Melatonin therapy adds extra benefit to varicecelectomy in terms of sperm parameters, hormonal profile and total antioxidant capacity: A placebo-controlled, double-blind trial.

In this study, we aimed at investigating the impact of melatonin supplementation on semen parameters, hormonal profile and total antioxidant capacity after varicocelectomy. Infertile male patients who were diagnosed with varicocele and underwent subinguinal varicocelectomy were included in the study. After performing subinguinal varicocelectomy, the patients were randomised into two groups: 27 receiving melatonin for 3 months and 27 as the placebo-controlled group receiving placebo for 3 months. The pre-operative parameters of semen analyses, hormonal profile and seminal oxidative stress status of both groups were compared with those of post-operative parameters. There were statistically significant improvements in post-operative parameters of semen analyses (sperm concentration, motility and proportions of normally formed spermatozoa), peripheral blood inhibin B and total antioxidant capacity in melatonin group compared with placebo group. In conclusion, melatonin therapy adds extra benefit to varicecelectomy in terms of sperm parameters, peripheral blood inhibin B and total antioxidant capacity; however, further studies including large number of samples are needed to make a proper decision on melatonin supplementation after varicocelectomy.

Valoración del crecimiento testicular tras el tratamiento del varicocele en la infancia y adolescencia en función de la técnica empleada (Palomo, Ivanissevich y embolización) / Evaluation of testicular growth after varicocele treatment in early childhood and adolescence based on the technique used (Palomo, Ivanissevich and embolization)

Objetivos. Analizar en función de la técnica empleada para tratamiento de varicocele, la recurrencia, alivio sintomático y crecimiento testicular en pacientes pediátricos y adolescentes. Material y métodos. Estudio descriptivo retrospectivo de 69 pacientes pediátricos y adolescentes diagnosticados de varicocele tratados en nuestro centro mediante abordaje abierto según técnica de Ivanissevich (TI), Palomo (TP) y embolización percutánea (EP) entre 2000- 2014. Las variables fueron edad, síntomas, volumen testicular diferencial (VD), técnica empleada, recurrencia, mejoría sintomática y VD tras el tratamiento. Se evaluó la asociación entre variables cualitativas (test de Chi cuadrado o prueba exacta de Fisher). Resultados. Se estudiaron 69 pacientes con mediana de edad de 14 años (7-19). Se realizó EP a 37 pacientes (53,6%), TP a 23 (33,3%) y TI a 9 (13%). Presentaron recurrencia 16 (23,2%), de ellos el 80% habían sido tratados mediante EP. Once pacientes tenían dolor al diagnóstico (15,9%), tras el tratamiento 100% de los tratados mediante EP presentaron alivio, mientras que en ninguno de los tratados mediante TI o TP mejoró el dolor. Al diagnóstico 37 pacientes (53,6%) presentaron hipotrofia testicular izquierda, en 28 casos el VD fue >20%. Tras el tratamiento, el VD se normalizó en 11 casos (39,2%). Conclusiones. La elección de la técnica terapéutica de varicocele en pacientes pediátricos y adolescentes debería depender de las características del paciente, presencia de síntomas, experiencia del centro y recurrencia previa. Independientemente de la técnica elegida el 39,2% de hipotrofias testiculares con DV >20% al diagnóstico alcanzaron la normalización del volumen testicular tras el tratamiento

Objectives. To analyze, depending on the technique employed, recurrence, symptomatic improvement and testicular growth following treatment of testicular varicocele. Material and Methods. Descriptive retrospective study of 69 pediatric and adolescent males diagnosed with varicocele treated in our center by open technique according Ivanissevich technique (IT), Palomo (PT) and percutaneous embolization (PE) between 2000-2014. Variables analyzed were age, symptoms, differential testicular volume (RV), employed technique, recurrence, symptomatic improvement and RV after treatment. Association between qualitative variables was evaluated (chi-square test or Fisher’s exact test). Results. 69 patients with a median age of 14 years (7-19) were studied. PE was performed in 37 patients (53,6%), PT in 23 (33,3%) and IT in 9 (13%). Recurrence occurred in 16 patients (23,2%), 80% of them had been treated with PE. Eleven patients had pain (15.9%), there was improvement in 100% of patients treated with PE, but none of those treated by PT or IT improved. At diagnosis, 37 patients (53.6%) had decreased testicular volume (left testicular hypotrophy), in 28 cases the RV was >20%. After treatment, the RV was normalized in 11 cases (39,2%). Conclusions. The choice of therapeutic technique in pediatric varicocele should be based on patient characteristics, symptoms, experience center for embolization and previous recurrence. Regardless of the chosen technique, 39,2% of testicular hypotrophy with VD >20% present at diagnosis normalized after treatment

A rational approach to the management of varicocele-associated nonobstructive azoospermia.

A consensus needs to be reached on a rational approach to infertile men with varicocele-associated nonobstructive azoospermia. Future studies are warranted to understand the mechanism behind the variable influence of varicocele on testicular function, which causes partial or complete damage of spermatogenesis in some cases and leaves it unaltered in others.

Other work has highlighted the limitations of using histopathology to predict success after varicocelectomy.

The morbidity associated with performing testicular biopsy on all men before varicocele repair appears to outweigh the benefit of any prognostic information obtained.

Microsurgical and nonmagnified subinguinal varicocelectomy for infertile men: a comparative study.

OBJECTIVE: To compare semen parameters, pregnancy, recurrence, and complication rates after microsurgical and nonmagnified subinguinal varicocelectomy for infertile men. DESIGN: Prospective, randomized study. SETTING: Ghodran General Hospital, Kingdom of Saudi Arabia. PATIENT(S): One hundred sixty-two infertile male patients with varicocele. INTERVENTION(S): Eighty-two patients were treated by microsurgical subinguinal varicocelectomy (MSSIV) (group I), whereas 80 patients were treated by conventional, nonmagnified subinguinal varicocelectomy (NMSIV) (group II). MAIN OUTCOME MEASURE(S): The patients were postoperatively evaluated by physical examination and semen analysis after 4 and 12 months. Pregnancy rate was monitored during the follow-up period. RESULT(S): Postoperatively, mean sperm count and motility improved significantly in both groups: 42.7% and 67.1% of the MSSIV group and 23.7% and 33.8% of the NMSIV group showed ≥50% improvement in sperm count and motility after 1 year. Patients having bilateral varicocele showed significantly better improvement of sperm count than those with unilateral varicocele after both MSSIV and NMSIV. The pregnancy rate at the end of the follow-up period reached 37.8% in the MSSIV group and 21.2% in the NMSIV group. The recurrence rate was zero in the MSSIV group and 11.3% in the NMSIV group. The rate of hydrocele formation was 1.2% in the MSSIV group and 8.7% in the NMSIV group. CONCLUSION(S): Microsurgical subinguinal varicocelectomy has a better improving effect on sperm count and motility, higher spontaneous pregnancy rates, and lower postoperative recurrence and hydrocele formation than conventional subinguinal varicocelectomy in infertile men.

The significance of microsurgical varicocelectomy in the treatment of subclinical varicocele.

OBJECTIVE: To assess the improvement of seminal characteristics and pregnancy rates after microsurgical varicocelectomy in men with subclinical varicocele. DESIGN: Retrospective study. SETTING: University infertility clinic. PATIENT(S): One hundred forty-three patients with a subclinical left-sided varicocele. INTERVENTION(S): Patients who agreed to microsurgical varicocelectomy (n = 25, surgery group), medical treatment with L-carnitine (n = 93 drug group), and those who did not agree to any treatment (n = 25, observation group) were enrolled. MAIN OUTCOME MEASURE(S): Semen characteristics were reevaluated twice 6 months after treatment. The natural pregnancy rates were estimated by telephone interview between 1 and 2 years after treatment. RESULT(S): In the surgery group, sperm counts improved significantly after microsurgical varicocelectomy. In the drug group, however, sperm parameters did not significantly improve after treatment. Natural pregnancy rates were 60.0% in the surgery group, 34.5% in the drug group, and 18.7% in the observation group. The natural pregnancy rate of the surgery group was higher than the other groups, and there were statistically significant differences among the three groups. CONCLUSION(S): Surgical treatment is the best option for management of subclinical varicocele.

The systematic use of intraoperative vascular Doppler ultrasound during microsurgical subinguinal varicocelectomy improves precise identification and preservation of testicular blood supply.

OBJECTIVE: To evaluate the impact of systematic use of intraoperative Doppler ultrasound during microsurgical subinguinal varicocele repair. DESIGN: Prospective clinical study. SETTING: Andrology laboratory and male infertility section of the urology department of a tertiary care hospital. PATIENT(S): Two hundred and thirteen men with clinical varicocele. INTERVENTION(S): Subinguinal microsurgical varicocele ligation using an intraoperative vascular Doppler flow detector. MAIN OUTCOME MEASURE(S): Number of veins ligated, lymphatic spared, arteries identified or accidentally ligated. RESULT(S): A statistically significant greater number of arteries were identified and preserved when intraoperative vascular Doppler was used. In addition, the average number of internal spermatic veins ligated was statistically significantly greater in the same group. Accidental artery ligation occurred in two cases (1.1%) in which the Doppler was not applied. There was no statistically significant difference in number of lymphatics spared between groups. CONCLUSION(S): Our findings showed that concomitant use of intraoperative vascular Doppler during microsurgical varicocelectomy allows more arterial branches to be preserved, and more internal spermatic veins are likely to be ligated. This device should be considered an attractive tool to improve surgical outcomes and safety.

Sistema de telemedicina mediante telefonía móvil para control postoperatorio en cirugía mayor ambulatoria. Estudio piloto / No disponible

Objetivo: Exponer el desarrollo del estudio piloto de un sistema de telemedicina (telecontrol postoperatorio domiciliario), previamente implementado y validado en la Unidad de Cirugía Mayor Ambulatoria del Hospital Clínico San Carlos de Madrid, mediante la utilización de telefonía móvil con sistema GPRS, que permite la toma y envío de imágenes de la zona operatoria en general y del apósito, vendaje y herida quirúrgica, en particular, para mejorar el control postoperatorio domiciliario de los pacientes de dicha unidad y evitar desplazamientos innecesarios al Servicio de Urgencia. Material y métodos: Se han incluido 96 pacientes intervenidos entre el 1 de junio y el 15 de octubre de 2004: 58,3% varones; edad 52,6 ± 14,2 (21-84 años). Se han identificado los procesos de mayor utilidad para la implantación del sistema de telemedicina (hernias inguino-crurales y umbílico-epigástricas; hallux valgus; síndrome del túnel carpiano; varices esenciales extremidades inferiores; varicocele e hidrocele). Se han analizado la capacidad y eficacia diagnósticas para establecer la magnitud de posibles complicaciones locales postoperatorias, mediante el análisis de imágenes realizadas con un total de 30 terminales móviles Nokia 6600 (formato JPEG, resolución 640 x 480), enviadas mediante mensajes MMS y visualizadas en un monitor de 17 pulgadas tipo estándar, de un ordenador personal con microprocesador Intel Pentium 4 de 1,41 GHz. Se ha analizado la opinión, valoración y satisfacción de los pacientes mediante formulario con 9preguntas (8 cerradas –6 dicotómicas puras, ofreciendo sólo dos opciones de respuesta, y 2 de opción múltiple con alternativas mutuamente excluyentes– y 1 pregunta abierta). La calificación del sistema se realiza con una nota en una escala del 1 al 10. Resultados: El 31% ha presentado problemas locales durante el postoperatorio domiciliario. Los más frecuentes han sido: hematomas(67%) (en hernias 88%, hidrocele y varicocele 50% y varices 50%) y el manchado hemorrágico (27%) (en hallux valgus 63% y en varices 50%), siendo sangre oscura, coagulada, en la mayoría de los casos (80 y 100% respectivamente). En el 95% de las 225 fotografías recibidas la calidad de la imagen ha sido buena y en todas se ha identificado la incidencia postoperatoria, permitiendo realizar la evaluación clínica de la situación así como la adopción de una conducta a seguir. El 56,6% ha manifestado que, de no haber dispuesto de este sistema de telemedicina, habría solicitado directamente la valoración presencial hospitalaria de dicha complicación. El 100% considera que se incrementa la sensación de seguridad en el postoperatorio domiciliario. La valoración ha sido calificada con una nota media de 8,9 ± 1 (límites 6 y 10, mediana 9 y moda 10). Conclusiones: Los resultados ponen de manifiesto que este sistema de telemedicina posee una probada capacidad y eficacia diagnóstica que le confiere una considerable utilidad para incrementar la seguridad y la calidad del control postoperatorio domiciliario en CMA, evitando desplazamientos innecesarios al hospital y aumentando claramente la satisfacción de los pacientes (AU)

Objective: To describe the development of a pilot study for a telemedicine system in our Ambulatory Surgical Unit (Hospital Clínico San Carlos in Madrid), using mobile phones with a GPRS system. This system allows the taking and sending of pictures of the surgical area, surgical dressing or bandage and the surgical wound, to improve the postoperative control in their home of the patients from our Unit and to avoid unnecessary displacements to the Hospital Emergency Service. Material and methods: The study included 96 patients undergoing ambulatory surgery between June 1st and October 15th, 2004: 58.3% were male, mean age was 52.6 ± 14.2 (21-84 years). We identified the procedures in which the introduction of the telemedicine system would be most useful (inguinal and femoralhernias, umbilical and epigastric hernias; hallux valgus; carpal tunnel syndrome; varicose veins of the lower extremities; varicocele and hydrocele). We analyzed the diagnostic capacity and effectiveness to establish the magnitude of potential postoperative local complications, by analysing images taken with a total of 30 mobilephones Nokia 6600 (JPEG format, 640 x 480 resolution), andsent via MMS messages displayed on a 17-inch standard monitor of a personal computer with Intel Pentium 4 microprocessor (1.41 GHz). We analyzed the opinion, evaluation and satisfaction of patients through a 9 questions survey (8 closed –6 purely dichotomous, offering only two response options, and 2 multiple choicequestions with mutually excluding answers– and 1 open question). The rating system was studied with a note on a scale from 1 to 10. Results: 31% presented local postoperative problems at home. The most frequent problems were: Haematomas (67%: 88% in hernias, 50% in hidrocele and varicocele, and 50% in varices) and blood-stained wounds (27%: 63% in hallux valgus and 50% in varices), the blood stain was dark or coagulated in most of the cases (80 and 100% respectively). In 95% of the 225 received pictures the quality of the image was good and in all of them the postoperative local complication was identified allowing us to make a clinical evaluation of the situation. In 56.6% of cases, had they not had this telemedicine system, patients would have gone directly to the hospital to evaluate this complication. They all (100%) agreed that there was an increased sense of postoperative security at home. This system was marked with a mean value of 8.9 ± 1 out of 10 (limits 6-10, median 9 and mode 10). Conclusions: According to the results obtained, this telemedicine system proves to be diagnostically effective and gives an increased sense of safety and quality of postoperative control in ambulatory surgery, and avoids unnecessary displacements to the hospital, clearly increasing patient satisfaction (AU)

Varicocele: Una entidad frecuente

El varicocele, cuadro clínico frecuentemente visto, es la causa corregible más común de infertilidad;sin embargo, a pesar de múltiples estudios aún existen muchas preguntas sin respuesta y mucho de hipóteticoen los conceptos respecto a la entidad. En el presemte artículo se revisan los diferentes criterios existentes sobre el varicocele: las posibles hipótesis etiológicas, la clínica, las ayudas diagnósticas, el tratamiento principalmente quirúrgico, y por último, se plantean las posibles teorías que causan su estrecha relación con la infertilidad. Se pretende que al aumentar el conocimiento sobre el varicocele se le otorgue mayor importancia y se logre prevenir sus complicaciones y secuelas, principalmente la infertilidad