Effect of physical activity level and occupation on resolution of pain after varicocelectomy: A prospective clinical study / Efecto del nivel de actividad física y profesión en la resolución del dolor posterior a varicocelectomía: un estudio clínico prospectivo

Introduction and objectives: Persistent scrotal pain after varicocelectomy is stressful for both surgeon and patient. The number of researches focusing on which patient will benefit more from the operation is increasing in the literature. In this prospective study, we aimed to investigate whether the patient's physical activity levels and occupations affect the success of varicocelectomy in terms of pain relief. Materials and methods: The data of 176 patients who underwent subinguinal microscopic varicocelectomy were analyzed according to BMI, age, varicocele grade, laterality, duration of pain, testicular volume difference, quality of pain, level of physical activity, and profession. The International Physical Activity Questionnaire was used to evaluate the level of physical activity. Patients were grouped as inactive, moderately active, and active according to this scale. Visual analog scale (VAS) scores of the patients were recorded before and after the procedure. Results: 135 patients (76.7%) reported complete resolution of their pain. Partial resolution of pain was observed in 34 patients (19.3%). Seven patients (4%) complained of the same pain level. Univariate analysis showed that patient occupations and physical activity levels significantly affected the pain level (p=0.041, p=0.032, respectively). In the multivariate analysis, only physical activity levels of the patients were statistically significant in predicting the resolution of pain (p=0.024). Conclusions: Patients with low physical activity levels who underwent microscopic varicocelectomy surgery are less likely to have postoperative pain. (AU)

Introducción y objetivos: El dolor escrotal persistente después de la varicocelectomía es una situación estresante tanto para el cirujano como para el paciente. En este estudio prospectivo, nuestro objetivo fue investigar si los niveles de actividad física y las ocupaciones del paciente afectan el éxito de la varicocelectomía en términos de alivio del dolor. Materiales y métodos: Se analizaron los datos de 176 pacientes que se sometieron a varicocelectomía microscópica subinguinal según IMC, edad, grado de varicocele, lateralidad, duración del dolor, diferencia de volumen testicular, calidad del dolor, nivel de actividad física y profesión. Se utilizó el Cuestionario Internacional de Actividad Física para evaluar el nivel de actividad física. Los pacientes se agruparon en inactivos, moderadamente activos y activos según esta escala. Las puntuaciones de la escala visual analógica visual de los pacientes se registraron antes y después del procedimiento. Resultados: Ciento treinta y cinco pacientes (76,7%) informaron resolución completa de su dolor. Se observó resolución parcial del dolor en 34 pacientes (19,3%). Siete pacientes (4%) todavía se quejaban del mismo nivel de dolor. El análisis univariado mostró que las ocupaciones de los pacientes y los niveles de actividad física afectaron significativamente el nivel de dolor (p=0,041; p=0,032, respectivamente). En el análisis multivariado, solo los niveles de actividad física de los pacientes fueron estadísticamente significativos para predecir la resolución del dolor (p=0,024). Conclusiones: Los pacientes con bajo nivel de actividad física que serán operados de varicocelectomía microscópica tienen menor probabilidad de presentar dolor postoperatorio. (AU)

Effect of physical activity level and occupation on resolution of pain after varicocelectomy: A prospective clinical study.

INTRODUCTION AND OBJECTIVES: Persistent scrotal pain after varicocelectomy is stressful for both surgeon and patient. The number of researches focusing on which patient will benefit more from the operation is increasing in the literature. In this prospective study, we aimed to investigate whether the patient's physical activity levels and occupations affect the success of varicocelectomy in terms of pain relief. MATERIALS AND METHODS: The data of 176 patients who underwent subinguinal microscopic varicocelectomy were analyzed according to BMI, age, varicocele grade, laterality, duration of pain, testicular volume difference, quality of pain, level of physical activity, and profession. The International Physical Activity Questionnaire was used to evaluate the level of physical activity. Patients were grouped as inactive, moderately active, and active according to this scale. Visual analog scale (VAS) scores of the patients were recorded before and after the procedure. RESULTS: 135 patients (76.7%) reported complete resolution of their pain. Partial resolution of pain was observed in 34 patients (19.3%). Seven patients (4%) complained of the same pain level. Univariate analysis showed that patient occupations and physical activity levels significantly affected the pain level (p=0.041, p=0.032, respectively). In the multivariate analysis, only physical activity levels of the patients were statistically significant in predicting the resolution of pain (p=0.024). CONCLUSIONS: Patients with low physical activity levels who underwent microscopic varicocelectomy surgery are less likely to have postoperative pain.

Viabilidad de la varicocelectomía subinguinal con gafas de aumento en el tratamiento de la infertilidad masculina / Feasibility of loupe assisted subinguinal varicocelectomy in treatment of male infertility

Objetivos: Evaluar el impacto de la varicocelectomía subinguinal con gafas de aumento sobre la calidad del semen, el nivel de testosterona sérica y las tasas de embarazo espontáneo.MétodosSe recogieron datos de forma prospectiva de 102 hombres infértiles con varicocele clínico. Se compararon los valores preoperatorios de los parámetros de análisis de semen y el nivel de testosterona sérica con los valores postoperatorios a los 6 meses. Se evaluó la tasa de embarazo espontáneo a los 6 meses.ResultadosLa edad media de los pacientes era de 31,56±4,31 años. Se registró infertilidad primaria en 86 pacientes e infertilidad secundaria en 16. Se observó varicocele bilateral en 79 pacientes y varicocele unilateral en 23. La concentración total de espermatozoides (×106/ml) antes y después de la varicocelectomía fue de 12,82±3,91 y 20,06±2,13, respectivamente (p<0,0001). La motilidad espermática total (%) pre y posvaricocelectomía fue de 37,67±7,23 y 55,46±4,51 respectivamente (p<0,0001). La morfología espermática (criterios estrictos de morfología Kruger, %) antes y después de la varicocelectomía fue de 3,11±0,80 y 3,70±0,78, respectivamente (p<0,0001). El nivel de testosterona sérica (ng/dl) antes y después de la varicocelectomía fue de 323,90±67,81 y 396,74±40,88 respectivamente (p<0,0001). La tasa de embarazo espontáneo en las parejas con infertilidad primaria y secundaria fue de 18,60% y 31,25%, respectivamente. La diferencia de tasas no fue significativa (p=0,251). La tasa global de embarazo espontáneo fue del 20,5%.ConclusiónLa varicocelectomía subinguinal con gafas de aumento es una modalidad segura y eficaz para el tratamiento de varones infértiles, especialmente cuando no se dispone de medios para la cirugía microscópica. Sin embargo, solo los estudios comparativos de gran tamaño o los ensayos multicéntricos pueden confirmarlo. (AU)

Objectives: To study the impact of loupe assisted subinguinal varicocelectomy on semen quality, serum testosterone level, and spontaneous pregnancy rate.MethodsThe data were prospectively collected for 102 infertile men with clinical varicocele. The preoperative values of semen analysis parameters and serum testosterone level were compared with postoperative values at 6 months. Spontaneous pregnancy was assessed at 6 months.ResultsThe mean age of patients was 31.56±4.31 years. Primary infertility was reported in 86 patients, while 16 had secondary infertility. Bilateral varicocele was seen in 79 patients while 23 had a unilateral varicocele. The total sperm concentration (x106/ml) before and after varicocelectomy was 12.82±3.91 and 20.06±2.13 respectively (P<.0001). The total sperm motility (%) before and after varicocelectomy was 37.67±7.23 and 55.46±4.51 respectively (P<.0001). The sperm morphology (Kruger/Strict morphology criteria, %) before and after varicocelectomy was 3.11±0.80 and 3.70±0.78 respectively (P<.0001). The serum testosterone level (ng/dl) before and after varicocelectomy was 323.90±67.81 and 396.74±40.88 respectively (p<0.0001). The Spontaneous pregnancy rate in couples with primary and secondary infertility was 18.60% and 31.25% respectively. The difference in their rates was not significant (P=.251). The overall spontaneous pregnancy rate was 20.5%.ConclusionLoupe-assisted sub-inguinal varicocelectomy is a safe and effective modality for treating infertile men, particularly when provision for microscopic surgery is unavailable. However, only large size comparative studies or multi-centric trials can confirm this. (AU)

A case of triple vas deferens complaining of infertility: A challenging case report

There are multiple congenital structural abnormalities that affect male urogenital tract which could affect either the male external genitalia, internal genitalia or both. Congenital anomalies of the vas deferens may be unilateral or bilateral that could be complete or segmental and include (agenesis, atresia, duplication, ectopy or diverticulum). Anomalies of the vas deferens may be isolated or may be associated with other congenital anomalies especially in the male urogenital tract. These rare vas anomalies may be discovered during genital examination (either clinically or radiologically) or even accidentally during inguinal surgeries as in varicocelectomy, hernia repair, vasectomy or orchiopexy. We hereby reported the first case of triple vas deferens in a 35-year-old male that was felt on spermatic cord examination and confirmed by trans-rectal ultrasonography. Thus, proper evaluation should be made for the cases of multiple vas deferens to avoid the accidental injury during the operation and to exclude other associated congenital anomalies. (AU)

Hay múltiples anormalidades estructurales congénitas que afectan al tracto urogenital masculino y que pueden afectar a los genitales externos masculinos, a los genitales internos o a ambos. Las anomalías congénitas de los conductos deferentes pueden ser unilaterales o bilaterales, que pueden ser completas o segmentarias e incluyen: agenesia, atresia, duplicación, ectopia o divertículo. Las anomalías de los conductos deferentes pueden ser aisladas o estar asociadas con otras anomalías congénitas, especialmente en el tracto urogenital masculino. Estas raras anomalías de los conductos deferentes pueden descubrirse durante el examen genital (ya sea clínica o radiológicamente) o incluso accidentalmente durante cirugías inguinales, como en la varicocelectomía, la reparación de hernias, la vasectomía o la orquiopexia. Por la presente comunicamos el primer caso de triple conducto deferente en un varón de 35 años que fue sometido a palpación en el examen del cordón espermático y se confirmó mediante ecografía transrectal. Por lo tanto, debe hacerse una evaluación adecuada de los casos de conductos deferentes múltiples para evitar la lesión accidental durante la operación y excluir otras anomalías congénitas asociadas. (AU)

A case of triple vas deferens complaining of infertility: A challenging case report.

There are multiple congenital structural abnormalities that affect male urogenital tract which could affect either the male external genitalia, internal genitalia or both. Congenital anomalies of the vas deferens may be unilateral or bilateral that could be complete or segmental and include (agenesis, atresia, duplication, ectopy or diverticulum). Anomalies of the vas deferens may be isolated or may be associated with other congenital anomalies especially in the male urogenital tract. These rare vas anomalies may be discovered during genital examination (either clinically or radiologically) or even accidentally during inguinal surgeries as in varicocelectomy, hernia repair, vasectomy or orchiopexy. We hereby reported the first case of triple vas deferens in a 35-year-old male that was felt on spermatic cord examination and confirmed by trans-rectal ultrasonography. Thus, proper evaluation should be made for the cases of multiple vas deferens to avoid the accidental injury during the operation and to exclude other associated congenital anomalies.

Feasibility of loupe assisted subinguinal varicocelectomy in treatment of male infertility.

OBJECTIVES: To study the impact of loupe assisted subinguinal varicocelectomy on semen quality, serum testosterone level, and spontaneous pregnancy rate. METHODS: The data were prospectively collected for 102 infertile men with clinical varicocele. The preoperative values of semen analysis parameters and serum testosterone level were compared with postoperative values at 6 months. Spontaneous pregnancy was assessed at 6 months. RESULTS: The mean age of patients was 31.56 ±â€¯4.31 years. Primary infertility was reported in 86 patients, while 16 had secondary infertility. Bilateral varicocele was seen in 79 patients while 23 had a unilateral varicocele. The total sperm concentration (×106/mL) before and after varicocelectomy was 12.82 ±â€¯3.91 and 20.06 ±â€¯2.13 respectively (P < .0001). The total sperm motility (%) before and after varicocelectomy was 37.67 ±â€¯7.23 and 55.46 ±â€¯4.51 respectively (P < .0001). The sperm morphology (Kruger/Strict morphology criteria, %) before and after varicocelectomy was 3.11 ±â€¯0.80 and 3.70 ±â€¯0.78 respectively (P < .0001). The serum testosterone level (ng/dL) before and after varicocelectomy was 323.90 ±â€¯67.81 and 396.74 ±â€¯40.88 respectively (P < .0001). The Spontaneous pregnancy rate in couples with primary and secondary infertility was 18.60% and 31.25% respectively. The difference in their rates was not significant (P = .251). The overall spontaneous pregnancy rate was 20.5%. CONCLUSION: Loupe-assisted sub-inguinal varicocelectomy is a safe and effective modality for treating infertile men, particularly when provision for microscopic surgery is unavailable. However, only large size comparative studies or multi-centric trials can confirm this.

Effect of varicocelectomy on fertility. Indications, techniques and results. / Efecto de la varicocelectomía en la fertilidad. Indicaciones, técnicas y resultados.

We define varicocele as the dilation of the veins that make up the pampiniform plexus, which is made up of three branches, the internal spermatic, deferential and external spermatic. The World Health Organization (WHO) has determined that varicocele is an important cause of male infertility. This has been acknowledged by several studies that have shown this cause-effect relationship. Varicocele does not always generate infertility. In fact, many patients with varicocele are fertile, decreasing their percentage in the progression of the pathology and the association with other factors such as tobacco, marijuana or endocrine disorders (diabetes or hypothyroidism). Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse (WHO). SURGICAL THERAPEUTICS: Surgery is indicated in cases of grade 3 varicocele (when seen through the scrotal skin and palpable as a 'bag of worms' without Valsalva maneuver), cases of atrophy or growth arrest with volume differences of more than 2cm3 between testes, when accompanied by pain and alterations in the spermiogram in young patients. CONCLUSION: The presence of varicocele determines the performance of varicocelectomy, with the inguinal approach in its three branches being the approach of preference. The laparoscopic approach will be used in specific cases.

Global vision system in laparoscopy. / Sistema de visión global en laparoscopia.

OBJECTIVE: The main difficulty in laparoscopic or robot-assisted surgery is the narrow visual field, restricted by the endoscope's access port. This restriction is coupled with the difficulty of handling the instruments, which is due not only to the access port but also to the loss of depth of field and perspective due to the lack of natural lighting. In this article, we describe a global vision system and report on our initial experience in a porcine model. MATERIAL AND METHODS: The global vision system consists of a series of intraabdominal devices, which increase the visual field and help recover perspective through the simulation of natural shadows. These devices are a series of high-definition cameras and LED lights, which are inserted and fixed to the wall using magnets. The system's efficacy was assessed in a varicocelectomy and nephrectomy. RESULTS: The various intraabdominal cameras offer a greater number of intuitive points of view of the surgical field compared with the conventional telescope and appear to provide a similar view as that in open surgery. Areas previously inaccessible to the standard telescope can now be reached. The additional light sources create shadows that increase the perspective of the surgical field. CONCLUSION: This system appears to increase the possibilities for laparoscopic or robot-assisted surgery because it offers an instant view of almost the entire abdomen, enabling more complex procedures, which currently require an open pathway.