-sectional analytical study included 70 men (aged ≥ 40 years). Of them, 60 patients were assigned to 3 study groups (n = 20/each): group (A) patients who had lower urinary tract symptoms (LUTSs) and erectile dysfunction (ED), group (B) patients who had LUTSs with no ED, group (C) patients who had ED with no LUTS, and other 10 age-matched patients who had no LUTS or ED acted as a control group (D). All patients were subjected to detailed medical and sexual history. International prostate symptom score (IPSS) was used to assess LUTSs, and international index of erectile function (IIEF) was used to assess ED. MAIN OUTCOME MEASURE: Transrectal ultrasound and penile Doppler ultrasound were used to assess zonal anatomy of the prostate and the vascular pattern of erection. RESULTS: There was a significant difference in IPSS between group A (26) and B (19) (P < .05). Each of groups A and C had significant lower peak systolic velocity (PSV) than each of groups B and D (P < .001/each). There was a significant positive correlation between transitional zone index (TZI) and IPSS (r = 0.71, P < .01), and significant negative correlation between TZI and both of IIEF (r = -0.48, P < .05) and PSV (r = -0.606, P < .05). CONCLUSION: This study clearly demonstrated that there were significant correlations between increased transitional zone volume, TZI, and decreased both of IIEF score and PSV. Qalawena MM, Al-Shatouri MA, Motawaa MA, et al. Association Between Prostate Zonal Volume and Erectile Dysfunction in Patients With Benign Prostatic Hyperplasia. Sex Med 2020;8:205-213.

Impact of Subinguinal Varicocelectomy on Serum Testosterone to Estradiol Ratio in Male Patients With Infertility.

OBJECTIVE: To assess the effect of varicocele and subsequent varicocelectomy on testosterone-estradiol ratio in patients presented with infertility or testicular pain. MATERIALS AND METHODS: In this prospective, controlled, clinical study, 135 men were assigned to 3 equal groups (n = 45 per group). The varicocele-treated "varicocelectomy" group included patients with varicocele who underwent loupe-assisted subinguinal varicocelectomy for infertility or testicular pain; the varicocele-not-treated "positive control" group included patients with varicocele who refused or who wished to postpone varicocelectomy; and the no-varicocele "negative control" group included fertile men without varicocele. The varicocele-treated patients underwent loupe-assisted subinguinal varicocelectomy for infertility or testicular pain. Semen analysis, serum testosterone, estradiol, follicle stimulating hormone, luteinizing hormone, prolactin, calculation of testosterone to estradiol ratio (T:E ratio), and scrotal Doppler ultrasound were assessed at baseline and 6 months later. RESULTS: Total testosterone levels and T:E ratio were in the normal range in all groups. Men with varicocele had significantly lower levels of total testosterone and T:E ratio than men without varicocele (P <.001 for each). Testosterone levels were 4.9, 4.6, and 7.3 ng/mL, and T:E ratios were 19, 17.4, and 28.1 in the treated, positive, and negative control groups, respectively. Testosterone level and T:E ratio were significantly higher in the negative control group than the other 2 groups at baseline assessment (P <.001 for each). These parameters improved significantly 6 months after varicocelectomy in the treated group; whereas, they remained unchanged in the 2 control groups. CONCLUSION: Varicocele is associated with the diminishing of total testosterone and T:E ratio, which were significantly improved after subsequent subinguinal varicocelectomy.